Markkula Center of Applied Ethics

Ethics Articles



Bioethics

Allocating Resources: A Wicked Problem
Planning for the ethical dilemmas that arise in a medical disaster
Margaret R. McLean
The Cost of Dying and Moral Choices at the End of Life
Podcast of a talk on the ethics of end-of-life decision making
Lisa Krieger
Kidneys for Sale: A Reconsideration
Ethical issues in a market for human organs
Miriam Schulman
Football, Concussions, and Character (podcast)
Fox Sports analyst Pereira explores whether the rules have caught up with the game of football
Mike Pereira
Spark of Conscience Inflames Debate: Conscientious Refusals in Health Care
A conference held at Santa Clara University November 2011exploring conscientious refusals in health care
no author
A Case of Conscientious Refusal: Rights and Responsibilities
A Pharmacist Refuses to Fill a Prescription for Contraception.
Margaret R. McLean
Body Image in Sports: What No One Seems to be Talking About
The problem of eating disorders for college athletes
Matt Savage
Down So Long: Helping a Friend With Depression
Megan struggles to deal with her friend and college roommate's depression.
Jake Teeny
Ethical Responsibilities of Hospital Trustees
Presentation to 2012 annual member Governance Conference of Premier Inc., one the two largest health care group purchasing organizations in the country.
Kirk O. Hanson
Keeping Track of Mom: Motion Sensor-Based Monitoring
Ethical challenges in using motion sensor-based technology to monitor the elderly
Courtenay Bruce
When a Physician Refuses to Transfer a Patient to Hospice
A Q&A about recourse for a patient whose doctor does not wish to facilitate hospice care.
Margaret R. McLean
Unavoidable Dilemmas in Bioscience
Center Bioethics Director McLean raises top ethical problems facing scientists and offers a framework for addressing them.
Margaret R. McLean
10 Milligrams (video)
Prize winning video on the use of study drugs on college campuses. From The Big Q contest for films on student ethics
Nicole Grazioli, Tara Khalilnaji, Jen LaPonte
Adderall=Cheating?
The ethics of taking study drugs. Entry in The Big Q contest for films on student ethics
Robyn Louie
Media's Effects on Body Image (video)
Commercials, movies, impact body image for students. Entry in The Big Q contest for films on student ethics
Kathryn Klein, Caitlin Whalen, Kristina Woodcock
Biotechnology and Ethics Class (video)
Students learn the science, social impact, and ethics behind advances in biotechnology
Evolving Vaccine Trials: Adaptive Informed Consent in the Global Context
Challenges of insuring that participants in the developing world understand clinical trials and consent freely
Brenda Everling
Thinking Ethically About MRSA
A set of materials on Methicillin-resistant Staphylococcus aureus for high school and college coaches, trainers, and athletic directors
MRSA: Best Ethical Practices (pdf)
Core ethical concerns for prevention and management of Methicillin-resistant Staphylococcus aureus
Margaret R. McLean
An Ethics Case About Managing MRSA: Stage 1
The ethical issues at various stages of an outbreak of Methicillin-resistant Staphylococcus aureus
Jack Penner
Thinking Ethically about MRSA
Combatting MRSA, a virulent, antibiotic-resistant staph infection, is a serious medical challenge for coaches and trainers. Spread mostly by skin-to-skin contact, the bacteria can easily be passed from one player to another on the field or in the locker room. But implementing best practices for preventing the infection also has an ethical side: It takes moral courage to bench a star player because he or she is infected.
HIV Vaccine Development: A Call for Justice
The case for vaccine development as the best approach to the HIV/AIDS pandemic
Erin Cleveland
Outbreak: Discussion Module
Materials on developing pharmaceuticals for the Developing World, based on the case, The Outbreak, on this Web site.
Kari Kjos
Taking Stock of Neglected Diseases
Only 10 percent of global health research is dedicated to conditions responsible for 90 percent of the worldwide burden of disease.
