FINAL Flashcards
1
Q
normative ethics
A
branch of moral philosophy that seeks to identify moral standards of right and wrong conduct
2
Q
practice ethics
A
attempts to justify a particular way of life and resolution to moral conflict
3
Q
virtue ethics
A
an ethical theory that focuses on personal character
4
Q
specification
A
process by which general principles are applied within specific cases; involves discernment of rules that are applicable to each case
5
Q
casuistry
A
case based method for resolving moral conflict
6
Q
narrative ethics
A
method of resolving moral conflict that relies on story use
7
Q
professionalism
A
activity that involves both the distribution of a commodity and the fair allocation of a social good, but that is uniquely defined according to moral relationships
8
Q
medical futility
A
situation when medical treatment cannot produce desired results
9
Q
substituted judgement standard
A
decide as the patient would decide- surrogates attempt to choose as the previously autonomous would have
10
Q
best interests standard
A
determining the best course of action for the patient- appropriate when patient was never autonomous
11
Q
principle of double effect
A
principle with 4 conditions that mist be satisfied to justify an action with one morally good and one morally wrong outcome
12
Q
quickening
A
occurs when a fetus begins to move independently of the mother
13
Q
somatic cell nuclear transfer
A
cloning (can be used to create a person or for purpose of harvesting stem cells)
14
Q
distributive justice
A
fair allocation of benefits and burdens of social and economic goods
15
Q
formal/ procedural justice
A
consistent application of material criteria and principles of justice
16
Q
material/substantive justice
A
specific criteria or principles used to determine what people are due
17
Q
liberty principle
A
Rawls first principle= everyone should have comprehensive set of liberties that is compatible with everyone having the same set
18
Q
difference principle
A
Rawls second principle= 1)inequalities should be attached to positions open to everyone under conditions of equality and 2) must be to greatest benefit of the least advantaged members
19
Q
clinical research
A
evaluates new treatments for safety and efficacy
20
Q
biomedical research
A
basic and applied research aimed at increasing medical knowledge
21
Q
preclinical research
A
aims to generate increased understanding of disease and new strategies for effective and safe treatments- measured in humans
22
Q
differences between modern and ancient hippocratic oath
A
globalization, individualism, and pluralisms of values (increased diversity), and technology have all changed the Hippocratic oath, but these updates have not changed the underlying aim of the profession to care for and protect patients
23
Q
3 core elements of the medical profession
A
devotion to medical service, public profession of values, and negotiation regarding values (with society)
-these elements work together by: devotion driving improvement, public profession acting as a way to police doctors and psychologically striving to be their best selves, and negotiation takes all different opinions into account (how to pay and what treatment is allowed)
24
Q
stages of the professional activism spectrum
A
routine advocacy, internal dissent, public dissent, direct disobedience, indirect disobedience, and principled exit from practice
25
autonomy and ethical theories
autonomy requires agency (ability to do) and liberty (freedom from constraints); ties to utilitarianism (greatest good for greatest number with freedom) and deontology (personal value)
-competence is important bc it allows for agency (no competence= no agency)- must be careful that HC profs cannot declare incompetent and strip agency
26
competence judgement problems
gatekeeping can be dangerous and can lead to the removal of autonomy of a competent agent:
autonomous authorization= precocious child= giving authorization for the moral right to choose
legal structures= rules to generally protect autonomy (18yo)
-in a perfect world we strive for AA, but legal structures must be in place to ensure consent formation**
27
informed consent
competence, voluntariness, disclosure, understanding, recommendation, decision, and authorization
28
influences on autonomy
coercion- threat of harm (physical or emotional)
persuasion (by reason- which can be permitted in disclosure, and emotion- not permitted)
manipulation- skewing the presentation of data to emphasize your position or withholding info
29
3 standards of surrogate decision making in practice
autonomy is taken first, but if not available then substituted judgement std, then best interests (best interests can be taken if bias exists in close relations)
30
professional obligations vs legal, personal morals, and personal values
legal= disagrees with profession obligations and cannot compromise profession
personal morals= religious and identity that guide all life choices
personal values= stand alone, influencing decisions and must be removed for professional obligations
31
conventional response to case of infected spouse
her right to life trumps his right to confidentiality
public health/ safety> confidentiality
-probs= this could damage the profession as a whole through the dr-pat relationship
-kipnis= we should always keep the confidential rule to protect the profession- ensure spouse gets treatment
32
patient responsibility vs dr obligations
there is an imbalance in power between drs and pats- therefore dr obligations carry more weight than patient responsibility
- also, historical pattern of paternalism and still subtle paternalism removes some patient control= dangerous
- we should place greater responsibility on dr bc they chose to take burdens for society (chose the profession)
33
prospective vs retrospective responsibility
pro= education, preventative forward looking
retro= seeking to assign blame/ culpability
* we favor pro bc assigning blame will change nothing, but improving for the future will account for all areas problem could have arisen in
-retro doesn't work bc many factors involved and pro will strengthen the dr pat relationship (follows duty to protect the vulnerable- socioeconomic), and saves money (political) and compassion based (virtue ethics)
34
