INTRODUCTION
     Ethics and science share a commitment to rational thinking. The scientific method is a form of
rational inquiry into FACTS. Where they differ is in the criteria used to judge these facts. The
scientific method uses a very specific set of rules and procedures as “proof’ of a fact. Ethics is a
rational inquiry into what is right and what is wrong for a specific action or belief. In this worksheet
we will use two different techniques to study bioethical topics. All work will be accomplished by a
group of 3-5 students and only 1 answer sheet must be completed for each group (Remember to put
everyone’s name on the finished answer sheet.

PART I: MAKING CLAIMS
     Bioethical decisions are difficult because they often require specialized knowledge about a new
procedure or technology. The bioethical issue used in this part of the worksheet is called “Medical
Decisions” and is centered on the process of organ transplantation. The information given is not
“all-inclusive” and some extrapolation of facts will have to be accepted. Read the background
information for Medical Decisions, and apply it to the following question. What claims can you make
for “FACT”, for “VALUE”, and for “POLICY” ?
A: Claim of Fact
     This is supported by facts or data such as statistics, graphs and research findings from reliable
and reputable sources which the audience can accept, An example of this type of claim is "Capital
punishment is not a deterrent to crime."
     To defend a factual claim you should:
     - Be sure that what you are trying to prove is clearly stated from the beginning.
     - All terms that might be controversial or ambiguous (i.e. "surrogate mother) should be
          defined at the start.
     - Data is sufficient, accurate, recent and from reliable sources. An authority with
          credentials from Harvard University who published an article in Scientific
          American will have higher credibility with an audience (and your teacher)
          than a citation from an article in the National Enquirer.
B: Claim of Value
     This attempts to prove that some things are more or less desirable than others based on
standards of taste and morality. Claims of value express approval or disapproval, and require
the audience to make a judgment. Advertisements are common sources of value claims, but
value claims emerge whenever people argue about what is good or bad, beautiful or ugly. An
example of this type of claim is, "Using animals for research is wrong."
     To defend a claim, of value you should:
     - Prove the values or principles to be more important than the end result.
     - Use examples and illustrations to clarify meanings and make distinctions.
     - Use the testimony of experts to prove that knowledgeable or highly regarded people
          share these values.
C: Claim of Policy
     This asserts that specific policies should be instituted as solutions to problems. The expressions
"should, must or ought to" are usually used. An example of this type of claim might be, "Using
microorganisms for biological warfare must be stopped."
     To defend a claim of policy you should:
     - Make your proposal for change clear, establishing the distinct benefits gained by
           adopting your proposal.
     - Support your proposal with solid data, moral considerations and common-sense reasons.

Here is a SAMPLE of the kind of thinking involved in this part of the worksheet.
Topic: Genetic Screening
Claim of Fact à Genetic screening is not a reliable predictor of disease.
Claim of Value à Results of genetic screening should be private.
Claim of Policy à Insurance companies should be permitted to require genetic screening.

     Below is the topic called “Medical Decisions”. Use it to complete the accompanying Answer Sheet.
Some of the information is factual and some is inferred for purposes of this worksheet. The group
should read the topic and then discuss it before completing the Answer Sheet. If everybody cannot
agree on an answer, then a simple MAJORITY decides what will be entered in the Answer Sheet.
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SITUATION: The following 3 people need liver transplants to live.
      All 3 are in critical condition and will die within 24 - 48 hours without a transplant.
      Only I donor liver arrives each week, and one should arrive today.
     Who should receive this liver, and why?
      Here is some background information about each of the people needing
           the transplant.

