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Dr Chris Willmott Dept of Biochemistry University of Leicester [email protected] Using case studies to promote ethical thinking and awareness University of Leicester Ethics teaching in the Biosciences, Leeds 2007 Dr Jim Parry Dept of Philosophy University of Leeds [email protected]

Case Studies in Ethics Teaching

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September 2007 presentation on using case studies to promote ethical thinking

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Page 1: Case Studies in Ethics Teaching

Dr Chris WillmottDept of BiochemistryUniversity of [email protected]

Using case studies to promote ethical thinking and awareness

University ofLeicester

Ethics teaching in the Biosciences, Leeds 2007

Dr Jim ParryDept of Philosophy

University of [email protected]

Page 2: Case Studies in Ethics Teaching

Approaches • Case studies/ scenarios

• Debate and role-play

• Newspapers

• Book extracts

• TV programmes

• Structured activity based on news footage

• Clips from other programmes

• Knowing what’s on and when

Page 3: Case Studies in Ethics Teaching

Bioethics = Bio AND Ethics! • Science – COULD it be done?

• Ethics – SHOULD it be done?

Important that both are being considered:

Science without ethics may be immoral

Ethics without science may be impossible

Page 4: Case Studies in Ethics Teaching

Case studies & scenarios • Case studies allow real-world framing of otherwise abstract ideas

• As such, can have a key role in opening upcomplex issues for students

• May be genuine or fictional (though latter work best when as close to real as possible)

Page 5: Case Studies in Ethics Teaching

Carl is a twenty-one year old builder. He is engaged to Julie, and she has recently discovered that she is expecting their first child. In 2001, Carl’s maternal grandfather died from Huntington’s disease (HD), a late-onset degenerative disease of the nervous system. HD is inherited in a dominant fashion; if you do have HD, you have a 50% chance of passing it on to your children. Carl’s mum has decided not to take the test to find out if she got the faulty copy from her father, but now that he is expecting to be a father himself, Carl is keen to find out if there is any risk that he has passed on the condition.

What are some of the issues at stake for Carl and Julie? What are the consequences of taking the test, or deciding not to? If you were Carl, what would you do?

Case study (1) – Carl and Julie

Page 6: Case Studies in Ethics Teaching

Carl can know his status and prepare accordingly

But his mum has made a conscious decision not to know, hence potential harm to her

Other consequences:- Carl’s relationship with Julie?- Carl’s relationship with baby?- Implications for Carl’s work?- Insurance implications, etc

Genetic screening

(Developed from episode of “Bitter Inheritance”)

Page 7: Case Studies in Ethics Teaching

Case study (2) – Wendy & Paul Wendy and Paul Carter have been married for twelve years. They would

love to have children. Unfortunately, Wendy had breast cancer when she was 28 and although the chemotherapy has brought total remission from the disease it also caused damage to her ovaries that has made her infertile.

Paul and Wendy have been on the waiting list at their local IVF clinic for a number of months awaiting donated eggs to try and have a baby.At present, however, there are 200 potential mothers seeking each donated egg and the couple know that realistically they may never receive a donated egg via the normal channels.

Researchers at the hospital attached to the IVF clinic have recently gained permission to carry out experimental procedures using eggs harvested from aborted foetuses. The technique is controversial, but for Paul and Wendy it may represent their only chance to receive a donated egg.

Page 8: Case Studies in Ethics Teaching

What are the issues involved in this case?

- Feel free to include aspects of the case that are likely to be issues for other people, your contributions need not be limited to your own opinions.

Case study (2) – Wendy & Paul

Page 9: Case Studies in Ethics Teaching

• This case - content is fictional but based on real ideas and statistics

- used in Session 1 of 6 in bioethics series- used as vehicle to introduce morephilosophical aspects

Case study (2) – Wendy & Paul

Page 10: Case Studies in Ethics Teaching

Deontological (first principles)• Does a foetus have any rights?• Does the “mother” have any rights or say in the

upbringing of their “grandchild”?• Should people be allowed to manipulate nature for

their own gain?

