This is a time when overpopulation is a growing problem. It seems that there is no slowing down of procreation even though people are aware of the problem. At the rate it is going I see that it will result in Authorities having to take drastic action to sustain the human race. Any decision they make will be unfair in some way. I wonder whether it would be right to stop trying to cure terminal illnesses such as Cancer and AIDS (as they seem an unbias/fair population control system). On the one hand it would be better for the future of mankind and yet it seems unjust to let people die when we can help them. Where does this issue stand with ethics? as it seems both moral and immoral.

Letting terminally ill people die will do little to slow population growth because the vast majority of these people are not going to have (additional) children anyway. But there are other solutions that would actually work. You write that there seems to be no slowing of procreation. This is quite false. Total fertility rates (average number of children per woman) have fallen spectacularly since 1955 ... but only in countries and regions where poverty has been meaningfully reduced. For example, the TFR of East Asia fell from 5.42 to 1.72 (below the rate of reproduction) -- and East Asia is the most populous region on Earth. So this is highly significant. There were large drops also in Portugal, Australia, Botswana, Italy, and so on. Where poverty persists, on the other hand, so do high TFRs. Many African states are good examples of this. Niger's TFR has increased from 6.86 to 7.15, and other high-poverty countries (Mali, Senegal, Equatorial Guinea) are not far behind. The evidence is overwhelming,...

There was a debate recently about organ donation, and one group of people adamantly opposed the notion of making organ donation mandatory or even opt-out, because, and I quote, "They're my organs and nobody else gets to decide what to do with them." Considering organ donation only ever occurs when a person is deceased and no longer has any use for the organs, how is ownership of organs even relevant to the discussion? Why shouldn't it be acceptable to make organ donation opt-out, or even mandatory?

The claim that a deceased person has no use for her organs, that the integrity of her body after her death is of no importance to her, is a claim that many dispute, typically in the context of some religious beliefs or others. It seems best for the state to avoid policies that some citizens find offensive on the basis of religious beliefs which the state is in no position to refute. Fortunately, we can avoid such policies in this case: by making organ donations opt-out, as you suggest, we'd have all the organs we might need. The reason against this which you cite ("They're my organs and nobody else gets to decide what to do with them") is not a good reason against the opt-out solution. Yes, they are her organs and she alone gets to decide what to do with them -- but we still need to have a fall-back default for those cases in which a person dies without leaving clear instructions. Here any default society might settle upon is in the same boat, e.g. subject to the objection that it may not be...

I am now taking a medication once a month to manage a symptom of a slow-growing cancer that I have. I just started Medicare last year and see by my statements that the cancer center charges my Medicare an enormous sum of money for this treatment and my oncologist says that there is not a generic equivalent that can be administered this way. Is it ethical for them to charge this sum (over $10,000) for an injection and is it morally "acceptable" for me to take this, at great cost to my fellow taxpayers?

It is very good of you to pay attention to these costs borne by others -- most people don't. Given the amount involved ($120,000 per annum), I think you should make an effort to find out more. Your oncologist says that no generic drug "can be administered this way" -- well, is there a compelling reason why it should be so administered, or would you be equally well off with the generic product administered in some other way? It is quite possible that your oncologist makes a lot more money from giving you the expensive medication rather than the cheaper one, so explore the question on the internet and perhaps also ring Medicare to get their opinion. If we all pay attention in this way, then it will be much harder for pharmaceutical companies and medical providers to overcharge the system we all pay for. If the expensive drug you are taking really is the only way to manage the symptom in question, then I would expect this symptom to be serious enough to justify this lavish reimbursement. But perhaps...

