Used with permission HCE430_EoriaMi_ W8_BioEthicattheMov 1 Running head: A CURE FOR PARALYSIS A Cure for Paralysis Michael Eoriatti Submitted to Sandra Woien PhD in partial fulfillment of HCE430 Regis University August 22, 2009
HCE430_EoriaMi_ W8_BioEthicattheMov 2 A Cure for Paralysis According to the Christopher & Dana Reeve Foundation (n.d.) there are nearly one in fifty people living with paralysis, or approximately six million people, and this number is 33% higher than previous estimates showed. To find a cure for paralysis, in this day and age, the medical community may need to make use of some extreme measures. At the same time, the medical community may also need to take into consideration several ethical theories and principles as they relate to human subject research. In 1996 the movie Extreme Measures was released into movie theaters. In this mystery thriller a medical ethical dilemma is posed to the audience to keep you thinking long after this movie concludes. The goal here is to create a cure for paralysis in the shortest amount of time possible by making use of human subjects, as guinea pigs, so progress can be made at a much faster rate than with the use of animals. Now is it ethically right by the medical community to make use of homeless human subjects who may have no purpose in this life and that no one will miss in a study to find a cure for paralysis? The purpose here is to present a summary; discussion and critique of this film Extreme Measures; state a thesis; show the justifications for that thesis; and then to show construction and denial of counterarguments. This movie begins with the escape of two naked patients from the back door of a building. One of these patients is picked up in the streets of New York City and comes to the emergency room (ER) of New York s Gramercy Hospital. Dr. Guy Luthan (Hugh Grant) is an emergency room doctor who comes in contact with this bizarre patient in the ER. This patient, a homeless man, suffers through some unusual symptoms including a wildly fluctuating heart rate while in the emergency room. Several labs are drawn; a hospital wrist band is removed from his wrist; and he pleads for the doctor s help mentioning a drug the doctor is not familiar with. When this man dies that night in the emergency room, Dr. Luthan attempts to follow up and find out
HCE430_EoriaMi_ W8_BioEthicattheMov 3 more about this patient only to find the body and all of the records have disappeared. He is then told by his superiors to drop the case. Dr. Luthan soon receives a call from the lab to confirm the patient died of a pulmonary embolism. As the doctor checks to authenticate the information he finds, once in the lab, that the lab made no such phone calls to his number. His boss again tells him to drop the case. As he continues to investigate what has happened to his patient his personal and professional life is attacked. His home is ransacked and cocaine is planted near his bedside. The police than arrest him and charges are filled. In the process he loses his job; the ability to ever practice medicine anywhere; and virtually all of his friends. He seeks out one homeless man who he has remained in contact with over the years. This man leads him to the homeless men s underground home. Dr. Luthan s ER patient, who died, also had lived there. Here he finds the second patient that had escaped on that night and in need medical treatment. He also learns more about several more homeless men disappearing off of the street. As they attempt to move this man to a hospital Dr. Luthan comes in contact with two men who are trying to stop his search for answers. Dr. Luthan is then shot and finds himself in the home of a nurse, Jody (Sarah Jessica Parker) who assisted him in the emergency room in Gramercy Hospital. He pleads for her help and once in her home finds that same drug name that was mentioned by the ER patient for whom he can find no records. He is then knocked unconscious and finds himself paralyzed in a hospital bed. Dr Luthan now finds himself in the care of Dr. Myrick (Gene Hackman). Dr Myrick performs spinal experiments on the homeless people, all of which all have died thus far, in an attempt to find a cure for paralysis. A visit from Dr. Myrick, at the bedside, informs Dr. Luthan he is paralyzed from the neck down. Dr. Myrick informs Dr. Luthan that if you could be healed and walk again what would you do to make that happen? Dr. Luthan s reply is anything. Dr.
