Bioethics Midterm Flashcards
Types of Deductive Arguments
Valid: affirming the antecedent, denying the consequent.
Invalid: affirming the consequent, denying the antecedent.
Types of Inductive Arguments
Generalization, Analogies, Inference to the best explanation.
Valid - affirming the antecedent
If P, then Q. P. So, Q.
Valid - denying the consequent
If P, then Q. Not Q. Thus, not P.
Invalid - affirming the consequent
If P, then Q. Q. So, P.
Invalid - denying the antecedent
If P, then Q. Not P. So, not Q.
Generalization
making an inference from a sample to a larger population.
How do you determine the strength of a generalization?
Must have a sufficient sample size, a representative sample, and a margin of error (prediction/range).
Analogies
arguments based on similarities. (ex: X has a, b, c, and d. Y has a, b, and c. So, probably Y has d too.)
Analogies - how to determine if argument is strong/weak?
The more relevant similarities are, the stronger the argument. The more relevant differences the weaker the argument.
Inference to the best explanation
The hypothesis that best explains an observation is the most likely cause of that observation.
Criteria - Inference to the best explanation
- scope - the more a hypothesis explains the stronger the hypothesis.
- simplicity - the fewer ad-hoc or when necessary assumptions of a hypothesis the stronger the hypothesis.
Fallacies
Bad arguments that often look good.
Types of fallacies
Straw man, appeal to the person, appeal to ignorance, begging the question, slippery slope.
Straw Man fallacy
distorting your opponent’s argument to attack it more easily.
Appeal to the person fallacy
appeal to the person attacking the person rather than the argument.
Appeal to ignorance fallacy
you can’t prove something is false so it must be true.
Begging the question fallacy
Arguing in a circle. The conclusion is assumed as one of the premises.
Slippery slope fallacy
Claiming a chain reaction will occur when really there is not good reason to believe it will.
General moral principles/theories (13 of them)
Ethics is the law, Golden Rule, Subjective Relativism, Cultural Relativism, Ethics is Religion, the Five Common Principles in Bioethics, Ethical Egoism, Act Utilitarianism, Rule Utilitarianism, Kant, Virtue Ethics, Feminist Ethics, and Natural Law Theory.
Ethics is the law
an act is right if it is legal and wrong if it is illegal.
criticism: many legal acts are immoral, and many illegal acts are moral.
Golden Rule
treat people the way you want to be treated.
advantage: it does require to consider others.
criticism: we should punish people even if we wouldn’t want to be punished. Others often don’t want to be treated as I do.
Subjective Relativism
an act is right for you if you believe it is right.
criticism: if true, then reasons don’t matter. It’s what you believe. If true, then no one could be mistaken in their moral beliefs. If true, then murder would be acceptable if you think it is.
Cultural Relativism
an act is right for you if your culture approves of the act.
advantages: if seems to support tolerance and it would say that individuals could be mistaken in their moral beliefs.
criticism: moral reformers would necessarily be wrong. what is one’s true culture? if true, then cultures could not be mistaken. if true, then reasons don’t matter.
Ethics is Religion
an act is right if God approves of the act and wrong if God disapproves of the action.
advantage: both individuals and cultures could be mistaken.
criticism: what is the right scripture? Does God exist…? If true, then murder would be right if God says to murder. if true, then God’s goodness would be lost.
The Five Common Principles in Bioethics
we should follow the strongest of the following principles.
* autonomy - self-governance (making own decisions)
* non-maleficence - do no harm
* beneficence - help others
* utility - bring overall good
* justice - fair, treating equally
advantage: it has universality. applies everywhere, and does not give the wrong answer.
criticism: it does not give us guidance on what to do when the principles conflict with each other.
Ethical Egoism
an act is right if it is in my self-interest.
criticism: if true, then murder could be right (if it is in my self-interest). other people’s interests matter.
Act Utilitarianism
an act is right if it maximizes overall happiness, everyone considered equally.
advantage: it takes everyone into account. it often gives the right answer.
criticism: it ignores the values of rights and justice. it ignores obligations to friends and family.
Rule Utilitarianism
follow those general rules which will bring about the most overall happiness.
advantage: it seems to overcome the objections to Act utili.
criticism: either there are no exceptions to the rules or there are exceptions & then the theory just ends up being act utilitarianism with all of its problems.
Kant
says it is the intentions that matter & not the consequences of an action. We are moral because we are rational (act from reason). Rational people should be treated with respect.
thinks we should follow the categorical imperative: act only on that maxim(rule) which can become a universal law. or act so as to treat people as an end & never as a means only. Don’t use people.
criticism: there are exceptions to the perfect duties. it is sometimes permissible to treat people as a means only.
Virtue Ethics
looks at what makes a good person (rather than a good act)
criticism: it is often unclear what to do. it does not offer guidance. what a virtuous person would do is often not clear. the virtues can conflict and it is not clear which one should be followed.
Feminist Ethics
the ethics of care.
criticism: we can care too little about some and we can care too much. We need to consider other values/principles than just care.
Natural Law Theory
gender & sexual attraction: some argue that it isn’t “natural” because of own morals but according to one’s moral is different for each person…
the doctrine of double effect
it is permissible (allowed) to intentionally do an act that has a good effect even when there is also a known bad effect that will occur.
criteria: action intended must be moral (good), bad effect must not be used to cause or obtain the good effect, intention must be to only cause the good effect. the bad cannot be intended, bad effect must not be greater in importance than good effect.
criticism: it will allow people to do bad/wrong actions by saying it wasn’t intended, even though they knew that bad effect would occur.
4 models of physician/patient relationships
paternalism, partnership, rational contractor, and the friendship model.
