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Morality & Medicine > Final > Flashcards

Final Flashcards

1
Q

Respect the patient’s decision

A

Autonomy

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2
Q

Act in the best interest of the patient

A

Beneficence

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3
Q

Avoid harm to the patient

A

Non-maleficence

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4
Q

Respect broader rights, norms and groups

A

Justice

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5
Q

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others

A

Harm principle

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6
Q

Employ the lease liberty-violating means possible, reserving more liberty-violating means when other means fail.

A

Least restrictive coercive means

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7
Q

Assist and compensate those burdened by public health intervention

A

Reciprocity principle

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8
Q

Stakeholders should have free and equal input into decision-making, and decision-making should be publicly accessible

A

Transparency principle

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9
Q

Involuntary commitment to mental health facility requires that one is suffering from a mental illness and poses (imminent) danger (of death or bodily harm) to oneself or others

A

US supreme court ruling O’Conner v. Donaldson (1975)

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10
Q

Involuntary mental health treatment can be provided if patient meets two conditions

A

PA bill 1233 (2018) for assisted outpatient treatment

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11
Q

Kantian contractarianism
The original position: veil of ignorance
1. Principle of liberty: same freedoms for all
2. Principle of equal opportunity: same opportunities for all
3. Difference principle: no unequal distribution of goods, except to improve the lot of the worst off (maximize welfare of minimally well)

A

Rawl’s Theory of Justice

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12
Q

Morality derives from human rights
- there are negative human rights (freedom, non-interference, owning property) but no positive rights (healthcare)
-redistributing goods (eg via taxation) generally violates property rights
-against restrictions on liberties, except to protect rights of self/others

A

Nozick’s libertarian Justice

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13
Q

Adjusting for black race can lead to a 16-18% increase in estimated glomerular filtration rate (eGFR), a number used for medication dosing and staging kidney failure, as well as for kidney transplant eligibility and priority

A

Race-Based GFR

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14
Q

Black adults have ____ the incidence of heart failure compared to white adults

A

Twice

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15
Q

Black infants are more than ____ as likely as white infants to die before their first birthday

A

Twice

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16
Q

Patients from ______ _____ are more likely to die in hospital from injury

A

Minority groups

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17
Q

Assault victims in trauma centers are more likely to die if they are ____, after adjusting for other variables

A

Black

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18
Q

Largely result from unequal access to healthcare and social determinants of health

A

Global health inequalities

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19
Q

Preferences, beliefs, and attitudes of which people are generally consciously aware, personally endorse, and can identify and communicate

A

Explicit bias

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20
Q

Attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner

A

Implicit bias

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21
Q

Algorithm used to predict health care needs for more than 100 million people is biased

A

Algorithmic bias

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22
Q

Injustice that results from oppressive social structures (institutional and cultural norms)
-inequalities result from social position
-racism, sexism, ableism
-unequal distribution of fundamental causes: social resources that shape health through multiple mechanisms

A

Structural injustice

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23
Q

When an individual is harmed in their capacity as a knower because of their membership in a social group
-has been studied in the context of the patient-provider relationship

A

Epistemic justice

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24
Q

Justice as victimized providing restitution or reparation to their victim for wrongs done (apology, compensation, retribution)
-focus on risk factors for poor health that result from social harm (discrimination) rather than other risk factors (age)

A

Corrective or restorative justice

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25
Q

-can help discover racial correlates of prognosis’s and treatment response
-improve medical outcomes
-eliminate race-based health disparities
-counter structural injustice
-study and combat racism and it’s detrimental effects on health

A

Arguments in favor of using racial categories

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26
Q

-racial categories aren’t scientific
-it is better to use specific genetics, ancestry, or skin tone rather than nonspecific racial categories
-use of racial categories perpetuates biological essentialism and injustices

A

Against using racial categories

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27
Q

Industry funds profitable research
-10/90 gap: 90% research spent on 10% of people
-neglected tropical diseases and ‘me-too drugs’

A

Research priorities

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28
Q

Let funders set their own priorities

A

Libertarianism about research funding

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29
Q

Let a central body set priorities according to societal needs

A

Socialism about research funding

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30
Q

Giving what doctors believe is the best care at that time that isn’t the drug being tested

