Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
A large-scale study shows that people who have certain genetic markers on chromosome 15 and also smoke cigarettes are far more likely to develop lung cancer than those who do not carry such markers. This study comes to the attention of Irwin, the owner of the Happy & Healthy Tobacco Company, which manufactures cigarettes. Irwin is concerned that his employees, many of whom smoke tobacco, will develop lung cancer — which would be bad for both his company’s healthcare costs and its public image. He decides to require all future employees to be tested for these genetic markers, and plans to hire only those who test negative.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
Check out some of our past Ethics Consult cases: