BCMH 1: Introduction to Bioethics & Ethical Theory (1)

Question 1

What are some of the type of questions that bioethics deals with? (5)

Answer 1

• Is it morally acceptable to give a terminal patient, who is in terrible pain a drug that will control the pain, but might also lead to death?
• Should a doctor, who is meant to preserve life, respect the wishes of a patient who refuses treatment that could save his/her life?
• Should a pharmacist dispense the morning after pill to a 12 year old?
• SA law allows women in the first trimester the right to terminate a
  pregnancy. Should HCP be allowed to refuse to perform abortions?
• Is it ethically justified for the State to require parents to vaccinate their children against MMR?

Question 2

What is Bioethics?

Answer 2

Bioethics is the exploration of moral and ethical questions surrounding life, health, science, medicine, and the environment.

Question 3

What disciplines does Bioethics encompass?

Answer 3

Bioethics encompasses philosophy, ethics, practical/applied ethics, and various fields related to life sciences, medicine, and environmental studies.

Question 4

What is the origin of the term philosophy?

Answer 4

Origin: two Greek words meaning “love of wisdom”

Question 5

What are the fundamental questions philosophy is concerned with?

Answer 5

• Philosophy is concerned with fundamental questions
  – Related to knowledge, existence, reason, values, morals, the mind, language, etc.

Question 6

• Examples of the kind of questions philosophy grapples with: (4)

Answer 6

– What is truth?
– Can we prove or disprove the existence of God?
– How can we tell good and bad logical arguments apart?
– What is the value of art?

Question 7

What are the foundational elements of philosophy?

Answer 7

Critical thinking and logical argumentation form the foundation of all philosophy.

Question 8

How does philosophy examine reality?

Answer 8

Philosophy uses rational inquiry to critically examine reality.

Question 9

Why is it necessary to justify beliefs and assumptions in philosophy?

Answer 9

Beliefs and assumptions need to be justified and explained logically and systematically in philosophy.

Question 10

What is the significance of defining important concepts in philosophy?

Answer 10

Important concepts in philosophy are clearly defined to facilitate understanding and discussion.

Question 11

How does philosophy engage with important questions?

Answer 11

Philosophy engages with important questions through debate, dialogue, and engagement with other points of view.

Question 12

What activities are intrinsic to philosophy regarding arguments?

Answer 12

Philosophy involves developing and articulating good and rigorous arguments, as well as the analysis and criticism of counter-arguments.

Question 13

What is a deductive argument?

Answer 13

A deductive argument consists of a conclusion and premises meant to provide reasons for believing the conclusion.

Question 14

Define validity in the context of deductive arguments.

Answer 14

An argument is valid if the conclusion could not be false if we assume the premises to be true.

Question 15

Define soundness in the context of deductive arguments.

Answer 15

An argument is sound if it is valid and all of the premises are true.

Question 16

Assess the deductive argument: Premise 1: Cats are mammals, Premise 2: All mammals are egg-laying animals, Conclusion: Cats lay eggs. Is it valid?

Answer 16

An argument is valid if the conclusion could not be false if we assume the premises to be true. (Premise 2 is a false premise)

Question 17

Assess the deductive argument: Premise 1: Cats are mammals, Premise 2: All mammals are egg-laying animals, Conclusion: Cats lay eggs. Is it sound?

Answer 17

An argument is sound if it is valid and all of the premises are true. (Premise 2 is a false premise)

Question 18

What is wrong with these arguments?

• That doctor is constantly cheating on his wife and does not take care of his own children. So, you shouldn’t take his views on health policy
  seriously.

Answer 18

• Ad Hominem fallacy (attack on the person)

Question 19

What is wrong with these arguments?

• Many professors of anatomy claim that testing medication on animals is morally acceptable. Given the expertise of these people, we should accept that such testing is, in fact, acceptable.

Answer 19

• Irrelevant appeal to authority fallacy

Question 20

What is wrong with these arguments?

• No-one has disproved the link between the MMR vaccine and increased incidence in autism. Responsible parents should refuse to have their children vaccinated for MMR.

Answer 20

Argument from ignorance

Question 21

What is wrong with these arguments?

• Pro-choice activists are murderers. Because their heartless & godless views have the upper hand, genocide is being committed against millions of innocents who are mutilated, poisoned & slaughtered in abortion clinics around the world.

Answer 21

• False appeal to emotion fallacy

Question 22

What is wrong with these arguments?

