final Flashcards
Euthanasia
Directly or indirectly bringing about the death of another person
for that person’s sake
Active euthanasia
Performing an action that directly
causes someone to die; “mercy killing”
Passive euthanasia
Allowing someone to die by not
doing something that would prolong life
Voluntary euthanasia
Euthanasia performed when competent patients voluntarily request or agree to it
Involuntary euthanasia
Bringing about someone’s death against her will or without asking for her consent although she
is competent to decide
Non-voluntary euthanasia
Euthanasia performed when patients are not competent to choose it for themselves and have
not previously disclosed their preferences
Active/Passive Euthanasia
Some contend that the distinction is crucial: active euthanasia
is killing, but passive euthanasia is letting die.
* The AMA has sanctioned the distinction.
* Some argue that there is no morally significant difference
between mercifully killing a patient and mercifully letting the
patient die.
Physician-Assisted Suicide
- A patient’s taking his or her own life with the aid of a physician
- The AMA has denounced PAS
- Many people (including some physicians) support its use
- To date, it is legal in Washington D.C. and California, Colorado, Hawaii, Oregon, Vermont, Washington, and Montana
Physician-Assisted Suicide: What Do Doctors Think?
In a 2014 survey of physicians (17,000 in U.S.; 4,000 in Europe):
54% of U.S. physicians say physician-assisted suicide should be allowed.
31% of U.S. physicians say it should not be allowed.
41% of European physicians say it should be allowed.
35% of U.S. and European physicians say they would not give life-sustaining treatment if they considered it futile;
19% say they would.
Public Opinion physician- assisted suicide
In a 2018 Gallup poll:
When a person has a disease that cannot be cured, do you think doctors
should be allowed by law to end the patient’s life by some painless
means if the patient and his or her family request it?
Yes, should: 72%
No, should not: 27%
Traditional view
Death is the cessation of breathing and heartbeat
Standard in law and medicine
Whole brain view:
An individual should be judged dead when all brain
functions permanently stop
Alternative notion
Higher brain standard:
Individuals are dead when the higher brain
functions responsible for consciousness permanently close down
Autonomy
Respecting people’s inherent right of self-
determination means respecting their autonomous choices
about ending their lives
Beneficence
If we are in a position to relieve the severe
suffering of another without excessive cost to ourselves, we
have an obligation to do so
Arguments against:
Moral difference between killing and letting die:
Killing is worse than letting die, so giving a patient a lethal
injection to affect an easy death is wrong, but disconnecting
his feeding tube may be permissible.
– Moral difference between intending someone’s death and
not intending but foreseeing it:
The former is wrong; the latter is permissible.
U.S. Health Care
- In 2010, almost 49 million people under the age of 65 were uninsured,
and almost 8 million of those were children. - Nearly a third of the under-65 population—almost 90 million people—
had no health insurance for at least part of 2006 or 2007. - In 2013, just before the ACA began to take effect, more than 44 million
people under age 65 were without coverage. - By 2016, there were still 27.6 million people under 65 who had no
health insurance coverage. - Reasons for lack of coverage: high cost of insurance, the absence of
coverage acquired through employment, and ineligibility for public
coverage.
Distributive justice
Justice regarding the fair distribution of
society’s advantages and disadvantages
Egalitarian theories of justice
Doctrines affirming that
important benefits and burdens of society should be
distributed equally
Libertarian theories of justice
Doctrines holding that the
benefits and burdens of society should be distributed through
the fair workings of a free market and the exercise of liberty
rights of noninterference
Utilitarian theories of justice
Doctrines asserting that a just
distribution of benefits and burdens is one that maximizes the
net good (utility) for society
Negative rights
imposes a duty not to interfere with a
person’s obtaining something
Positive rights
imposes a duty to help someone in her effort to get something A “right to health care” refers to a positive right and involves the notion that society has an obligation to provide health benefits
Libertarians
would reject “a right to health care.”
