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Ethics Final Flashcards

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1
Q

what is the principle of double effect

A

there is an action and there is a good effect and a bad effect

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2
Q

applications of the rule of double effect (RDE) aka when is it okay

A

self defense:
-defensive homicides
-intension is defense
Military settings:
strategic bombing
-civilian casualties
-Sacrificing life for others
Medicine:
-terminal sedation
-complications
adverse drug reactions
-loss of pregnancy
-medical aid in dying

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3
Q

what is the rule of double effect

A

-systemic way of assessing complex real life problems that have a good intended effect and a bad foreseen unintended and unavoidable effect that may be permissible
-this system is a stepwise fashion

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4
Q

what are the steps of the principle of double effect

A
  1. Action (object must be good or morally indifferent)
  2. Intention must be for the good effect not the bad effect
  3. the bad (evil) must not be the means to the good effect
  4. proportionality- the goo gained must outweigh or be equal to the bad effect each life is equal
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5
Q

describe the action of the evaluation of the principle of double effect/ rule of double effect (step 1)

A

-aka the object
-the system starts here (step 1)
-make sure to label the action properly
-if this is wrong everything else is wrong
-describe the action in a way that is attentive to the specific situation
-what am i doing? what do others think I’m doing?
-dont use morally loaded language, and no morally loaded labels

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6
Q

describe the intention of the of the evaluation of principle of double effect/ rule of double effect (step 2)

A

-step 2
-why does the person want to do the action
-there are immediate, further (intermediate) and ultimate intentions
-some intentions are very good and others are very bad
-these must all be included in the discussion at this point
-if you leave critical good or bad intentions out you will arrive at a wrong answer
-you have to have the intent of a good effect

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7
Q

describe the circumstances of the evaluation of principle of double effect/ rule of double effect(step 3)

A

-this is step 3
-relevant factors that surround the action (object) and impact the morality of the action (object)
-you have to talk about all the relevant information of the setting in which the action (object) took place
-the action that you take in one setting has to be totally moral but immoral in another setting

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8
Q

what is the distinction between means and effects

A

-the bad effect must not be a means to the good effect
-if the bad effect directly causes the good effect the agent would have intended the bad effect in pursuit of the good effect

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9
Q

what is the proportionality between the good effect and the bad effect

A

-the bad effect is permissible only if the proportionate reason compensates for permitting the foreseen, tolerable bad effect

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10
Q

what is Physician assisted death (PAS, MAID)

A

Physician provides the lethal drug with instructions for use but is not the agent. Patient is the agent who gets drug, decides time and place. Patient is the direct agent.

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11
Q

what do we need to know from Arras for the final

A
  1. keep an open mind and entertain a thought without necessarily accepting it
  2. legal rulings:
    -liberty (privacy)
    -equal protection
    -withdrawal of care is not the same as PAS/ Euthanasia
  3. For PAS:
    -autonomy
    -merciful act
    -depression and hopelessness
    Against PAS:
    -immoral
    -physician conflict
    -slippery slope (limits for children/ infants)?
    -AD for PAS/ euthanasia
    Abuse:
    -policy regulations, equity issues, obstacles
    -voluntary (insurance telling patient that they have to let the cancer run its course in order to cover treatment)
    vulnerable(poor/ minorities)
    -reporting/oversite
    -conflict of interest: managed care, capitation, incentives, government funding, families
  4. Policy: legislation is better than backward judicial case approach
    -morality of individual acts v. wisdom of public policy
    -dismissal of social consequence: PAS/ euthanasia- rights (could be seen as passive euthanasia, bc only the patient can do it but the doctor is enabling it)
    -who determines if life ends is more importnat than who ends life
    Equal protection:
    -withholding care is same as doing
    -extension of surrogates, AD’s
    -AND allowing natural death v PAS (is the intention the same)
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12
Q

what is WLST

A

withdrawal of life sustaining therapy
-if the patient has the ability to make decisions, fully understands the consequences of their decision, and states they no longer want a treatment, it is justifiable to withdraw the treatment.

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13
Q

when is withdrawal of treatment justifiable

A

-if the treatment no longer offers benefit to the patient. (have in mind short term goal)
-Pt has valid AD that fits the situation, or a surrogate/proxy acting in good faith with consent of EC

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14
Q

what are the 2 ways you can be declared dead in the U.S? Why the change?