A

Standard care

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31
Q

Informed consent, protection of vulnerable populations

A

Respect for persons

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32
Q

Public Health Service study of natural history of late-stage syphilis in 400 adult black males
-men denied access to antibiotics
-told they were being studied and treated for bad blood

A

Tuskegee Syphilis study

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33
Q

-research must be based on a scientific and ethical protocol submitted to a research ethics committee
-informed consent of participants is required
-placebos should only be used when no proven treatment exists or when forgoing treatment is scientifically necessary and will not result in harm
-participants must be provided therapy after the trial
-all research should be pre-registered and results published

A

The declaration of Helsinki (2013)

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34
Q

Genuine disagreement in the expert clinical community about which treatment is better
-pts have right to the known best available medical care
-pts should not be deprived of effective care or harmed by lack of access
-best interest of pt should not be sacrificed

A

Equipoise

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35
Q

Minors and adults with reduced capacity (mental Illness or reduced consciousness)

A

Autonomy: special populations

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36
Q

Irreversible loss of consciousness and cognitive function, demonstrates sleep-wake cycles

A

Persistent vegetative state

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37
Q

Prolonged unconsciousness, cannot be woken

A

Coma

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38
Q

Partial conscious awareness

A

Minimally conscious state

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39
Q

Written by patient when capable
-directs end of life care, including withdrawal of life support

A

Living wills

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40
Q

SDM make decisions based on:
-patient preferences (if any) as expressed in an advance directive or as documented in the medical record
-the patient’s views about life and how it should be lived
-how the patient constructed his or her life story
-the patient’s attitudes towards sickness, suffering, and certain medical procedures

A

Standard of substituted judgement

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41
Q

When patient’s preferences cannot be determined, decisions should be made by SDM based on:
-the pain and suffering associated with the intervention
-the degree of potential for benefit
-impairments that may result from the intervention
-quality of life as experienced by the patient

A

Best interest standard

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42
Q

Death of biological organism
Death of the self (the ‘I’)

A

Concepts of death

43
Q

Same self or ‘I’ over time

A

I-dentity (personal identity)

44
Q

Consists in the same consciousness extending through time and space, unified through memory and self-identification

A

Personal identity (John Locke on I-dentity)

45
Q

Permanent/irreversible loss of circulatory and pulmonary function or permanent/irreversible loss of functional integration

A

Death of biological organism

46
Q

Permanent/irreversible loss of consciousness

A

Death of the self

47
Q

Permanent/irreversible loss of circulatory and respiratory functions

A

Cardiopulmonary criterion for death

48
Q

Permanent/irreversible loss of all brain functions ‘higher’/cognitive and ‘lower’/reflexive/autonomic
-includes loss of function of brain stem

A

Whole brain criterion for death

49
Q

Permanent loss of higher brain’s cognitive/sensory/motor functions
-includes loss of function of cerebral cortex

A

Higher brain criterion for death

50
Q

Death is determined by cardiopulmonary criterion or whole brain criterion

A

Uniform determination of death act of 1981

51
Q

Intrinsically mattering morally
-may imply welfare and rights (receive life support, not be killed)

A

Moral status

52
Q

Persons have moral status

A

Kant

53
Q

Creatures capable of happiness/misery have moral status

A

Mill

54
Q

Organ donors must be dead before procurement of organs begins and organ procurement itself must not cause the death of the donor

A

Dead donor rule

55
Q

-culturally accepted, including in some faiths
-makes death a biological concept
-cardiac death is relatively easy and quick to determine

A

I’m favor cardiopulmonary criterion for death

56
Q

-excludes individuals on ventilators with lack of functional integration due to brain stem damage who are plausibly biologically dead
-excludes some individuals with permanent lack of consciousness who plausibly lack moral status

A

Against cardiopulmonary criterion for death

57
Q

-widely medically accepted
-makes death a biological concept
-ties death to a feature that is plausibly linked to moral status: consciousness
-can be tested neurologically

