Sought After Cells

Created by Catherine Rainbow for an undergraduate course at Davidson College.
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 his invention.

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 correct?

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.

Act Utilitarianism
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.

Rule Utilitarian
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 significantly reduced.

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.

Resources Cited

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.

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.

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.

© Copyright 2002 Department of Biology, Davidson College, Davidson, NC 28035
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