Rashmi Borah | The Ohio State University
National Collegiate Research Conference, Harvard University
January 22, 2015
 Voluntary, permanent removal of a currently
healthy limb or organ for preventative
purposes
 Establish a risk of diseas...
 For this project:
◦ presence of a gene (BRCA-1 or BRCA-2) has been
linked to heightened chances of breast or ovarian
can...
 Defends HOW a decision should be made,
rather than WHAT decision should be made
◦ Not proving that POR is “right” or “wr...
 Patient has the right to make decision for him
or herself
 Obligatory maintenance of autonomy 
patient incurs the majo...
 Physicians and other health care personnel
are morally obligated to fully inform patients
of the impact of a procedure
◦...
 Patients: external factors  blocks
autonomous decision-making
 Physicians: limited discussion  failure to
provide eno...
 Evaluate past medical cases that can inform any
future decisions
 Discuss three non-physiological considerations
that c...
 How will organ removal affect patient’s state of
mind?
 Case #1: Body Integrity Identity Disorder
 2000: Dr. Robert Sm...
 Overwhelmingly affects women
 Prophylactic mastectomies, hysterectomies
and oophrectomies involve organs that can
be im...
 Who is the decision being made for?
 Discussion required about motivations
behind decision to undergo/not undergo
treat...
Physiological:
•Gene presence
•Family history
•Extent of cancer
risk reduction
•Surgical risks
•Recovery time
Decision bas...
Physiological:
•Gene presence
•Family history
•Extent of cancer
risk reduction
•Surgical risks
•Recovery time
Non-Physiolo...
 POR is an individual decision, but certain
factors can hinder truly autonomous
decision-making
 Past cases can help inf...
 I extend tremendous gratitude to the following
faculty, organizations and funding sources:
◦ Faculty: Dr. Mariko Nakano,...
 “BRCA1 and BRCA2: Cancer Risk and Genetic Testing.” National Cancer Institute Fact Sheet
Database, 2009. Reviewed 08/05/...
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POR_Harvard_01222015_FINAL

