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ethics exam 1 > exam 1 > Flashcards

exam 1 Flashcards

1
Q

Maslow’s hierarchy of needs

A
  1. physiological needs
  2. safety needs
  3. belongingness and love needs
  4. esteem needs
  5. self-actualization
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2
Q

physiological needs (basic needs)

A

food, water, warmth, rest

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3
Q

safety needs (basic needs)

A

security, safety

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4
Q

belongingness and love needs (psychological needs)

A

intimate relationships, friends

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5
Q

esteem needs (psychological needs)

A

prestige and feeling of accomplishment

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6
Q

self-actualization (self-fulfillment needs)

A

achieving one’s full potential, including creative activities

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7
Q

kholberg

A
  1. similar to piaget
  2. 6 phases
  3. girls are relationship based in moral development
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8
Q

piaget

A

believed kids start at an amoral stage

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9
Q

massey

A
  1. value cohort theory

2. ethical relativism

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10
Q

value cohort theory

A
  1. we develop our values based on where we were born and at what time in history
  2. ex: baby boomers; depression area= save food
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11
Q

ethical relativism

A

whether something is ethical based on the situation

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12
Q

gilligan

A
  1. worked with kholberg
  2. girl’ weren’t getting to the moral development stage
  3. Kholberg thought girls did not develop as much (Gilligan disagreed)
  4. She found that girls came to conclusions in different ways (talk it out and work it out method)
  5. ex: Hines-> broke into the store to get meds for dying wife
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13
Q

autonomy

A
  1. right to self-determination, self-governance, and freedom of choice
  2. conditions: patient has to be competent and not be coerced
  3. not a pure concept
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14
Q

beneficence

A

obligation to do good and help others

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15
Q

specifications of beneficence

A
  1. specified by society
  2. necessary goods (food, water, oxygen, shelter, education, health, etc).
    a. we agree that everyone should have health care, but gets messy with money
    b. only some people have free health care
    ex: medicare (elderly/disabilities/chronic disease)
    medicaid, veterans, children, inmates, workers comp for injuries, indian health service for reservations
  3. limited by the provider’s skill and informed consent
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16
Q

criticism of beneficence

A

paternalism interferes

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17
Q

nonmaleficence

A
  1. do no harm (primum non nocere)
  2. specifications: principle of double effect
  3. how to weigh good vs harm
    (a. principle of proportionality……b. the wedge of principle)
  4. medical errors are the number 3 cause of death in the US
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18
Q

Justice

A
  1. fair, equitable, or owed
  2. distribute according to merit/need
  3. distributive justice and the concept of rights
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19
Q

justice (fair, equitable, or owed)

A

every person should have an equal share of the benefits and burdens unless there is a reason to discriminate

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20
Q

justice (distributive according to merit/need)

A

merit: based on contribution or effort
need: misfortune, disability, special talents, opportunities lost, past discrimination, other societal restrictions

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21
Q

justice (distributive justice and concept of rights)

A
  1. negative rights: right to be left alone (ex: DNR)
  2. positive rights: right to something that another is obligated to provide (ex: public school, health care in prison, for elderly, active/retired military)
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22
Q

competency

A
  1. necessary for autonomy
  2. specifications (a. understands situation and consequences, b. decision is based on rational reasons and understood logic, c. sincerely held religious beliefs vs delusions)
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23
Q

Deontology (duty oriented)

Kant

A
  1. human life has intrinsic value and deserves respect independent of the consequences
  2. right and wrong is based on the duty to an individual
  3. focus on individual worth, self-respect, fairness, autonomy
  4. categorical imperative: unconditional moral law (golden rule, 10 commandments)
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24
Q

deontology (duty oriented)

John Rawls

A
  1. social contract for functional and just societies
  2. uses a hypothetical to determine what’s fair (a. “original position” and “veil of ignorance” b. it’s in our self-interest to make sure everyone is treated equally)
  3. inequalities are acceptable if the least fortunate are helped
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25
Q

Deontology (duty oriented)

Robert Nozick-libertarian

A
  1. focus on freedom, autonomy, and individual rights
  2. american dream
  3. we should influence people to take steps toward improving their own situation
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26
Q

criticisms of deontology

A
  1. less helpful for complex social policy problems (ex: maldistribution and equity)
  2. assumes liberty and capacity for individual decision making
  3. presents difficulty when duties conflict
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27
Q

utilitarianism (consequence-oriented or telological)