Utilitarians
could endorse a derivative right to health care.
Egalitarians
could favor a bona fide entitlement to a share of
society’s health care resources (e.g., a right to a “decent
minimum” of health care).
Do you think it is the responsibility of the federal government to make sure
all Americans have health coverage, or is that not the responsibility of the
federal government?
Is 45%
Is Not 52%
The Human Rights Approach: Justice and Health Care
- The idea is that we can best achieve just distributions of health
and health care by ensuring that human rights in general are
respected - Respecting human rights contributes to well-being and health
(including access to health care) - Respecting human rights encompasses fair treatment, freedom
from coercion, nondiscrimination, protection from abuse,
equality, and other entitlements
Rationing
Rationing cannot be avoided.Dilemmas arise most acutely among individual patients and
providers who must contend with scarce life-saving resources.
Transplants
the central moral issue: What criteria should be
used to decide which patients get transplants, and who should
make the decisions?
Macroallocation
What portion of a society’s resources
should go towards healthcare?
Microallocation
Who should receive specific resources?
Utilitarian
Greatest benefit to person/society
Egalitarian
Emphasize the moral equality of all
Libertarian
Whoever can pay for it – let the market decide
Justice and Microallocation
QALY
Probability of Success
Patient Need
Social Value
Distributive justice
Justice regarding the fair distribution of society’s advantages and
disadvantages.
Egalitarian theories of justice
Doctrines affirming that important benefits and burdens of society should be
distributed equally.
Major Provisions:
- Most individuals required to have health insurance beginning in 2014.
- Individuals who do not have access to affordable employer coverage will be able to purchase coverage through a Health Insurance Exchange. Small businesses will be
able to purchase coverage through a separate Exchange. - New regulations will be imposed on all health plans that will prevent health insurers from denying coverage to people for any reason, including health status, and from
charging higher premiums based on health status and gender.
Medicaid will be expanded to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) for all individuals under age 65. - From 2010 to 2014, as the economy improved and the main provisions of the Affordable Care Act (the ACA, or “Obamacare”) took effect, the number of uninsured among people under 65 dropped to 32 million. But the reasons for lack of coverage remain the same: high cost of insurance, the absence of coverage acquired through employment, and ineligibility for public coverage.
Epidemic
a disease that occurs in larger numbers than
expected in a particular population and geographic area
Pandemic
an epidemic that goes worldwide
Coronaviruses
cause respiratory illness in humans, (SARS,
MERS, the common cold, and COVID-19)
- COVID-19 (SARS-CoV-2)
causes mild symptoms in most
people but severe illness and death in others
Ezekiel J. Emanuel et al. identify four fundamental values that
should govern resource allocation:
Maximizing the benefits
– Treating people equally
– Promoting and rewarding instrumental value
– Giving priority to the worst off
Ethicists generally agree that some criteria should not be used
to decide who has access to a limited or scarce resource
» Wealth
» Fame
» Political power
» First-come, first-served
» Moral worth
» Social utility
Health status
disability does not always indicate compromised
health.
Quality of life
disabled people do not necessarily have lower
quality of life.
Social utility
disabled people are no less valuable members of
society.
Quarantine
people who have been exposed are separated
from others.
Self-isolation
people who are sick or have symptoms are
asked to stay home and go out only in an emergency.
Libertarians
what matters most is individual freedom and a
person’s right to direct their own life for themselves.
Communitarians
what matters most is not individual liberty
but the common good, what’s best for the community as a
whole.
COVID-19 Falsehoods
Misinformation is a falsehood, a statement that is factually
incorrect.
Disinformation is a deliberate falsehood, a statement that is
factually incorrect on purpose (a lie).
Who Spreads False Information?
Deliberate deceivers knowingly traffic in lies to score partisan points, show support for their tribe, troll the opposition, exact revenge, or make a buck.
Self-deceivers are motivated to hold false beliefs despite contrary evidence.
