Developing World

An African country is experiencing high rates of a fatal disease. The only means of reducing infections is to kill all of the sheep in the country that carry the disease. The country’s health department asks an American doctor to do research to identify the number of people afflicted with the disease. The country wants to decide if enough people are afflicted to kill the sheep, as it would severely reduce the food supply.

The doctor needs to take blood samples from 1,000 villagers. He tries to explain the reason for his study to the villagers, but they do not believe that diseases are caused by viruses; but instead by bad spirits. A government representative says that the villagers will gladly give their blood if told that it is part of a religious ceremony that will scare the bad spirits away. Should the doctor agree to the deception?

Smoking Study

You are a famous researcher at Norwich University who has been approached by a cigarette company about doing research aimed at determining if smokers with certain genetic profiles are at greater risk of developing lung cancer. There is some evidence to suggest a genetic connection to lung cancer in smokers. However, you suspect that the cigarette company will use the information to claim that smoking is safe for those who do not have the genetic propensity to lung cancer. Is it unethical for you to participate in the study? Can you ethically participate under certain conditions?

Conflict of Interest

Pharmaceutical companies routinely hire doctors at research universities to carry out clinical trials for approval of experimental drugs. These doctors are paid well for their work, but some wonder if the payments raise a conflict of interest. Do you see a conflict of interest in these payments, and if so, is there a way to resolve the conflict while allowing doctors to get paid for drug research?

Anorexia

A 21 year old woman with anorexia is recruited by a local hospital for a research trial that will examine certain chemical levels in the blood and spinal fluid of those with anorexia. The trial involves removing blood and spinal fluid every day for three weeks. The woman is told that the study is not likely to be of benefit to her; it is only for general knowledge of the condition. She readily agrees to enter the trial. However, a nurse working with her worries that people with anorexia are often motivated by masochistic tendencies. Should she be allowed to enter the trial?

Cheating the Research?

A 48 year old man has a form of cancer with no known cure. The only treatment just slows the growth of the tumor. He tells his doctor that he only wants treatment if it has a chance of saving his life. His doctor learns of a research trial for a drug that has shrunk tumors in 20 percent of the cases. The only way to get the drug is through the trial. The study involves giving half of the patients the drug, and the other half a placebo, with the groups chosen at random. As his doctor, she will know if he is in the control group. The man says that he will enter the trial only on condition that the doctor notifies him if he is in the control group so that he can leave the trial. Should the doctor agree?

Treatment on a Child

An 8 year old girl develops a rare degenerative disease that will kill her in a few years if not treated. The only known treatment has only a five percent success rate, but minor risks. Her father agrees to put her into an experimental protocol involving a treatment that has a twenty percent success rate, but a higher risk. The treatment causes severely elevated cholesterol levels that normally taper off over time. The individual must complete the six weeks of treatment if it is to be successful.

After two weeks the girl’s cholesterol level is alarmingly high and the care team wants to end the treatment. The father insists on continuing until the end of the six weeks. What should the care team do?

Ulysses

A 24 year old man has schizophrenia that can only be controlled with Prolixon. He develops a form of cancer that is treated with chemotherapy; however, one of the drugs used in the chemotherapy interacts poorly with Prolixon, and so he must go off of the drug for the six weeks of treatment. The situation is fully explained to him and he agrees to the chemotherapy. After two weeks he is in a psychotic state so severe that he is curled up in his bed smearing feces on himself. He is also sick from the chemotherapy and refuses any further treatment. Must his care team end the treatment?