A
  1. doctrine that utility is sole standard of moral conduct
  2. greatest good for the greatest number of people
  3. focuses on the consequences of a decision
  4. intentions are irrelevant
  5. “the end justifies the means”
28
Q

types of utilitarianism- act

A
  1. weighs the actions and consequences and selects the actions that maximized the greatest good
  2. ex: kill and harvest one healthy person’s organs to save 10 other people
  3. most pure form
29
Q

types of utilitarianism- rule

A
  1. rules are created that have the greatest net benefit

2. can’t kill people for organs legal because it would cause havoc in society

30
Q

types of utilitarianism- preference

A
  1. what reasonable people would want for themselves

2. we should respect the patient’s wishes- DNR

31
Q

criticism of utilitarianism

A
  1. unworkable: cant agree on definition of happiness
  2. inadequate: can’t account for some of our basic moral attitudes
  3. sacrifices individuals for the greater good- Paternalistic
32
Q

virtue-based ethics

A
  1. solution is based on the personal character of the moral agent and not the particular action
  2. virtuous person- aristotle ( honest, caring, compassionate, just, wise, kind)
  3. criticism: wouldnt work in the example of jody and mary (twins)
33
Q

natural law ethics

A
  1. right or wrong based on laws of nature
  2. st. thomas aquinas: do good and avoid harm (principle of double effect)
  3. criticism: we have so much modern medicine and technology that can improve life (life or death surgery)
34
Q

authority based theories of ethics

A
  1. typically religion based
  2. not often useful to health care providers
  3. important to understand because some patients/families draw on this (respect religious beliefs about disease, treatment, suffering etc)
35
Q

gaylin’s position

A

just because you know what’s right doesn’t mean you’ll do it

36
Q

autonomy- gaylin; what drives human behavior?

A
  1. vs animal instincts; we make choices

2. Kant: coined the idea that autonomy and dignity are the basis of who we are as humans

37
Q

rationality- gaylin; what drives human behavior?

A
  1. ability to make decisions that make sense
  2. come to conclusions about what is right and wrong
  3. formed at very early age
38
Q

emotions- gaylin; what drives human behavior?

A
  1. stronger driving force behind many choices

guilt, shame, pride

39
Q

good conscience; what drives human behavior?

A
  1. doing good even when you could do bad; compass
40
Q

does knowledge help us resolve moral dilemmas

A
  1. only when we want to do the right thing

2. we need the emotional drivers to guide our behaviors

41
Q

what tools does society use to promote “doing good”

A

laws and consequences

42
Q

dwyer article- primum non tacere

A

first do not be silent

43
Q

dwyer- primum non nocere

A

first do no harm

44
Q

dwyer- ethical dilemmas and speaking up

A
  1. resident asks you to get a patient to sign a consent form but didnt know anything about the procedure. they tell you to just get it signed and then later tries to add something to the form
  2. negative language and attitude about a patient
  3. physician was doing overwhelming amounts of unnecessarily painful tests on a dying child
  4. told a physician about an unusual finding on skin and they ignore it
  5. practicing on patients that wouldnt be able to afford care otherwise
45
Q

dwyer- students are obligated to speak up

A
  1. learn how to speak up early so its easier when you’re healthy
  2. speak up for patient’s care; be an advocate
  3. obligation to learn and to care
46
Q

Paternalism

A
  1. intending good while limiting patient autonomy
  2. patients with cancer in 60s werent told their diagnosis
  3. you need to know so you can choose treatments
  4. criticism of beneficence
47
Q

principle of double effect

A
  1. action must be good or indifferent
  2. only the good effect is intended
  3. the harmful effect cant be a means to achieving good
  4. must be proportionality between the good and bad effects
48
Q

principle of proportionality

A
  1. must be proportionate good to justify permitting or risking harm
  2. ex: liver donation- tricky; very vascular
49
Q

wedge principle

A

slippery-slope: allowing one undesirable or questionable action will lead to other undesirable actions (pandora’s box)

  1. logical form: any violation to a basic moral rule will undermine that rule
  2. empirical form: focuses on consequences of allowing an exception to a moral rule
  3. people use this to argue against assisted suicide
50
Q

belmont report

A
  1. formed the basis for federal regulations on human research
  2. creation of the IRB (institutional review board)
51
Q

health inequalities

A

descriptive term to refer to the total variation in health status across individuals within a population or to a difference in average or total health between two or more populations. generally involve comparison of population averages. it is a property of populations rather than individuals

52
Q

health inequities

A
  1. difference that society judges to be morally unacceptable
  2. referring to either to populations affected by inequalities or the causes and consequences of inequalities
  3. how to tell of a social inequality is an inequity: through references to the relative social position of different populations
53
Q

health care reform

A

increase number of health care providers and increase access to HC

54
Q

current practices similar to rationing

A
  1. distribution of scarce goods (organs we prioritize not ration)
  2. prioritization of services (triage, we treat the person with the most pressing issue/sickest person we can treat first)
  3. allocation of financial resources (theres only so much money allocated to health care)
  4. limiting access to certain services
55
Q

hackler’s definitition

A

policies and procedures that results in individuals being denied services that would be of significant medical benefit for them for reasons other than absolute scarcity or inability to pay