Bullshitters don’t care whether what they say is true or false but intend to deceive their audience about their motives.
Read Critically
1) Accept claims that are supported independently by reliable authorities,
evidence, or other claims that you know to be true.
2) Accept claims that are adequately supported by the source itself through
citations to other credible sources (experts, research, reports, etc.) or
through references to supporting facts.
3) Reject claims when there is good reason for believing them false.
4) Suspend judgment on claims that you are unsure of, for it is
unreasonable to accept a claim without good reasons, and the only cure
for uncertainty about a source’s claims is further research and reflection
Inherency
the notion that certain traits of mind, character, and
temperament are inescapably part of a racial group’s nature
Inferiorization
the treatment of certain groups as inferior to
other groups
Racial Antipathy
morally blameworthy because general racial
bigotry, hostility, and hatred are vices, especially when they are
directed against people who have suffer solely because of their
membership in a racial group.
Racism Is Empirically Wrong
- The consensus among scientists and scholars is that the traditional view
of races—that there are distinct groups of people sharing significant
biological characteristics—is false. - Race has no physical scientific basis.
- Race is a social construction, an idea we endow with meaning through
daily interactions.
Discredited
Based on obvious biases, faulty assumptions, methodological errors,
and motivated reasoning
Scientific Racism
The attempt to prove there are separate races, race explains basic
differences among people, some races are superior to others
Why Not Discard the Concept of Race?
Race-based social grouping has led to real differences in resources,
opportunities, and well-being.
* The concept of race must be conserved in order to facilitate race-based social movements or policies.
Racism Is Morally Wrong
Respect for persons—persons possess inherent worth and have rights—the
rights of free expression, choice, and privacy, the right not to be coerced, enslaved,
cheated, or discriminated against.
* Principle of justice—equals should be treated equally unless there is a
morally relevant reason for treating them differently—and racial difference is not
morally relevant.
* Utility—we should produce the most favorable balance of benefit over harm for
all concerned and racist beliefs, words, and actions can do harm or lead to harm
that is magnified when operating through institutions, corporations, governments,
and the law.
Individual Racism
Person-to-person acts of intolerance or discrimination
Institutional or Structural Racism
Unequal treatment that arises from the way organizations,
institutions, and social systems operate
Health Disparities and Race
Infant mortality—the number of infants who die before their first
birthday per 1,000 live births
– In 2013, the infant mortality rate among African Americans (11.1 per
1,000 live births) was double the rate among whites (5.06 per 1,000 live
births).
– American Indians/Alaska Natives and Puerto Ricans also experienced
higher infant mortality rates (of 7.61 and 5.93 per 1,000 live births,
respectively) than whites.
– In 2015- % of low-birthweight infants rose in African American and
Hispanic infants
* Life expectancy—a measure of the overall health of a
population, typically expressed as the average number of years
a newborn would be expected to live
– In 2014, the life expectancy for white males was 76.5 years, African
American males was 72.0 years, Latino males was 79.2 years.
– In the same year, life expectancy was 78.1 years for African American
females, 81.1 years for white females, and 84.0 years for Latina
females.
* Age-adjusted death rates—sum of deaths in a population from
all causes except old age
– The age-adjusted death rate per 100,000 (for the years 2012–2014)
was 729.1 for whites and 858.1 for African Americans.
– The death rate due to heart disease was 165.9 deaths per 100,000 for
whites and 206.3 deaths for African Americans.
– For cancer the death rate was 161.9 for whites but 185.6 for African
Americans; for diabetes, 19.3 for whites, 37.3 for African Americans.
Reasons for Race-Based Health Disparities
Laying the blame on socioeconomic status (SES) is too simplistic:
* Chronic exposure to racial discrimination has deleterious effects on
the physical and mental health of individuals.
* Residential segregation can exacerbate the rates of disease among
minorities and reduce the sense of urgency about the need to
intervene.
* Implicit bias and prejudice leads to widespread differences in health
care by race and ethnicity.