Kari Kjos
Unavoidable Ethical Dilemmas of Pandemic Flu
Questions for policy makers preparing for pandemics
Kirk O. Hanson
Be Not Afraid: Catholic Views of Advanced Care Planning
Clergy and religious comment on end-of-life directives
Miriam Schulman
Hospital's Ethical Obligation to the Uninsured
Reflection on the case of a patient with Crohn's disease
Nick Welter
Duty of the Physician to an Uninsured Patient
Reflection on the case of a patient with Crohn's disease
Ella Sanman
The Case of Madisyn Whitfield: Chronic Illness and the Uninsured
A young woman suffering from Crohn's disease cannot afford treatment.
Anna Kozas
Role of Friends in a Medical Emergency
Reflection on the case of a patient with Crohn's disease
Richelle Neal
Importance of Relationships in the Case of Gabriela Rivera
A physician and president of Cross Cultural Health Care Concepts reflects on the case of a Latino family facing end-of-life decisions.
John Silva
Honzel Fellowship in Health Care Ethics
New gift supports undergraduate student in health care and bioethics
From Chronic to Critical: A Latino Family Confronts End-of-Life Decisions
A case study of an elderly Puerto Rican immigrant to the United States suffering from the effects of diabetes.
Karen Peterson-Iyer
Palliative Care: An Ethical Obligation
SCU senior honors thesis argues that the principles of beneficence and nonmaleficence require that hospitals, in addition to clinicians, offer palliative care
Stephanie C. Paulus
A Difficult Birth: Navigating Language and Cultural Differences
A case about Undocumented Parents and a Difficult Birth
Karen Peterson-Iyer
Difficult Birth: Navigating Language and Cultural Differences - Reflections by Rebecca J. Hester
Response to a case study A Difficult Birth: Navigating Language and Cultural Differences
Rebecca J. Hester
Difficult Birth: Navigating Language and Cultural Differences - Reflections by Nayamin Martinez
Response to a case study A Difficult Birth: Navigating Language and Cultural Differences
Nayamin Martinez
Difficult Birth: Navigating Language and Cultural Differences - Reflections by Karen Peterson-Iyer
Response to a case study A Difficult Birth: Navigating Language and Cultural Differences
Karen Peterson-Iyer
Difficult Birth: Navigating Language and Cultural Differences - Reflections by Marc Tunzi
Response to a case study A Difficult Birth: Navigating Language and Cultural Differences
Marc Tunzi
Difficult Birth: Navigating Language and Cultural Differences - Reflections by Marc Tunzi
Response to a case study A Difficult Birth: Navigating Language and Cultural Differences
Marc Tunzi
Culturally Competent Care for Latino Patients: Introduction
An introduction to Culturally Competent Care for Latino Patients
Karen Peterson-Iyer
Church Autonomy in Medical Ethical Decision Making
An SCU student reflects on artificial nutrition and hydration for patients in a persistent vegetative state
Nicole Van Groningen
Pharmacogenomics, Ethics, and Public Policy
How personalized medicine can develop in a way that promotes the good of both individuals and the broader society
Karen Peterson-Iyer
Conflicts in Physician-Patient Relationships
Chair of the President's Council on Bioethics Edmund Pellegrino discusses the conflicts that can arise between patient autonomy and the personal beliefs of doctors, nurses, and pharmacists
Miriam Schulman
Cancer: A Failure to Communicate - Reflections by Abdelmalek Yamani
Response to a case study where cultural misunderstandings interfere with medical care for a cancer patient.
Abdelmalek Yamani
Pandemic Influenza Ethics Tool
Ethical issues to consider in preparing for a pandemic, prepared for the Santa Clara County Public Health Department
Margaret R. McLean
Cancer: A Failure to Communicate - Reflections by Karen Peterson-Iyer
Response to a case study where cultural misunderstandings interfere with medical care for a cancer patient.
Karen Peterson-Iyer
Cancer: A Failure to Communicate
A case study of how cultural misunderstandings interfere with medical care for a cancer patient.
