Complete Module 4 Teacher Support Materials - NIH Office of ...

Master 4.3 Answer KeyMax’s Case: Thyroid Cancer, Men II, and Genetic TestingQuestion1. Who had thyroid cancer,and when were theydiagnosed with it?AnswerJames, Harriet, and Nick all had thyroid cancer; all were diagnosed with it intheir teens, 20s, or 30s.2. Who died of thyroid cancer? James, Harriet, and Nick died of thyroid cancer.3. Of those who had thyroidcancer, who is known to havehad MEN II?4. Who died of reasons not relatedto thyroid cancer?At this point, no one (even those who had thyroid cancer) is known to have hadMEN II.Susie, when she was 32 years old.5. Who has elevated levels ofthyroxine, which could bea warning sign of futurethyroid cancer?6. If someone had MEN II, whatwould his or her genotype be?7. If someone did not have MENII (even if he or she did havethyroid cancer), what would hisor her genotype be?Diane.The MEN II gene is dominant. The genotype could be homozygous dominant (TT)or heterozygous (Tt). Since the dominant allele is rare, assume that a person withMEN II is heterozygous.Homozygous recessive (tt).Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Teacher Support Materials, Module 4TSMPage 4-1

Master 4.6 Answer KeyThyroid Cancer, Men II, and Genetic Testing: Checking for Understanding1. What is MEN II? Although many kinds of cancer are linked with MEN II, 100 percent of peoplewith the gene for MEN II will get cancer of what organ?MEN II is multiple endocrine neoplasia 2. People with this disease almost always develop a certain typeof thyroid cancer and may also develop other kinds, such as adrenal gland, brain, and bone cancer.2. The Alzheimer’s disease genetic test doesn’t predict Alzheimer’s disease with certainty; a personwho tests positive for E4 has only a 13-to-57-percent lifetime risk of Alzheimer’s disease. If aperson tests positive for the mutation that causes MEN II, what is the chance that the person willget thyroid cancer?100 percent.3. There is no followup medical procedure that will prevent onset of Alzheimer’s disease. Whatfollowup medical options are there for a person who has tested positive for the mutation thatcauses MEN II?The thyroid can be removed before any sign of cancer. Therefore, the person will never get thyroid cancer.Because the person doesn’t have a thyroid gland anymore, they need to take a daily medication.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.4. As noted, this type of thyroid cancer is caused by an autosomal dominant mutation. What doesthis mean? (What does autosomal mean? What does dominant mean?)An autosomal gene is a gene that is not on the X or Y chromosome. If one inherits the dominant versionof the gene from one or both biological parents, he or she will develop the disease.5. Other than the predictive value of the test and the options for followup medical care, what is anotherdifference between Alzheimer’s disease and the type of thyroid cancer associated with MEN II?The most typical type of Alzheimer’s arises at older ages (age 65 or older); the type of thyroid cancerassociated with MEN II arises by a person’s 30s. Alzheimer’s involves brain degeneration; MEN II leadsto an aggressive cancer if left untreated.6. If Max were to test positive for the mutation, would he know anything more about anyone elsein his family? Explain, and be as specific as possible.If Max tests positive, that means that others in his family could also have inherited the same mutation. Forexample, his aunt and uncle could both have inherited this mutation, along with his cousins. This means thatothers in the family may want to follow up with their own genetic tests for the MEN II mutation.Teacher Support Materials, Module 4TSMPage 4-2

Master 4.7 Answer KeyWhat Impact Would Max’s Newly Discovered Mutation Have on Him and Others?Name Age 1. If Max had the mutation, what is the chance that the person belowalso inherited the mutation?Max 15 1. 100%2. What is the chance that the person would develop thyroid cancer?2. 100%Pierre 39 No additional info; married into family; assume he’s homozygous recesive (tt).Sally 9 1. 50% chance of being heterozygous (Tt);50% chance of being homozygous recessive (tt).2. 50%Diane 31 1. 50% chance of being heterozygous (Tt);50% chance of being homozygous recessive (tt).Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.2. 50%Lindsey 5 1. 25% chance of being heterozygous (Tt);75% chance of being homozygous recessive (tt).2. 25%Eula 80 1. 50% chance of being heterozygous (Tt);50% chance of being homozygous recessive (tt).2. 50%, but she is 80 years old and free of thyroid cancer, so she must behomozygous recessive (tt).Teacher Support Materials, Module 4TSMPage 4-3