HCE430_EoriaMi_ W8_BioEthicattheMov 4 Luthan is than left alone in the room to think. As time has passed since the visit with Dr. Myrick a fly lands on Dr. Luthan s hand and he moves his hand to rid the fly. At the same time Jody walks in and informs him he is not paralyzed and he needs to get out of this hospital. She must leave the room because the doctors are now looking for her. She informs Dr. Luthan that another doctor is running a test for a drug to cure paralysis and is using homeless people that no one will miss as guinea pigs for this medication without their consent. He believes he has the right to do this because he has a family member that is paralyzed as do many of the people who work for him. As Dr. Luthan attempts to escape this hospital a confrontation occurs with one of the workers. Dr. Luthan soon meets up with Dr. Myrick in the lobby and he attempts so sway Luthan to join his team telling him that these homeless people are heroes and losing one to save millions is worth the sacrifice. Dr. Luthan informs Dr. Myrick they have not chosen to be heroes. Dr. Luthan questions Myrick as to how he has the right to involve people in a study without their consent. He tells Myrick that they did not choose you; you chose them. Dr. Luthan informs Myrick that you cannot do that; you took an oath. Myrick is then caught in the line of fire by an FBI Agent who arrives. As the movie ends; Mrs. Myrick, now a widow, hands the discs and documentation regarding the research completed by her husband to Dr. Luthan telling him that my husband was trying to do the right thing in the wrong way. He opens the package, views the materials and then proceeds towards a neurology building where he is now working. Discussion and Critique The movie Extreme Measures presents a story line that is at times is too simplified. As the movie begins two men escaping from a study center; one man s final destination is the emergency room of a major hospital. As he is confronted that evening by several doctors and nurses, in the ER, he asks for help and exhibits some bizarre symptoms. He speaks of a drug that
HCE430_EoriaMi_ W8_BioEthicattheMov 5 no one is familiar with and has an arm band on that no one can recognize. There are times in the ER where we find him alone on a gurney with no one asking additional questions about his unusual circumstances. Upon his death there appears to be no record of his treatment within this major hospital. As one doctor seeks answers another doctor encourages him to leave it alone. An ER death would require notification of family and a call to the coroner along with additional paper work making this ER situation a bit simplified; unbelievable; and disappointing for those viewing this movie. As Dr. Luthan continues to seek answers concerning this ER patient and fails to drop the case his home is soon ransacked and cocaine is planted near his bedside. Charges are filled and he is before the hospital Board of Directors for the loss of his position as a doctor. There is no trial or court room appearance; an attorney does makes a brief appearance informing the doctor that he could negotiate with the court for a lesser charge. The doctor is soon without a job. This process of setting up the doctor; filing charges; and removing him from the hospital is again simplified to fit the story line and does not come close to duplicating the same scenario in real life. Dr. Luthan soon finds himself in the care of Dr. Murick. Dr. Myrick is involved in a study center housing many homeless men who are used as subjects for a drug study to cure paralysis. As one begins to see the extent of the Dr. s research facilities; the number of human participants involved in the study; the death of several human subjects; the medications needed to operate such a study; and the support staff needed one begins to question how such an entity could exist, behind closed doors, in our world today. Once again this movie has simplified the existence of this Dr. s study center. The viewer finds it hard to believe this type of center would exist in a major city today and go unnoticed while it makes use of several human subjects for research and in the process kills many of them.
HCE430_EoriaMi_ W8_BioEthicattheMov 6 So in the final evaluation this film does not present, in numerous situations, a realistic picture of the current conditions in our health care setting. This film was neither informative nor factually sound as we look at several of the situations presented throughout the story line. This film does present to the viewer numerous ethical issues throughout its production; the nurse does not serve as an advocate for the patient in the ER; the patient at times is left unattended in the ER on a gurney; the doctor receives no support form superiors about his ER patient or his removal from the hospital; Dr. Murick is taking homeless people off of the streets, against their will, to be used in a study for developing a drug to cure paralysis; several family members of those involved with Dr. Myrick are presented throughout this film as paralyzed and unhappy; in the end the research collected by the deceased Dr. Murick is presented by his wife to Dr. Luthan and the viewer is left to decide how Dr. Luthna should continue this research. Throughout this film the viewer is presented with several ethical issues to contemplate yet the film is weak in its duplication of many events in the real world making the story line a bit hard to believe. Thesis Presentation In the movie Extreme Measures we see several ethical issues presented throughout this film. The one ethical issue most emphasized involves Dr. Myrick removing homeless individuals, who have no family and have no purpose in life, off of the street against their will and making use their bodies as a means to finding the right medication to cure paralysis. The justification here is shown throughout the film as the viewer constantly sees several family members suffering with paralysis. These homeless individuals are not provided with any type of informed consent or explanation of what they will be used for and their questions are not answered. They are provide food and shelter and are described by the doctor, who is conducting this study, as heroes. Several of these study participants suffer and die due to their participation in this study.
