informed consent

“Grow Your Own Marrow Donor” Ethics and Consequentialism: The Ayala Family Saga

/ Jack Marshall / 24 Comments

Anissa Ayala and her custom-made bone marrow donor

Once again, the fans of that ethically corrosive twin of  “the ends justifies the means,” consequentialism, were holding court in the mass media, as the “Today Show” revisited a two-decade old ethical outrage to declare that it was all perfectly fine after all…because it worked.

Thus does television, itself dominated by ethically-dim writers, producers and stars, corrupt the public. So here we go again:

Does the fact (if it indeed is a fact) that Osama bin Laden capture and execution was facilitated by torture make torture less ethically wrong?

No.

Do the fortuitous results of any action that was unethical from its inception change the nature of that conduct from unethical to ethical.

Again, no.

Is conceiving a child solely to provide donor bone marrow to her cancer-stricken older sister ethically acceptable as long as the sister’s cancer is cured?

Absolutely not!  But to listen to the “Today Show,” and revoltingly, the “Today Show’s” resident medical correspondent Dr. Nancy Snyderman, it is not only ethically acceptable but laudable. Because it worked.

Twenty years ago, Abe and Mary Ayala were desperate because Anissa, their 16-year-old daughter, had been diagnosed with leukemia. Chemotheraphy proved ineffective, and neither the Ayalas nor their son was a compatible bone marrow donor. The Ayalas had long before decided that two children were enough; Abe had a vasectomy. But then Mary came up with the idea of having another child in the hopes that it would be a bone marrow donor who could save Anissa’s life. Continue reading →

Parental Responsibility, Child Exploitation, and Billboard Ethics

/ Jack Marshall / 8 Comments

Here’s a rule of thumb: Don’t give the rights to reproduce your child’s photograph to a photographer or ad agency unless you are prepared to accept however it is used, and certain that your child will not be harmed or embarrassed as a result.

Is that so hard?

Tricia Fraser has sued Life Always and Majella Cares Heroic Media, an anti-abortion group, claiming it used her daughter’s picture in “a racist, controversial advertising campaign” that is “defamatory, unauthorized, and offensive,” posting the 4-year-old girl’s photo on a giant billboard by the Holland Tunnel and another in Florida.

Nice try. But there is nothing racist about the campaign, and nothing defamatory about using her daughter’s photo in it.  Continue reading →

Home-Grown Mengeles, And What We Must Learn From Them

/ Jack Marshall / 4 Comments

Josef Mengele: researcher, utilitarian, monster

We knew, or should have known, that this extremely ugly shoe was bound to drop eventually.

Last autumn, when the U.S. apologized for federal doctors infecting prisoners and mental patients in Guatemala with syphilis 65 years ago, it put us on notice that a vile and unethical cultural standard had taken hold of the American medical and scientific communities in the 20th century, one that held  it was “right” for the weakest, most powerless and most disposable of human beings to be tricked, coerced or bribed into serving as subjects for experiments that could lead to miraculous cures and treatments for the rest of the population. This–depriving human beings of their rights and lives in the interest of science—is “the ends justify the means” at its worst. But the Guatemala experiments proved that this was once flourishing and respectable in the U.S. scientific and medical research communities, so it would have been surprising if there weren’t more stories of home-grown Mengeles, and sure enough, there were. The U.S. acknowledged as much when it apologized for the Guatemalan tests. Now we have details. Continue reading →

Baseball’s Free Agent Follies: Dumb Clients, Conflicted Agent

/ Jack Marshall / Leave a comment

Baseball’s super-agent Scott Boras has his annual off-season conflict of interest problem, and as usual, neither Major League Baseball, nor the Players’ Union, nor the legal profession, not his trusting but foolish clients seem to care. Nevertheless, he is operating under circumstances that make it impossible for him to be fair to his clients.

This year, Boras has three aging outfielders in his stable, all with some Hall of Fame credentials, all with fading skills, and all without jobs. Their names are Manny Ramirez, Johnny Damon and Andruw Jones. Thanks to a glut of unsigned hitters still on the market, the price for each of these three—once, when they were young, in the 8-figures a year range—is falling fast. According to an analysis by ESPN, only six, and possibly as few as three, possible teams are still looking to fill slots on their rosters suitable for Ramirez, Damon, and Jones, and none of them will sign more than one, if any. Continue reading →

Ethics and Altzheimer’s Testing: An Easy Call

/ Jack Marshall / 6 Comments

Sometimes I think bioethicists spend too much of their time looking for new ethical dilemmas rather than giving thoughtful guidance on the dilemmas we already have. A recent example: the New York Times wrote about a supposed ethical dilemma appearing in the wake of new tests that reveal the likelihood of whether an individual will get Alzheimer’s at some point in the future. As the article put it:

“Since there is no treatment for Alzheimer’s, is it a good thing to tell people, years earlier, that they have this progressive degenerative brain disease or have a good chance of getting it?…It is a quandary that is emblematic of major changes in the practice of medicine, affecting not just Alzheimer’s patients. Modern medicine has produced new diagnostic tools, from scanners to genetic tests, that can find diseases or predict disease risk decades before people would notice any symptoms. At the same time, many of those diseases have no effective treatments. Does it help to know you are likely to get a disease if there is nothing you can do?”