Master 4.8 Answer KeyThyroid Cancer and Genetic Testing: Harms and BenefitsComplete the chart below by applying relevant scientific facts about genetic testing and followupmedical care for this type of thyroid cancer.Type of Harmor BenefitHarmsBenefitsPhysical• If Max tested positive and received preventativesurgery, he would need to recoverfrom the surgery. This would likely be a verytemporary harm. However, there is alwaysa small chance of more major complicationsfrom surgery.• There are many types of thyroid cancer, andMax is being tested for the mutation thatcauses just one type. If he tests negative, hemight falsely interpret this to mean that hehas zero lifetime risk of thyroid cancer andmight not be as careful about getting thyroidcheckups and screenings, which could savehis life were he to develop thyroid cancer.• If Max tested positive, he could have followupsurgery that would eliminate hischance of thyroid cancer.• Even if Max didn’t have the preventivesurgery, a positive test result would leadto more screenings and the cancer wouldbe detected earlier.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Psychological(Emotional)SocialEconomic• If Max tested positive, he might be upsetat first, especially if the testing happensagainst his will.• Max might feel angry about inheritingthis mutation.• Max might feel guilty about not inheritingthis mutation, knowing that others in hisfamily may have inherited it.• If Max tested positive and got the followupsurgery, he would have a thin scar thatmight be embarrassing.• If Max tested positive, others might stigmatizehim for having a mutation that willlead to cancer.• The test is expensive and puts a financialdrain on whoever pays for it.• If Max tested negative, he would feelrelieved and would benefit emotionally.• If Max tested positive, he would beable to take concrete medical action,and by taking this kind of control overhis own life, he might experience anemotional benefit.• Max’s friends and family memberswould greatly benefit from Max’sstaying alive, in terms of social andfamily relationships.• Preventive surgery would probably costless than cancer medications andtreatments (which would probablyinclude surgery).• Max would probably miss less school orwork if he had the preventive surgeryrather than cancer treatment later on.Teacher Support Materials, Module 4TSMPage 4-4

Who Should Decide Whether Max Gets Tested? (Day 3, Activity 7)Who Should Decide Whether Max Gets Tested?­Remind students that “Who should decide?” and “Should Max gettested?” are two different questions. For example, even though astudent thinks that it’s a good idea for Max to get tested and thatstudent knows that Max is against having the test, he or she couldstill be in favor of Max being the decision maker.Students overwhelmingly think it’sobvious that Max should decide:respect for Max demands that Maxdecide for himself.Students overwhelmingly think it’sobvious that Max’s dad should decide.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Teacher can follow up with questionssuch as:• What if Max were only five years old?• Why is it morally permissible fora parent to decide on behalf of a5-year-old but not a 15-year-old?Students answer that a 15-year-oldis more rational than a 5-year-old.Teacher can follow up with questionssuch as:• Is Max’s rational capacity fully developed?• How do you know that it is developedenough to make a completelyautonomous decision about ahigh-stakes genetic test?Students comment that Maxis still a minor, so his fathershould decide.Teacher can follow up witha question such as, Is what islegal always ethical?Students comment that the decisionis too high-stakes for Max.Teacher can respond with followupquestions such as:• Don’t teenagers make otherhigh-stakes decisions, such asdriving and playing high-risksports? Is there a differencebetween letting Max make up hisown mind about playing a highrisksport andhaving a genetic test?• What if Max were 18? The decisionwould still be high-stakes.Should Max’s dad still decide?Teacher Support Materials, Module 4 (Page 1 of 2)TSMPage 4-5

Who Should Decide Whether Max Gets Tested? (Day 3, Activity 7)continuedAdditionally, the teacher can pose other hypothetical scenarios for the class to consider, including these:• Who should get to decide whether Max should have the genetic test if the genetic test were not100-percent predictive of a future disease or condition? What if a positive result indicated only a70-percent chance of thyroid cancer developing?• Who should get to decide if the medication had very prolonged and negative side effects?• Who should get to decide if the age of onset were in the patient’s 50s, 60s, or 70s?• Who should get to decide if no followup medical care were available for a positive test result?Teachers should also make sure that students keep the core ethical question—Who should decide?—at the forefront of the discussion. This discussion is not about whether Max should have the test orwhether it would be best for Max to have the test.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Teacher Support Materials, Module 4 (Page 2 of 2)TSMPage 4-6

