Guidelines to Write the Responses to the Case Studies In responding to the assigned case study, I expect you to assume the frames of mind of an ethicist as follows: 1. Be judicious: read the case at least twice and then ask yourself what is at stake in the context of the parties involved. 2. Be empathetic: think about the underlying assumptions which guide the parties who are involved in the case. Then try to draw out the erroneous and correct aspects of their positions on that basis. 3. Be sensitive to the religious and cultural differences of the parties involved and attempt to reconcile any such differences in a fair and equitable fashion. 4. In making recommendations to solve the dilemma of the given case, try to be realistic and sensible to current practices, norms, and beliefs. 5. Be aware of your own cultural, religious, and social background in order to prevent it from distorting your ethical judgment. 6. Do not allow religious norms to be the sole standard of your ethical judgment. 7. Apply the golden rule; treat the case, more specifically the interests of the parties involved as you would wish your own interests to be treated. 1 Case studies : Assisted Reproduction This is a difficult subject because it involves reproductive issues. In our culture, reproductive liberty, the freedom to decide when and where to conceive a child is highly protected, and this can make these cases much more difficult. Case 1 There are two types of surrogacy. One type involves a surrogate mother who uses her own egg and carries the baby for someone else. The other type is a "gestational surrogacy" in which the mother has no genetic tie to the child she carries. In the case presented, a gestational surrogate is used. A woman, after a bout with uterine cancer had a hysterectomy (surgical removal of the uterus). Before, its removal, however, she had several eggs removed for possible fertilization in the future. Now married, the woman wishes to have a child with her husband. Obviously she cannot bear the child herself, so the couple utilizes a company to find a surrogate mother for them. The husband's sperm is used to fertilize one of the wife's eggs, and is implanted in the surrogate mother. The couple pays all of the woman's pregnancy-related expenses and an extra $18,000 as compensation for her surrogacy. After all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000. Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple's child, after carrying the pregnancy to term, the surrogate says that she has become too attached to "her" child to give it up to the couple. A legal battle ensues. Questions for Case 1 · In the United States it is illegal to pay a person for non-replenishable organs. The fear is that money will influence the poor to harm their bodies for the benefit of the rich. · Do you see a para ...

1. Guidelines to Write the
Responses to the Case Studies
In responding to the assigned case study, I expect you to assume
the frames of mind of an ethicist as follows:
1. Be judicious: read the case at least twice and then ask
yourself what is at stake in the context of the parties involved.
2. Be empathetic: think about the underlying assumptions which
guide the parties who are involved in the case. Then try to draw
out the erroneous and correct aspects of their positions on that
basis.
3. Be sensitive to the religious and cultural differences of the
parties involved and attempt to reconcile any such differences
in a fair and equitable fashion.
4. In making recommendations to solve the dilemma of the
given case, try to be realistic and sensible to current practices,
norms, and beliefs.
5. Be aware of your own cultural, religious, and social
background in order to prevent it from distorting your ethical
judgment.
6. Do not allow religious norms to be the sole standard of your
ethical judgment.
7. Apply the golden rule; treat the case, more specifically the
interests of the parties involved as you would wish your own
interests to be treated.

2. 1
Case studies : Assisted Reproduction
This is a difficult subject because it involves reproductive
issues. In our culture, reproductive liberty, the freedom to
decide when and where to conceive a child is highly protected,
and this can make these cases much more difficult.
Case 1
There are two types of surrogacy. One type involves a
surrogate mother who uses her own egg and carries the baby for
someone else. The other type is a "gestational surrogacy" in
which the mother has no genetic tie to the child she carries. In
the case presented, a gestational surrogate is used.
A woman, after a bout with uterine cancer had a hysterectomy
(surgical removal of the uterus). Before, its removal, however,
she had several eggs removed for possible fertilization in the
future. Now married, the woman wishes to have a child with her
husband. Obviously she cannot bear the child herself, so the
couple utilizes a company to find a surrogate mother for them.
The husband's sperm is used to fertilize one of the wife's eggs,
and is implanted in the surrogate mother. The couple pays all of
the woman's pregnancy-related expenses and an extra $18,000
as compensation for her surrogacy. After all expenses are taken
into account the couple pays the woman approximately $31,000
and the agency approximately $5,000. Though the surrogate
passed stringent mental testing to ensure she was competent to
carry another couple's child, after carrying the pregnancy to
term, the surrogate says that she has become too attached to
"her" child to give it up to the couple. A legal battle ensues.
Questions for Case 1