• Either global warming is a natural phenomenon, or it is caused by human activity. All the scientific evidence we have shows that the burning of fossil fuels is not responsible for increased temperatures. So global warming must be natural.

Answer 22

• False dilemma fallacy
  ◦ Fallacy of the missing middle
  ‣ Lots of other factors play a role

Question 23

What is ethics?

Answer 23

Ethics is a branch of philosophy concerned with questions of morality, including concepts of right and wrong, good and bad, virtue, justice, and values.

Question 24

How is ethics characterized by the questions it asks?

Answer 24

Ethics is characterized by the kinds of questions it asks about morality, virtue, justice, and values.

Question 25

How does ethics approach moral questions?

Answer 25

Ethics grapples with fundamental, theoretical, and applied moral questions using the same methods as other branches of philosophy.

Question 26

What fundamental questions does ethics ask about morality?

Answer 26

Ethics asks fundamental questions such as: Is it meaningful to talk about morality? Do we have free will? Is what is right relative to one’s culture? Is ethics merely personal opinion? This area is known as Metaethics.

Question 27

What theoretical questions does ethics ask about morality?

Answer 27

Ethics asks theoretical questions like: On what basis can we decide what conduct is right or wrong? Is the right action determined by consequences or by respect for persons? Are moral questions best resolved in terms of human rights? This area is known as Ethical Theory.

Question 28

What practical/applied questions does ethics ask about morality?

Answer 28

Ethics asks practical questions such as: Is abortion wrong? Should physician-assisted dying be legal? Is it ethical to share confidential patient information via WhatsApp? Was SA’s pandemic tobacco sale ban justified? These questions apply normative ethical theories practically and fall under Applied/Practical Ethics.

Question 29

What is the nature of bioethics?

Answer 29

Bioethics is a type of practical/applied ethics.

Question 30

How long has medical ethics existed?

Answer 30

Medical ethics has existed for centuries in some form.

Question 31

Why have people historically grappled with ethical issues in medicine?

Answer 31

People have historically struggled with ethical issues in medicine due to the nature of healthcare, which deals with matters of life and death, illness and wellness, bodily integrity, etc.

Question 32

Why are ethical considerations always relevant in healthcare?

Answer 32

Ethical considerations are always relevant in healthcare because medicine deals with matters of life and death, illness and wellness, bodily integrity, etc. There are always ethical issues related to these aspects.

Question 33

How long has the importance of ethics been acknowledged in healthcare?

Answer 33

Almost for as long as there have been any kind of healthcare practitioners, there has been acknowledgment of the importance of ethics.

Question 34

By mid-20th Century there was already an emphasis on: (4)

Answer 34

• the need for ethical practices in the health care professions
• the principles of non-maleficence (do no harm) & benevolence (do good)
• the need to respect privacy; uphold confidentiality
• The need to respect professional boundaries

Question 35

What historical events and trends led to the emergence of bioethics?

Answer 35

The confluence of significant historical events, social trends, and medical advances, especially in the decades after WWII, brought the ethical challenges associated with healthcare to the attention of the world. This eventually led to the establishment of a new academic field known as bioethics.

Question 36

What contributed to the exponential growth of medical ethics in the 1960s-1970s?

Answer 36

Medical ethics experienced exponential growth during the 1960s-1970s, becoming a sub-discipline known as ‘biomedical’ ethics and then ‘bioethics’, broadening its scope.

Question 37

What event triggered the growth of medical ethics?

Answer 37

The Nuremberg Doctors Trial of 1946-7 played a significant role. It involved 23 doctors, administrators, and others charged with crimes against humanity for experiments and procedures performed on prisoners and civilians by Nazis.

Question 38

What was the outcome of the Nuremberg Doctors Trial?

Answer 38

The trial resulted in an international realization that there needed to be ethical standards for medical experiments using human subjects. It led to the creation of one of the first human rights documents: The Nuremberg Code, which outlined principles including voluntary consent, absence of coercion, properly formulated scientific experiments, and beneficence.

Question 39

What was the Tuskegee Institute’s Syphilis Study?

Answer 39

The Tuskegee Institute’s Syphilis Study was conducted by the Public Health Service in the USA between 1932 and 1972. It involved 600 mainly poor black American men, 399 of whom already had syphilis.

Question 40

What was the aim of the Tuskegee Institute’s Syphilis Study?

Answer 40

The aim of the study was to observe the natural development of syphilis in black men who were left untreated.

Question 41

How were participants misled in the Tuskegee Institute’s Syphilis Study?