Who Should Have Access to the Results?(Day 3, Activity 8)Who Should Have Access to the Results?­Make sure that students understand what Max’s positive test result means for others in the family.1. Does it mean that others in the family have also inherited the mutation? (No)2. Would a negative test result from Max mean that others in the family are free of the mutation? (No)Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Students overwhelmingly think it’s obvious thatMax’s father should share the information.Students think that everyone should know because“they are part of the family.”Teacher reminds students that family members canonly learn this information by getting themselvestested. Max’s results will not tell them anythingdefinitive about themselves.Teacher asks whether the father could share informationthat Max has had a genetic test and that therehas been concern of a particular inherited mutationin the family. Then, each affected family membercould decide about getting genetically tested.Students overwhelmingly think it’s obvious thatMax’s father should not share the information.Teacher asks students to brainstorm scenarios inwhich a person has an obligation to share informationwith others. For example, these scenarioscould include1. diagnosis of a very contagious disease and2. patient tells therapist that he or she intendsto kill or hurt someone.Teacher asks whether there is a differencebetween scenarios above vs. sharing results ofMax’s test. If so, what are the differences? If not,why are they similar?Students can compare the following phrasings:Which is preferable and why?1. “Max has had a genetic test for an inherited mutation related to thyroid cancer. He asked menot to share his test results, but you can get yourself tested if you choose, and I can give youmore information about the test itself.”2. “Max has had a genetic test for an inherited mutation related to thyroid cancer. Since his resultsmay have a bearing on your own health, I can tell you the results if you want to know.”3. “Max has tested positive for a mutation related to thyroid cancer. This means you have a ____percent chance of also having inherited the mutation.Teacher Support Materials, Module 4TSMPage 4-7

Supplementary Informationon Alzheimer’s Disease and MEN II*Disease Characteristics Alzheimer’s Disease MEN IIBrief overviewDifferent types of Alzheimer’s diseaseexist. This module focuses on the moretypical kind of Alzheimer’s disease,which arises past the age of 65. EarlyonsetAlzheimer’s disease, on theother hand, can arise in a person’s 30s.Alzheimer’s disease affects memory,problem-solving ability, and even personality.Eventually, it is fatal.This inherited disorder almost always leadsto a type of thyroid cancer called medullarythyroid carcinoma. MEN II is defined bythe overactivity of the thyroid, adrenal, andparathyroid glands. Tumors can appear inany of these glands, but they do not necessarilyappear at the same time. If the cancerspreads, it may spread to places such asbones and the brain.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Prevalence (total numberof current cases) in theUnited StatesSymptomsBrief description ofmutation frombiochemical perspectivePredictive abilityof genetic testMedical Responseto a Positive Test Result*MEN II, multiple endocrine neoplasia type 2.Over 5 million people.Problems with memory, thinking, andconcentration that extend beyond thenormal aging process.The version of the ApoE gene (on chromosome19) inherited from each parentplays a role in the development of themore typical (not early-onset) form ofAlzheimer’s. The gene comes in threeversions: E2, E3, and E4. The E4 versionelevates a person’s chance of gettingAlzheimer’s, whereas the E2 versionmay actually lessen the chance. The E3version does not seem to affect a person’schance of getting Alzheimer’s.Partial: positive test result means13–57% lifetime chance of gettingAlzheimer’s.There is no medical action to preventAlzheimer’s disease. However, thedisease does seem to have an associationwith diseased arteries and type2 diabetes. Therefore, eating well andpromoting good cardiovascular healthmay serve to lessen one’s chance ofgetting Alzheimer’s disease.Approximately 10,000 people.Age of Onset Age 65 or later. Teens, 20s, 30s.Severe headache, rapid heart rate, sweating,irritability, loss of weight, high bloodpressure, and enlarged lymph nodes.Mutation in a proto-oncogene namedRET (on chromosome 10), which leads tounregulated cell growth.Full: positive test result means nearly100% chance of thyroid cancer.Preventive removal of the thyroid gland(often by age 10) and thyroid hormonesthen taken orally. This followup medicaltreatment eliminates the chance ofthyroid cancer.Teacher Support Materials, Module 4TSMPage 4-8