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PART II: RISK/BENEFIT ANALYSIS
      Those who study ethics have identified three guiding principles as the foundation for ethical
decision making;
1. Beneficence
      The principle of beneficence states that we should promote good for others and avoid harm to them.
This principle can be applied to whole groups of people as well as individuals. The application of this
principle in bioethical decision making requires us to ask: will our decision result in a greater balance of
good over harm? For example, critics of the Human Genome Sequencing Project have raised several
questions requiring the application of the beneficence principle. These questions include: Whose genes
will be sequenced? Will this project result in any human suffering? Will there be a greater good for all
as a result of this project? Can the information resulting from the genome project be used against people?
2. Respect for Autonomy
      The core of this principle is the intrinsic value of the individual. Each person has fundamental self
worth and dignity which should be respected by others, even if they hold different values. ln addition,
individuals should have freedom to control their lives. Using the Human Genome Project as an example,
questions that require consideration of this principle. Will the information gained from this
project have an impact on the freedom of individuals to determine career choices? How will the
information be used by health care professionals in determining treatment? Will there be any limits on
personal decision making?
3. Justice
     There are three ways to approach the principle of justice. The first is that everyone has an equal
right to basic needs - food, shelter, clothing, health care, education, employment The second is that
some individuals have earned the right to special treatment based on their merit A third approach is to
treat everyone equally regardless of perceived merit When applying the principle of Justice one can
either look at the outcomes of a decision or consider the process leading to the outcome while remaining
neutral as regards the outcome itself. Questions about the Human Genome Project which can be
considered using this principle are: What is the most equitable way to distribute the funds earmarked
for scientific research? On the basis of contribution to society? Merit? Best use of resources?
If values are going to be included and discussed in the classroom, teachers and students should
have a basic understanding of the principles of ethics. Otherwise debates and discussions become
“free-for-alls" leaving students with the conclusion that the issues are irresolvable and that only
experts (an make decisions.

     In this part of the worksheet you will look at specific scenarios of people in situations that require
a bioethical decision. Using risk/benefit analysis as a critical thinking tool, students try to come to a
decision as a group and as individuals. Risk/benefitting is only one means of addressing moral issues.
One would hope that ethical decisions are based on more than R/B analysis. However, this method
facilitates initial considerations of ethical/moral problems. It involves brainstorming, literature search,
small and large group discussion, recognition and weighing facts and opinions, and decision-making skills
related to current bioethical issues.
      Use following the procedure to complete Part II of the Answer Sheet.
1. Read all of the scenarios involving bioethical dilemmas
2. As a group decide which dilemma you wish to discuss, and use to fill in the Answer Sheet.
3. Take time to share information or ideas about the issue with the whole group (i.e. brainstorm).
4. Fill in the Risk/Benefit Analysis Sheet (Part II on the Answer Sheet) as you discuss the different
      ideas. Use this information as a basis for later portions of the Analysis. Be sure to discuss the
      difference between a fact and an opinion. Remember: If disagreements occur, the majority decision
      is written on the Answer Sheet.
5. When done everyone in the group should be prepared to share their decisions and points of views with
      the rest of the class.

     Below are 4 bioethical scenarios to be discussed, to be used to complete the accompanying Answer
Sheet. All of the scenarios are factual, but many have similar “real-life” cases. The entire group
should choose one of the scenarios and then discuss it fully before completing the Answer Sheet.
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1. James, a recent graduate from a mid-western teachers' college was excited about his new job as a
      biology teacher. However, one week prior to the opening of school, James was notified by the school
      board that he would not be offered employment due to the fact that he tested positive for the
      existence of a gene for Huntington's Disease. According to the school board chairperson, their
      decision was based on the fact that James would eventually cost the school system hundreds of
      thousands of dollars in health benefits. Should James' individual rights be protected? Should he be
      given employment? Did the school board act within the boundaries of law?

2. Recently a couple conceived a child in hopes the baby's bone marrow cells could save the life of a
      teenage daughter who is dying of leukemia. The dying girl needed a bone marrow match and that is
      most likely among siblings. It was predetermined by the couple that if the bone marrow matched it
      would be removed from the baby by a surgical process as soon as medically possible, which is
      approximately 2 years old. Is it right to conceive one person to serve the needs of another? Can
      parents distribute one child's bodily parts to save another child? Does one have a right to
      "Grow-his-own-spare-parts"?

3. A fireman has a positive pre-symptomatic test for Huntington's Disease (HD). He has not told his
      employer because he fears he will be fired. He has only a few more years to go before he can retire
      comfortably with 20 years on the force. Meanwhile, he worries that he is already in the early stages
      of the disease, because he is starting to make errors in judgment The last time he went out to a fire,
      the chief told him to pull the truck forward. Instead he put it in reverse.

4. Mr. Hodges has Huntington's Disease (HD). Since he has been unable to work for the last three years,
      he, his wife and their three teenage children have been on government-assisted welfare programs
      for more than two years. As his disease progresses, Mr. Hodges is very likely to be institutionalized
      in the near future. It is estimated that the Hodges family will cost the government $150,000.
      Because society must take responsibility for the Hodges family, should screening be compulsory for
      the children? If they are tested, would you require full disclosure of all information but no further
      government interference or should prenatal testing be mandatory when the teenagers become
      pregnant? Would you favor discontinuing government aid if affected individuals chose to have
      children even after they have received complete information regarding the potential genetic risks?