A

In Favor of whole brain criterion

58
Q

-includes individuals on ventilators with functioning heart/lungs, which are central vital functions that plausibly sustain biological life
-includes people who retain some functional integration outside the brain
-excludes some individuals with permanent lack of consciousness who plausibly lack moral status

A

Against whole brain criterion

59
Q

-ties death to a feature that is plausibly linked to moral status: consciousness
-would allow for more transplantable organs

A

In favor of higher brain criterion

60
Q

-difficult to test for complete lack of consciousness/higher brain function
-takes death out of the realm of biology where it is properly understood
-includes some individuals with biological function/integration who plausibly have moral status
-has an unethical motivation: using people as ends to organ transplantation

A

Against higher brain criterion

61
Q

-promotes patient autonomy, including religious autonomy
-death is plausibly a pluralistic concept

A

In favor of letting patient decide on death criterion

62
Q

-death is plausibly a singular objective fact, to be settled by diagnostic evidence alone
-lead to counting fewer people as dead and less transplantable organs (assuming opting for cardiopulmonary criterion only)

A

Against letting the patient decide death criterion

63
Q

The physician intentionally, actively kills the patient for the patient’s benefit

A

(Active) euthanasia

64
Q

The physician intentionally helps the patient kill themself

A

Physician-assisted suicide (PAS)

65
Q

Euthanasia or PAS

A

Physician assisted death/dying (PAD)

66
Q

The physician withholds or withdraws life-prolonging treatment

A

Passive euthanasia

67
Q

-can relieve suffering
-can allow persons to die with dignity
-may be patient’a autonomous choice
-may ease the burden on health system and family caused by slow death

A

In favor of PAD

68
Q

-permitting PAD will lead to killing patients in other circumstances
-PAD will lead to devaluing of human life, and other downstream consequences, including loss of trust in medical profession

A

Slippery slope objection to PAD

69
Q

-violates respect for persons
-killing is not universalizable
-rebuttal: can promote agency and dignity

A

Kantian objection to killing with intention

70
Q

-doctor’s oath forbids it
-violates the doctor’s role as healer
-violates the ethos of medicine: to cure disease and prolong life
-rebuttal: doctor’s role and the ethos of medicine are consistent with promoting good death

A

Hippocratic objection to killing with intention

71
Q

Death cannot harm us/we should not fear death
-when death is here, we are not (this cannot harm us)
-harms consist in bad experiences, yet death is the absence of experience
-we don’t fear the time before our birth, thus we should not fear our death

A

Lucretius and Epicurus on the badness of death

72
Q

Death can harm us by depriving us of good future possibilities
-one misfortune in death is asynchronous with our life
-death is the deprivation of possibilities, possibly good ones
-death is loss of a future (unlike prenatal non-existence)

A

Nagel on the badness of death

73
Q

-act or omission?
-causes death?
-death is intended?

A

Determinants and dimensions of killing

74
Q

Where G is good and H is harm, an action that brings about G and H is not unethical so long as G is intended and H is not

A

Double effect

75
Q

-euthanasia may be more prone to abuse
-PAS is more ethical because killing is indirect

A

In favor of distinguishing euthanasia from PAS

76
Q

-distinction discriminates against those not physically able to kill themselves
-the killing in euthanasia is also indirect

A

Against distinguishing euthanasia from PAS

77
Q

May distinguish killing from letting die
Maintaining distinction: may support different moral judgements
Dissolving distinction: may harmonize moral judgements

A

Acts vs. omissions

78
Q

-causation is a physical process
-continuous physical connection between the cause and the effect
-absences are not casual
-omissions do not satisfy this account, the acts do

A

Process accounts of causation

79
Q

-causes make a difference to their effects
-the occurrence of the effect depends on the occurrence of the cause
-absences can be casual
-both acts and omissions may satisfy this account

A

Difference-making accounts of causation

80
Q

Two situations identical in all ethically relevant ways demand same ethical judgment

A

Ethical consistency

81
Q

-right not to be interfered with and to have control over one’s body
-right not to be prevented from obtaining reproductive care (including abortion care)