Supplementary Information on HNPCC*“Microsatellite instability” (also known as MSI) is very often associated with HNPCC. Microsatellitesare stretches of the genome with repetitive sequences such as “AAAAA” or “CGCGCGCG.” Thesestretches are especially prone to developing errors, when a mismatch-repair gene is mutated. (However,15 to 20 percent of sporadic, or noninherited, colon cancers also display MSI.) Because MSI isassociated with 90 percent of colon cancers caused by HNPCC, the presence of MSI usually meansthe person has HNPCC.Most commonly, the mutated gene is either MLH1 or MSH2, both of which are part of chromosome 2.Both the MLH1 and MSH2 proteins are responsible for DNA repair. The mutations leading to HNPCCare autosomal dominant mutations and include insertions, nonsense mutations, and mutations atsplicing sites. The normal MLH1 protein contains 746 amino acids, coded for by 19 exons. Whenthe corresponding gene is mutated, an abnormal MLH1 protein is formed, and it is more difficult forthe cell to properly correct DNA damage. However, on its own, this abnormal protein isn’t enoughto cause cancer; other mutations must also arise over the person’s lifetime. Therefore, these othermutations are somatic. If these somatic mutations occur in a person’s colon cells, for example, theperson will get colon cancer. If these somatic mutations occur in a person’s ovary, ovarian cancerwould instead develop. Thus, each of these cancers (when associated with the MLH1 or MLH2mutation) displays a polygenic inheritance pattern.Cancer Risks in the General Population Compared with Individuals with HNPCCCopyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Cancer General Population Risk HNPCC Risk HNPCCMean Age of OnsetColon 5.5% 80% 44 yearsEndometrium 2.7% 20–60% 46 yearsStomach less than 1% 11–19% 56 yearsOvary 1.6% 9–12% 42.5 yearsUrinary tract less than 1% 4–5% approximately 55 yearsBrain, centralnervous systemless than 1% 1–3% approximately 50 yearsSource: http://www.genetests.org/. Copyright University of Washington and Children’s Health System, Seattle. Reprinted with permission.* Hereditary nonpolyposis colorectal cancer.Teacher Support Materials, Module 4TSMPage 4-9

Comparison of Alzheimer’s Disease, MEN II, and HNPCC*Disease Characteristics Alzheimer’s Disease MEN II HNPCCPart of body (most)affectedExamples of other partsof the body that couldalso be affectedBrain Thyroid gland Large intestine, colon— Adrenal glands, parathyroidglands, bones, brainCancer? No Yes YesStomach, uterus, ovariesCopyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Age of onset 65 or older Teens, 20s, 30s Mid 40s, on average; onsetbefore age 20is very rare.Positive test resultindicates what lifetimepercentage chanceof disease?13–57% Nearly 100% 80% by age 75Medical followupavailable?Mutation inheritableby future generations?Mutation typeNo medical interventionis known to lowerone’s chance of developingAlzheimer’s disease.General wellness should bestressed, as it should be forany patient.Yes, full removal of thyroidfollowed by daily medication.This eliminates anychance of thyroid cancer.Yes Yes YesAutosomal, incompletedominanceAutosomal, dominant*MEN II, multiple endocrine neoplasia type 2; HNPCC, hereditary nonpolyposis colorectal cancer.Yes, more regular colonoscopies(usually beginningat age 20 to 25) inhopes of early detectionof any colon irregularities.Also, dietary changesand medication might berecommended. Surgery isalso possible (to removecolon, ovaries, etc.), butfrequent screenings arethought to offer the samemedical benefit in terms oflifespan.Autosomal, dominantTeacher Support Materials, Module 4TSMPage 4-10