Answer 41

Participants were told they were being treated for “bad blood” rather than being informed about their actual diagnosis of syphilis.

Question 42

When was penicillin validated as an effective cure for syphilis, and what happened with the study after that?

Answer 42

Penicillin was validated as an effective cure for syphilis in 1947. However, the study continued even after this discovery.

Question 43

How did the Tuskegee Institute’s Syphilis Study come to an end?

Answer 43

The study was terminated only after the situation was reported in the media in 1972.

Question 44

What were some of the consequences of the Tuskegee Institute’s Syphilis Study?

Answer 44

As a result of the study, 28 participants died of syphilis and more than 100 suffered from related ailments. Additionally, 40 wives were infected, and 19 children were born with congenital syphilis.

Question 45

What did the Tuskegee Institute’s Syphilis Study lead to? (2)

Answer 45

• Led to the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research in 1976
• Guidelines were drawn up & published in 1979 in what has become known as the Belmont Report

Question 46

What are the 3 main principles of the Belmont Report?

Answer 46

– Respect for persons (grounds need for consent)
– Beneficence
– Justice

Question 47

• So, one reason for the development of bioethics related to concerns about the need for more _______ treatment of human subjects in medical experiments –
• But there were other clinical cases and _______ developments that also contributed to interest in bioethics

Answer 47

ethical
technological

Question 48

Who was Karen Anne Quinlan?

Answer 48

Karen Anne Quinlan was a 21-year-old who collapsed and went into a coma in 1975, suffering brain damage due to extended respiratory failure.

Question 49

What was Karen Anne Quinlan’s medical condition?

Answer 49

Karen Anne Quinlan remained in a persistent vegetative state after suffering brain damage from extended respiratory failure. She was kept alive with a respirator and tube feeding.

Question 50

What legal and ethical challenges did Karen Anne Quinlan’s family face?

Answer 50

Karen Anne Quinlan’s family faced threats of being charged with murder when they requested to remove her from the respirator. The hospital helped them obtain a protection order from the courts.

Question 51

How did the legal case regarding Karen Anne Quinlan conclude?

Answer 51

In 1976, the New Jersey Supreme Court ruled in favor of Karen Anne Quinlan’s family, allowing her to be removed from the machines. She lived in a persistent vegetative state until 1985.

Question 52

What ethical questions did the Quinlan case raise?

Answer 52

The Quinlan case raised ethical questions about the distinction between ‘ordinary’ and ‘extraordinary’ measures to preserve life, and it highlighted how advances in medical technology give rise to new ethical dilemmas.

Question 53

What impact did the Quinlan case have on medical ethics?

Answer 53

The Quinlan case led to a review of the definition of death, with “brain death” becoming more commonly used instead of “irreversible cessation of circulatory and respiratory functioning.”

Question 54

Advances in medical knowledge, practice & healthcare technology in the last 100 years have created new moral questions: (8)

Answer 54

Question 55

• These factors combined to create interest in ethical issues related to medicine, life & death, health, the responsibilities of doctors, etc
• So, bioethics grew into a very important field of practical _____
• One of the tasks of this field was to try to provide theoretical grounds for how to act morally – turned to _____.

Answer 55

ethics
Philosophy

Question 56

What is missing in each argument?

Answer 56

Question 57

What is necessary for an argument that makes value-based claims about how we ought to act?

Answer 57

Such arguments MUST rely on at least one premise that describes the moral value being relied on.

Question 58

How does the moral value premise function in value-based arguments?

Answer 58

The moral value premise serves as a logical bridge between claims about what “is” the case (facts) and a conclusion about what “ought” to be the case (value claims).

Question 59

What is David Hume’s “is/ought” problem?

Answer 59

David Hume’s “is/ought” problem states that we cannot derive a conclusion about what ought to be from premises about what is.

Question 60

Why do all applied ethics arguments require a transitional premise?

Answer 60

All applied ethics arguments need a transitional premise that describes the moral value because it addresses David Hume’s “is/ought” problem and establishes the basis for value-based claims in ethical arguments.

Question 61

What are examples of moral value premises in abortion arguments? 3)

Answer 61

• We should always act in a way that results in the best overall consequences for those affected.
• It is unethical to prevent others from exercising their rights.
• It is wrong not to always act in accordance with God’s laws.

Question 62

What are some additional moral value premises? (3)

Answer 62

• We should respect the considered choices of autonomous patients.
• We are entitled to protect ourselves, even if it entails force.
• Doctors should prioritize the interests of their patients.

