Exam 2 Flashcards
Problem with resource allocation
How to best distribute resources at both the macro and micro levels
2 types of rights
Positive rights and negative rights
Positive rights
Entitlements to perform certain action, or to be in certain states
Negative rights
Entitlements that others NOT perform certain actions or not be in certain states
What does it mean if you have a right to have/do something?
Others cannot prevent you from having/doing that action
What are the sources of rights
God
Government/institutions
Just being a human being
Where will the funding for healthcare come from?
US, either privately or publicly
Private funding for healthcare
Comes from our income
Public funding for healthcare
Comes from tax revenue
2 conceptions of justice came from
Robert Nozick and John Rawls
Robert Nozick’s view
Libertarian view (justice as protecting entitlements)
- No person or gov has any right to a resource properly owned by another, so using taxes to pay for another’s healthcare is the same as using that person (wrong)
- Healthcare is a privilege, not a right.
John Rawls’ view
Justice as fairness/equality
- Justice requires a fair distribution of resources, such that some members of society do not disproportionately benefit without a net benefit for all members
John Rawls’ thought experiment
- You do not know anything about who you are or what you will do
- Make rules to decide what is moral or not
- Under these circumstances, people will ensure that all have equal access to the societal good, and a just society would likely consider healthcare as a human right
Examples of necessities
Clean air and water
Examples of privileges
Drivers license
Exotic Life-Saving Treatments (ELT)
Any number of life-saving treatments where demand is greater than availability
- Called exotics because they are comparatively among procedures
- Scarce resource
Rescher criteria for ELT
1) Criteria of inclusion/exclusion: decides who the candidates for ELT are
2) Criteria selection: decides who actually gets the ELT
Rescher states the process must be
1) Simple, so that all parties understand
2) Be plausible and patently reasonable to all
3) Be rationally defensible (fair)
Rescher’s factors for choosing candidates
1) Constituency factor: a hospital can exclude a patient who is not a client
2) Prospect of success factor: can exclude those which won’t be helped as much as others
3) Progress-of-science factor: a hospital that specializes in a specific kind of ailment can justly exclude patients that don’t fit criteria
Rescher’s factors for choosing recipients
1) Relative likelihood-of-success factor: same as before but not on an individual basis
2) Life-expectancy factor: does the patient have a long life ahead
3) Family role factor: is the person a mother, father, etc or a loner
4) Potential future-contributors factor: will the patient be valuable to society
5) Past services-rendered factor: has the patient been valuable to society
NOT ALL FACTORS ARE THE SAME TYPE OF FACTOR (some are biomedical while others are not)
Problems with Rescher’s selection
ELT selection may not be just a medical decision
- Looks utilitarian
- Rescher says there is no uniquely “best” system, none are optimal
Rescher’s lottery of life and death
Point system plus randomness for those with roughly equal point total
2 types of liver disease
ARESLD: alcohol-related end-stage liver disease
- cause: alcohol use/abuse
ESLD: end-stage liver disease
- cause: anything but alcohol
HCFA Recommendation
Medicare should cover transplant surgery for those with alcoholic cirrhosis who are abstinent
DECISION: treatment approved by HHS Secretary Sullivan with NO required period of abstinence for those diagnosed with alcoholic cirrhosis
Moss/Siegler’s Proposal
ARESLD patients should not compete equally with ELSD patients
- alcoholism IS a disease
What does alcoholism cause
A disease that results in a chemical dependency, a biological need
- So, is the decision to drink at that point a free choice?
