Chapter 7: Advance Directives

AI Diagnosis Accuracy Case Description: An AI tool diagnoses a 40-year-old woman with breast cancer, but the doctor disagrees based on clinical judgment. The AI has a 95% accuracy rate. Ethical Question: Should the doctor follow the AI’s diagnosis?

A. Yes, due to its high accuracy.
B. No, prioritizing clinical judgment.
C. Yes, if confirmed by tests.
D. No, unless the AI is 100% accurate.

Gene Editing for Enhancement Case Description: Parents request CRISPR to enhance their unborn child’s intelligence, a non-therapeutic use, in a country where it’s legal but controversial. Ethical Question: Is this use of gene editing ethical?

A. Yes, if legal and consented.
B. No, it risks unintended consequences.
C. Yes, if benefits outweigh risks.
D. No, unless medically necessary.

Telemedicine Privacy Breach Case Description: A 30-year-old man discusses depression via telemedicine. The platform is hacked, exposing his session to the public. Ethical Question: Who bears primary ethical responsibility?

A. The patient, for using telemedicine.
B. The doctor, for not ensuring security.
C. The platform provider, for weak security.
D. No one, as it’s an unforeseeable breach.

Robotic Surgery Consent Case Description: A surgeon uses a robotic system for a 50-year-old’s appendectomy, mentioning it briefly but not its experimental status or risks. Ethical Question: Is this consent adequate?

A. Yes, if the patient agreed.
B. No, it omits key details.
C. Yes, if risks are minimal.
D. No, unless fully explained.

AI Triage in Emergencies Case Description: An ER uses AI to triage patients during a mass casualty event, prioritizing a 20-year-old over a 60-year-old based on survival odds, despite equal severity. Ethical Question: Is this AI triage ethical?

A. Yes, it maximizes survival.
B. No, it discriminates by age.
C. Yes, if transparent to staff.
D. No, unless humans override.

Germline Editing Risks Case Description: A couple opts for germline editing to remove a cancer gene, knowing it may affect future generations unpredictably. Ethical Question: Should this proceed?

A. Yes, with their consent.
B. No, due to future risks.
C. Yes, if risks are studied.
D. No, unless reversible.

Wearable Health Data Sharing Case Description: A 25-year-old’s fitness tracker data is sold to insurers by the manufacturer, raising his premiums, without explicit consent. Ethical Question: Is this data use ethical?

A. Yes, if in the terms of service.
B. No, without specific consent.
C. Yes, if anonymized.
D. No, unless he benefits.

Autonomous AI Treatment Decisions Case Description: An AI system prescribes antibiotics for a 35-year-old’s infection without doctor review, missing a rare allergy that causes a reaction. Ethical Question: Was relying on AI ethical?

A. Yes, if usually accurate.
B. No, without human oversight.
C. Yes, if the patient consented.
D. No, unless fully tested.

Gene Editing for Rare Diseases Case Description: A 10-year-old with a rare genetic disorder is offered somatic gene editing with uncertain long-term effects. Parents consent. Ethical Question: Is this ethical?

A. Yes, for therapeutic benefit.
B. No, due to unknowns.
C. Yes, if risks are disclosed.
D. No, unless proven safe.

Telemedicine Access Disparity Case Description: A rural 60-year-old lacks internet for telemedicine, missing care, while urban patients benefit. The clinic prioritizes telemedicine. Ethical Question: Is this prioritization ethical?

A. Yes, it’s efficient.
B. No, it widens disparities.
C. Yes, if alternatives are sought.
D. No, unless all have access.

AI Bias in Diagnosis Case Description: An AI tool misdiagnoses skin cancer in a 45-year-old Black patient due to training on mostly White skin data. Ethical Question: Is using this AI ethical?

A. Yes, if it’s the best available.
B. No, due to bias risks.
C. Yes, if adjusted later.
D. No, unless retrained.

Brain-Computer Interface Consent Case Description: A 30-year-old with paralysis joins a trial for a brain-computer interface. Risks to cognition are unclear, and he’s eager but uninformed. Ethical Question: Is his consent valid?

A. Yes, if he signed.
B. No, without full risk disclosure.
C. Yes, if benefits are high.
D. No, unless a neurologist explains.

3D-Printed Organ Ethics Case Description: A hospital offers a 3D-printed liver transplant to a 50-year-old, untested in humans, with consent but high cost, limiting access. Ethical Question: Is this offer ethical?

A. Yes, with consent.
B. No, due to inequity and risks.
C. Yes, if affordable later.
D. No, unless tested.

Virtual Reality Therapy Case Description: A 40-year-old with PTSD uses VR therapy, triggering a severe flashback due to untested intensity. He consented generally. Ethical Question: Was this use ethical?