My question is: “What’s the dilemma?” Continue reading →

Lying to Mom

/ Jack Marshall / 10 Comments

The call was from my mother’s case worker at the hospital.

The night before, my mother, 89, had fallen in her apartment, the seventh fall in ten days and, like the others, a direct result of her stubborn refusal to use a cane or a walker despite her unsteadiness. This time she had not been able to dissuade me from taking her to the emergency room, where we both lingered until nearly 6 AM as she was X-rayed, CAT-scanned, and given a battery of tests. The staff felt she needed to be checked-in to stay for a couple of days, especially since she was hallucinating. I agreed, over Mom’s protests; it would also provide me some more time to figure out how to prepare my home for her to move in, at least temporarily. There is no way I am going to let her fall again.

Now the case worker was calling to tell me that my mother was resisting treatment. She wanted to go home, she said, and was physically resisting efforts to give her an M.R.I. Would I please come over and persuade her?

The hospital was only fifteen minutes away, and as I drove there, I pondered various strategies. With my mother, you get one shot. If your first argument doesn’t persuade her, nothing will. I could explain why the M.R.I. would help the doctors clear her for release, but that one could backfire if the test revealed something that in fact led to a longer stay. One ploy kept pushing itself to the front of the line: Continue reading →

Baby Jesus Ethics

/ Jack Marshall / 12 Comments

Perhaps it was the story about the camel falling over during the Nativity Scene rehearsal, but I have begun to have ethical qualms about the use of real infants to play Baby Jesus in Christmas scenes and pageants. This morning, Fox News featured another one, with Mary and the gang holding a five-month-old child outside in sub-freezing temperatures. “He’s very warm, ” Mary said of the star of the show (I guess a Christmas pageant is one show where the “star” is literally a star; Baby Jesus is, what, the leading man? A key prop?). “Jesus” was wrapped up like a mummy, though his face looked cold. Was it really necessary to have a real child? Continue reading →

Ten Ethics Questions for the Pat-Down Defenders

/ Jack Marshall / 9 Comments

I, like you, have been reading and listening to my various “My Obama, may he always be right, but my Obama, right or wrong” friends try to argue that having TSA agents sexually assault non-consenting adults is a perfectly reasonable and benign exercise of government power. I, like you, am tired of the posturing and excuse making. Their arguments, in essence, all boil down to: a) they have no choice b) they have our best interests at heart c) it’s no big deal, and 4) trust them, they know what they are doing.

I suggest that you, as I will, pose the following questions to your trusting friends, perhaps beginning with a preliminary query regarding whether they themselves have undergone the humiliating and invasive pat-down procedure that they so willingly approve of for others.

Then ask them these: Continue reading →

Unethical Quote of the Week: The Los Angeles Times

/ Jack Marshall / 11 Comments

“If you can’t handle such a minor inconvenience, perhaps you should stay on the ground.”

—The Los Angeles Times Editorial Board, in an editorial called “Shut up and Be Scanned,” dismissing the objections of travelers who find the gonad and breast-fondling patdowns now being used by TSA screeners embarrassing and obtrusive. Continue reading →

Dr. James Watson: There, But For Red Tape, Goes Dr. Mengele

/ Jack Marshall / 5 Comments

Dr. James D. Watson, Nobel Prize winner, will always have a place among the highest echelons of scientific achievement, no matter what thoughtless and dangerous things he says. Still, the co-discoverer of the double helix is slowly tarnishing his reputation by a series of gaffes. A few years ago, he opined that there was no way to avoid the conclusion that African-Americans just weren’t as intelligent, on average, as whites: the predictable uproar sent him into retirement. Now, as Watson reaps the well-deserved bounty of career honors in his eighties, he is endorsing the retreat from the standards of medical research ethics originally inspired by the diabolical human experimentation performed on helpless adults and children by nightmarish Nazi researcher, Dr. Josef  Mengele. Mengele believed that human beings could be reasonably sacrificed if the benefits to society and humanity generally were great enough, in his estimation, of course. Apparently, so does Watson. Continue reading →