Karen Peterson-Iyer
Cancer: A Failure to Communicate - Reflection by Doha Raik Hamza
Response to a case study where cultural misunderstandings interfere with medical care for a cancer patient.
Doha Raik Hamza
Cancer: A Failure to Communicate - Reflections by Dr. Sheik Hassan and Dr. Hossam E. Fadel
Response to a case study where cultural misunderstandings interfere with medical care for a cancer patient.
Dr. Sheik Hassan and Dr. Hossam E. Fadel
Confronting a Fetal Abnormality: Sensitivity to a Muslim Patient
A case study raising issues of culturally competent health care for a Muslim woman.
Karen Peterson-Iyer
Introduction to Culturally Competent Care
Background on how cultural differences affect the provision of care in a clinical setting
Karen Peterson-Iyer
Culturally Competent Care for Muslim Patients: Introduction to Cases and Reflections
Background on the specific ethical issues involved in providing culturally competent care to Muslim patients.
Karen Peterson-Iyer
Confronting a Fetal Abnormality: Reflections by Doha Raik Hamza
Response to a case raising issues in culturally competent health care for a Muslim woman.
Doha Raik Hamza
Confronting a Fetal Abnormality: Reflections by Sheik N. Hassan and Hossam E. Fadel
Response to a case raising issues in culturally competent health care for a Muslim woman.
Sheik N. Hassan and Hossam E. Fadel
Confronting a Fetal Abnormality: Reflections by Karen Peterson-Iyer
Response to a case raising issues in culturally competent health care for a Muslim woman.
Karen Peterson-Iyer
Confronting a Fetal Abnormality: Reflections by Abdelmalek Yamani
Response to a case raising issues in culturally competent health care for a Muslim woman.
Abdelmalek Yamani
Balancing Nonprofit Interests
Should an HIV/AIDS program focus on prevention or treatment?
Jessica Silliman
Ethics, Autonomy and the Treatment of Tuberculosis in Impoverished Patients in India
Undergraduate research addressing problems in applying the ethical principle of autonomy to contagious disease.
Kelsey Whittier
Medical Ethics Meets Organizational Ethics
Lessons from both clinical and business ethics apply in a hospital context.
With Health Care and Justice for All
Catholic social teaching and the ethics of access to health care.
Margaret R. McLean
'G' Is for Genes and Genomes
Genetic testing poses ethical problems for individuals who may learn they have an illness for which there is no treatment.
Margaret R. McLean
'H' Is for Heredity and Huntington's
An introduction to the ethics of genetic counseling and genetic testing.
Margaret R. McLean
'I' Is for Information
an introduction to confidentiality and informed consent.
By Margaret R. McLean
'J' Is for Justice
What principles should guide the distribution of scarce medical resources such as organs for transplant?
Margaret R. McLean
ABC
An introduction to basic issues in health care ethics.
Margaret R. Mclean
'C' Is for Compassionate and Caring Community
An introduction to the virtue of compassion in a health care context.
Margaret R. McLean
'D' Is for Discussions, Decisions, and Directives
End-of-life decisions are aided by advance discussions and directives.
Margaret R. McLean
'E' Is for Everyday Ethics
While the big issues like cloning or end-of-life treatment may catch the headlines, we deal with important ethical issues every day.
Margaret R. McLean
'F' Is for the Future
A discussion of consequences as an approach to ethics in a health care context
Margaret R. McLean
Personalized Medicine: The Ethics of Access
Pharmacogenomics sparks new therapeutic possibilities and new threats to the U.S. health care system.
Karen Peterson-Iyer
Pandemic Ethics
Questions for health care institutions about preparing ethically for a disaster.
Margaret R. McLean
Medical Decision Making for Publicly Conserved Individuals: Policy Recommendations
Analysis of problems confronting public guardians making end-of-life care decisions.
Theresa Drought
End-of-Life Decision Making: Case 1
A physician has questions for a public guardian in charge of the medical care for a conserved patient.
