Bioethics Home Page | Syllabus | Old Exams | Web Resources



LAW AND MEDICINE -- BIOETHICS
Spring 1997
Prof. Mayo

Final Examination
May 7, 1997           6:30 p.m.          3 hours

1. This is an open-book exam.  You may bring into the exam room the assigned casebook, all class handouts, your class notes, and your outline, including any outline that may have been prepared jointly with other members of the class.

2. There are three questions with the following suggested times:

   Question I (essay): 90 minutes
   Question II (short-answer): 45 minutes
   Question III (essay): 45 minutes
 
Points will be allocated on a weighted basis that accords with the suggested times.

3. Unless the question states otherwise, assume that all patients and providers are citizens of Texas and that all treatment decisions arise in Texas.

4. All questions should be answered in a bluebook.  Please use dark ink, not pencil; write on every other page of the bluebook; and don't skip lines.

5. When time is called, please turn in your bluebook(s) and this exam (inside the bluebook(s)).


  Question I (Suggested time: 90 minutes)

 University Medical Center (UMC) is considering a new protocol to increase the availability of donor organs for its organ transplant program.  UMC has asked you for your analysis of the ethical and legal issues raised by the following plan:

 

   Analyze the legal and ethical issues raised by the NHBD protocol.  Identify any questions that need to be answered before an analysis may be completed.  Suggest modifications to the protocol that could be adopted by UMC to avoid the problems identified.
 

Question II (Suggested time: 45 minutes)

State whether each of the following assertions is true or false and very briefly (i.e., not more than 3 sentences) state why.

1. David Duncan operates a surrogacy agency for couples who desire to have a child with the assistance of a surrogate mother.  For a fee, Duncan will handle the screening (physical and psychological), draft the contracts, and establish the escrow fund out of which the surrogate's expenses and fee are paid.  In most states with statutes on the subject, such an arrangement is either unenforceable or illegal or both.

2. Respect for autonomy derives directly from Kant's deontological ethics and is often inconsistent with the utilitarianism of Mill and Bentham.

3. Amy Anderson has been certified in writing by one physician to be incompetent and to have a terminal condition.  Amy has a directive to physicians and a durable power of attorney for health care that names her husband as her agent.  Her husband has directed that all life-sustaining procedures be stopped.  If the physician complies with the husband's request, she will be afforded all applicable immunities under the Durable Power of Attorney for Health Care Act, but not the immunities listed in the Natural Death Act.

4. Same facts as preceding question, except: Amy is pregnant.  Life-sustaining procedures may not be withheld or withdrawn as long as she is pregnant, and the agent lacks the authority to consent to an abortion; therefore, life-sustaining procedures must be continued until after the baby is born.

5. Becky and Charlie are married.  Becky does not produce viable ova.  Becky consents to an in vitro process by which a donor egg is combined with sperm from Charlie, and the resulting embryo is implanted in Becky's uterus.  On these facts, the resulting child will not be the legitimate offspring of Becky and Charlie.

6. University Hospital is creating an IRB.  Its appointment of 6 members from its teaching faculty (4 physicians, 1 nurse, and 1 pharmacist), all of whom are experienced clinical investigators in research involving human subjects, meets FDA requirements.

7. Federal research policy approves germ-cell therapy for therapy (i.e., to treat or correct a genetic condition or disease) but not for enhancement.

8. Edith Edwards has contracted a highly contagious viral infection.  Her physician, an infectious-disease specialist, instructs Edith to refrain as much as possible from contact with her family for the next 72 hours.  As long as the physician has no physician-patient relationship with any other family members, he is under no legal duty to warn them of Edith's contagious condition.

9. Fred and Ginger are the parents of a newborn son, Harry, with numerous life-threatening and untreatable genetic anomalies.  Although the baby was genetically tested in utero, the tests either failed to detect the genetic problem or were misinterpreted.  Negligence on the part of the testing laboratory has been stipulated.  Although Harry and his parents probably have meritorious actions for wrongful life and wrongful birth, respectively, they are unlikely to recover monetary damages for more than medical expenses and pain and suffering.

Question III (Suggested time: 45 minutes)

You work in the office of a Texas state senator as a legislative assistant.  The senator has received the following draft bill and asked you to analyze it:

In particular, the senator has asked you to answer the following questions:

 A.

 (i)  What would the bill ADD to Texas law?  What CHANGES in Texas law would the bill produce?

 (ii)  Who is benefited by this bill?  Who is harmed?  

B.

 If the bill were enacted into law, what would be the status of the law if the U.S. Supreme Court were later (i) to reverse the courts of appeals in Compassion in Dying and Quill, or (ii) to affirm the courts of appeals (as to result and reasoning) in those two cases?

 ***EXAM ENDS***