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Ethical and Legal Issues of a Caring-Based Practice Case Study # 1 You are working in a research facility that is currently conducting clinical trials to identify the causes of a variety of blood disorders. Nadia, a 26-year-old woman, has answered an advertisement seeking individuals of Ashkenazi Jewish descent to participate in a study of hematologic disorders. Nadia has no significant health history issues. She reports on her health forms that she has no family history of hematologic disease, but that her mother and aunt both died from breast cancer. All participants have signed informed consent forms indicating their understanding of the risks involved in the taking of blood samples and agree to be informed if the presence of a hematologic disorder is discovered. No specific consent is requested if testing reveals the presence of any other disease processes. Nadia’s test results reveal a 185delAG mutation in the BRCA1 gene, which is associated with a substantially high risk for the development of breast and ovarian cancer. Case Questions: Given Nadia’s family history of breast cancer, the gene mutation is a likely predictor of a future cancer diagnosis. Using the deontological approach, what points or questions would you consider as you discuss the ethical considerations in informing Nadia of the mutation despite the fact that the focus of the trial was hematologic disorders? One of your colleagues argues against telling Nadia, at least until after the clinical trial has ended, on the basis that Nadia has shown no signs or symptoms of breast cancer, and this may cause her undue stress, not to mention influence the trial results. How is this colleague demonstrating paternalism? Another colleague points out that no specific consent has been provided or requested if the presence of any other disease processes is found through the testing and wonders if informing Nadia would reveal that the trial failed to adequately address informed consent. What is the purpose of informed consent and how would you respond to this colleague? As the discussion begins to circle back to causing Nadia undue stress and concern. What principle of autonomy should you use to diffuse your colleagues’ position? Nadia’s situation created a concern within the group that as the trial continued, additional issues might arise. Thus, the group needs a consistent, systematic method for acting when confronted with ethical dilemmas. How can the mnemonic ETHICAL be used as a framework for this group? Instructions: Your response must utilize two references not more than 5 years old. One reference should be the course reference book (Dunphy) and the other is from a peer-reviewed journal or guidelines or from the other course reference books.