HCE430_EoriaMi_ W8_BioEthicattheMov 7 This writer believes it is wrong to make use of homeless subjects in research studies as they were used by Dr. Myrick in this film. It is only right to make use of human subjects, in research studies, with the use of full informed consent and to answer all questions from each participant before one voluntarily participates in a research study. Justification of Thesis The World Medical Association (WMA) (2003) has developed the Declarations of Helsinki as a statement of the ethical principles for medical research involving human subjects. This declaration is addressed primarily to physicians and was adopted by the 18 th WMA General Assembly in June of 1964 and last amended by the 59 th WMA General Assembly in October, 2008. These declarations state that it is the duty of the physician to promote and safeguard the health of patient, including those who are involved in medical research. Dr. Myrick does nothing to promote and safeguard the health of these homeless patients. In medical research involving human subjects, the well-being of the individual research subject must take preference over all other interests. Dr. Myrick is only concerned with a cure for paralysis; the well being of individual research subject is not taken into consideration. It is the duty of the physician who is involved in medical research to protect the life, health, dignity, integrity and right to self determination of the research participants. Dr. Myrick does nothing to protect the life, health, dignity, integrity or right to self determination of these research participants. Participation by individuals must be voluntary. Dr. Myrick removed these individuals from the street against their will. In all medical research involving proficient human subjects, each must be sufficiently informed of the aims and potential risks of the study and any discomfort they may experience. Dr. Myrick makes no attempt to inform these homeless study participants. According to University of Washington School of Medicine (n.d.) there are many ethical issues that must be taken into consideration when a research study makes use of participants who
HCE430_EoriaMi_ W8_BioEthicattheMov 8 are human beings. The first concern of an investigator will be the safety of the research participants. The investigator must carefully consider the benefits versus the risks for each study participant. Dr. Myrick gave no consideration to the benefits versus the risks for these homeless people. Informed consent must be obtained in writing after the participant has had an opportunity to understand the risks and ask appropriate questions to the investigator. Informed consent is an ongoing process as the study continues. Dr. Myrick did not make use of informed consent at the beginning of the study or at any time throughout the course of this study. The investigator must address how to handle any type of injury occurring in or as a result of the study and who will pay for the care. Dr. Myrick killed several homeless people and did not address this issue during this study. The ethical issues in human subject research have received increasing attention over the last 50 years. Institutional Review Boards for the Protection of Human Subjects (IRB s) have been established at most institutions that undertake research with humans (para. 1). The National Institute of Environmental Health Sciences presents us with an article addressing ethics in research and why it is important. According to Resnik (2003) ethics are norms for conduct that distinguish between acceptable or unacceptable behavior (para. 1). Ethical principles in research studies, as it relates to human subject protection, will include the following principals. One has a duty to minimize harms and risks and in turn maximize benefits for each study participant; one has a duty to respect human dignity, privacy and autonomy; one has a duty to take special precautions with vulnerable populations; and to be sure and distribute the benefits and burdens of all research in a fair manner. Dr. Myrick was not concerned with minimizing harm and risk and maximizing benefits for each study participant; the Dr. did not respect human dignity and autonomy; he took no special precautions with this vulnerable population; and he failed to distribute the burdens of research in a fair manner.
HCE430_EoriaMi_ W8_BioEthicattheMov 9 According to Bennett-Woods (2005) respect for person maintains that human beings have intrinsic and unconditional moral worth and should be treated as if there is nothing of greater value (p. 7). As individual human beings we are free and responsible persons entitled to informed consent in research and decisions regarding study design and interventions. Dr. Myrick provided no informed consent regarding study design and interventions. Autonomy according to Pence (2008) refers to the right to make decisions about one s own life and body without coercion by others (p. 167). Autonomy is the capacity for self-determination. To respect autonomy is to respect the person s right to make choices and take action based on the persons own values and belief system. Dr. Myrick did not respect autonomy as these homeless people did not have the right to make choices and take action based on their values and belief systems. The principal of veracity states that one should tell the truth, honesty is the best policy, and not intentionally deceiving or misleading study participants. Dr. Myrick was dishonest with each of these homeless people. Research participants need to have enough relevant information, informed consent, to be able to make informed rational decisions. Dr Myrick provided no information to his study participants. Not telling the truth in the doctor-patient relationship can lead to serious harm, not only is patient autonomy undermined but the patients who are not told the truth about an intervention experience a loss of trust. Honesty matters to patients, they need it because they are burdened with pressing questions; which require truthful answers. Dr. Myrick was not honest and failed to answer questions. According to Kantian Ethics human beings have the ability to reason as the basis of our status as moral agents and morality than is grounded in reason. As human beings we are rational beings with ability to exercise reason and free will in making decisions and choosing our actions. According to Bennett-Woods (2005) Kant recognizes a perfect duty as one we must always observe; it is our duty not to needlessly harm another person. An example here is we should not