A. Yes, if he agreed.
B. No, without specific warnings.
C. Yes, if monitored.
D. No, unless fully tested.

AI Predictive Analytics Case Description: An AI predicts a 25-year-old will develop diabetes, prompting aggressive intervention without symptoms or patient consent. Ethical Question: Is this intervention ethical?

A. Yes, to prevent disease.
B. No, without consent.
C. Yes, if accurate.
D. No, unless symptomatic.

Gene Editing Equity Case Description: A clinic offers gene editing for a genetic disorder only to wealthy patients, excluding a 30-year-old who can’t pay. Ethical Question: Is this exclusion ethical?

A. Yes, it’s a private service.
B. No, it violates justice.
C. Yes, if publicly funded later.
D. No, unless all can access.

Robotic Caregiver Autonomy Case Description: A robotic caregiver adjusts a 70-year-old’s medication without human input, causing an overdose. The patient had agreed to its use. Ethical Question: Was this deployment ethical?

A. Yes, with consent.
B. No, without oversight.
C. Yes, if usually safe.
D. No, unless flawless.

AI in Mental Health Case Description: An AI chatbot counsels a 20-year-old with depression, missing suicidal cues a human might catch, despite consent. Ethical Question: Is this AI use ethical?

A. Yes, if consented.
B. No, due to limited sensitivity.
C. Yes, if supervised.
D. No, unless equal to humans.

Genomic Data Privacy Case Description: A 35-year-old’s genomic data from a trial is hacked and sold, despite assurances of confidentiality. Ethical Question: Was the research team ethically responsible?

A. Yes, for poor security.
B. No, if unforeseeable.
C. Yes, if not anonymized.
D. No, unless they profited.

Telemedicine Misdiagnosis Case Description: A doctor misdiagnoses a 45-year-old’s rash via telemedicine due to poor video quality, delaying treatment. Ethical Question: Is telemedicine appropriate here?

A. Yes, if convenient.
B. No, without clear visuals.
C. Yes, if followed up.
D. No, unless in-person is impossible.

AI Resource Allocation Case Description: An AI allocates ventilators in a pandemic, favoring employed patients over unemployed ones, based on “social value.” Ethical Question: Is this allocation ethical?

A. Yes, for societal benefit.
B. No, it’s discriminatory.
C. Yes, if transparent.
D. No, unless medically based.

CRISPR Off-Target Effects Case Description: A 15-year-old receives CRISPR for a genetic disease, but off-target edits cause a new mutation, disclosed as a risk. Ethical Question: Was this use ethical?

A. Yes, with consent and disclosure.
B. No, due to harm.
C. Yes, if treatable later.
D. No, unless risk-free.

Smart Implant Monitoring Case Description: A 60-year-old’s smart pacemaker shares real-time data with his doctor and manufacturer, without his full understanding. Ethical Question: Is this monitoring ethical?

A. Yes, for health benefits.
B. No, without clear consent.
C. Yes, if anonymized.
D. No, unless he opts in.

AI Bias in Trials Case Description: An AI-designed trial excludes minorities due to biased data, skewing results for a new drug. Ethical Question: Is this trial ethical?

A. Yes, if effective for some.
B. No, due to exclusion.
C. Yes, if adjusted later.
D. No, unless inclusive.

Nanotechnology Risks Case Description: A 50-year-old joins a trial for nanobots to treat cancer, with unknown long-term risks not fully explained. Ethical Question: Is this consent ethical?

A. Yes, if he agreed.
B. No, without full disclosure.
C. Yes, if risks are low.
D. No, unless studied.

Virtual Patient Simulations Case Description: Medical students train on a VR patient modeled after a real person’s data without their consent, for educational purposes. Ethical Question: Is this use ethical?

A. Yes, for education.
B. No, without consent.
C. Yes, if anonymized.
D. No, unless public data.

AI End-of-Life Decisions Case Description: An AI recommends withdrawing life support for a 70-year-old based on prognosis, overriding family wishes. Ethical Question: Is this recommendation ethical?

A. Yes, if accurate.
B. No, without human input.
C. Yes, if family consents.
D. No, unless legally binding.

Gene Editing in Embryos Case Description: Scientists edit embryos to prevent a disease, discarding unedited ones, with parental consent but public controversy. Ethical Question: Is this ethical?

A. Yes, with consent.
B. No, due to embryo ethics.
C. Yes, if disease is severe.
D. No, unless universally accepted.

Telemedicine in Low Literacy Case Description: A 65-year-old with low literacy uses telemedicine but misunderstands instructions, worsening his condition. Ethical Question: Is telemedicine suitable here?

A. Yes, if accessible.
B. No, without support.
C. Yes, if simplified.
D. No, unless in-person.

AI Predictive Policing in Health Case Description: An AI flags a 30-year-old as a suicide risk based on social media, notifying police without his consent. Ethical Question: Is this ethical?

A. Yes, to save a life.
B. No, without consent.
C. Yes, if imminent danger.
D. No, unless he’s informed.