fact value distinction
your values can impact which "facts" are real to you and which are not. we must also take social facts into account when dealing with patients to account for diversity
=default is that death is a scientific fact, but need to ground in social fact bc depending on values the patients definition of death may change
35
radical longevity concerns
1- disenfranchized youth leading to revolt of the social structure bc decreased jobs
2-personal= death would become sudden and violent and the standard age for death would keep getting pushed back
3- death grounds value (beauty, seriousness (make the most of life), decreases boredom/ tedium, honor/ heroism)
---irrational immortality= seeking to add incomplete years to increase completion in life is irrational
Kant= look to children, community, and culture for stored value
36
quant vs qual futility
```
quant= low chance of survival (Dr is the one to make the call)
qual= 100% survival but quality of life is threatened (patient must make the call)
```
37
physiological futility
= dr and patient should work together- patient determines values and dr determines chance of occurrence
-probs= 1) does not match everyday use, 2) air of perceived certainty, 3)does not even address the real moral issue
38
physician, professional, and moral autonomies failing with refusal to treat arguments
```
phys= phys are not slaves to the patient- BUT are contained by the profession and value of putting patient first- also do not need medical degree to decide to treat or not
professional= backed by profession BUT profession is checked by societal negotiations.. probs= these cases are a last resort and the values grounding judgements are intensely personal and only patient can make them
moral= conscientious objection, but this is check by impact on patient (which trumps core to moral values, basis in professional norms, and central to personal identity)
```
39
NICU decisions and autonomy
shift to comfort and care- override autonomy (no informed consent) and drs make the decision that the parents want to but cannot at that time
40
Re A -vs- double effect and acts and omissions
DE= one action leads to two outcomes (one good and one bad)- have foresight into both, but only ONE is intended
A&O= death caused by illness, passive removal of care from doctor
Re A= not DE bc both were intended (saving one patient and killing another) and not A&O bc this was pure action
solution= devils choice- in an intensely perverse situation where opting out is not possible, the moral weight lies in the desire (both actions and outcomes were known and intended, but desire was for the morally good one)
41
palliative care that results in death with Devils choice
- justifies intention to relieve pain= desire for outcome carries the ultimate weight and relieves some burden
- distinction between causal and moral responsibility of doctor
42
Wolf takeaways on voluntary euthanasia
- utilitarianism supports euthanasia
- VE is prima facie permissible bc it protects autonomy
- mental illness qualifies as suffering and does not undermine autonomy
- physical pain qualifies as autonomy and VE is better than terminal sedation
- slippery slope argument has no backing in states/ countries where VE is legal
43
gender difference in VE
no one is talking about the contextual details with VE- tenderized virtues would disproportionally push women to VE so they are not a burden
3 feminist criticisms of rights based model (right to pure unconstrained autonomy)=
-ignored context (history, situation...)
-actively erases context and vulnerability
-confuses 2 questions= what patient may ask and what dr may do
***automatically suspect when arguments do not account for differences and fail to attend to vulnerabilities of women and other groups
44
abortion arguments (Thomson)= 6
premise= life begins at conception
1-self defense
2- right to body and life >rt to life (coat example)
3-we do not require others to give bare necessities to another (violinist) rt to body > rt to life
4- has woman assumed responsibility? risk NEVER entails responsibility
5-"should" with pro-life involves virtue aspect- no one is required to be virtuous- worst= shaming
6-standard for pregnant women is extremely disproportionate to normal virtues
45
thomson objections and responses
- late in abortion is not permissable= Thomson agrees that there are exceptions in timeline (woman-fetus to mom-child)
- right to terminate vs right to death... coercion is greatest evil
46
standard view with pro-life
std view= human life is valuable bc it is human
- problems= contraception as murder, PVS, organ donation, biblical, alien life
- solution= move to future of value argument for pro-life
47
7 arguments for and against pharmacists right to object
pharmacists position= professional autonomy (need to have autonomy to decide which med combos are harmful), freedom of democracy= conscientious objection, employment discrimination (protect morals)
patient position= fiduciary role, EC is not an abortifacient, patient impact outweighs objection, potential for abuse
solution= middle ground where pharms can object but must provide other care or alternatives/ referrals
=professional ethics of putting the patient first and phys having higher obligation, but also morals are accounted for/ autonomy
48
2 main problems with enforcing gestational responsibility
- how do you enforce it
| - how to determine culpability
49
problem with conflict model for mother-child relationship
distinguishing two patients from one pregnant woman-
responsibility for everything in pregnancy would go to mother even if she doesn't have socio eco tool to protect the fetus
-incarceration for miscarriage
-solution= look to therapy and education (prospective responsibility) instead of punishment
50
2 confusions in standard account of procreative liberty
- procreative liberty giving contextual norm to ethical analysis (should not be used for any other time than to have or to not have the fetus)
- thinking that having a pregnancy is the same as how to build a family (dangerously close to eugenics)
51
richer ethical framework over procreative liberty
REF should acknowledge what it means to flourish versus plain and unconditional love for those in your family
-designer babies are wrong bc of REF, not proc. lib.
