by Jacob M. Appel MD, JD September 16, 2022

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, 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.

Warren is a 52-year-old writer who has been troubled by sexual fantasies about underage boys and girls since his adolescence. Multiple trials of psychotherapy have done nothing to reduce his urges. A psychiatrist recommended chemical castration through hormonal injections, but Warren has learned that these treatments can increase his risk of having a stroke. Instead, he asks a surgeon in his community, Harold Hunnicutt, MD, to castrate him "the old-fashioned way." Warren is on Medicaid and has no money of his own.

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.

Check out some of our past Ethics Consult cases:

Biopsy Kids' Brains Even Though They Won't Benefit?

Let Researcher Create Mouse-Human Brain?

Let Look-Alike Sisters Commit Insurance Fraud?

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