Question 63

What is the purpose of moral theories?

Answer 63

Moral theories seek to provide a single moral value premise that enables us to decide what is right and wrong in all situations. This premise is often referred to as a “theory of right action.”

Question 64

What is one of the most important theoretical questions in ethics?

Answer 64

One of the most important theoretical questions in ethics is: How do we decide what is the morally right thing to do in any situation?

Question 65

What is the goal when addressing the theoretical question in ethics?

Answer 65

The goal is to develop a theory of right action that can provide the basis for determining whether any and all actions are morally right or wrong.

Question 66

What is Divine Command Theory?

Answer 66

Divine Command Theory posits that we should act in accordance with God’s commands. However, this theory may not be practical in a professional context of religious pluralism as it requires prior faith commitments.

Question 67

Why might Divine Command Theory not be suitable in certain contexts?

Answer 67

Divine Command Theory may not be suitable in contexts of religious pluralism because it relies on prior faith commitments.

Question 68

What are the two most influential types of moral theories of right action?

Answer 68

The two most influential types of moral theories of right action are utilitarianism and duty-based (deontology) theories.

Question 69

What is utilitarianism?

Answer 69

Utilitarianism is a type of consequentialism where an action is morally right if the likely consequences of that action are, on aggregate, more positive than negative for all affected. Positivity is measured in terms of pleasure, happiness, well-being, or preference satisfaction.

Question 70

What are duty theories in deontology?

Answer 70

Duty theories in deontology propose that there are certain actions that we have a duty to perform or refrain from performing. Keeping promises is such a duty, as is refraining from lying, killing, or stealing.

Question 71

What is the principle of universalizability in deontology?

Answer 71

The principle of universalizability states that if everybody decided to break their promises to suit themselves, no one would ever believe promises that are made. Contracts would be meaningless. Therefore, for instance, nobody would extend credit to anyone else.

Question 72

The Organ Donor Thought Experiment

Utilitarianism: (3)

Answer 72

• Cannot account for why this act would be wrong
• Lives are seemingly exchangeable
• End justifies means

Question 73

The Organ Donor Thought Experiment

Duty theories (deontology): (4)

Answer 73

• We cannot treat persons just as means to our own ends, we need to respect their inherent value (how you get to the consequence also matters)
• Boils down to ‘respect for persons’
• No life can replace another
• No just ends without just means

Question 74

What is Utilitarianism?

Answer 74

Utilitarianism is a theory of right action where an action is morally right if the likely consequences of that action are, on aggregate, more positive than negative for all affected.

Question 75

How does Utilitarianism assess the morality of an action?

Answer 75

Utilitarianism requires a calculation of all the good consequences minus all the bad consequences of an action for all affected individuals.

Question 76

What challenges does Utilitarianism face?

Answer 76

Utilitarianism faces challenges such as predicting consequences, ensuring consideration of all consequences, and allocating values to different consequences.

Question 77

How does rule utilitarianism address some of the problems of traditional utilitarianism?

Answer 77

Rule utilitarianism, or practice utilitarianism, tests more general moral rules or practices against the requirement of achieving the greatest good for the greatest number.

Question 78

Give examples of rules in rule utilitarianism.

Answer 78

Examples of rules in rule utilitarianism include: “We should generally keep our promises” and “Innocent people should not be framed for crimes they did not commit in order to appease the public’s desire for justice to be served.”

Question 79

What is Deontology?

Answer 79

Deontology is a theory of right action where actions that are morally right are those that we have a duty to perform or refrain from performing.

Question 80

How do we determine what rules or duties are in Deontology? (3)

Answer 80

• Common morality suggests that there are moral duties agreed upon by most people worldwide, such as not lying, cheating, stealing, or killing.
• Universalizability requires that these duties or rules apply to everyone equally.
• Immanuel Kant proposed the Categorical Imperative as the key to moral duties, which dictates treating others as ends in themselves and not merely as means.

Question 81

What are the problems with Deontology? (2)

Answer 81

• Deontology can seem rigid and dogmatic, unable to consider consequences (e.g., Kant’s stance on lying to save a life).
• It may appear cold and lacking in compassion, advocating for duty even when it’s unpleasant or challenging.

Question 82

What has dominated Normative Ethics in terms of rival theories?

Answer 82

Normative Ethics has been dominated by two rival theories: Duty-Based (Deontology) and Utilitarian (Consequentialist) theories, but there are other perspectives as well.