Elizabeth Menkin
End-of-Life Decision Making: Medical Care for a Conserved Patient
A physician has questions for a public guardian in charge of the medical care for a conserved patient.
Elizabeth Menkin
End-of-Life Decision Making for Patients With Dementia
A public guardian must make decisions for a 78 year-old woman with severe dementia, and multiple illnesses.
Elizabeth Menkin
End-of-Life Decision Making: Case 2
A public guardian must make decisions for a 78 year-old woman with severe dementia, and multiple illnesses.
Elizabeth Menkin
Reading List on End-of-Life Decision Making
A bibliography on legal, ethical, and medical aspects of end-of-life decisions.
Assisted Suicide: A Right or a Wrong?
An examination of the ethical issues in physician-assisted death.
Claire Andre and Manuel Velasquez
The Case of the Depressed Patient
A doctor must decide if a patient's decision to stop dialysis is motivated by depression.
Melinda Lee
Schiavo Case and the Future of Ethics at the End of Life
Notes from a presentation on the ethical issues raised by the Terri Schiavo case
Gerald Coleman, S.S. and Lawrence Nelson
Don't Take Your Organs to Heaven
An analysis of the ethical issues in organ donation
Margaret R. McLean
The Outbreak
This fictionalized case addresses the ethical issues confronting governments, NGOs, and pharmaceutical companies when faced with an epidemic.
Kirk O. Hanson
Dying with Dignity
The president of St. Patrick's Seminary looks at the political and moral debate about physician-assisted suicide.
Gerald D. Coleman, S.S.
Future of Food: An Introduction to the Ethical Issues in Genetically Modified Foods
Center Director of Biotechnology and Health Care Ethics Margaret R. McLean looks at the future of genetically modified food.
Margaret R. McLean
Pharmaceutical Decisions in Response to Epidemics: A Case Study
A video presentation, from the Ethics Center Conference, "The Future of Pharmaceuticals," which was held Oct. 3, 2003.
Markkula Center for Applied Ethics
Medical Decision Making for Conserved Patients: When There Is No One to Decide
The Markkula Center for Applied Ethics has recommended a pilot study for implementating five recommendations concerning medical decision making for conserved patients.
Future of Food
The Center's annual biotechnology conference.
Stem Cells, Moral Status, and California Proposition 71
Gerald D. Coleman, SS, professor of moral theology at St. Patrick's Seminary, and Lawrence Nelson, Santa Clara University lecturer in philosophy discussed stem cells, moral status, and California Proposition 71, exploring the controversy over the ethical implications of stem cell research.
Margaret McLean, Gerald D. Coleman, SS, Lawrence
Brief Case for the Moral Permissibility of Stem Cell Research
The central questions regarding the ethics of stem cell research are 2 in number: One, do embryos have any moral status, entities that deserve moral respect and are owed some duty? Two, if embryos have some moral status, what kind, or degree, of respect are they entitled to and what particular duties are they owed by moral agents?
Lawrence J. Nelson
Notes on Proposition 71
Notes on California Proposition 71, "The Embryo Cloning and Stem Research Bond Act," offering a moral compass to guide us through these concerns.
Gerald D. Coleman, S.S.
Cases in Medical Ethics: Student-Led Discussions
A selection of medical ethics cases designed to help determine whether medicine is the correct calling for pre-medical students.
Chris Cirone
Steroids and Sports: The Ethics of Winning
Steroid use by athletes is a form of cheating.
Michael Dillingham
Neuroethics: The Neuroscience Revolution, Ethics, and the Law
When science expands our understanding of something so central to human existence, these advances will necessarily cause changes in both our society and its laws. This paper seeks to forecast and explore the social and legal changes that neuroscience might bring in four areas: prediction, litigation, confidentiality and privacy, and patents.
Hank Greely
Gruesome tests on cadavers betray donors
We need a national system that eliminates for-profit middlemen and offers complete and accurate information to donors and their families about how donated bodies and parts might be used.
