Final Flashcards
1
Q
Respect the patient’s decision
A
Autonomy
2
Q
Act in the best interest of the patient
A
Beneficence
3
Q
Avoid harm to the patient
A
Non-maleficence
4
Q
Respect broader rights, norms and groups
A
Justice
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
6
Q
Employ the lease liberty-violating means possible, reserving more liberty-violating means when other means fail.
A
Least restrictive coercive means
7
Q
Assist and compensate those burdened by public health intervention
A
Reciprocity principle
8
Q
Stakeholders should have free and equal input into decision-making, and decision-making should be publicly accessible
A
Transparency principle
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)
10
Q
Involuntary mental health treatment can be provided if patient meets two conditions
A
PA bill 1233 (2018) for assisted outpatient treatment
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
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
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
14
Q
Black adults have ____ the incidence of heart failure compared to white adults
A
Twice
15
Q
Black infants are more than ____ as likely as white infants to die before their first birthday
A
Twice
16
Q
Patients from ______ _____ are more likely to die in hospital from injury
A
Minority groups
17
Q
Assault victims in trauma centers are more likely to die if they are ____, after adjusting for other variables
A
Black
18
Q
Largely result from unequal access to healthcare and social determinants of health
A
Global health inequalities
19
Q
Preferences, beliefs, and attitudes of which people are generally consciously aware, personally endorse, and can identify and communicate
A
Explicit bias
20
Q
Attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner
A
Implicit bias
21
Q
Algorithm used to predict health care needs for more than 100 million people is biased
A
Algorithmic bias
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
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
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
25
-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
Arguments in favor of using racial categories
26
-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
Against using racial categories
27
Industry funds profitable research
-10/90 gap: 90% research spent on 10% of people
-neglected tropical diseases and ‘me-too drugs’
Research priorities
28
Let funders set their own priorities
Libertarianism about research funding
29
Let a central body set priorities according to societal needs
Socialism about research funding
30
Giving what doctors believe is the best care at that time that isn’t the drug being tested
Standard care
31
Informed consent, protection of vulnerable populations
Respect for persons
32
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
Tuskegee Syphilis study
33
-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
The declaration of Helsinki (2013)
34
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
Equipoise
35
Minors and adults with reduced capacity (mental Illness or reduced consciousness)
Autonomy: special populations
36
Irreversible loss of consciousness and cognitive function, demonstrates sleep-wake cycles
Persistent vegetative state
37
Prolonged unconsciousness, cannot be woken
Coma
38
Partial conscious awareness
Minimally conscious state
39
Written by patient when capable
-directs end of life care, including withdrawal of life support
Living wills
40
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
Standard of substituted judgement
41
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
Best interest standard
42
Death of biological organism
Death of the self (the ‘I’)
Concepts of death
43
Same self or ‘I’ over time
I-dentity (personal identity)
44
Consists in the same consciousness extending through time and space, unified through memory and self-identification
Personal identity (John Locke on I-dentity)
45
Permanent/irreversible loss of circulatory and pulmonary function or permanent/irreversible loss of functional integration
Death of biological organism
46
Permanent/irreversible loss of consciousness
Death of the self
47
Permanent/irreversible loss of circulatory and respiratory functions
Cardiopulmonary criterion for death
48
Permanent/irreversible loss of all brain functions ‘higher’/cognitive and ‘lower’/reflexive/autonomic
-includes loss of function of brain stem
Whole brain criterion for death
49
Permanent loss of higher brain’s cognitive/sensory/motor functions
-includes loss of function of cerebral cortex
Higher brain criterion for death
50
Death is determined by cardiopulmonary criterion or whole brain criterion
Uniform determination of death act of 1981
51
Intrinsically mattering morally
-may imply welfare and rights (receive life support, not be killed)
Moral status
52
Persons have moral status
Kant
53
Creatures capable of happiness/misery have moral status
Mill
54
Organ donors must be dead before procurement of organs begins and organ procurement itself must not cause the death of the donor
Dead donor rule
55
-culturally accepted, including in some faiths
-makes death a biological concept
-cardiac death is relatively easy and quick to determine
I’m favor cardiopulmonary criterion for death
56
-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
Against cardiopulmonary criterion for death
57
-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
In Favor of whole brain criterion
58
-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
Against whole brain criterion
59
-ties death to a feature that is plausibly linked to moral status: consciousness
-would allow for more transplantable organs
In favor of higher brain criterion
60
-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
Against higher brain criterion
61
-promotes patient autonomy, including religious autonomy
-death is plausibly a pluralistic concept
In favor of letting patient decide on death criterion
62
-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)
Against letting the patient decide death criterion
63
The physician intentionally, actively kills the patient for the patient’s benefit
(Active) euthanasia
64
The physician intentionally helps the patient kill themself
Physician-assisted suicide (PAS)
65
Euthanasia or PAS
Physician assisted death/dying (PAD)
66
The physician withholds or withdraws life-prolonging treatment
Passive euthanasia
67
-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
In favor of PAD
68
-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
Slippery slope objection to PAD
69
-violates respect for persons
-killing is not universalizable
-rebuttal: can promote agency and dignity
Kantian objection to killing with intention
70
-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
Hippocratic objection to killing with intention
71
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
Lucretius and Epicurus on the badness of death
72
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)
Nagel on the badness of death
73
-act or omission?
-causes death?
-death is intended?
Determinants and dimensions of killing
74
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
Double effect
75
-euthanasia may be more prone to abuse
-PAS is more ethical because killing is indirect
In favor of distinguishing euthanasia from PAS
76
-distinction discriminates against those not physically able to kill themselves
-the killing in euthanasia is also indirect
Against distinguishing euthanasia from PAS
77
May distinguish killing from letting die
Maintaining distinction: may support different moral judgements
Dissolving distinction: may harmonize moral judgements
Acts vs. omissions
78
-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
Process accounts of causation
79
-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
Difference-making accounts of causation
80
Two situations identical in all ethically relevant ways demand same ethical judgment
Ethical consistency
81
-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)
Reproductive autonomy as a negative right (a liberty)
82
-a right to have reproductive care provided (including abortion care)
Reproductive autonomy as a positive right
83
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)
The harm principle (J.S Mill) with reproductive autonomy
84
A right to not be killed
The right to life as a negative right
85
A right to have life support provided
The right to life as a positive right
86
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
Non-personhood argument
87
An individual with rights
Moral sense
88
An individual with certain capacities
Descriptive sense
89
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”
John Locke on (descriptive) personhood
90
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
Non-personhood argument objections
91
Most fetuses have a future like ours.
abortion deprives them of that future.
Therefore, abortion is immoral
FLO argument
92
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
Violinist argument
93
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
Objections to FLO argument
94
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
Objections to violinist argument
95
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
Fetal container model
96
Fetus is a proper part of carrier
In favor:
-early stage fetus cannot survive independent of carrier
-fetal carrier organismic integration
Fetal parthood model
97
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?)
Utilitarian Justice on abortion laws
98
-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
Rawlsian Justice on abortion laws
99
Abortion restrictions may violate basic reproductive liberty (caver: the harm principle)
Libertarian Justice on abortion laws
100
Any injustices impact particular social groups and result from oppressive laws:
-sexism
-ableism (selecting based on future disability)
Structural injustice in abortion laws
101
Currently limited clinical application, some gene therapies in development and testing
-possibility of editing embryos looms
Gene editing
102
-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?
The non-identity problem
103
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
Personal account model
104
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
Joint account model
