Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, .
Pediatric oncologist Carla Crusher, MD, believes that a specific form of pediatric brain tumor is closely associated with early childhood exposure to certain chemicals. To test her theory, she wants to conduct a study that will take biopsies of these always-fatal tumors from afflicted children and compare them with the chemical-exposure histories reported by the children's parents. She hopes that the biopsy samples of those children exposed to the chemicals will display distinctive neurochemical markers, while those children who also have tumors but whose parents report no chemical exposure will not have these markers. In the long run, her goal is to demonstrate a chemical exposure-brain tumor connection that will lead to restrictions on these chemicals, ultimately saving children's lives.
The catch to this study is that the children involved will not benefit directly in any way. In fact, they will have to undergo a brain biopsy, which comes with risks: infection, bleeding, pain at the extraction site. Since these children are too young to consent on their own -- most are between 3 and 5 years old -- Crusher plans to seek permission from their parents.
She intends to persuade them to participate by saying, in part, "Think of all the other parents and children you'll be helping."
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
Check out some of our past Ethics Consult cases:
Let Researcher Create Mouse-Human Brain?