Author(s): Michael S. Pritchard, Department of Philosophy, Western Michigan University & Theodore Goldfarb, Department of Chemistry, State University of New York at Stony Brook
NOTE: This contribution appeared as a featured resource in the online and printed issues of ENC Focus: A Magazine for Classroom Innovators Vol. 8 no.3, published by the Eisenhower National Clearinghouse for Mathematics and Science Education-ENC.
Albert Coppola, Robert Frost Middle School, Deer Park
John Marr, West Hollow Middle School, Melville
Mary Kay Marr, Paul J. Gelinas Jr. High School, Setauket
Dennis O'Hara, Miller Place High School, Miller Place
John Piropato, William T. Rogers Middle School, Kings Park.
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Students should be given the following fact sheet to study as a homework assignment in preparation for this ethics lesson. To increase the likelihood that students will take this assignment seriously, they can be told that a brief (five minute) written quiz based on the fact sheet will be given at the beginning of the lesson.
Facts About Low Birthweight Infants
Students should be divided into cooperative learning groups of three of four students. These groups should each be given the case study to read and discuss, and questions to answer (see below).
The teacher should lead the entire class in a discussion of the answers recorded by the cooperative learning groups to each of the questions.
If time permits, all, or part of the following class period should be devoted to a teacher-led follow-up discussion of the optional questions. The value of this session can be enhanced by asking the students to prepare answers to some, or all of these questions in advance, as a homework assignment.
Dr. Robert Fisher - Dr. Fischer, 46, is a pediatrician (children's doctor) and an expert in the care of the newborn at Public University Hospital. He has developed a new medical procedure that has an 80% survival rate for extremely low birthweight (under one pound) babies. Previously, using the normal intensive care given to low birthweight infants, there was almost no chance of survival for such tiny babies. Unfortunately this new method is extremely expensive, costing $450,000 per baby.
Joy Smith - Joy Smith, 30, is a clerk in the accounts receivable for the Community Waste Management Corp. She is the mother of one child (Susan, see below) and is and on March 9 she will complete the fifth month of her second pregnancy. This pregnancy, like her first one has been difficult. She would like to work until just before her due date, but back pains are making it increasingly difficult to do her job. She has ignored the advice of her obstetrician to give up smoking and social drinking during her pregnancy because of the harm that these habits can cause to her fetus.
Michael Smith - Michael Smith, 32, is married to Joy. He is one of the most skilled machinists at Delta-Delta Electronics and earns a base salary of $58,000 per year. Three years ago he and his family moved into an attractive new four-bedroom home. With the new mortgage and a second child on the way, which means that his wife will not be working for at least two years after the baby is born, he has been taking all the overtime work that is available. He hopes that he and Joy will be able to afford the college educations for their children that they didn't have.
Susan Smith - Susan, 12, is in her first year at Middleville Middle School. She has made a good adjustment to the new school environment and has developed a large group of friends. She is excited about the prospect of having a brother or sister after years of wishing for a sibling. Susan is already in the school band and the drama club. She also serves one period each day as an assistant in the school library. This year she hopes to try out for the Cheer Leader Squad. At home she has a nice large room with her own TV, VCR and Stereo. She is trying to convince her parents that she also needs her own phone. She has begun thinking about college and would like to attend a good private university like Cornell.
Dennis Copa - Dennis Copa, 49, is the owner of Delta-Delta Electronics, a small sized, private company with 34 employees. Increased competition in the electronics field has recently reduced the company's profit. Sales of the company's most successful consumer products have leveled off. The company lost a recent bid for a government defense contract. Mr. Copa knows that if he doesn't reduce the amount of expensive overtime work he may have to lay off two or three of his employees. He is also looking into negotiating a reduction in health benefits with the employees union.
