|The Case of John Moore
Adapted from "John Moore v. The REAGENTS OF THE UNIVERSITY OF CALIFORNIA
et al." Supreme Court of California No. S006987
On October 5, 1976, John Moore made his first visit to UCLA Medical Center
for treatment of his newly diagnosed condition of hairy-cell leukemia.
Upon arrival from his home state of Washington, John Moore met his treating
physician, Dr. David Golde. After multiple tests in which significant
amounts of bodily substances were extracted from Moore, Dr. Golde verified
that Moore had hairy-cell leukemia and had him hospitalized. Little did
Golde know that upon observance he would find a rare type of T-lymphocyte
that produced an abnormally large amount of immune system regulating proteins
called lymphokine proteins in Moore's blood.
On October 8, 1976 Dr. Golde strongly suggested that Moore undergo a splenectomy
in order to remove his oversized diseased spleen to slow the progression
of the cancer. John Moore signed a consent form permitting the operation.
Golde then proceeded to take the formal steps to receive portions of Moore's
spleen for further research purposes. Golde did not, however, inform Moore
that he intended to use portions of his spleen for further research nor
did Golde request Moore's permission for such research. On October 20,
1976, Moore's spleen was removed at UCLA Medical Center.
Following Moore's surgery, Dr. Golde required the Moore return to the
UCLA Medical Center for follow-up care and treatments. These treatments
included further extractions of bodily substances from Moore. Unbeknownst
to Moore, these bodily substances were being used for Dr. Golde's research
purposes rather than for medical tests pertaining to Moore's health. Moore
made multiple visits to the UCLA Medical Center from his home in Seattle
from 1976 until 1983. Dr. Golde also directed Moore to only visit the
UCLA Medical Center for treatment because his follow-up treatments could
only take place there and under his care.
In 1979, Dr. Golde and Shirley Quan, a researcher employed by the University
of California, developed a cell line, a culture of cells that reproduce
perpetually, from Moore's T-lymphocytes called the Mo cell line without
Moore's knowledge. This cell line was commercially important because it
could biologically produce lymphokine proteins at a lower cost than the
synthetically manufactured lymphokine proteins. Dr. Golde and Quan applied
for a patent of the cell line in order to establish and protect their
invention of the MO cell line. They were both awarded the patent on March
20, 1984 with the Reagents of the University of California named as the
assignee of the patent. During the waiting period for the patent, Genetics
Institute approached Dr. Golde and the Reagents in order to gain the privileged
and exclusive access to the MO cell line in exchange for thousands of
shares of its common stocks, high paying salaries and fringe benefits.
The transaction took place and Dr. Golde began to receive payment for
John Moore became suspicious of Dr. Golde's treatment regimen and began
to question him about purposes of his visits to UCLA Medical Center. Moore
even asked whether Dr. Golde was specifically using his bodily substances
for any commercial endeavors. Dr. Golde denied Moore's allegations and
discouraged further questions about possible research results. Moore's
suspicion reached a climax when in September of 1983 he was asked to sign
a consent form that relinquished all of his and his heirs' rights to a
cell line or any other type of product that may be developed from his
blood samples. Although pressured to sign this form, Moore indicated that
he would not give up his rights and proceeded to gain the advice of a
lawyer. The lawyer determined that Dr. Golde and his associate Quan had
recently received a patent on a cell line developed from Moore's blood
samples (2). Moore then took Dr. Golde, Quan, the Regents of the University
of California, Genetics Institute, Inc. and Sandoz Pharmaceuticals Corporation
to court on thirteen different causes of action including conversion,
lack of informed consent and breach of fiduciary duty.
Which party should own the rights to the donated cells?
According to a variety of ethical theories, were Dr. Golde's actions ethically
If Dr. Golde were a deontologist, he would have to determine to whom he
owes his obligations. As a physician, he has a special obligation to his
patient, John Moore. Dr. Golde has pledged to follow professional standards
of medicine, which include respecting a patient's autonomy and prioritizing
the patient's health. According to the facts of the case, Dr. Golde had
been successful in containing Moore's cancer for many years and obtained
Moore's consent to perform research on his spleen. Dr. Golde did not,
however, inform Moore during his follow-up visits to UCLA Medical Center
that the new bodily substance samples taken from him were being used for
further research and not for the sole purpose of determining Moore's status
of health. It appears that Dr. Golde fulfilled his obligations to Moore
except in the case of informing him of his intent to use Moore's bodily
substances for research and financial endeavors.