Evaluative Criteria for the Final AssessmentcontinuedLevel ofAchievementGeneral Characteristicsof ResponseActual Student ResponseAnalysis of ResponseDevelopingStudent provides one or tworeasons or is unable to fullyapply both the ethical considerationsand the relevantscientific facts.“By getting her tested, [her mother]can give her a longer life by givingher better access to colonoscopiesand medication. It has been proventhat when colon cancer is detected inits early stages, … 90 percent ofpatients will live at least five yearsafter diagnosis….”Ethical Considerationsminimizing harms and maximizingbenefitsAttention to physical benefits butnot to potential harms. (To fullyexamine this consideration, thestudent would need to weigh outmore harms and benefits than justphysical benefit.)Scientific Facts• Early detection predictsgreater longevity.UnacceptableStudent provides one or tworeasons but is unable to applythe ethical considerationsand the relevant scientificfacts.“[Camilla’s] family should decide…because they are responsible for[Camilla] and they want to makesure that [she is not going] to getthe cancer.”OrStudent provides a reason(parental responsibility) butapplies no ethical considerationsand has the scientific facts wrong.(Student seems to think that thetest results can prevent or curethe cancer.)Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.“It is important for Camilla to havethe test so that her parents cantest themselves and their otherchildren.”Student doesn’t understandthat family members can gettested independently of Camillaand that her results—whetherpositive or negative—offer nodefinitive information.Teacher Support Materials, Module 4 (Page 2 of 4)TSMPage 4-12

Evaluative Criteria for the Final AssessmentcontinuedIf Camilla were to have the genetic test, who else (if anyone) should learn the results (other thanCamilla, her doctor, and her mother)?Level ofAchievementExemplaryGeneral Characteristicsof ResponseStudent provides two reasonsand clearly understands howto apply both the ethicalconsiderations and therelevant scientific facts;student elaborates, and showsoriginal thinking; student goesbeyond class discussions.Actual Student Response*“If Camilla were to take the test,she should not have to tell herfamily. It is her medical result,and she should be able to keep [it]confidential. Secondly, the othermembers of the family alreadyknew they were at risk, becauseFelicia had colon cancer. The otherfamily members could take thetest as well. They could then tellthe results to whichever familymembers they want. Not only wouldthis solution allow Camilla to keepher confidentiality, but the resultswould also be much more helpful tothe person taking the test than justknowing Camilla’s results. Becauseit is her information, Camillashould control her course of action,and what is happening. “[Finally,]unlike something like HIV, the geneis not transmissible or except to heroffspring….”Analysis of ResponseEthical Consideration• Confidentiality• Minimizing harms,maximizing benefitsScientific Facts• Mendelian genetics andspecific inheritance patternsapply to this situation.• Infectious and inheriteddiseases are significantlydifferent.• The nature of the genetic testCopyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.“Camilla’s mother should shareinformation about the HNPCCtest availability with the familywhile keeping Camilla’s personalgenetic testing results confidential.The testing does pave the way forsignificant medical intervention andbenefit, so it would be a good idea tomake sure that all family membersknow about the availability of thetest. Each family member could thenmake up their own mind for testing.Camilla’s results don’t definitivelypredict other family members’results, anyway. Even if Camilla isnegative, her sisters could still havethe mutation.”Continued*Note that this response could be exemplary or proficient, depending upon the nature of the class discussions. If it extends reasonablyfar beyond class discussions, it would be exemplary.Teacher Support Materials, Module 4 (Page 3 of 4)TSMPage 4-13