The following dilemma has arisen in my work as a health professional. I suppose it is more of an ethical conundrum than anything else. Imagine the following scenario: Someone is seeking help because they believe they may be at high risk of developing condition X. Our assessment suggests that they are in fact at high risk of developing condition X. Part of the reason they are high risk is BECAUSE they are worried they may develop condition X. As you can imagine informing the person of the results of their assessment can actually lead to that high risk person developing condition X. Health professionals have a clear duty to respect autonomy (including telling people the truth), balanced with a duty not to cause harm, and a duty to do good. Bearing this in mind, what should we tell the clients about the results of their assessment? NOTE: They would still be at high risk of developing condition X if we didn't assess or treat them. What we appear to do currently is assess them, but when communicating...

This is an interesting problem, very crisply stated. Variants of it occur in other life contexts as well. Thus truthful reporting of information can be counterproductive, for example, in the work of Human Rights Watch or Amnesty International in situations where such information may undermine the reputation of a political party or faction that, all things considered, is better than its rivals. This case is different from yours in that the responsibility for being truthful is primarily to third parties: to those who rely on the NGO to report the whole truth and nothing but the truth about the various governments, parties, or factions and their conduct. In your case, where the responsibility is basically to the patient, the practice you and your colleagues have developed seems entirely right to me. Maybe your slight doubts about this practice can be mitigated by a brief further thought about autonomy. Contrary to what you suggest, I do not think that respecting autonomy requires being entirely candid....

Some friends and I have been debating the question of state mandated vaccination. There are actually several different pieces to this. First, forcing someone to undergo a medical procedure seems to be a major violation of their individual rights. Or is it? Second, there are always risks with any medical procedure, including vaccination. Does the value to the group of controlling infectious disease trump the right of the individual to free choice of risk? Some people might prefer the risk of disease. Third, what about parental responsibility? How far does the state have the right to force medical procedures on minors, against the parent's objections? Thanks for your help!

Vaccinations protect the vaccinated person. But they also protect others (who would come into contact with the vaccinated person if she were to be infected) and the population at large (as the disease has less of a chance to spread if there a fewer usable carriers). Given this situation, a classic collective action problem can arise. The cost and risk of getting vaccinated are mine alone, while much of the benefit is dispersed. So it is quite possible that it is better for each not to get vaccinated (regardless of what others do) even while it is also better for all that all get vaccinated than that none do. (In numbers: Suppose the cost and risk of getting vaccinated is 6 and the benefit to oneself is 3 and the benefit of another person getting vaccinated in a 101-person community is 0.05. Then, if all get vaccinated, everyone gains: 3 + 100*0.05 - 6 = +2. But each can reason this way: The first term is +3, the second is whatever it is independently of what I do, and the third term is -6. So I will...

I am a baseball coach/manager. In my stepson's baseball league, another team has a child (these are pony league players - 13 & 14) who has some arm problems. I know he has had an MRI (know the MRI tech) and also that his doctor instructed him never to pitch again. The coach and parents are aware of this too - yet the coach still pitches him in games. Other parents discuss this problem, yet no one seems willing to step up and do something about this. Since I know the story, would it be ethical if I anonymously informed the league? There may be a potential liability issue at stake here too. This kid is going to ruin his arm before he gets to high school. I am also trying to balance the confidentiality of the medical relationship vs. the kid's welfare. Should I even be considering this?

He will ruin his arm -- that's a major burden for a child who loves sports. The goal of saving his arm seems a lot more important than the other considerations you mention. But perhaps you don't actually have to make this choice. Instead of informing the league, you might just talk to the MRI technician (who already knows that you know, and is responsible for your knowing, the boy's condition). Urge the technician to tell the doctor that the boy is being pitched by his coach and that his parents apparently approve of this. (The technician can say that this information comes from someone else without saying that this someone else -- you -- knows about the severity of the boy's injury.) The doctor can then decide what to do -- e.g., telephone the boy and/or the parents or write them a stern letter, and, if all else fails, communicate her or his concerns to the league. The doctor best understands the boy's condition and can speak about it with the greatest authority.

Is it ethical for surgeons to use economic considerations when setting their fees? For example, is it ethical for a surgeon who is known to have better results for a certain operation to charge more than a surgeon who has worse results? Likewise is it ethical for a surgeon who has a scarce skill in a region to charge exorbitant fees for that skill simply because it would be unaffordable for most patients to travel to another region to attend another surgeon?

