Ethics Consult: Make Mentally Disabled Man Donate Stem Cells?

Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true 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 60-year-old patient, Morty, has developed an acute form of leukemia and is told a stem cell transplant represents his best odds for long-term survival. There are no matches in any bone marrow registries and doctors feel his best option would be a hematopoietic stem cell harvest apheresis with a related donor. The procedure is far less invasive than a bone marrow transplant, requiring that a donor take medication for a few days, at which point peripheral blood stem cells are collected via a blood cell separator machine until a sufficient quantity are obtained. The procedure is mildly inconvenient for the donor, but generally without significant pain or long-term risks. It can be done as an outpatient, and the donor may resume normal activities within hours.

Morty has only one living relative — his brother, Lou, who suffers from significant intellectual disabilities and lives in a nursing facility. He cannot possibly understand the reasons for donating stem cells to Morty or the minor risks involved. What he does say, when asked, is “No doctors!” over and over again. Morty visits Lou a few times each year, usually bringing along a stuffed animal, and Lou appears to take pleasure in these visits, although the brothers have never had a close relationship.

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.

And check out some of our past Ethics Consult cases:

Confront Mentor Over Abusive Research?

Withdraw Life-Saving Treatment if Siblings Can’t Agree?

Stop Treating Ultra-Expensive Patient?