A

-cardiopulmonary and whole brain death
-can keep people alive
-need for organ
-legal issues
-estate/ inheritance issues

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15
Q

-the 3 components of futility that are in trotters article

A

-a goal
-an action to achieve the goal
-virtual certainty goal will not be achieved

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16
Q

the important elements in the Baby does cases

A

-there were two baby does
Baby Doe 1: resulted in the baby doe rules
-Baby Doe rules
-Baby Doe Squads
-Sinage (laws) in the NICU about discrimination

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17
Q

Describe Minor Decision Making

A

-designates a mature minor so they can make independent medical decisions
-marriage
-mature minor doctrine
-emancipation
-armed services duty

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18
Q

what is the principle that is the most important consideration in pediatric decision making

A

-best interest

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19
Q

What argument was not used in Robert George’s paper “Embryo ethics”

A

-ensoulment
-this is the moment in time in which soul enters the body

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20
Q

what are the 4 arguments used in Robert George’s paper “Embryo ethics”

A

-not a different kind-Human DNA
-genetically new, distinct organism
-initial growth directed from within-this is the 14 day rule
-the 14 day rule means that we can grow embryos in lab for 14 days
-active disposition- develops many different structures

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21
Q

Describe Judith Thompsons defense on abortion

A

-having a right to life does not give a right to use another persons body

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22
Q

Organs procurement is causing the death of patients, true or false and why or why not

A

-false
-the first rule is that the donor must be dead before nay organ is retrieved

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23
Q

Is it okay for catholic married coupes to use contraceptives to prevent pregnancy

A

false
-this is an ERD

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24
Q

Is it true or false that active euthanasia is legal in any state and is it true or false that physician assisted suicide is active euthanasia

A

-false for both
-PAS might be passive for the doctor by active for the patient bc they have to pick up the prescription and prepare it

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25
Q

True or false: PVS is defined as whole brain death

A

-false
-bc the brainstem is still working

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26
Q

baby squads came about due to the death of which baby?

A

Baby Doe 1

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27
Q

give the details about why the baby squads came about

A

-baby doe 1
-April 9, 1982 in Bloomington, IN
-down syndrome with tracheoespohseal fistula
-the family was told that the baby had 50% chance of surviving surgical repair
-not a very good prognosis for future function
-family decides not to treat
-family physician and pediatrician disagree
-the case was filed as neglect under the Indiana child in need services statute
-the lower courts sided with the parents and the Indiana supreme court doesn’t want anything to do with it
-infant died before supreme court case
C. Evverett Coop was surgeon that had fixed this problem before and he said the baby had greater chance than 50% he said the choice was based on discrimination and Reagan were incensed

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28
Q

What was the decision to forego Baby Doe #1’s treatment based on

A

-discrimination due to the fear of future disability
-Reagan Administration rules under See 504 of Rehabilitation Act 1973
-Sinage in NICU’s Hotline # and baby does squads (regulations)
‘discriminatory failure to feed and care for handicapped infants in the facility is prohibited by federal law’ Janurary 1984

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29
Q

Who was Baby Doe #2

A

-Keri- Lynn was born on October 11, 1983 with Spina Bifida, hydrocephalus, kidney damage and microcephaly (small head)
-stony brook medical center
-Lawrence Washburn, Vermont, files suit
-1986 US Supreme Court: Bowmen V AHA struck down first rules (privacy and parental autonomy using ‘best interest’ and autonomy of states)
-On June 1, 1985 Baby Doe Amendment is law and it is still in effect
-1988 Revision of Child Abuse Prevention and treatment Act (CAPTA)

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30
Q

what is the importance of Baby K

A

-October 13, 1992, Stephanie Keene born at Fairfax Hospital, Washington, D.C.
-Anencephaly (only had midbrain and was never going to wake up) (baby also has resp problems)
-Mother refused abortion on religious grounds.
-Mother insisted everything must be done!
-Tx to SNF at 6 weeks, off vent, Full Core.
-Multiple re-admits for respiratory distress and apnea.
-Tracheostomy at 3rd admission, 6 mos old.
-Hospital must treat based on EMTALA (emergency medical treatment and active labor act) , Rehabilitation act 1973, ADA
-Treatment of respiratory distress and apnea. Anencephaly not the issue.
-Baby K died April 1995, 2.5 yrs of age.

