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Medical Moral Dilemmas

posted: 3.31.14 by Donna Winchell

In an essay we include in Elements of Argument, “The Case for Torture,” Michael Levin asks under what circumstances it would be all right to use torture. The immediate impulse might be to say never. He presents some rather convincing hypothetical scenarios, however, to test readers’ steadfastness in sticking to that answer. What if a terrorist was captured after planting an atomic bomb in Manhattan? If there was no doubt about his guilt, should torture be used to get him to reveal where the bomb was? What if the bomb was on a crowded jet? What if the terrorist knew where a kidnapped baby was? He is not talking about torture as a punishment but as a way to save innocent lives. His conclusion: “There are situations in which torture is not merely permissible but morally mandatory.”

A recent news story raised similar questions about whether it is ever “not merely permissible but morally mandatory” to deny a dying child medication that could potentially save him. The child is seven-year-old Josh Hardy in Memphis, who in February was in heart and kidney failure because of a virus ravaging his body, weakened by four bouts with cancer. A drug exists that might save him, but representatives of Chimerix, the company that makes it, claimed that helping Josh would mean hurting others. Elizabeth Cohen, senior medical correspondent at CNN, wrote, “They’re adamant that spending the time to help Josh and others like him will slow down their efforts to get this drug on the market.” The president of the company admitted that he would feel horrible if Josh died, but that if the company spent the time and money on cases like Josh’s, that would be time and money taken away from the effort to make the drug accessible to far more people in the future—and if Josh died, which was quite possible, the drug would look bad when it is taken to the FDA for approval.

So is it “morally mandatory” to deny a dying child medication that might save him if it would delay getting the drug more quickly to a larger number of people? Following the FDA’s policy for “compassionate use,” the company gave the drug to 451 patients during 2009-2012, when what could be learned from that use was helpful in its development. They said no to Josh initially because there is little to be learned from these individual cases anymore.

Arthur Caplan, director of the division of medical ethics at New York University’s Langone Medical Center, summed up the situation: “You couldn’t get a more troub­ling and impossible-to-resolve moral dilemma than this one.” The media campaign launched by Josh’s family, however, turned the tide in his favor. Over 20,000 people signed a petition urging the drug company to give him the drug, and its executives were inundated with messages via social media. In March, Josh was given the drug, and within days, he was making remarkable improvement. Still, there are arguments that medical decisions cannot be “crowdsourced.” There have been complaints that medical care cannot go to the patient whose supporters make the loudest public outcry.

Cases like this one can show our students how the argumentative skills that they are learning apply in the “real world.” Although anyone would feel compassion for Josh, there is validity to the warrant underlying Chimerix’s initial denial of his family’s request. We found enough similar cases involving complex issues of medical ethics to devote a whole chapter of readings to the subject in Elements.

[Photo Credit: The Physician by Adrian Clark; Flikr]

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