CASE STUDIES IN BIOETHICS can enrich high school classes across the curriculum. A story like the one presented here about Baby K cannot help but fire the imaginations of students. Whose right is it to make decisions for a helpless infant? What does it mean to be born without a brain? Should medical considerations trump legal, religious, ethical, financial, and cultural ones in a situation like this? With the wisdom of hindsight, what ought to have been done for Baby K?
This case is one of six in a curriculum unit called "Babies" that was developed for high schools at the Kennedy Institute of Ethics at Georgetown University. The full curriculum includes four units, each using a number of cases to illustrate a single bioethics theme. Unit 1 features cases about babies born at risk or injured early in life. Unit 2 addresses organ transplantation. Unit 3 focusses on research involving human subjects. Unit 4 is about eugenics.
Each case is true; each raises tough questions; few, if any, have single "right" answers. Through analyzing the cases, identifying the ethical conundrums they present, and clarifying what aspects of each case are medical, legal, personal, and cultural, students can gain an appreciation for the complexity of the decision making involved in them.
Bioethical dilemmas, once rare, are now commonplace, in part because new medical technologies have outpaced our ability to understand their implications. For example, American society has yet to develop policies and, where appropriate, laws to deal with the consequences of "halfway technologies"--those that keep people alive but not sentient. Every individual bumps up against bioethical dilemmas sooner or later. Our motivation for developing these units was to give students experience in thinking about complex questions and developing strategies for coping with them both intellectually and emotionally.
In our experience, most students come to the discussions of these cases with pre-formed opinions about what ought to happen. In presenting these cases, teachers need to emphasize the importance of keeping discourse civil, listening respectfully to the opinions of others, weighing competing factors, and entertaining diverse and divergent perspectives.
The story of Baby K, like the other stories in the three units, raises fascinating and troubling questions. Some teachers have found that the richest discussions arise when they teach collaboratively with colleagues from other departments. Such cross-disciplinary discussions show students that, although the school day may be compartmentalized, problems in life are not. While the questions raised in difference courses provide varying springboards for discussion, we find that students eventually get around to discussing the same wide-ranging issues.
In economics classes, teachers have embarked on classroom discussions about Baby K by asking whether allocating half a million dollars on a futile medical treatment for one baby who was "born dying" is an appropriate use of the limited resources available for health care. What, for example, did this large expenditure of money do to the premiums of other members of Baby K's HMO and to the medical services that were available to them? Or, backing away from financial considerations, at what point is it even appropriate to make medical decisions on the basis of dollars?
The case gives U.S. history students an excellent opportunity to examine the bearing of the First and Fourteenth Amendments on contemporary medical ethics. Did the courts fail to uphold the wall of separation between church and state when they agreed to support Baby K with federal money?
Ethics teachers have triggered their discussions by considering whether Baby K's dignity was compromised by allowing her to be a "slave to technology." Students have considered the concept of "personhood" and what actually would have been the fairest treatment for the baby. …