Consequentialist (outcomes)• What would be the psychological effects on the

child?• If the child turns out to be “defective” then who is

culpable? • What is the likelihood of success?

Case study (2) – example comments

Page 11: Case Studies in Ethics Teaching

Principles of Biomedical Ethics (Beauchamp & Childress) propose 4 principles:

1. Non-maleficence Don’t do harm

2. Beneficience Do good, act in the best interests of others

3. Autonomy Maximise freedom for individual or community

4. Justice Treat equal cases equally and unequal cases differently

Making ethical decisions

Page 12: Case Studies in Ethics Teaching

Carl can know his status and prepare accordingly (Autonomy, Beneficience)

But his mum has made a conscious decision not to know, hence potential harm to her

Other consequences:- Carl’s relationship with Julie?- Carl’s relationship with baby?- Implications for Carl’s work?- Insurance implications, etc

Genetic screening

(Adapted from episode from series “Bitter Inheritance”)

Page 13: Case Studies in Ethics Teaching

TV footage – why? • Familiar visual medium

• Can be used to:- convey information- as discussion starters

• Clips save time over full programme

Page 14: Case Studies in Ethics Teaching

What sort of programmes? • Documentaries, e.g.

- A child against all odds (2006)- Who’s afraid of designer babies? (2005)- The dark secret of Hendrik Schön (2004)

• Drama e.g.- Holby city (various, esp 2006)- The Simpsons (e.g. Trash of the titans, 1998)- Million dollar baby (2004)

• News clips- topical- pithy summary

Page 15: Case Studies in Ethics Teaching

News clip – structured activity Therapeutic Cloning

You are going to see a 3 minute video from Five News on June 16th 2004, discussing an application by a team of scientists at Newcastle University for permission to carry out “therapeutic cloning”. Read through these questions before you see the clip, so you know what to look out for.

From the video Explain how therapeutic cloning would work What is the source of the eggs to be used in this research?

What is the stated aim of the research? Thinking deeper In the clip, Professor Murdoch says: “Imagine a child, say a ten year old child, now who is diabetic who’s cells that normally produce insulin are not working properly, so that child will have to take insulin injections for the rest of their life. Possibly, in five or ten years time, we could be in a situation where we could take a tiny piece of skin from that child, do some work within the laboratory to tell that skin cell to forget that it was ever a skin cell, to learn to become a stem cell, which means that it has no background

information about what it is going to be, and then teach that stem cell to become an insulin secreting cell so that cell can be planted back into the child and then the diabetes theoretically would be cured.” Compare this with the explanation of how therapeutic cloning would work; - in what ways was it different, and - in what ways was it the same? What objections to stem cell research are mentioned in the video? What other reasons (not mentioned) may cause people to object to therapeutic cloning? What technical difficulties might make this work difficult to achieve?

Page 16: Case Studies in Ethics Teaching

GATTACA – questions to consider GATTACA (Dir: Andrew Niccol, 1997) is set “in the

not too distant future”. Having watched the clip, consider the following questions:

1. How realistic is the genetic screening process shown in the film? Which aspects can already be done? Which are likely to be more difficult?

2. Screening of this type would be controversial. What are some of the potential benefits, and what are some of the potential problems?

3. Consider your answers to Q2. What form of ethical thinking does each represent?

4. Does this film offer any insights into current development in genetic screening?

Page 17: Case Studies in Ethics Teaching

GATTACA – Science issues Technology shown could offer selection, not

enhancement – gene can only be included if mum or dad had it!

Current PGD? Future PGD?Genetic determinism? How much of us as individuals

is down to our genes and how much down to other factors (food intake, trauma, etc)?

Page 18: Case Studies in Ethics Teaching

GATTACA – Ethical issues Genetic discrimination – ‘Valids’ v ‘In-valids’? A

‘made-man’ v a ‘faith-birth’? A ‘vitro’ v a ‘utero’? Insurance moratorium in UK (until 2011). Risk and

social exclusion?What would it be suitable to check for? Diseases?