56
Q

oregon tried to ration things

A
  1. went around asking people all over the state what procedures they thought should be covered- democratic process (bottom of the list: fertility treatment)
  2. squeezed dollars, denied some things that were possibly experimental or very expensive and allocated that money elsewhere
  3. if we were to try to implement that on national level, it would be very difficult because of how fragmental our health care system is
57
Q

goals of health care reform

A
  1. improve access to care
  2. improve quality of care
  3. contain costs for care
58
Q

expanded coverage of obama care

A
  1. individual purchase mandate (pay penalty fine if you dont have insurance)
  2. medicaid expansion
  3. health insurance exchanges ( online shopping for insurance plans)
  4. eliminating coverage barriers (a. no more caps on lifetime care, b. cant deny care to people with pre-existing conditions, c. cant charge women more than men
59
Q

legality of obamacare

A
  1. supreme court case to see if the penalty fine for not following the individual mandate is legal (ruling upheld the penalty fine on the basis that the federal government is allowed to tax people
  2. however, a subsequent supreme court case was held (a. states objected to expanding medicaid, b. supreme court ruled to let individual states decide whether they want to expand medicaid)
60
Q

edge and grove

A
  1. hines needed a lifesaving drug for his wife but it was too expensive and the pharmacist wouldnt give it to him at a discount or a loan, so he broke in and stole it.
  2. theories of value development
61
Q

baille

A
  1. principles of beneficence and nonmaleficence

2. wedge principle

62
Q

callahan

A
  1. review of his field (bioethics) and reasons why it failed
  2. critique that bioethics has a lack of emphasis on the common good and person responsibility
  3. communitarian bioethics that blends cultural and personal judgement
  4. there’s a personal responsibility to consider what is good for the total community (ex: you can eat burgers and 6pack everyday but it wont be a positive impact for the community)
  5. evolution of the field of bioethics to have a great emphasis on autonomy and justice
  6. abuse of human subjects (tuskegee, alabama: study of syphilis; took advantage of poor black men and didnt tell them that they have syphilis; coerced them by saying theyd get free health care. when a cure was found, the men were still not told of their diagnosis)
  7. bellmont report
  8. impact of biomedical innovation on ethics and society (a. control over procreation. b. aging population, c. new insights into human nature, especially mental health.)
63
Q

cassell- application of principles to clinical medicine

A
  1. talks about belmont report
    (a. ethical guidelines for human subject research. B. outlines autonomy, beneficence, and justice)
  2. starts with a case study (a. a new drug to dissolve clots was produced and they tried their early clinical trial on a homeless man without proper consent. B. they discontinue after he develops an arrhythmia)
  3. contrasted with another case of a woman with aggressive breast cancer- she opted to try a last resort treatment for a bone marrow transplant
    (a. chemo had damaged her bone marrow, so they were trying to replenish it so she could make RBCs
    b. the cancer returned to bone in her spine after surgery
    c. doctors drop a “truth bomb” in a letter form in medical jargon)
  4. talks about how ethical principles have changed over time
    (a. beneficence: 1. physicians have moved away from ideals- kindness, caring. 2. what constitutes good has changed over time. 3. it was more important in the past to be kind when there were less options for treatment)
    (b. autonomy: 1. meaning of respect has changed over time. 2. doctors also used to not tell their patients about terminal disease like cancer- paternalism. 3. now autonomy in decision making is very important even for terminal patients.)
    (c. justice: 1. medicine is now a commodity in the marketplace 2. the goal is on the most medical care for the money we spend, but doesnt mean we have good outcomes)
  5. conclusion: story about a women with breast cancer that’s not responding
    (a. she isnt told of how severe it is, comes back to the hospital for an unrelated fracture. she sees a lot of different specialists that all tell her different things and she eventually dies.)
    (b. the shift of treating the patient as an individual to treating specific body parts instead of the person as a whole)
64
Q

childress and fletcher

A
  1. critique of the role of autonomy in ethics
  2. argues that autonomy shouldnt always be the overriding principle
  3. prima facie- “first face” or overriding principle
    (a.they say autonomy should normally be prima facie but there are exceptions.)
    ( b. you have to take into account- time and the community 1. having ongoing dialogues about what the patient wants 2. our choices have to be looked at in context of the community 3. the right to autonomy is stronger when talking about the right to refuse and lesser when demanding a service)
  4. futility as a firewall to autonomy (a. ex: if a patient is demanding a treatment that wont help them)
  5. controversy over autonomy to a patient’s right to die (a. physician assisted suicide. b. could influence other’s decisions and affect the community)
65
Q

Shelton

A
  1. the harm of “First, do no harm”: primum non nocere
  2. the problem with the suggestion of doing no harm
    (a. there’s always a risk for harm with anything we do
    b. there is inherent harm in the delivery of health care (ex: pain after surgery is not due to mistake)
    c. creates a sense of medicine being perfect, patients expect more (1. patients dont take responsibility for their own health (ex: if they know what pill they usually take they’ll point it out if the nurse tries to administer an incorrect medication) d. people dont want to admit they made a mistake, but it’s pertinent in health care both to correct the error, and to learn from it
  3. error and risk (a. there is always risk to surgery, but it’s still the best option for care. b. people can be allergic to something, surgeons might find something they didnt know about mid-surgery)
66
Q

sorrell

A
  1. sorting out myths from reality about obamacare (a. myths: people thought we’d have “Death panels” b. myths: illegal immigrants can get free health care)

ethics exam 1 (1 decks)

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