Nikolas Evans, a 21-year, was assaulted outside a bar in Austin TX. After being rushed to the hospital, he was placed on life support. After doctors determined that he was brain dead, they approached the mother about organ donation.

Nikolas' mother consented to the organ donation, but only after her son's sperm had been collected. She argued that Nikolas had always talked about having children and that with sperm collection a surrogate could be used to fulfill that wish. The hospital didn't have the necessary equipment needed to perform an electro-ejaculation procedure to honor her request.

In order for sperm to be viable, it must be obtained while the person is still alive or up to 24 hours after death.Because of these time constraints, Nikolas' mother hired an attorney who asked that his body be preserved so that a procedure could be performed.

ISSUE: There a couple of ethical issues in this case. First, is a mother allowed to request sperm donation as part of the organ procurement procedure? Second, does the mother have the right to donate her child's sperm to posthumously father a child?

Attorneys for Nickolas' mother argued that the body must be preserved in order for the court to rule on these issues.

RULE: One of the issues that the court struggled with is that there was no legal precedent to use in deciding such issues. However, the court agreed with Nickolas' mother and ordered that the body be preserved, because not doing so would cause irreparable harm.

EMPHASIS: The law doesn't catch up immediately with medical and scientific advances. With any new medical or scientific advancement, there will always be new and never before-considered ethical issues.

Question:

1. Should an electro-ejaculation procedure be performed only by consent through a living will? Explain your answer.
2. If the judge rules against Nickolas' mother, what would happen to his sperm? Can you think of any arguments for or against this issue? Explain your answer.

10-2 Court Case:

FACTS: On January 26, 2009, Nadya Doud-Suleman gave birth to eight children through Cesarean section. The eight children were conceived via in vitro fertilization. It was newsworthy because it was only the second time that eight children had been born in one pregnancy, the first in the US. The press dubbed Nadya as Octomom.

Public opinion quickly went from excitement to anger when it was revealed that Nadya already had six children conceived through in vitro fertilization.Adding to the anger was that the fact that Nadya was a single mother on welfare. Opponents expressed concerns aboutwhether or not a single mother could adequately care for 14 children and about the impact such a scenario would have on public assistance.

The doctor who performed the in vitro procedure that resulted in the eight pregnancies soon faced public and professional scrutiny. Dr. Kamrava's attorney stated, "The question isand society may not approvebut if it's satisfactory between patient and physician, that is something to be weighed very significantly."

ISSUE: The California State Medical Board filed a formal complaint against Dr. Kamrava, alleging gross negligence for implanting the number of fertilized ovum at one time; failing to refer Nadya to psychological evaluation; failure to exercise "appropriate judgment;" failure to question Nadya's actions; the excess use of repeated procedures and the prescribing of fertility drugs; and failing to maintain medical records.

The medical board struggled with whether or not Dr. Kamrava's license should be revoked or suspended. Dr. Kamrava maintained that he wasn't negligent because he was following his patient's wishes.

RULE: The medical board revoked Dr. Kamrava's license, rationalizing that probation or suspension would not provide the appropriate deterrent needed to protect the public from further actions by Dr. Kamrava.

EMPHASIS: Even though the actions were technically not illegal, this case raised several ethical concerns. One of the reasons for providing this case was to emphasize how a professional Code of Ethics plays a role in working as a healthcare professional.

Question:

1. One argument raised was that Nadya was on welfare. Should the law limit the number of children that welfare will pay for?Explain your answer.
2. What do you think about the doctor saying he was just following the patient's wishes? Explain your answer.

10-3 Court Case:

FACTS: Born on August 22, 1965, healthy identical twin boys were named Brian and Bruce. At 6 months of age, the boys were diagnosed with phimosis. Phimosis is a condition where the foreskin cannot fully retract over the glans penis. Left untreated it can lead to repeatedinfections, urinary problems, and penile scarring. The medical treatment for phimosis is circumcision.

The circumcision of Brian occurred without problems. However, during the circumcision of Bruce, the procedure caused severe and extensive injury to the penis that doctors determined was beyond surgical repair.Concerned about is future emotional well-being and sexual function, Bruce's parents sought out noted psychologist Dr. John Money at John Hopkins University. Dr. Money's practice focused on gender identification. After the consultation, Dr. Money believed that the best thing to do for Bruce was to undergo sexual reassignment surgery. The surgery was performed at 22 months of age, and Bruce was now referred to as Brenda.

Dr. Money continued to treat "Brenda" for several years afterwards. He wrote numerous professional articles on his treatment of "Brenda," referring to the twins as John/John. Bruce and Brenda's situations presented what Dr. Money thought was an ideal research situation to study and better understand the development of gender identify.

As "Brenda" reached adolescence, estrogen and other supplements were given to her to assist in the development of breasts and other female attributes. Neither Dr. Money nor "Brenda's" parents, to her that she had been born a boy.

ISSUE: Such a case raises multiple ethical issues. Questions arose regarding the parent's right to authorize such treatment and Dr. Money's handling of the situation for research purposes.

RULE: While this isn't a court case, many of Dr. Money's colleagues were highly critical of his handling of the situation.

EMPHASIS: After several years of treatment, "Brenda" became clinically depressed and eventually refused to see Dr. Money any longer. At one point, "Brenda" even threatened suicide.After a consultation with an endocrinologist, at age 13 "Brenda" was told about the botched circumcision and sexual reassignment surgery. Afterwards, "Brenda" started to live as a boy, calling himself "David." He later underwent several surgeries, including a double-mastectomy and two phalloplasty operations (to correct the penis) and received testosterone injections.

David continued to live as a man and even got married, helping his wife raise his step-children. On May 5, 2004 "David" separated from his wife and committed suicide.

Questions:

1. At what age do you think that "Bruce/Brenda" should have been told about the sexual reassignment surgery? Explain your answer.
2. From a strict scientific and research perspective, this was an ideal case. But at what point do you negate science and research in the name of ethics? Explain your answer.

10-4 Court Case:

FACTS: [Instead of the names of the plaintiffs being used in court cases, names are replaced with initials.] The parents of an 8-year-old girl brought her to Southern Baptist Hospital of Florida. The child was diagnosed with acute monocytic leukemia, severe anemia, and a low blood platelet count. Doctors recommended chemotherapy as the most appropriate treatment, which would also necessitate blood transfusions.

The parents of the child were Jehovah's Witnesses, who do not accept blood transfusions for religious reasons. The hospital filed an emergency petition with the court asking them to override the parent's wishes and to provide the chemotherapy treatment and blood transfusions.The parents argued that the transfusions would create undue suffering of the child and violate their religious beliefs.

ISSUE: The question before the court was whether or not they had the authority to override a parent's wishes and if so, what standards should be used to do so.

RULE: The court ruled that "... the parent's wishes may be overcome when there is sufficient medical evidence to invoke the parens patriae authority, and to establish the child's welfare will be best served by the disputed treatment." In the written opinion, the court explained that "... the policy of advancing the best interests of the child is well rooted in this state and guides the courts in many diverse contexts.

EMPHASIS: While the Best Interest of the Child laws are most often used to determine custody issues, this case not only identifies where the courts can medically apply the Best Interest of the Child law, but also bases their decision on their parens patriae authority.

Questions:

1. What do you think about judges being able to overrule the wishes of the parents?Explain your answer.
2. Why do you think the law allows the courts to overrule a parents wishes? Explain your answer.