Joseph Sullivan - Joseph Sullivan, 58, has been the Chief Executive Officer (CEO) of Mega Insurance Corporation for four years. Mega has the contract to provide family health insurance coverage to the workers at Delta -Delta Electronics. Partly due to the increased cost of medical care, Mega's profits have been decreasing for two years. Mr. Sullivan knows that if he doesn't reverse this trend, the stockholders are not likely to retain his services as CEO. He has already down-sized the payroll as much as he can. One option he is looking into is declaring a larger number of new medical procedures to be "experimental" and therefore not eligible for coverage under the terms of the company's insurance policies.
On February 27th Joy goes into premature labor and gives birth to a baby boy at Public University Hospital. Thomas weighs only 15 ounces. Joy had an easy delivery, is in excellent health, but she and Michael are faced with some very serious and troublesome decisions. They have been told about Dr. Fischer's new procedure for extremely low birthweight babies like Thomas. But they have also been informed that the hospital's policy on low birthweight babies is that "unusual" extreme care, such as that required by the Fischer procedure will only be employed if it is covered by medical insurance, or if the baby's parents agree to full financial responsibility. Otherwise, Thomas will be put in the normal intensive care unit for newborns, which means his chances of survival would be very small. Michael contacts Mega Insurance Corp. and is told that they consider Dr. Fischer's procedure to be experimental, and not covered under his policy. The hospital informs the Smiths that if Thomas is to receive the greatly enhanced survival prospect of the Fischer procedure they will have to agree to pay $300,000 -- the difference between the procedure's $450,000 cost and the maximum amount Mega will pay for intensive care for newborns.
Joy and Michael have less than 24 hours to make a most difficult decision. If they can somehow come up with $300,000 they can increase Thomas' chances of surviving for more than a few days, from nearly zero to 80%. They also are told that even if he does survive, the chances of him being a normal, healthy child are less than 50%. He would have an increased risk of having many serious ailments and a 25% chance of dying before the age of 10.
The Smith's total savings amount to $20,000. Fortunately, Joy has a rich uncle who she is sure would agree to help them get a bank loan for the remaining $280,000. But meeting the monthly payments will require a drastic reduction in the family's lifestyle. Joy and Michael decide to involve Susan in the decision. She is told that if they agree to the pay for the Fischer treatment the family will have to sell their new home and move into a much less expensive one in a less attractive neighborhood. Susan will have a smaller room and she will soon have to begin baby-sitting to pay for most of her entertainment expenses. When she is 13 Susan will have to take care of Thomas after school so that her mother can begin to work part time. She will surely have to abandon the idea of having her own phone and also of attending an expensive private college. Michael also knows that before making a decision he will need to confront Mr. Copa and try to persuade him to make an exception and permit Michael to continue to earn at least as much overtime pay as he has in the recent past.
Teachers report that the student complaint "That isn't fair" is becoming increasingly common. Frequently what the student means is that some personal expectation or desire is not being met. This lesson provides an excellent opportunity to get students to confront the difficulty of meeting individual needs within the constraints imposed by a society with limited resources.
As the students should learn from this lesson, the task of developing necessary policies for prioritizing the allocation of human, material or financial resources in an ethically fair manner is extremely difficult. The rub is that there are strongly held, sharp differences of opinion about what constitutes a fair policy. For example, wealthy people will generally favor a system that allows limited resources to be purchased by anyone who can afford them, whereas poor people will demand a system that distributes these resources in a manner that provides equal access to people in all economic strata.
These are issues that will become increasingly important as rapid advances in biomedical technology continues to make it feasible to devise healthcare options that can not possibly be made available to everyone. Government officials in the Oregon have already learned how divisive it can be to attempt to define a scheme for rationing healthcare. Questions like whether a kidney transplant should go first to the patient who needs it most desperately, or to the one whose life is likely to be prolonged the most, can not be answered in ways that will be agreed to by everyone. All of today's students will be choosing governmental officials who will be faced with the task of achieving a political consensus on these vital, value-laden questions.
Return to Part 2 - Model Classroom Lessons
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