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Medical Ethics > Exam 2 > Flashcards

Exam 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Problem with resource allocation

A

How to best distribute resources at both the macro and micro levels

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2
Q

2 types of rights

A

Positive rights and negative rights

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3
Q

Positive rights

A

Entitlements to perform certain action, or to be in certain states

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4
Q

Negative rights

A

Entitlements that others NOT perform certain actions or not be in certain states

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5
Q

What does it mean if you have a right to have/do something?

A

Others cannot prevent you from having/doing that action

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6
Q

What are the sources of rights

A

God
Government/institutions
Just being a human being

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7
Q

Where will the funding for healthcare come from?

A

US, either privately or publicly

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8
Q

Private funding for healthcare

A

Comes from our income

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9
Q

Public funding for healthcare

A

Comes from tax revenue

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10
Q

2 conceptions of justice came from

A

Robert Nozick and John Rawls

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11
Q

Robert Nozick’s view

A

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.

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12
Q

John Rawls’ view

A

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

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13
Q

John Rawls’ thought experiment

A
  • 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
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14
Q

Examples of necessities

A

Clean air and water

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15
Q

Examples of privileges

A

Drivers license

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16
Q

Exotic Life-Saving Treatments (ELT)

A

Any number of life-saving treatments where demand is greater than availability
- Called exotics because they are comparatively among procedures
- Scarce resource

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17
Q

Rescher criteria for ELT

A

1) Criteria of inclusion/exclusion: decides who the candidates for ELT are
2) Criteria selection: decides who actually gets the ELT

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18
Q

Rescher states the process must be

A

1) Simple, so that all parties understand
2) Be plausible and patently reasonable to all
3) Be rationally defensible (fair)

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19
Q

Rescher’s factors for choosing candidates

A

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

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20
Q

Rescher’s factors for choosing recipients

A

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)

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20
Q

Problems with Rescher’s selection

A

ELT selection may not be just a medical decision
- Looks utilitarian
- Rescher says there is no uniquely “best” system, none are optimal

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21
Q

Rescher’s lottery of life and death

A

Point system plus randomness for those with roughly equal point total

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22
Q

2 types of liver disease

A

ARESLD: alcohol-related end-stage liver disease
- cause: alcohol use/abuse
ESLD: end-stage liver disease
- cause: anything but alcohol

23
Q

HCFA Recommendation

A

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

24
Q

Moss/Siegler’s Proposal

A

ARESLD patients should not compete equally with ELSD patients
- alcoholism IS a disease

25
Q

What does alcoholism cause

A

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

26
Q

Ageism

A

Discrimination based on age

27
Q

Fair innings

A

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

28
Q

Fair Innings argument

A
  1. Before you reach a fair innings, you are entitled to reach it
  2. 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
29
Q

2 intuitions fair innings aims to preserve

A

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

30
Q

Threshold age (70 years)

A

Represents the totality of a fair innings and anything less is unjust

31
Q

Thomson on abortion

A

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

32
Q

Thomson’s classical liberalism

A

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)

33
Q

Fonda

A

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

34
Q

Right to life

A

The right to not be killed unjustly
- Are abortions unjust?

35
Q

Abortions which are not unjust killings (Thompson)

A
  1. Abortions where the patient is a rape victim
  2. Abortions where the patient will lose her life
  3. Abortions where precautions were taken to prevent pregnancy
36
Q

2 types of Samaritans

A
  1. The Good Samaritan: this person does more than what is morally required
  2. The Minimally Decent Samaritan: this person does what is morally decent to do, but not more
37
Q

Thomson’s conclusions

A
  • 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
38
Q

Morally indecent abortions (Thomson)

A
  1. Abortions of convenience
  2. Late-term abortions
39
Q

What properties must something have in order to be a person/have a serious right to life?

A

Self-conciousness

40
Q

Other proposed cut off points for right to life

A
  • Conception
  • Human form
  • Spontaneous movement
  • Viability
  • Location outside of the womb
    NONE of these are based on any moral principle for Dooley
41
Q

The ordinary view of personhood

A

Persons are nothing more than living human individuals
- This view should be considered the default

42
Q

What constitutes a human person

A

“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

43
Q

If the fetus is a person…

A

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

44
Q

Doctrine of Double Effet

A

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

45
Q

Finnis’ 2 main ethical principles

A

Health care providers should make all decisions based on:
1) Non-maleficence: do no harm
2) Justice: treat like cases alike

46
Q

Finnis’ answer to rape

A

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

47
Q

Finnis’ answer to mother-fetal conflict

A

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

48
Q

Summary of abortion views

A

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

49
Q

General logical constituents of all abortions arguments

A

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

50
Q

Important anti-abortion problem

A

How is “human being,” if it is only a biological category, morally relevant

51
Q

Important pro-choice problem

A

How do psychological characteristics make a moral difference

52
Q

Essential questions to move forward abortion debate

A

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

53
Q

Marquis’ basic argument

A
  1. Depriving someone of a future like ours is morally impermissible
  2. Abortion deprives someone of a future like ours
    SO: Abortion is morally impermissible
54
Q

Why should we accept Marquis’ view

A
  1. The view explains why death is considered such a terrible thing to be avoided
  2. The view allows for the wrongness of killing someone, if not many, non-humans
  3. It permits active euthanasia
  4. It doesn’t allow for the killing of infants
  5. It avoids personhood/potentiality pitfalls

Medical Ethics (1 decks)

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