Michael Meyer
Politics and Science
Whatever one's view on the stem cell debate, good ethical thinking is never the result of compliance. It involves rigorous consideration of possible actions, not capitulation to a prefabricated conclusion, political or otherwise.
Margaret R. McLean
Stem Cells in the Treatment of Diabetes: Therapeutic Potential and Ethical Considerations

Catherine Mastroieni
Xenotransplantation: Weighing Individual Benefit and Risks to the Public
Welcome to the world of xenotransplantation, where healthy animal organs are swapped for failing human organs.
Margaret R. McLean
Short People
Implications of the FDA decision to allow the use of human growth hormone to treat short stature of unknown origin.
Miriam Schulman
Listening Behind the Questions: How Experts Can Improve the Public Discourse on Gene Patenting
Important ethical issues lie behind popular concerns about genetics.
Miriam Schulman
Framework for Thinking Ethically About Human Biotechnology
The Markkula Center for Applied Ethics Framework is applied to issues in biotech.
Margaret R. McLean
Homeland Health Security
The SARS epidemic should convince us to prepare for the terror of disease-bearing microbes.
Margaret R. McLean
Doctor-Patient Confidentiality
Letter to the editor of the New York Times.
Rob Elder
Friends don't let friends starve themselves
A student reflects on the ethical duties to friends who have eating disorders.
Meg Parker
Minority Patients Need Culture Brokers
Cultural differences must be taken into account in providing medical care.
Margaret R. McLean and Margaret A. Graham
Of SNPS, TRIPS, and Human Dignity: Ethics and Gene Patenting
Report on a Center conference about the law and ethics of gene patenting.
Miriam Schulman
Is smallpox the real threat?
Post 9/11, we focus on protecting ourselves against a biological assault, but our crumbling health care infrastructure is a more immediate danger.
Margaret R. McLean
Persistent Indeterminate State: Reflections on the Wendland Case
One of the lawyers in this precedent-setting end-of-life case discusses who should make decisions for incompetent patients.
Lawrence J. Nelson
Tough Talk: Finding the Words for Living With Loss
Guidelines for discussion of end-of-life issues.
Dale G. Larson
Last Things
Introduction to a collection of articles on end-of-life ethics.
Reluctant Realism
Research on attitudes toward end-of-life issues in the San Jose Hispanic community.
Margaret R. McLean and Margaret A. Graham
Bargain
Bargaining with God about death.
Miriam Schulman
Blanket of Peace
A student reflects on her first experience dealing with death in her co-curricular work at O'Connor Hospital.
Maliheh Movassat
Caring to the End
Ethics for caregivers.
William C. Spohn
Red Light, Green Light: The California Cloning and Stem Cell Laws
A report on California laws responding to the State's Advsiory Committee on Human Cloning.
Margaret R. McLean
Russian Hostage Rescue Shows the Danger of 'non-lethal' Weapons
Ethical issues in the deployment of supposedly non-lethal weapons.
Margaret R. McLean and S.L. Bachman
Respecting What We Destroy
A framework for looking at the moral standing of stem cells.
Michael J. Meyer and Lawrence J. Nelson
Secret Behind Lower Teen Pregnancy
The determination of the African-American community to combat teen births, and the success that concerted community action has had in transforming child-bearing behavior.
June Carbone
Shhhhhhh, Don't Tell
What should a physical therapist do when she suspects that her patient isn't being entirely honest with his physician?
Wolfe, Smith, McLean, Shanks
We've Got You Covered
Covering for an incompetent RN creates problems for patients.
Wolfe, Williams, Smith, Silvestri, McLean
You Are What You Eat
Personal responsibility in maintaining good health.
Miriam Schulman
Does Old Age Make Suicide Ethical?
Ethical considerations regarding suicide for the terminally ill.
Rob Elder
Should Violent Felons Receive Organ Transplants?
Reflection on the decision to grant a California prisoner a heart transplant.