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31
Q

what is double effect

A

-Rule used to justify withholding/withdrawal of artificial nutrition and hydration or any other LST.
-Right to refuse care. Nonbeneficial or burdensome
-Not “Double Effect.”
-WLST is Not PAS or euthanasia (its allows choices to be made by the patient or family, that care is overly burdensome and futile)

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32
Q

What are the 2 arguments used to justify PAS

A

-Autonomy
-Relief of suffering

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33
Q

What are the 3 argument against PAS

A

-Immoral killing of innocent people
-Conflict of interest (physicians have to make ppl get better)
-Slippery slope liberalization of practice

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34
Q

what are the 3 criteria for death

A

Psychological criterion: State of unconsciousness: body and mind are no longer an active functional unity.
Biological criterion: State of widespread, non-function across organ systems. Cardiorespiratory and nervous system shutdown.
Irreversible criterion: States become irreversible within minutes (5 -10) due to necrosis of key organ systems.

35
Q

Describe baby ethics

A

3 Baby Doe exceptions to giving treatment to newborn infant. (these still exist in the law)

-Permanent unconsciousness
-Futile treatment
-Virtually futile treatment causing inhumane burdens

36
Q

what are the 4 elements of the RDE must be followed in order to determine if an action is morally permissible?

A
  1. The object (action) must be morally good or at least neutral.
  2. The bad effect must not be intended.
  3. The good effect cannot be the result of the bad effect.
  4. The good effect is proportional (outweighs or =) to the bad effect.
  5. WLST does not need, RDE Refusal of care
  6. WLST is NOT Euthanasia or PAS
37
Q

what are neurologic conditions

A

-Condition where patients have some awareness which may be intermittent or limited.
-Minimally conscious state, impaired but they can interact by moaning and doing purposeful, things, extremely disabled
-Severe brain injury resulting in permanent unconsciousness with sleep-wake cycles.
-PVS (Unresponsive wakefulness syndrome)

38
Q

Describe organ donation and what is felt in be a reason for change in the definition of death (the laws)

A

-Organ procurement
-Criminal law, Tort law, Estate law, Life Insurance claims.

39
Q

what is palliative care

A

-Use of escalating doses of medications to relieve pain and suffering at end of life, even though it may hasten death.
-Palliative (terminal) sedation
-Explain how RDE justifies.
-Action is control of pain(using reasonable doses to relive pain)
-Intention is relief of suffering not killing the patient. Death of pt is not means of relieving pain. The relief of suffering is a good act even if medications hasten death.

40
Q

Landmark case used to justify Hysterectomy not as abortion but as permissible?

A
  1. Hysterectomy is morally neutral procedure when used for uterine cancer.
  2. Intention is to treat cancer, not terminate pregnancy.
  3. Death of fetus does not cure the uterine cancer.
  4. Mother’s life saved is equal to unfortunate foreseen and permittable loss of fetus
41
Q

What is physician assisted suicide

A

-this is also known as PAS
-this is when the physician writes the prescription and provides instructions for how the patient should prepare the medicine that will kill them
-the patient has to do it themselves and cant be in the hospital while they take the meds
-also known as Medical Assistance in Dying (MAID)

42
Q

what is euthanasia

A

-physician participates in the intentional deliberate act to cause the immediate death of a person with a terminal incurable or painful disease by the medical administration of a lethal drug (active)
-this is illegal in the U.S.