It may also matter what sort of operation we are talking about. If this is cosmetic surgery (beautifying belly buttons, say), then the service does seem quite similar to other commodities (face cream), and the reasons against the surgeon's charging what she will seem quite weak. As we move to the other end of the spectrum -- to operations that are a matter of life and death -- Peter Fosl's points become ever more compelling. Such operations should not be rationed on the basis of wealth: A medically important operation that is routinely available to the wealthy should also be available, in roughly the same quality, to the poor. Call this the medical equity principle (MEP). It does not follow from the MEP (here comes my second point) that it is unethical for the best surgeons to charge more. Societies that have organized themselves around the MEP need to have enough high-quality doctors to take care of the medical needs of all. To attract people into the profession of surgeon, and to entice them...

Is it ethical for a surgeon to perform an operation on his own mother? Especially when it may involve the finding of a cancer?

Doctors try to avoid such situations, and, I think, for good reason. They add extra stress to what is already a difficult task -- stress for the surgeon and also stress for the patient. Such extra stress, in turn, is likely to diminish the prospects for success. And a surgeon who performs a major operation on his mother may then be acting unethically by not giving his patient the best chances of a successful outcome. If so, he should step aside, even if his mother would prefer to be operated by him. But what if some surgeon is, and is known by his mother to be, especially cool and unemotional, thus adding no stress to the proceedings? Or what if he is much better than the other available surgeons so that his greater skill more than makes up for the extra stress? In such cases, I would think, there's nothing unethical about him doing the operation himself -- provided, of course, his mother agrees. So, as I see it, performing a surgical operation on a loved one is not unethical as such, it is...

Imagine I am a scientist working for a pharmaceutical company and I spend 25 years working on a drug that will cure a disease. I patent my work, but the patent only lasts for 8 years. In that time, the pharmaceutical company sells the drug at a high price but uses most of its profits to fund more research. After 8 years, anyone can replicate my drug. Why should I allow generic brands, in that 8 years, to make my drug? I know many more people would have access to it if I did, but at least when my company is in control of it there are quality controls and secondly, my work is not only funding more research but is something I invested a great portion of my life in. Is it fair to argue for generic drugs in that case?

Your reasoning appeals to a false dichotomy. You assume that either we give monopoly pricing powers to inventors and thereby effectively deny access to recent drugs to poor patients or we allow generic companies to compete and thereby effective deprive inventors of their rewards and of funds for new research ventures. But there are further options. One would be to allow generic companies to compete immediately (thereby reducing the price of a new medicine to near the marginal cost of production) and then to reward inventors in another way, for example with a reward (out of public funds) proportioned to the impact of their invention on the global disease burden. All patients would benefit for much cheaper access to recent drugs, and taxpayers would pay a little more. Millions of lives would be saved through this innovation -- not merely because poor patients get access to cutting-edge drugs, but also because biotech and pharma companies would gain an incentive to research remedies for the...

Do patients have an absolute moral right to the confidentiality of their medical records?

An absolute right is presumably one that cannot be outweighed, forfeited, and/or alienated. (Such a right can still be waived -- e.g., by allowing your doctor to show your medical records to someone you nominate.) Let's look at these three issues with regard to the assumed moral right to the confidentiality of one's medical records. It seems evident that this right can be outweighed. Suppose, for example, that a society faces a serious risk of a pandemic involving a life-threatening and highly virulent pathogen (ebola, avian flu). May such a society require doctors to notify the authorities of any positive diagnosis so as quickly to isolate the patient and prevent contagion? With potentially millions of lives at stake, any right to confidentiality must surely give way. Less confidently, I would also think that the right in question can be forfeited, at least in part. Here is a possible case. Suppose the right is not outweighed by the danger to a single person. So, even where AIDS is still a...

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