- We are only responsible for free choices not unfree ones
Ageism
Discrimination based on age
Fair innings
There is an amount of time which constitutes a reasonable life-span or what is called a “fair innings”
- Age for fair innings = 70 years
Fair Innings argument
- Before you reach a fair innings, you are entitled to reach it
- Once you reach a fair innings, you are living bonus time
CONCLUSION: after you reach a fair innings, you can be fairly denied treatment or resources in favor of a younger patient
2 intuitions fair innings aims to preserve
1) The anti-ageist intuition that all life is precious to those who want theirs to continue
2) The intuition that the old shouldn’t be given endless treatment at the expense of the needful young
Threshold age (70 years)
Represents the totality of a fair innings and anything less is unjust
Thomson on abortion
First step: set aside debate about fetus being a person or not, and says for the sake of argument, that it is in fact a person
- Says some abortions are just/or unjust even if the fetus is considered a person
Thomson’s classical liberalism
1) You have a right to control what happens to and inside your body
2) Generally, this right overrides the violinist’s right to use your body
You have a right to defend yourself against Itzhak’s threat to your life, even if it kills him (so abortion is permissible to save the life of the mother)
Fonda
We don’t have a right to the bare minimum it takes to keep us alive, so the fact that you or the violinist requires X to continue living does not establish a right to X
Right to life
The right to not be killed unjustly
- Are abortions unjust?
Abortions which are not unjust killings (Thompson)
- Abortions where the patient is a rape victim
- Abortions where the patient will lose her life
- Abortions where precautions were taken to prevent pregnancy
2 types of Samaritans
- The Good Samaritan: this person does more than what is morally required
- The Minimally Decent Samaritan: this person does what is morally decent to do, but not more
Thomson’s conclusions
- We all fought to be at least minimally decent Samaritans
- Laws which would outlaw abortions would force women into doing much more that what is morally required of them: it would force them to be good Samaritans
Morally indecent abortions (Thomson)
- Abortions of convenience
- Late-term abortions
What properties must something have in order to be a person/have a serious right to life?
Self-conciousness
Other proposed cut off points for right to life
- Conception
- Human form
- Spontaneous movement
- Viability
- Location outside of the womb
NONE of these are based on any moral principle for Dooley
The ordinary view of personhood
Persons are nothing more than living human individuals
- This view should be considered the default
What constitutes a human person
“Any entity which, remaining the same individual, will develop into a paradigmatic instance of a substantial kind already is an instance of that kind”
When a sperm penetrates an ovum, the resulting one-cell organism which will become a human person, ALREADY IS ONE
If the fetus is a person…
1) Direct abortions are always wrong and anything else shouldn’t even be called an abortions
2) Every living human individual is equal with respect to the right to life
3) The unborn are not aggressors nor unjust
4) Double-effect procedures are permissible
Doctrine of Double Effet
It is sometimes permissible to cause serious harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end
Finnis’ 2 main ethical principles
Health care providers should make all decisions based on:
1) Non-maleficence: do no harm
2) Justice: treat like cases alike
Finnis’ answer to rape
A rape victim may, as a defense against the attacker’s sperm, take medical precautions to prevent conception
However, once conception occurs, an abortion is not permissible. The fetus is innocent of his/her father’s attack
Finnis’ answer to mother-fetal conflict
In cases of mother-fetal conflict, Finnis invokes double-effect: it is permissible that a fetus may die as an affect of saving the mother’s life, where such life saving is the sole intention and NOT the direct killing of the fetus
Summary of abortion views
Thomson: Some abortions are not unjust killings, some are
Tooley: Abortions and infanticide are permissible because only self-conscious persons have a right to life
Finnis: All abortions that are intentional killings are impermissible
Marquis: Abortion is impermissible, using conception is not
General logical constituents of all abortions arguments
1) Claims characterizing fetuses (person or not)
2) General moral principle (right to life or not)
3) Then apply 2 given 1 and assert the conclusion
Important anti-abortion problem
How is “human being,” if it is only a biological category, morally relevant
Important pro-choice problem
How do psychological characteristics make a moral difference
Essential questions to move forward abortion debate
What makes the killing of a person wrong?
- NOT the brutalizing effect on the murderer
- NOT the fact that we’re connected in a special way to others and will be missed
ANSWER: the loss of life harms the victim, specifically it deprives them of a future
Marquis’ basic argument
- Depriving someone of a future like ours is morally impermissible
- Abortion deprives someone of a future like ours
SO: Abortion is morally impermissible
Why should we accept Marquis’ view
- The view explains why death is considered such a terrible thing to be avoided
- The view allows for the wrongness of killing someone, if not many, non-humans
- It permits active euthanasia
- It doesn’t allow for the killing of infants
- It avoids personhood/potentiality pitfalls
