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Thyroid Cancer, MEN II,* and Genetic Testing—Relevant FactsName(s)Scientific QuestionWhat is your thyroid?What is thyroid cancer?What causes thyroid cancer?Which of Max’s genes wouldbe tested?AnswerYour thyroid is a gland near your voice box. This gland produces a hormonecalled thyroxine, which controls your metabolism.Cancer means that you have an overproduction of a certain type of cell. Thyroidcancer means that the patient has a tumor in his or her thyroid gland. This tumoris capable of spreading to other parts of the body. If left untreated, thyroidcancer is fatal. However, if caught early and surgically removed, it has a 95%cure rate.There are many types of thyroid cancer, and people develop thyroid cancer fordifferent reasons. It can be caused by inherited mutations, environmentallycaused mutations, or a combination of both.Max would be tested for a mutation in a gene called RET. This mutation causesmultiple endocrine neoplasia type 2 (MEN II), which leads to one specific typeof thyroid cancer. It is very unusual for cancer to be caused by a single mutation.Usually, cancer is the result of the accumulation of many different mutations,some inherited and others environmental. The inherited mutation hereis an autosomal dominant mutation.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.If Max has the mutation,how likely is he to get thyroidcancer?Is it possible to not have thismutation but still get thyroidcancer?Can you have surgery or takeany medication to preventyourself from getting thyroidcancer?Your Own Relevant QuestionMax would have a nearly 100% chance of getting thyroid cancer in his teens,20s, or 30s.Yes. There are many other genes that affect one’s lifetime chance of gettingthyroid cancer.Yes. Max’s thyroid could be surgically removed now. If this were to occur, Maxwould have a 0% lifetime chance of thyroid cancer. Because he would no longerhave his thyroid gland, Max would need to regulate his metabolism by taking athyroid pill each day.Answer*Multiple endocrine neoplasia type 2.Master 4.4
Genetic Testing—Key Concepts• Some genetic tests are completely predictive—a positive result means you have or will definitely getthe medical condition.• Other genetic tests—such as the APOE test for Alzheimer’s disease—can only tell you if you are ata greater-than-average risk for developing a condition; the tests can’t predict with certainty that youwill get it.• Sometimes the disease develops at a very young age, other times it occurs in midlife, and yet othertimes it occurs late in life.• Sometimes responses such as surgeries or medications exist to prevent the condition. In such cases,knowing about the condition (or the risk factor) can help you reduce the bad consequences of thecondition or can reduce or completely eliminate the risk. Other times, there is no response that willdefinitely lower your risk of the condition.• Often, test results have implications not only for the person being tested, but also for geneticallyrelated family members such as siblings. This possibility raises many questions about whatinformation the person being tested should share with family members.• Many people have expressed concern about how best to ensure that results of a genetic test remainconfidential and how to avoid discrimination based on genetic information. For example, somepeople are concerned that insurers and employers could find ways to use this information to denyhealth coverage or work opportunities to people with certain genetic predispositions.Copyright © 2009 Education Development Center, Inc. Exploring Bioethics.Permission granted for classroom use.Master 4.5
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NIH CurriculumSupplement SeriesGrad
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Education Development Center, Inc.D
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This material is based on work supp
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About the National Institutes of He
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Introduction
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activity of assessing different rea
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teaching strategies that will help
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2. The ability to distinguish an et
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quence of choosing one path over an
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Table 1. Assessing Student Justific
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Challenges in TeachingBioethics and
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How Exploring Bioethics Can HelpFor
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Prompts to encourage students to re
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Table 2d. Students say they already
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Resources forTeaching BioethicsBeau
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Table 3. Ethical Issues and Curricu
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Each module is divided into three d
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Table 4. Alignment with NSES Life S
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About the Web SiteThe Web site for
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1Module 1Bioethics Concepts and Ski
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• apply important ethical conside
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In Advance1Copies, Equipment, and M
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Teaching Sequence1Day 1: What’s i
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new medication, she is able to stay
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6. Read the list of Round 1 questio
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• With respect to performance enh
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LE/LE/LLE/LPoint out that some of t
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Organizer for Day 1: What’s in a
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Day 2: Four Key Questions1PurposeDa
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4. Emphasize that when bioethicists
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15. Ask students to list as many et
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Organizer for Day 2: Four Key Quest
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Encourage students to share example
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Activity 7:Using Ethical Considerat
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4. Ask a representative from each g
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Organizer for Day 3: Core Ethical C
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References and Resources1Informatio
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What Type of Question? ROUND 1—Et
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What Type of Question? ROUND 3: Eth
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Round 4Q9Should embryonic stem cell
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Oscar Pistorius—The Fastest Man w
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Four Key Questions and Statementof
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Carl’s CaseCarl listened to his t
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1Module 2Balancing Individual and C
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adopting vaccination policies that
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In Advance1Copies, Equipment, and M
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Teaching Sequence1Day 1: Exploring
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the key stakeholders, and taken int
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You may wish to highlight the dange
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ClosureAsk students to reflect on t
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Day 2: Community Immunity1PurposeOn
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10. Ask all students in the class t
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• While an unvaccinated person’
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ClosureRecap for students that the
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Tell only the students who were tag
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5. Divide students into pairs, and
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17. Share with students that becaus
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13. Note that the Boston and Dublin
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Teaching StrategiesYou may want to
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Ask each member of the pair to read
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1Centers for Disease Control and Pr
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Get Kids Vaccinated or ElseGet Kids
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Name(s)Station 2—Vaccine RisksDir
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Station 1: Vaccine-Preventable Dise
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MumpsBefore the mumps vaccine was i
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Station 2—Vaccine RisksNote: Like
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Smallpox VaccineThe smallpox vaccin
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Station 4—ExemptionsExemptions vs
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State Exemptions Allowed as of Fall
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Name(s)What are the ethical conside
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Vaccination Status CardsVaccinated
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Opting Out of a Vaccine—Variables
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Measles in DublinIn 2000, an outbre
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What are some of the different pers
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Issues Explored• What is the fair
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Day 3—What Is Your Recommendation
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Teaching SequenceNoteAssign this ho
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Teaching Strategies: Jigsaw Techniq
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Some students might think that the
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11. Explain to students that they w
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Inform students that they will now
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2. Tell them that one liver has bec
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6. If it does not naturally arise,
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Criteria relevant to allocating liv
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Organizer for Day 2: Identifying St
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Day 3: What Is Your Recommendation?