Evaluative Criteria for the Final AssessmentcontinuedLevel ofAchievementGeneral Characteristicsof ResponseActual Student ResponseAnalysis of ResponseProficientStudent provides two reasonsand clearly understands how toapply both the ethical considerationsand the relevantscientific facts; although theexplanation is organized andlogical, it repeats much ofwhat was already discussedin class.See sample response above.If this response essentiallyrephrases a class discussion, itwould be proficient.Same as analysis aboveCopyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.DevelopingUnacceptableStudent provides one reason,or is unable to fully apply boththe ethical considerations andthe relevant scientific facts.Student provides one reasonwith very little or no applicationof the ethical considerations andthe relevant scientific facts.“The only other people that shouldlearn the results of Camilla’s genetictest are the ones [who themselvescould have the mutation]. Both ofCamilla’s sisters, Erlinda and Ella,could have inherited the [mutation],meaning that they, too, are at riskof being diagnosed with or developingcolon cancer in the future. Asthe mutation is autosomal anddominant, if it is present only oncein either or both of her sisters, theywill also have a [high chance of]colon cancer and will need to knowthis before making any decisions [regardingfollowup care]. Her paternalgrandfather, Ronald, [could] also beaffected [as he] could still feasiblydevelop colon cancer, even thoughhe is past the average age of 44.Felicia should not learn the resultsbecause she specifically asked not tobe informed.”“Nobody [else] should get to see theresult. If people are in constant fearthat others will learn their medicalinformation, they will be disinclinedto ever get tested.”Ethical Considerationsconfidentiality and physical benefitof followup medical careScientific Facts• Colon cancer typically arisesin someone’s mid 40s, andMendelian genetics applies tothis situation.• However, the student doesn’tmake it clear that Camilla’sresult won’t give any definitiveinformation regarding thesisters.(Student has successfullyapplied some of the scientificfacts [age of colon cancer onset,for example], but doesn’tmake it clear that Camilla’sresult won’t give any definitiveinformation regarding thesisters.) To bring this responseto the next level, the studentcould write something suchas, “Learning that a close relativehas an inherited mutation isdifferent from learning that aninherited form of colon cancermay run in the family. Therefore,it’s important that the sisterslearn of Camilla’s test result,especially if she turns out to bepositive. This will more likelyencourage them to take the testthemselves, and receive earlyfollowup care if necessary.”Ethical Considerationbeginning of confidentialityScientific FactsnoneTeacher Support Materials, Module 4 (Page 4 of 4)TSMPage 4-14

Extension (Optional)Should Employers Have Access to Genetic Test Results?Estimated Time: 45 minutesIf you have another class period to devote to this work, you might want to explore this ethical question:Should employers be able to require and gain access to genetic testing results that could affect a person’sability to do his or her job? Master 4.11: About Retinitis Pigmentosa will guide you and your studentsthrough an exploration of a degenerative eye condition. This case focuses on the following question:Should airline companies be able to screen prospective pilots for associated genetic mutations?Procedure1. Give each student a copy of Master 4.11.2. Read the scenario aloud and pose the following ethical question: Should an airline companybe able to require perspective employees to have a genetic test for retinitis pigmentosa?3. Remind students that the next step is to consider all relevant information. A great deal ofinformation is available in Master 4.11.4. Ask students, “Who or what will be affected by the decision?”5. Ask students to identify the relevant ethical considerations.Students will likely identify ethical considerations such as minimizing harms and maximizingbenefits, fairness, and respect for persons.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.6. Now that students have identified the ethical considerations, help them elaborate on theirinitial ideas by asking questions such as these:a. What are the associated harms and benefits for airline companies that requireretinitis pigmentosa genetic screening for perspective employees?Students will likely bring up economic benefits as part of this discussion.b. What are the associated harms and benefits for prospective employees who receiveretinitis pigmentosa genetic screening from airline companies?Students may bring up• economic harms if these employees are not hired as a result of a positive test,• emotional harms if the prospective employee must now explain to family and friendswhy he or she was not hired, and• economic or emotional benefit if the prospective pilot can now choose a different careerthat he or she can do for a longer period of time.Teacher Support Materials, Module 4 (Page 1 of 2)TSMPage 4-15

Extension (Optional)continued•c. How do the harms and benefits compare? Which outweighs the other? Why?d. Should a company be able to require this kind of information from prospectiveemployees? Why or why not?Note: By bringing up coercion, you can connect this to the ethical considerationof respect for persons.e. If airlines refuse to hire someone with retinitis pigmentosa, is this unfairdiscrimination? Why or why not?Note: This links back to the ethical consideration of fairness.f. Compare and contrast the current case with the following:Should an airline company be able to require prospective employees to have aroutine vision test (including peripheral vision)? If prospective employees donot pass this test, the company plans to not hire them. Additionally, thecompany will conduct annual vision tests of all employees. Failure to pass meansthat the person’s contract will not be renewed.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Note: In this case, the motivation is more about safety than economic benefit for theairline company.g. Should an airline company be able to require prospective employees to have adrug test for a substance such as marijuana? If the test comes back positive, thecompany plans not to hire or train the prospective pilot.Teacher Support Materials, Module 4 (Page 2 of 2)TSMPage 4-16