Paternalism
adult-child relationship. physician leads, patient obeys.
criticism: good health is not shared value, patient autonomy is missing.
Partnership
adult/adult model based upon collegiality collaboration & covenant.
criticism: it doesn’t work for all situations, patients sometimes don’t want it and are not rational/informed enough. physician may have to do things the don’t want to do or don’t think are right.
Rational
there is an agreement of an exchange of good & services with government sanctions. physicians don’t have to treat people they don’t want to treat.
criticism: people often don’t rationally pick their doctors. care and benevolence is missing.
Friendship
physician is a special purpose friend. adult/adult with care being central.
criticism: friendships take time and often there isn’t time, it is hard to have a friendship when sick, physicians have a duty to treat even when care or friendship is absent.
Ackerman (support paternalism=support patient autonomy)
Noninterference does not support patient autonomy. Argues: autonomous behavior is self-governance based upon deliberation & reflection. there are many cognitive constraints in a medical setting that interfere with autonomous behavior. so sometimes physicians should intervene to protect a patient’s autonomy.
Ackerman - criticism
Physican could abuse this principle and just force patients to do what they want.
Burt - They were right not to let Cowart die.
Cowart: They should have let him die. They were wrong to intervene.
We should not just follow patient autonomy, we should ensure they are making a good decision.
We have a right to control our bodies.
Newton
argues: nurses are skilled and caring professionals whose role requires sub-services to physicians.
Bad arguments for Newton’s position
- Nurses are ill educated (didn’t get the education needed to be a physician)
- Nurses are understaffed & have lots of red tape (already have enough work/tasks)
Good arguments for Newton’s position
- the urgency and tenseness of the situation does not allow for another autonomous professional.
- The care and compassion that a nurse provides is not compatible with sound judgment.
Kuhse
nurses should be autonomous professionals who are ready to challenge a physician to protect patients. They should be patient advocates.
Replies to Newton to support Kuhse’s arguments:
*often there is time to challenge a physician.
* care and compassion help make better decisions, not worse.
*many cases don’t require a lot of care & compassion.
* physicians may have medical authority, but they don’t have overall authority. patients do & nurses should protect their authority.
- nurses should avoid the doctor/nurse game to have clear communication = don’t directly challenge the doctor, indirectly challenge them.
Standard Proxy Theory
- do what is in the advance directive (plan)
- do what the patient would want
- do what is in the best interest of the patient
What are the two kinds of advance directives?
Proxy directive: says who you want to make decisions for you.
Instructional directive: what you would like done when you can’t make decisions for yourself.
Issues around advance directives
- they are too restrictive (if have Alzheimers -> limited what can choose/do)
- they are too vague (some words/needs can be misunderstood/or just need more info.)
- who should be the proxy? (difficult to decide or proxy is not fit to be a proxy b/c they have different values)
- past vs. present wishes (usually respect present wishes over past but depends on patient directive)
When is it permissible for a medical professional to lie to a patient? - Lipkin
Lipkin: it is permissible to lie to a patient.
* b/c it is impossible to tell the whole truth to the patient
*often patients are badly harmed by being told the truth
* so long as it is done for the good of the patient, not telling the truth or the whole truth is permissible and even required.
When is it permissible for a medical professional to lie to a patient? - Higgs
Higgs: lying is intentionally withholding information or saying something untrue with the intent to mislead.
* knowing the whole truth is difficult, but medical professionals should say “I don’t know” when they don’t know.
* the medical professional does not need to say everything, but enough should be said for a rational person to make a decision.
* most people do want to know their medical conditions.
* telling the truth causes less harm if the telling is done better (w/ care and concern).
Why does a patient have a right to confidentiality?
- It is a legal requirement
- trust and openness results from confidentiality & the medical team can treat the patient better
- confidentiality treats the patient with respect. they have a right to confidentiality.
- confidentiality supports patient autonomy.
Two types of privacy:
- the right to be left alone.
- the right to control information about yourself.
Rachels: why privacy is important
- privacy of info in competitive situations
- privacy protects people from embarrassing situations
- Confidential information can get in the wrong hands
- Privacy is important to build various types of social relationships = TRUST
Criticism: Kant would say people have a right to privacy even if it doesn’t help relationships. (right to privacy b/c person is moral and should be RESPECTED)
Importance of Diversity: why is it important to include people from all backgrounds and identities?
- better for employees:
* most employees prefer to have a diverse workforce.
*employees are more likely to stay.
* employees are encouraged to be themselves rather than fitting in. - it is better for patients:
* patients trust doctors more that look like them.
* better decisions are made in a diverse culture.
* doctors who trained in diverse setting = treat people more equally than physicians who have not (less bias).
How to creat a welcoming environment (to keep a diverse workforce)?
- make all voices feel heard
- address issues of bias quickly & openly
- listen well
- avoid diversity for diversity’s sake. It should be part of the culture and not just done on paper. it is to make a better or more just clinic/hospital.
Informed consent
being informed of possible options & freely choosing on of them.
what supports informed consent?
- autonomy - it is a patient’s choice & information is needed to make a true autonomous choice.
- beneficence & utility - it benefits the patient and brings more overall happiness.
- patients are happier when they are in control.
- Kant- informed consent treats patients with respect. they deserve it as rational beings. it is their body.
What is needed for informed consent?
- the patient needs to be competent (ability, knowledge to do so). when are people sufficiently competent?
- how much information is needed? how much is sufficient? generally, the rational person standard is used.
- is the consent free? do they have time to make a decision? do they feel comfortable asking questions? do patients feel pressured?
Information needed for informed consent
what the procedure or research is
risks
benefits
options
diagnosis & prognosis for your condition
costs/payment