Gender? Physical features? Character traits?What costs to the individual and to society are worth

paying in order to select-out diseases?What do such attitudes say about people with

disabilities now? Role of genetics in forensics?

Page 19: Case Studies in Ethics Teaching

Knowing what’s on and when For scheduled programmes:• Radio Times, etc• www.trilt.ac.ukTelevision and Radio Index for Learning and Teaching

Page 20: Case Studies in Ethics Teaching

Knowing what’s on and when For scheduled programmes:• Radio Times, etc• www.trilt.ac.ukTelevision and Radio Index for Learning and Teaching• www.tvgenius.co.uk

But, news is not known in advance• Today programme (Radio 4)• BBC website, esp. Health and Science/Nature sub-sections

Page 21: Case Studies in Ethics Teaching

Getting hold of programmes & clips • Off-Air Recordings

- recorded at time of transmission- requires Educational Recording Agency licence

• Back-up www.bufvc.ac.uk/services/offair.htmlBritish Universities Film & Video Council

• Increasing availability of streamed news clips, esp.on the BBC website, but shortly also on the Newsfilm online site (http://newsfilm.bufvc.ac.uk)

Page 22: Case Studies in Ethics Teaching

• Think of as many ways as possible that you might link one or more of the following news stories to your teaching of:

(a) basic bioscience and/or (b) bioethics?

Hwang cloningscandal

TGN1412drug trial

Face transplant

Images from http://news.bbc.co.uk/

Using News stories in Bioscience

Page 23: Case Studies in Ethics Teaching

Immunological

Lifestyle issues

TechnicalEthical

Psychological

Face transplants

Image from http://news.bbc.co.uk/

For patient?For potential patients?

For wider society?Face and identity? Rejection rates?

(30-50% over first 2-5 yrs)Harmful effects of immunosuppressive drugs?

Availability of donor face?Functionality of transplant?

Plan B if rejected?

Risks v BenefitsMotivation?

Media intervention?Cancer risk?

Page 24: Case Studies in Ethics Teaching

Face transplants

http://www.bbc.co.uk/sn/tvradio/programmes/horizon/broadband/tx/faces/vote/

Page 25: Case Studies in Ethics Teaching

Use of animals in research

Design of clinical trials Regulation of

clinical trials

Science of this trial

TGN1412 Drug trial

Image from http://news.bbc.co.uk/

Role of the MHRA?Role of ethics committees?Recruitment of volunteers?

Location of trial?Liability?

Phases of a trial

What are monoclonal antibodies?

What are T lymphocytes?What are CD28 markers?

Is this an example of the weakness or animal models?

Would there be lots more disasters without animal expts?

Conduct of this trialSelection of dosage?

Time for infusion of drug?Appropriate safety in place?

Page 26: Case Studies in Ethics Teaching

Peer review and publication

Research ethics

Science of stem cells

Fraud

Ethics of stem cells research

Hwang cloning scandal

Image from http://news.bbc.co.uk/

Therapeutic cloning

Page 27: Case Studies in Ethics Teaching

Helpful websites e.g. www.bioethicsbytes.wordpress.com

Page 28: Case Studies in Ethics Teaching

Helpful websites e.g. www.bioscience.heacademy.ac.uk/resources/ethicsbrief.htm

Bioethics BriefingsSix titles and

others to follow

Page 29: Case Studies in Ethics Teaching

Helpful websites e.g. www.beep.ac.uk

Page 30: Case Studies in Ethics Teaching

Helpful websites e.g. www.at-bristol.org.uk/cz/Default.htm

Page 31: Case Studies in Ethics Teaching

References • Blackman M. (1997) Pig-Heart Boy, Corgi Books

• Southgate C. (2002) The use of the rainforest as a test case in environmental ethics, in Bioethics for Scientists (Ed: Bryant, Baggott la Velle and Searle)

• Willmott C. (2004) Ethics and Bioethics Bioethics Briefing No. 1 (LTSN/ Higher Education Academy Centre for Bioscience), available online at http://www.bioscience.heacademy.ac.uk/resources/ethicsbrief.htm