Scenario 1
Prompt 1
Ethics is the moral principles that influence one’s character and behavior, hence their actions. The first ethical dilemma in the first scenario is whether Suzanne should undergo a diagnostic test to ascertain whether she inherited a gene from her father that causes familial Alzheimer’s disease. After being diagnosed and being found positive, another dilemma is whether they should have kids with her husband David, given the 50% probability of the children inheriting the gene that causes the disease. After the decision of having kids, the other dilemma is whether to protect the children from inheriting the disease by the utilization of pre-implantation genetic diagnosis (PGD).
What should Suzanne do? Should she be tested?
Given the high probability of Suzanne carrying a dominant gene for familial Alzheimer’s disease, she should be tested. The pro in undertaking the test is she will know her ultimate fate and better be prepared to handle the outcome. They will be in a better position to ensure the long term care for Suzanne, and they can also increase the value of her life insurance. Also, most insurance covers take care of the cost of genetic tests (Borson et al., 2013). The disadvantage is the probability of constantly living with the fear of her predicament, hence, the reduction of her quality of life. Also, she is likely to face discrimination at the workplace when her workmates know about her condition, and family and social interactions are likely to be negatively impacted. Besides this, its insurance company can get the test results and negatively influence the couple’s goal to increase the value of Suzanne’s life insurance (Klitzman et al., 2014).
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Prompt 2
The stakeholders that are directly involved in decision making are David and Suzanne. They are responsible for all major decisions on whether to take the taste and how to react to the results of the test. The children, the insurance company and the medics who interact with the couple in the treatment of Suzanne’s sister and possibly Suzanne in the future are the indirect stakeholders.
Should they have children?
Yes, since it is possible to ensure the kids do not inherit the Alzheimer’s gene from Suzanne. Having Kids is advantageous because the couple will have a chance of being happy in a complete family. Another advantage is in the case that Suzanne’s condition progresses and such a state stresses David, he will have solace by interacting with the children and knowing that even when Suzanne is not there, they can carry on her legacy. They will hence help him manage stress and prevent burnout (Fazio et al., 1999). It is, however, a disadvantage on Suzanne because, in the end, she might not be able to know them or even interact with them in a meaningful manner. The children might also grow without the full support of both parents; hence, they might be affected psychologically, especially if David will not be able to fully support them. Also, David as a caregiver is likely to be affected emotionally (Wawrziczny et al., 2016).
Prompt 3
The situation can generate the greater good when it is possible for Suzanne and David to take advantage of the time they still have together before the onset of the disease to save up for insurance and have kids through PGG.
Should Suzanne and David have PGD ?
Vitro fertilization is a procedure used for conception, one that reduces the chances of inheritance of genetic diseases and helps with fertility. The couples should know the potential risk of this procedure before undergoing it. Eggs are harvested and fertilized with the sperms in a lab. Suzanne and David should Have PGD. The argument for the procedure is the necessity of protecting the children against the probability of inheriting the disease (Saidah et al., 2018). Just as such screening is okay, screening for the sex of the baby is also fine. One of the, most notable advantages of getting kids through this process is that they are likely to be healthy and without the gene that causes. It is disadvantageous on Suzanne because of the possibility of a miscarriage, congenital disabilities, miscarriage, and ectopic pregnancy, among others (Kamphuis et al., 2014). On David’s side, he could experience crumps and uterine infection. Another disadvantage is some insurance covers do not cover IVF cost, hence might be a liability to the couple.
Scenario II
Prompt 1
The ethical dilemma is whether or not to subject a baby to genetic tests that have no cure,
Prompt 2
The stakeholders are the child and his or her parents.
Prompt 3 .
The greater good can be achieved by subjecting the child to genetic tests for conditions that have no cure only when there is an utmost need.
Should the baby be subjected to tests for diseases that have no cure?
Yes, the baby should be subjected to tests. This answer is influenced by the fact that the advantages of undertaking the test out way the disadvantages. The disadvantages are related to the cost and distress for the parents, and baby and tests take up a lot of resources (Botkin, et al., 2015). It is advantageous on the parents' side since they can learn how to manage the condition in case the baby is found positive (Wright et al., 2018).
References
Borson, S., Frank, L., Bayley, P. J., Boustani, M., Dean, M., Lin, P. J., ... & Stefanacci, R. G. (2013). Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimer's & Dementia , 9 (2), 151-159.
Botkin, J. R., Belmont, J. W., Berg, J. S., Berkman, B. E., Bombard, Y., Holm, I. A., ... & Wilfond, B. S. (2015). Points to consider: ethical, legal, and psychosocial implications of genetic testing in children and adolescents. The American Journal of Human Genetics , 97 (1), 6-21.
Fazio, S., & Bartelt, T. (1999). Caretaker burnout: Supporting families of patients with Alzheimer's disease. American family physician , 60 (7), 2165.
Kamphuis, E. I., Bhattacharya, S., Van Der Veen, F., Mol, B. W. J., & Templeton, A. (2014). Are we overusing IVF?. Bmj , 348 , g252.
Klitzman, R., Appelbaum, P. S., & Chung, W. K. (2014). Should life insurers have access to genetic test results?. Jama , 312 (18), 1855-1856.
Saidah, T. K., do Amaral, W. N., Evangelista, P. G., Ghiggi, R. S. S. F., & kassem Saidah, M. (2018). Pre-implantation genetic study and its importance for fertilization in the prevention of genetic disorders. Human Reproduction Archives , 33 (1), 0-0.
Wawrziczny, E., Pasquier, F., Ducharme, F., Kergoat, M. J., & Antoine, P. (2016). From ‘needing to know’to ‘needing not to know more’: an interpretative phenomenological analysis of couples' experiences with early‐onset Alzheimer's disease. Scandinavian journal of caring sciences , 30 (4), 695-703.
Wright, C. F., FitzPatrick, D. R., & Firth, H. V. (2018). Paediatric genomics: diagnosing rare disease in children. Nature Reviews Genetics , 19 (5), 253.