David Perry
National Ethics Agenda
The Ethics Agenda was developed by the Emerging Issues Program of the Markkula Center for Applied Ethics at Santa Clara University. Through this program, the Center provides timely analysis and opinion on ethical issues in the news.
Elder, Hanson, Schulman, McLean, Perry, Carbone
Ethics and Personhood: Some Issues in Contemporary Neurological Science and Technology

David Perry
Double or Nothing
A discussion of cloning from scientific, ethical, and religious perspectives.
Robins K. Sterns
Awareness Is Not Enough: Gender in the HIV/AIDS Pandemic in Africa
The role of gender inequality in the spread of AIDs in Africa.
Charlotte Vallaeys
Healing The Wounds that Never Heal
A medical researcher struggles with access to experimental procedures for patients with Epidermolysis Bullosa.
Alfred Lane, M.D.
When What We Know Outstrips What We Can Do
Our genes contain information that scientists hope will help in the treatment of many diseases. Huntington's dissease provides a window on the choices we face as medicine increases our ability to intervene in human genetics.
Margaret R. McLean
Cloning
This paper discusses the significant ethical and moral questions intertwined in this "scientific" achievement of cloning by speaking with SCU campus experts in biology, medicine, religious studies, patent law, engineering, technology, agriculture, and ethics.
Robin K. Sterns
Cloning: Just Because We Can, Should We?
"If we can, we will" is a dangerous motto for medicine.
Margaret Mclean
Who Gets Seen
Access issues in health care.
Peter Facione and Noreen Facione
Law of Advanced Directives
Legal Documents Can Ease End-of-Life Decisions
Karen Markus
Aid in Dying
A discussion of physician-assisted death.
Michael J. Meyer
Confronting the Ultimate Questions
Advance Directives give patients a voice when they can't speak for themselves.
Margaret McLean
Life and Death With Dignity: Editor's Note
Introduction to end-of-life questions
Miriam Schulman
The Sole Remaining Supplier
What are the ethical questions involved when a company is the only supplier of a high-risk, life-saving product?
Thomas Shanks
Challenging the Conception of Care in Nursing
Review of Helga Kuhse's book, Caring: Nurses, Women and Ethics
David Perry
Global Distribution of AIDS Pharmaceuticals
Ethical issues in the distribution of AIDS drugs, especially in the developing world.
David Perry
'A' is for Autonomy
A brief definition of autonomy as viewed in the context of medical ethics.
Margaret R. McLean, Ph.D.
California Cloning: The Ethics of Human Cloning and Stem Cell Research
Report on a Center conference on the state regulation of cloning.
MCAE
'B' is for Beneficience (and Baseball)
A brief description of beneficence in a medial context.
Margaret R. McLean, Ph.D.
Life and Death and the Applied Ethics Center at O'Connor
Durable power of attorney for health care.
Margaret R. McLean, Ph.D.
Are you Lost or Something?
A discussion of virtues in a hospital context.
Margaret R. McLean, Ph.D.
The Long Distance Cancer Treatment
Does an HMO have a responsibility to provide care at the closest possible medical center?
Thomas Shanks
Physician's Role in Organ/Tissue Donation
What are the ethical questions involved when asked to help out an illegal immigrant in desperate need of help?
Margaret R. McLean, Ph.D.
Prescribing Under the Influence
The impact of gifts from drug companies to physicians.
E. Haavi Morreim
Attack of the Killer Tomatoes?
An exploration of the ethics of genetically modified foods.
Miriam Schulman
Memories
In ethics, how we decide is just as important as what we decide
Margaret R. McLean, Ph.D.
Happy Birthday!
Ethics in a hospital context.
Margaret R. McLean, Ph.D.
Questions Anyone?
Questions facing a professional ethicist.
Margaret R. McLean, Ph.D.
The Acupuncture Alternative
Do physicians have a duty to refer patients to alternative forms of therapy?
Anh Tran, S.J.