A

Reproductive autonomy as a negative right (a liberty)

82
Q

-a right to have reproductive care provided (including abortion care)

A

Reproductive autonomy as a positive right

83
Q

Liberties can (sometimes) be restricted to prevent harms to others
-abortion may be impermissible if abortion harms the fetus by killing the fetus (or depriving the fetus of a future)

A

The harm principle (J.S Mill) with reproductive autonomy

84
Q

A right to not be killed

A

The right to life as a negative right

85
Q

A right to have life support provided

A

The right to life as a positive right

86
Q

Only persons have a right to life
-no fetus is a person
-therefore, no fetuses have a right to life
-therefore, abortion is not immoral, even if it would violate the right to life

A

Non-personhood argument

87
Q

An individual with rights

A

Moral sense

88
Q

An individual with certain capacities

A

Descriptive sense

89
Q

A person is “a thinking intelligent being, that has reason and reflection, and can consider it self as itself, the same thinking thing in different times and places”

A

John Locke on (descriptive) personhood

90
Q

1: ambiguous use of ‘person’ (equivocation?)
2: permits killing neonates/letting them die
3. Ignores welfare and interests for non-rights holders that have partial moral status

A

Non-personhood argument objections

91
Q

Most fetuses have a future like ours.
abortion deprives them of that future.
Therefore, abortion is immoral

A

FLO argument

92
Q

Regardless of the moral standing of the fetus, we do not have a duty or obligation to let someone use our body for life support. Abortion would only be immoral if it violated such a duty. Therefore, abortion is not immoral

A

Violinist argument

93
Q

1: a fetus could have a bad future or miscarriage
2: contraception deprives gametes/embryo of FLO, but contraception isn’t immoral
3: ignores fetus’s moral status
4: if deontological, doesn’t identify pregnant person’s specific duties. If consequentialist, ignores wider consequences

A

Objections to FLO argument

94
Q

1: immoral to withdraw consent for fetal life support
2: parents have special duties to their offspring
3: we should allow the violinist the opportunity to access artificial life support instead

A

Objections to violinist argument

95
Q

Fetus is contained within a carrier, not part of carrier
In favor:
-late stage fetuses can survive independently of carrier
-organisms often reside inside another organism, but aren’t part of the organism

A

Fetal container model

96
Q

Fetus is a proper part of carrier
In favor:
-early stage fetus cannot survive independent of carrier
-fetal carrier organismic integration

A

Fetal parthood model

97
Q

Must consider all consequences of laws, incl wrt economy, population control, and public health, and add up (dis)utilities for all beings with moral status (including future beings?)

A

Utilitarian Justice on abortion laws

98
Q

-Across state: differing laws is unequal liberties
-within state: abortion restrictions may create unequal opportunity for pregnant compared to non-pregnant people due to health and social costs of pregnancy and parenthood, unequal opportunity for economically advantaged vs disadvantaged to access out of state care

A

Rawlsian Justice on abortion laws

99
Q

Abortion restrictions may violate basic reproductive liberty (caver: the harm principle)

A

Libertarian Justice on abortion laws

100
Q

Any injustices impact particular social groups and result from oppressive laws:
-sexism
-ableism (selecting based on future disability)

A

Structural injustice in abortion laws

101
Q

Currently limited clinical application, some gene therapies in development and testing
-possibility of editing embryos looms

A

Gene editing

102
Q

-Concerns ‘identity-determining acts’: the act itself determines the one whose interests we’re considering
-these challenge our intuition that the act is right or wrong because the one is not harmed or benefited
Can instead ask:
-would they have a wonderful life? Which future is better?

A

The non-identity problem

103
Q

Genetic information is the individual patient’s private health information
-usual norms of confidentiality apply
-confidentiality is normally broken only to prevent serious harm to others
-consistent with patient-centered care

A

Personal account model

104
Q

Ownership for genetic information is shared among genetic relatives
-usual norms of confidentiality do not apply
-genetic information is normally withheld from relatives only to prevent serious harm
-consistent with family-centered genetic counseling and the shared nature of a family history

A

Joint account model

Morality & Medicine (1 decks)

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