43
Q

when does RDE apply

A

-in cases where it is nonbeneficial treatment is withdrawn or withheld
-patients have the right to refuse treatment that they feel are nonbeneficial or burdensome
-the catholic church does not support vitalism
-there is a nonbeneficial care policy at each hospital

44
Q

What is WLST and when is justifiable to discontinue life sustaining treatment

A

-withdraw or withhold life-sustaining treatments
-if the patient has the ability to make decision, fully understands the consequences of their decision, and states they no longer want to a treatment
-if the treatment no longer provides a benefit to the patient
-patient has a valid advanced directive, that fits the situation or a surrogate/ proxy acting in good faith with consent of EC

45
Q

Tell me about Phyllis Smith

A

-a 79 year old woman in failing health
-she is admitted with abdominal carcinomatosis
-has a pacemaker that has kept her alive for 29 yrs
-has been in declining health for 3 years
-wants to turn off her pacemaker
-has DMC
-RDE did no apply

46
Q

Do different standards apply to withholding or withdrawing care

A

-many clinicians feel that it is easier to withhold a treatment such as mechanical ventilation than to withdraw it
-legally it is equally justifiable

47
Q

what is vitalism and what is the church’s view on it

A

-preserving physical life at all
costs but rather asks us to embrace the virtues of fidelity (faithfulness to those in need), compassion (suffering with those who are suffering), and individual dignity

48
Q

what is considered obligatory by the church

A
  • Food and water
    -whether by mouth or by artificial means—are considered obligatory unless a person is imminently dying
    -However, the use of other technology may be optional depending on whether the means (treatments) are “ordinary” or “extraordinary.
49
Q

what is ERD 56 (preserving life)

A

-A person has a moral obligation to use ordinary or proportionate means of preserving his or her life
-Proportionate means are those that in the judgment of the patient offer a reasonable benefit and do not entail an excessive burden or impose excessive expense on the family or the community

50
Q

what is ERD 57 (think of your case, key word is disproportionate)

A

-A person may forgo extraordinary or disproportionate means of preserving life
-Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden or impose excessive expense on the family or the community

51
Q

ERD 58 (hint food and water)

A

-there is an obligation to provide patients with food and water
-providing medically assisted nutrition and hydration for those who cannot take food orally
-obligation extends to patients in chronic and presumably irreversible conditions (“PVS”) who can reasonably be expected to live indefinitely if given such care
-Medically assisted nutrition and hydration become optional when they cannot reasonably be expected to prolong life or when they would be “excessively
burdensome for the patient or would case significant physical discomfort, for example
resulting from complications in the means employed.”
-as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.

52
Q

ERD 59

A

The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching

53
Q

ERD 60 (euthanasia)

A

-Euthanasia is an action or omission that of itself or by intention causes death in order to alleviate suffering Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way
-Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that
they can live with dignity until the time of natural death

54
Q

What is life

A

-“the quality that distinguishes a vital and functional being from a dead body.”
-“an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction.”
-“the sequence of physical and mental experiences that make up the existence of an individual.”

55
Q

what is resuscitation

A

Restoring organ function as well as the mind-body relationship

56
Q

what are loss of key functions

A

Biologic: nervous, respiratory, and circulatory.
Psychological: consciousness, ability to interact with surroundings and people

57
Q

Describe organ retrieval

A

Not based on brain-death or DDR
Utilitarian concept:
-Nonmaleficence
-Respect for autonomy
-Respect for human dignity

58
Q

what are the problems with brain death

A

-Confuses a prognosis with a diagnosis.
-Based on permanent unconsciousness.
-PVS?
-Loss of functioning of the person “as a whole.”
-Alan Shewmon
-Societal consensus on definition of death.

59
Q

what is Neurorespiratory criteria

A

brain injury leading to permanent loss of the capacity for consciousness, the ability to breathe spontaneously, and brainstem reflexes

60
Q

what physical examination has to be done to look for brain death

A

-Profound coma – “eyes-closed unconsciousness”
-Radiographic findings explain brain injury – critical brain injury
-No eye movement (doll’s eye); no pupillary response
-No corneal reflexes
-No cough or gag reflex; no motor response to pain
-Apnea test – failed
-Ancillary testing if needed:
-Brain scan, angiogram, EEG, MRI, CT angiogram

61
Q

Describe donation after cardiac death

A

-Withdrawal of care
-Ventilator withdrawn in OR
-Cardiac arrest within 60(90) minutes
-Death declared 2 - 5 minutes after cardiac arrest*
-NRP, new technique to reverse ischemia

62
Q

Describe voluntary donation

A

-Living donor program.
-No reliance on dead donor rule.
-“Permanent unconsciousness” and “Imminently dying” would require specific definitions and societal acceptance.
-Withdrawal of care for any reason could be acceptable for “immanent death.”