Dr. Golde has an obligation to his colleagues and society as well. As
a research physician, he has decided to take on the responsibility of
increasing the amount of medical knowledge in the world. It appears then
that Dr. Golde should pursue the creation of the MO cell line because
the cell line's existence will prove beneficial to society to whom he
owes much of his training and own medical knowledge. Dr. Golde must also
follow professional guidelines when collecting tissue samples from Moore.
In this case, Dr. Golde did not appropriately fulfill his obligation to
his patient and colleagues.
Overall, if Dr. Golde were a deontologist, then his duty is to both take
care of his patient to the best of his ability and to pursue the creation
of the special cell line that will benefit society. Dr. Golde fulfilled
all of his obligations to his patient and to society except in the case
of informing his patient, Moore, of his financial and research interests.
Thus Dr. Golde should be held responsible for compensating John Moore
for his perhaps unnecessary visits to UCLA Medical Center and for with
holding pertinent research information.
As an act utilitarian, Dr. Golde deems actions ethically correct as long
as they benefit the most people possible. In the case of John Moore, Dr.
Golde has a greater responsibility to society then to the patient, Moore,
because the creation of the MO cell line will serve the purposes of many
rather than just Moore. Since act utilitarianism does not emphasize the
principle of justice, Dr. Golde should take all necessary actions to create
the cell line regardless of consequences for John Moore. Dr. Golde should,
however, make certain that his actions do not jeopardize the patenting
of the cell line because this may delay society's ability to access the
cell line for therapeutic purposes.
Dr. Golde's first priority as an act utilitarian is to create the MO cell
line so that society will benefit from its medicinal benefits. This means
that Dr. Golde does not have to prioritize Moore's rights unless infringement
of Moore's rights means that the MO cell line will become unavailable
to the public. In the legal case it appears that the patenting of the
MO cell line was not hindered by the fact that Dr. Golde did not inform
Moore of his intentions to use his cells for financial gain. Thus, Dr.
Golde made an ethically correct decision because he was able to create
the cell line and have it patented so that society could access it via
the pharmaceutical company.
If Dr. Golde were a rule utilitarian, then he would pursue his research
because of its benefit to society, but only upon the completion of all
necessary documentation from John Moore. Unlike act utilitarianism, rule
utilitarianism emphasizes the principle of justice.
As a rule utilitarian, Dr. Golde would have most likely informed Moore
of his research and intentions before he actually obtained the spleen
samples. However, the facts of this case state that Dr. Golde did not
inform Moore of his research and intentions to seek financial gain from
such research. Therefore, Dr. Golde was unethical when he refused to inform
Moore of his research purposes and should compensate Moore for his additional
trips to UCLA Medical Center and for with holding pertinent information
required by the patient-physician relationship. Since Dr. Golde obtained
consent to perform research upon Moore's spleen, however, he does have
the right to patent the MO cell line so that society will benefit from
its therapeutic benefits.
A rights advocate believes that the ethically correct choice is the one
that protects a patient's legal rights. If Dr. Golde were a rights advocate,
he would simply follow the law and professional physician standards throughout
his research. He would have probably informed Moore that his extracted
cells could be used for research and financial purposes before he even
started his research. Regardless, Dr. Golde does have the right to patent
intellectual property that he gains from his research because he did in
fact obtain consent from Moore for his initial research. Thus it was ethically
correct for Dr. Golde to patent the MO cell line since he obtained Moore's
consent for research. However, since a physician is required to inform
his patient of any financial gains from additional testing, Dr. Golde
infringed upon Moore's rights and owes him compensation for doing so.
A paternalist is an authoritarian who believes that the ethically correct
decision is the one that has the patient's best interest in mind regardless
of the patient's will. This viewpoint does not take the patient's autonomy
into consideration, but only the choices that are the most beneficent
for the patient and others. If Dr. Golde were a paternalist, he would
disregard Moore's autonomy and continue his research on his tissue with
or without Moore's consent to do so. By creating the MO cell line, Dr.
Golde would be creating the most good for the most people regardless of
Moore's knowledge or consent.
A libertarian is a person who respects and prioritizes a person's autonomy.
In this particular case it is interesting to note that a libertarian could
either agree or disagree with Dr. Golde's method of obtaining Moore's
consent to perform research upon his cells. On one side, a libertarian
could stand by Dr. Golde's actions stating he obtained valid consent from
Moore, including consent to profit from his research, and therefore, had
the right to proceed with the research. Once Moore consented, Dr. Golde
had the right to research, manipulate and patent the MO cell line without
further consent from Moore. On the other hand, however, a libertarian
who prioritizes a patient's autonomy may argue that Moore was in not properly
informed of the possible outcomes of research upon his cells. Therefore,
a libertarian may conclude that Dr. Golde did not thoroughly explain his
research protocol or the possibility that he may profit from his research
to Moore. Thus according to a libertarian, Dr. Golde could also be reprimanded
for with holding pertinent information from Moore.