HCE430_EoriaMi_ W8_BioEthicattheMov 10 experiment on people solely for the benefit of others. If it is wrong to involve one set of subjects in dangerous research without their consent, then it would be wrong to involve any subject in dangerous research without their consent (p. 20-1). Dr. Myrick did not give these homeless men the information needs to make decisions or choose an action and he did needlessly harm many of these men. The principal of fidelity requires that we act in ways that are loyal. This will include keeping our promises and being trustworthy. With role fidelity we have expectations that are associated with a doctor that patients might expect. The expectations include the following; treating the patient with respect; adhere to a professional code of ethics; follow the policies and procedures of our organization and applicable laws; and you will honor agreements made with the patient. Dr. Myrick did not follow the expectations of role fidelity associated with his profession; he did not keep promises; was not trustworthy; and he did not honor agreements make with the patients. Construction and Refutation of Counter Arguments Teleology is an ethical theory that evaluates human action based on the end result. The rightness or wrongness of an action is based only on the goodness or badness of their consequences. One example of teleological theories would include utilitarianism. In this film if we were to address only the end result or outcome of this research and Dr. Myrick uncovers a cure for paralysis we have created happiness for approximately six million people. In this case Dr. Myrick s action of making use of homeless people to arrive at this cure for paralysis may be considered the right action to take based on the end result. Utilitarianism will define a moral act solely in terms of the outcome of that act or its consequences. The principal of utility or the Greatest Happiness Principal tells us that actions are right if they produce the greatest balance of happiness over unhappiness. So no action is right or
HCE430_EoriaMi_ W8_BioEthicattheMov 11 wrong until that action is judged in respect to its consequences. An action then is right if it produces the greatest benefit to the greatest number of people. A cure for paralysis will create a benefit for over six million people. The homeless people Dr. Myrick is using have no family or friends other than the homeless people they live with. So their loss of life is insignificant and would create minimal unhappiness. According to the Greatest Happiness Principal the actions here by Dr. Myrick would be right as they would result in the greatest sum of happiness if a cure is found. The utilitarian theory make use of two main applications, act and rule utilitarianism. Act utilitarianism will address the consequence of an action in a particular circumstance. Here an act is considered right if it produces the highest utility in that individual circumstance. As we address the use of uniformed homeless people in this research study; taken against their will; their exposure to unknown risks; the lack of informed consent; and the death of many individuals we find in this instance Dr. Myrick s actions are ethically wrong for the consequences of these actions are not considered to be good. Conclusion The movie Extreme Measures is weak in its presentation of a medical dilemma involving the use of homeless men, in a research study, to find a cure for paralysis. The writer here believes in the use of full informed consent and to answer all questions from each participant before one voluntarily participates in any type of research study. As we address several of the current ethical theories and principals it is clear the doctor in this film followed few if any of these ethical principles and theories used in health care today. The writer objects to the use of human subjects for research in the manner demonstrated in this film.
HCE430_EoriaMi_ W8_BioEthicattheMov 12 Resouces Bennett-Woods, D. (2005). Ethics at a glance. Retrieved June 30 th, 2009 from Regis university department of nursing, Ruechert Harman School for Healthcare Professionals at http://rhchp.regis.edu/hce/ethicsataglance/index.html Christopher & Dana Reeve Foundation (n.d.). Paralysis Resource Center; Paralysis Facts & Figures. Retrieved on August 15, 2009 from http://www.christopherreeve.org/site/c.mtkzkgmwkwg/b.5184189/k.5587/paralysis_f acts Figures.htm Ethics in Medicine; Univerity of Washington School of Medicine (n.d.). Research Ethics retrived on August 18, 2009 from http://depts.washington.edu/bioethx/topics/resrch.html NIEHS National Institute of Environmental Health Sciences (2003). What is Ethics in Research & Why is It Important? Retrieved on August 18, 2009 from http://www.niehs.nih.gov/research/resources/bioethics/whatis.cfm Pence, G.E. (2008). Medical ethics: Accounts of the cases that shaped and define medical ethics (5th ed.). Boston: McGraw-Hill. The World Medical Association (2003). World Medical Association Declaration of Helsinki; Ethical Principles for Medical Research Involving Human Subjects. Retrieved on August 19, 2009 from http://www.wma.net/e/policy/b3.htm