Published on: Mar 4, 2016
Source: www.slideshare.net


Transcripts - POR_Harvard_01222015_FINAL

  • 1. Rashmi Borah | The Ohio State University National Collegiate Research Conference, Harvard University January 22, 2015
  • 2.  Voluntary, permanent removal of a currently healthy limb or organ for preventative purposes  Establish a risk of disease prior to removal
  • 3.  For this project: ◦ presence of a gene (BRCA-1 or BRCA-2) has been linked to heightened chances of breast or ovarian cancer in the future ◦ Rate of POR to avoid developing cancer is increasing ◦ Justify the permanent removal of an organ based on the probability (not guarantee) of a disease  complicated and involved decision
  • 4.  Defends HOW a decision should be made, rather than WHAT decision should be made ◦ Not proving that POR is “right” or “wrong”  For this project: focus on improving the decision-making model
  • 5.  Patient has the right to make decision for him or herself  Obligatory maintenance of autonomy  patient incurs the majority of the impact from this procedure
  • 6.  Physicians and other health care personnel are morally obligated to fully inform patients of the impact of a procedure ◦ Both positive and negative elements  Limiting discussion to physiological considerations violates this premise, and reduces the ethical soundness of a resulting decision
  • 7.  Patients: external factors  blocks autonomous decision-making  Physicians: limited discussion  failure to provide enough considerations for a truly informed decision  How can we accommodate both of these points into the POR decision-making model?
  • 8.  Evaluate past medical cases that can inform any future decisions  Discuss three non-physiological considerations that can contribute to informed decision-making ◦ Therapeutic benefits ◦ Population-specific concerns ◦ Motivation for decision and maintenance of autonomy  Demonstrate how non-physiological considerations contribute to the ethical status of a decision
  • 9.  How will organ removal affect patient’s state of mind?  Case #1: Body Integrity Identity Disorder  2000: Dr. Robert Smith removed healthy limbs from two patients ◦ Extreme criticism ◦ Patients reported improved quality of life following limb removal ◦ For cancer patients: removal of a “ticking time bomb” could alleviate stress of a potential disease
  • 10.  Overwhelmingly affects women  Prophylactic mastectomies, hysterectomies and oophrectomies involve organs that can be important to a woman’s identity and sense of self  Case #2: Ashley treatment ◦ Sterilization, “loss of womanhood” ◦ Association between organs and identity is a critical discussion with a tremendous individual impact
  • 11.  Who is the decision being made for?  Discussion required about motivations behind decision to undergo/not undergo treatment ◦ Anjelina Jolie op-ed: decision made “for [her] children’s future” ◦ “The Deferential Wife” phenomenon ◦ Refusal to undergo treatment for aesthetic reasons, concerns about partner’s perception of organ loss
  • 12. Physiological: •Gene presence •Family history •Extent of cancer risk reduction •Surgical risks •Recovery time Decision based on these reasons alone may not be fully informed = not entirely ethical; neglects personal impact Non-Physiological: •Residual feelings regarding decision—”permanence for probability” •Personal association with organs (gendered or otherwise) •Therapeutic benefits/risks •Reason for undergoing/not undergoing procedure Decision based on these reasons alone may not be fully informed = not entirely ethical; neglects necessity of procedure
  • 13. Physiological: •Gene presence •Family history •Extent of cancer risk reduction •Surgical risks •Recovery time Non-Physiological: •Residual feelings regarding decision—”permanence for probability” •Personal association with organs (gendered or otherwise) •Therapeutic benefits/risks •Reason for undergoing/not undergoing procedure Decision is more informed by considering both physiological and non-physiological elements of this decision = a more ethical decision REGARDLESS of what decision is actually made
  • 14.  POR is an individual decision, but certain factors can hinder truly autonomous decision-making  Past cases can help inform future decision- making  Multiple factors from multiple angles are required for the decision to be truly informed and thought-out  a more ethically sound decision
  • 15.  I extend tremendous gratitude to the following faculty, organizations and funding sources: ◦ Faculty: Dr. Mariko Nakano, Dr. Ryan Nash, Dr. Sigrun Svavarsdottir, Matthew Vest ◦ Organizations: The Ohio State University Center for Bioethics, The Center for Bioethics and Human Dignity ◦ Funding:  Pelotonia Undergraduate Student Fellowship, The Ohio State University Comprehensive Cancer Center  Undergraduate Research Office Summer Fellowship  Ohio State University College of Arts and Sciences Honors Thesis Scholarship
  • 16.  “BRCA1 and BRCA2: Cancer Risk and Genetic Testing.” National Cancer Institute Fact Sheet Database, 2009. Reviewed 08/05/2013.  Clarke, Aileen, Yu Mei Cheing, Klim McPherson. “Removing Organs ‘Just in Case’ – Is Prophylactic  Removal of the Ovaries a Good Thing?” Journal of Epidemiology—Community Health. 2006 March; 60(3): 186-187  Gessert, Charles. “The Problem with Autonomy.” Minnesota Medicine, April 2008. Online Access.  Jolie, Angelina. “My Medical Choice.” The New York Times, The Opinion Pages, Los Angeles. May 14, 2013. Accessed online, January 3, 2014: http://www.nytimes.com/2013/05/14/opinion/my-medical- choice.html?_r=0  Levi, Neil. Moral Relativism: A Short Introduction. Oxford: Oneworld, 2002  Moscucci, O and A Clarke. “Prophylactic Oophrectomy: A Historical Perspective.” Journal of  Epidemiology—Community Health. 2007 March; 61(3): 182-184  Smith, Robert. “Amputee Identity Disorder and Related Paraphilias.” Psychiatry. 2004 April; 8(3): 27-30  “The Belmont Report: Ethical Principles and Gudielines for the Protection of Human Subjects Research.” The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. DHEW Publication No. (OS) 78-0012. September 30, 1978.  Westlund, Andrea. "Selflessness and Responsibility for Self: Is Deference Compatible With Autonomy?" Philosophical Review 112:4 (October 2003) 483-523.

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