3. · In the United States it is illegal to pay a person
for non-replenishable organs. The fear is that money will
influence the poor to harm their bodies for the benefit of the
rich.
· Do you see a parallel between this case and this law?
· Can allowing surrogate mothers to be paid for their troubles
allow poorer women to be oppressed?
· Does paying the surrogate harm her and/or the child's dignity?
· Is it selfish/conceited for this couple to want children of their
own genetic make-up?
· If yes, does this change if you can "easily" have a child?
(Note: Over 100,000 children in the U.S. are waiting to be
adopted. However, most are older, have several siblings, or
have special needs.)
· On their website, the AMA says "that surrogacy
contracts [when the surrogate uses her own egg], while
permissible, should grant the birth mother the right to void the
contract within a reasonable period of time after the birth of the
child. If the contract is voided, custody of the child should be
determined according to the child's best interests."
· Do you see any problems with this? (What's a reasonable
time? In a way can you steal the surrogate's child?)
· One of the main arguments against the use of
surrogate mothers is that carrying and giving birth to a child is
such an emotional event that it is impossible to determine if the
surrogate will be able to give up the child. Though adults enter
into the contract, the child could ultimately suffer if a long
custody battle ensues (as it could in states where surrogacy
contracts hold no legal value, such as Virginia).
· With the possibility of such battles, do you think it is
acceptable for parents to use a surrogate mother?
· Do you think that if the surrogate is awarded the baby, this
could cause emotional harm to the child?
· Who do you think should receive the child, and why?

4. Case 2
A married couple wishes to have a child; however, the 32
year old mother knows that she is a carrier for Huntington's
disease (HD). HD is a genetic disorder that begins showing
signs at anywhere from 35-45 years of age. Its symptoms begin
with slow loss of muscle control and end in loss of speech, large
muscle spasms, disorientation and emotional outbursts. After
15-20 years of symptoms HD ends in death. HD is a dominant
disorder which means that her child will have a 50% chance of
contracting the disorder. Feeling that risking their baby's health
would be irresponsible, the couple decides to use in vitro
fertilization to fertilize several of the wife's eggs. Several eggs
are harvested, and using special technology, only eggs that do
not have the defective gene are kept to be fertilized. The
physician then fertilizes a single egg, and transfers the embryo
to the mother. Approximately 9 months later, the couple gives
birth to a boy who does not carry the gene for the disorder.
· Is this a case of eugenics? "Eugenics" is defined as "the
hereditary improvement of the human race controlled by
selective breeding" (dictionary.com)
· Would it be acceptable for the parents to select for sex as
well, or should they only select an embryo that does not have
HD? How would this be different?
· Is it ethical for this couple to have a baby when the mother
could begin showings signs of HD when the baby is just a few
years old?
· With this technology possible, would it be ethical for
this couple to have a child without genetically ensuring it would

5. not have the disease?
· What if we did not have this technology, would it be ethical
for a known carrier to have a child? (If not, how far should this
carry?
· A carrier for cystic fibrosis (which is recessive)?
· Weighing everything we have discussed, do you believe the
couple acted ethically?
Case 3
Date: June 22, 2005. A 27-year-old man is brought into a
New York City emergency room with a 101-degree fever, and
what he believes is chickenpox (Varicella). After a brief
examination, the 35-year-old physician is puzzled because the
pox do not appear to be typical of the varicella-zoster virus.
Worried, he calls in another physician for her opinion. She
takes one look at the patient, determines he has small pox, and
immediately orders him to be quarantined. She notifies the

6. Centers for Disease Control and Prevention (CDC) and asks
them what should be done. While doing background on the
patient, he tells the physicians that he is a flight attendant and
that he has flown to Orlando, FL, Los Angeles, CA, Chicago,
IL, and Seattle, WA in the past few weeks while working.
Though he is given excellent treatment, and had been in perfect
health a few days earlier, the patient dies 7 hours after
admittance to the hospital.
The CDC decides that mandatory small pox vaccines will be
administered to all workers in the NYC hospital, and to all
patients who were in the ER. His co-workers are all given
mandatory vaccines as well, as are all people living in his
apartment complex. They also ship stored quantities of the
vaccine to all of the cities where the man had flown to for work.
The vaccines are offered to citizens of these cities. Finally, all
people, along with their families who had been on the man's
flights in the weeks preceding the appearance of the disease are
forced to receive the vaccine. The flight attendant was most
likely given small pox by a bio terrorist who flew on his plane
sometime during the past week/week and a half. The terrorist
would have been contagious but would not have shown
symptoms. Virtually every person the man came into contact
with would have gotten the virus.
· Is it ethical for the CDC to force people to get the vaccine?
· An LA woman on the flight is religiously opposed to vaccines.
Under California law she can normally refuse vaccines on
religious or personal grounds. However, the government says
she must receive the vaccine or face mandatory quarantine.
What do you think of this?
· Do you think that for more common diseases, for example
measles, that it is ethical for the state to allow people to refuse
vaccines (even for religious grounds)
· What if their refusal can harm others who cannot have the
vaccine, such as people who are immunocompromised like
AIDS patients?
· Is it ethical for someone to refuse the vaccine?

7. · You had driven down to Los Angeles 5 days ago to visit a
friend for the weekend. While in town, you visited many tourist
attractions. You are worried and you try to get the vaccine, but
are denied it because of limited resources. What do you think of
this?
· Citizens begin calling for the mandatory quarantining of
people directly exposed to the victim, i.e those living in his
apartment complex, those working in the ER, those who flew on
the plane in the prior week. What do you think of this?
· The smallpox vaccine, like many other vaccines (example: oral
polio vaccine) can actually transmit the virus to others. In light
of this, is it ethical for people to get the vaccine? (Note: they
are vaccinating those who may not want to be vaccinated)
· Today, should health care workers be allowed/forced to get the
smallpox vaccine? What about non-health care worker citizens?
·