63
Q

ERD 38( infertility)

A

When the marital act of sexual intercourse is not able to attain its procreative purpose, assistance that does not separate the unitive and procreative ends of the act, and does not substitute for the marital act itself, may be used to help married couples conceive.

64
Q

ERD 39 (destroying embyros)

A

Those techniques of assisted conception that respect the unitive and procreative meanings of sexual intercourse and do not involve the destruction of human embryos, or their deliberate generation in such numbers that it is clearly envisaged that all cannot implant and some are simply being used to maximize the chances of others implanting, may be used as therapies for infertility.

65
Q

ERD 40

A

Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child.28

66
Q

ERD 41 (IVF)

A

Homologous artificial fertilization (that is, any technique used to achieve conception using the gametes of the two spouses joined in marriage) is prohibited when it separates procreation from the marital act in its unitive significance (e.g., any technique used to achieve extracorporeal conception).

67
Q

ERD 42 (surrogacy)

A

Because of the dignity of the child and of marriage, and because of the uniqueness of the mother-child relationship, participation in contracts or arrangements for surrogate motherhood is not permitted. Moreover, the commercialization of such surrogacy denigrates the dignity of women, especially the poor.

68
Q

ERD 43 (adoption)

A

A Catholic health care institution that provides treatment for infertility should offer not only technical assistance to infertile couples but also should help couples pursue other solutions (e.g., counseling, adoption).

69
Q

ERD 45

A

Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation. In this context, Catholic health care institutions need to be concerned about the danger of scandal in any association with abortion providers.

70
Q

ERD 47 (operations and pregnant women)

A

Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.

71
Q

ERD 48 (pregnancy outside of uterus)

A

In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion

72
Q

ERD 49 (labor)

A

For a proportionate reason, labor may be induced after the fetus is viable

73
Q

ERD 50

A

Prenatal diagnosis is permitted when the procedure does not threaten the life or physical integrity of the unborn child or the mother and does not subject them to disproportionate risks; when the diagnosis can provide information to guide preventative care for the mother or pre- or postnatal care for the child; and when the parents, or at least the mother, give free and informed consent. Prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect

74
Q

ERD 52

A

Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning.

75
Q

ERD 53 (tying tubes)

A

Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology, and a simpler treatment is not available

76
Q

indirect abortion

A

pregnant womanhas a cancerous womb that must be removed, removing it would produce an indirect abortion.

77
Q

what are the 3 exceptions of care for infants

A
  1. The infant is chronically and irreversibly comatose;
  2. The provision of such treatment would merely prolong dying, not be effective in ameliorating or correcting all of the infant’s life-threatening conditions, or otherwise be futile in terms of the survival of the infant; or
  3. The provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane.
78
Q

what can minors consent to in Colorado law

A

-Treatment for addiction to or use of drugs.
-Treatment for sexually transmitted diseases.
-Contraception and Pregnancy.
-Abortion, 48 hours after notification of parent or guardian.
Notification is in person, by sealed envelope marked “Personal and Confidential”.

79
Q

what can minors consent to in Colorado law

A

-Treatment for addiction to or use of drugs.
-Treatment for sexually transmitted diseases.
-Contraception and Pregnancy.
-Abortion, 48 hours after notification of parent or guardian.
Notification is in person, by sealed envelope marked “Personal and Confidential”.

80
Q

what is colorado law on emancipated minors

A

-Sole responsibility for their support
-Married or living away from parents
-Armed forces
-No “Mature Minor” designation.
-Ethical obligation to involve minors

81
Q

how are decisions made for minors

A

-Best Interest of minor is paramount!
-Parental authority is very important.
-Disagreements between minor and parent(s) or guardians need mediation.
-Privately with medical staff.
-Legal venue.

82
Q

what is assent

A

-A minor patient’s non-binding expression of agreement to recommended treatment.
-Informed consent is a legality whereby the legal guardian gives permission for the recommended treatment.

83
Q

what is dissent

A

-Harder issue than Assent.
-Non-binding refusal of care by a minor.
-As the gravity of the illness and risk of treatment increase, refusal by a minor is harder.
-Courts will usually go with preservation of life overall arguments except for religious arguments – but not always.

Nursing (11 decks)

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