Although all four of the ethical theories suggest different motives
for patenting the MO cell line, they all concur that Dr. Golde was ethically
correct in doing so. The only ethically controversial issue was whether
or not Dr. Golde should have informed Moore of his possible financial
gains that he may receive upon the completion of his research. A rights,
rule utilitarian and deontologist would have stated that Dr. Golde should
have informed Moore of his financial interests. However, the act utilitarian
and paternalist may disagree with this stance because they believes
that it is ethically correct to take any action that benefits the majority
of people regardless of whether the rights of a single person are disregarded.
The Supreme Court of California made the ultimate decision in the Moore
vs. the Reagents of the University of California et al.
The Supreme Court of California's Decision (1)
The Supreme Court of California concluded that Moore did not have a cause
of action for conversion. The court found that Moore could not claim that
his donated cells were still his property because he had consented to
allow Dr. Golde perform research on samples of his spleen following surgery.
The court also stated that no court had ever "imposed conversion
liability for the use of human cells in medical research" (1). The
Supreme Court of California determined that it would be too great of a
burden upon research physicians to require that they know that each tissue
sample had been obtained via extensive informed consent procedures before
initiating research. If researchers had to obtain this specific information
each time that they collected a tissue sample, their progress would be
The court did find that Moore had not been sufficiently informed of Dr.
Golde's financial interests, which may have affected his treatment of
Moore. Therefore, Dr. Golde would have to compensate Moore for with holding
pertinent information. The four other defendants were not indicted for
"breach of fiduciary duty" because they were not physicians
and did not owe this special obligation to Moore. The rest of Moore's
causes of actions were demurred.
The Supreme Court of California decided the case as predicted by the analysis
of the four ethical theories. John Moore should have been informed of
Dr. Golde's intent to use Moore's additional bodily substance samples
for research and financial gains. However, Moore did not have the right
to claim that his donated cells were still his property once he signed
the informed consent form allowing Dr. Golde to perform research.
This entire case may have been averted had the informed consent been facilitated
appropriately and perhaps with a few additional clauses. For instance,
if the original informed consent form contained a clause clearly stating
that the patient donating the material could not benefit from the intellectual
property rights gained from the research upon their respective tissue
sample, then John Moore would have never claimed conversion as a cause
of action (3). Instead he would have known that he was donating his tissue
freely and for the pure purpose of furthering science. Moore would have
no basis to claim ownership of his donated cells.
It would have also been beneficial to Moore had he known the specific
nature of the research of his spleen tissue and of the continuation of
the research (3). Had he known that Dr. Golde was specifically looking
for cells that bolstered the immune system to help other patients, Moore
might have been more confident in Dr. Golde's research. If Dr. Golde desired
to further research concerning Moore's tissue, then he should have respected
Moore's autonomy and requested further consent to obtain new tissue samples
in order to continue his research.
In John Moore vs. The Reagents of the University of California, Dr. Golde
abused the physician-patient relationship in order to obtain scholarly
and financial benefits. He did have the right to claim intellectual property
rights for his invention of the MO cell line, but should have maintained
the integrity of the scientific research process while collecting his
data. This case highlights the necessity of applicable ethical theories
in scientific research. Scientific research must always be intertwined
with ethics in order to preserve the honesty of the collected data that
drives scientific breakthroughs and to protect the test subjects who provide
the most valuable and vulnerable resource available, themselves.
1. "John Moore, Plaintiff and Appellant, v. THE REAGENTS OF THE
UNIVERSITY OF CALIFORNIA et al., Defendants and Respondents." LEXIS-NEXIS:
Academic Universe. 51 Cal. 3d 120. Supreme Court of California No. S006987.
(July 9, 1990): 52 pp. Online. Internet. Accessed April 27, 2002. http://www.web.lexis-nexis.com
2. Stone, Adam. "The Strange Case of John Moore and the Splendid
Stolen Spleen." University of California, Berkeley. (1996): 28 pp.
Online. Internet. Accessed April 27, 2002. http://socrates.berkeley.edu/~astone/research.html
3. Johnstone, Eve et al. "Human tissue and biological samples
for use in research." Medical Research Council. (April 2001): 37
pp. Online. Internet. Accessed May 2, 2002. http://www.mrc.ac.uk/pdf-tissue_guide_fin.pdf