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Activity 9:Understanding Past and C
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ClosureReinforce to students that t
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Ask students whether they think the
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Liver Function and FailureHepatitis
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Name(s)Banting decided that he woul
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Name(s)The COC distributed the peni
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Name(s)The Admissions and Policy Co
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Liver and Liver-Transplant Fact She
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Page 195 and 196: Patient ProfilesAnitaAnita is a 19-
Page 197 and 198: Additional Patient InformationAnita
Page 199 and 200: The United Network for Organ Sharin
Page 201 and 202: Comparing the Past and Current UNOS
Page 204 and 205: 1Module 4Weighing Benefits and Harm
Page 206 and 207: An optional extension activity incl
Page 208 and 209: In Advance1Preparing the Envelopes
Page 210 and 211: Teaching Sequence1Day 1: Deciding t
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Page 216 and 217: See Teacher Support MaterialsSupple
Page 218 and 219: ClosureTo close the class, remind s
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Page 222 and 223: Activity 5:Who or What Will Be Affe
Page 224 and 225: Activity 6:Exploring the Relevant E
Page 226 and 227: 11. Give each student a copy of Mas
Page 228 and 229: 1Ask students, “What are some rea
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Page 232 and 233: ReflectionDisplay the posters from
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Page 236: 1Retinitis PigmentosaFoundation Fig
Page 239 and 240: Alzheimer’s Disease and Genetic T
Page 241 and 242: Name(s)Now, on your own, answer the
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Page 247 and 248: What Impact Would Max’s Newly Dis
Page 249 and 250: Your Tentative ThoughtsName(s)1. Do
Page 251 and 252: Ethical Questions• Who should dec
Page 253 and 254: Extension (Optional)About Retinitis
Page 255 and 256: Issues Explored• Why is it import
Page 257 and 258: Key Science Knowledge*• Nature of
Page 259 and 260: Teaching SequenceDay 1: Research wi
Page 261 and 262: 13. Ask students, “Should I just
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Page 265 and 266: it is ethically acceptable. For exa
Page 267 and 268: Students should recognize that rese
Page 269 and 270: ClosureAsk the class whether they t
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Page 273 and 274: Activity 4: Returning to Your Decis
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Page 277 and 278: 5. Summarize two key points about r
Page 279 and 280: • The Belmont Report has served a
Page 281 and 282: Organizer for Day 2:Harms and Benef
Page 283 and 284: Day 3: Analyzing the Willowbrook Ca
Page 285 and 286: Deciding on and Recording Main Poin
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Letter to ParentsThis is the letter
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What Are the Relevant Ethical Consi
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Name(s)(Fill out with your partner.
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Name(s)(Fill out individually.)Your
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Issues Explored• Should there be
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Key Science Knowledge*• DNA, RNA,
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4. Ask students for their prelimina
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8. Tell students to come to the nex
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Day 2: Deepening Your Thinking—So
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You may wish to note that• Cases
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2. Direct students to turn to their
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Organizer for Day 2: Deepening Your
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Day 3: Making a Recommendation—Se
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Those cases where students do not t
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3. Ask a representative from each g
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Activity 9: Returning to Alba’s C
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1Ear MiceBBC News. 2002. Artificial
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Alba’s CaseSince the early 1990s,
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Dyed FeathersPeople dye bird feathe
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Giant Panda BreedingThe giant panda
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Mad-Cow-Disease CowsMad cow disease
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Purebred DogsHumans have geneticall
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Spider-Silk GoatsSpider silk is str
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VealVeal is meat from calves that i
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Assessing Harms, Benefits, and Pote
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Final Assessment of Alba’s CaseRe
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This curriculum supplementwas devel
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