The Johnson's have 2 children. Both young boys. Adam is 6 and John is 3. Adam was diagnosed with Acute Leukemia 7 months ago. Thankfully he was able to respond well to treatment and went into remission much quicker than expected. Unfortunately, in recent testing the oncologist has detected signs of a relapse. Secondary therapy is an option but comes with greater risks. There is significantly higher toxicity with these drugs and a second remission is not certain. This leads the oncologist to recommend an experimental drug that requires bone marrow transplant but helps reduce rejection.

For this to work, a histocombatible donor must be found. Adam's brother is not a matching donor. This leads to Adam's parents consulting an endocrinologist about in vitro fertilization as they consider having another child. They get information about pre-implantation genetic testing and in vitro procedures. Neither of them show any concerns or doubts about what they are considering. This solely about the process.

Mr. Johnson's sperm is used to impregnate his wife's harvested eggs. Histocompatability tests begin. A family friend asks Mrs. Johnson, "Are you two having a new only in hope that Josh will survive and hopefully have a second chance?" After an uncomfortable silence Mrs. Johnson replies, "Of course not. We will love this new baby, just like Adam and John. There is just the added benefit of helping their sibling." Later that afternoon, when she goes to the clinic to meet her husband, she begins to cry uncontrollably.

1.What if Adam doesn't take well to the transplant and dies anyway? What will they tell their new child one day if the questions asked about the circumstances of their birth and what mental effects could this have on the child, especially if Adam doesn't survive.

2.What is the role of the physician in this situation? Is this a case where an ethics consult was necessary? Why or why not?

3.What is the goal of medicine? Is it to prolong life for as long as possible, regardless what methods and means are being considered? Prolonging life at all costs is considered "over-treatment" in geriatrics. Is that the same here?