52
problem with cultural norm of altruistic women
sees women as gifts to be given- hinders ability for them to act autonomously
53
gift giving model dangers
women are murdered and harmed the most by people close to them, the idea that the family hierarchies will not harm women in surrogacy situations is grossly naive
- also commodification of women bodies and exploiting the poor
- Raymond believes surrogacy can only by anonymous to be safe
54
3 central questions to justice in HC
- is HC a special good?
- when are health inequalities unjust?
- when are HC limits just?
55
3 central questions expanded
- HC is a special primary good bc while everyone needs it, the health needs between individuals may be vastly different
- Health inequalities are unjust when the social determinants are unequal
- HC limits are just when 4 conditions are met: procedural, relevance, appeals, and enforcement
56
argument from desert and its failure
argument= immigrants don't deserve HC bc they broke the law and US citizens should be prioritized since there are limited resources
probs: -we give HC to prisoners who broke the law
- we can redistribute funding to give more for HC
- problematic bc it essentially brings HC down to what one "deserves"- saying lowest rungs of society must compete for HC- HC is a primary good, not a prize
57
argument from professional ethics and failures
1- public health (if we don't treat immigrants, public disease will spread)- prob= treats immigrants as means to end
2- confidentiality (drs should not act as border patrol)
3- doctors should care for those in need- too broad bc no one is saying they shouldn't and leads to slippery slope of doctors leaving to help MOST in need
58
argument from human rights and failure
arg= immigrants are humans and therefore deserve HC.. prob= this is a conclusion and not an argument
59
Dwyer's alternative
social responsibility argument= immigrants pay taxes and participate in our society, and therefore deserve the same goods
-counter = this would increase immigration (nonseq. - if goal is deference, legalize murder)
60
fewer mistakes argument with presumed consent
70% of the pop would donate organs and keeping with this majority, we should presume consent so we make fewer autonomy mistakes
-counter= mistaken removals are morally worse than mistaken nonremovals
61
non-interference vs respect for wishes model of autonomy
```
NI= do not touch body after death- no extra procedures unless directly permitted
RFW= do not violate future plans- when one dies, ones future wishes still apply, but their body does not require non-interference
```
62
NI and RFW with presumed consent
only RFW applies bc we must do something with the body if no express notification- both forms of removal violate RFW so they are both equal and data supports that more people want donation so we should presume consent
63
reciprocal altruism
from evolutionary theory- symbiosis= enlightened self interest
64
how do 4 premises of altruistic stranger kidney donation fail?
low risk to donor- fails bc there is still a risk of death for the donor and loss of kidney if a family member needs it
risk/ benefit ratio-donor incurs all risk and recipient incurs all reward
psychological benefits- a small percentage do say they regret donating and this is unacceptable
altruism- guilt as rhetorical device is not morally justifiable and we cannot motivate people to put them in the way of harm
65
opting in paradigm
incentivizes donor registration and includes greater number of resources for transplant- reduces scarcity = opt in to receive transplant priority if needed and say you will donate organs upon death
66
3 links between health and human rights
direct HR to health violation (any duty unfulfilled leads to health impact)
HR violation leads to health impact (segregation, torture)
violation of HR in response to health (forced sterilization)
67
Denver principles
impact social responsibilities and ethics towards those affected- helps drs and society see people with HIV as people and not patients/ diseases
68
resistance to medicalization
medicalization= turning someone into their diagnosis- to resist it is to treat people as unique and not a disease
69
3 types of duties generated by human rights with HIV
1) to respect (do not violate health or HR- forced incarcerations)
2) to protect (from discrimination in civil society- housing)
3) to fulfill (provide effective and cheap treatment with cultural differences taken into account)
70
1991 clinical studies change
switched from majority academic centered to private sector (70% private)
71
repercussions of for-profit model of clinical trials
- facilities are run down
- researchers are profit driven and motivated for high volume low care- may not even have medical degree
- participants and vulnerable
72
narrow focus of international research
10/90 ratio, ignores social determinants of health, anemic theory of justice= assumes cooperation and equal levels of power
73
duties of justice for intl' research- 3 levels
duties of rectification- make up for history with colonialism, fix 10/90 ratio, do not further exploit the countries
local authorities- avoid internal brain drain, provide for people in fair distribution, social determinants of health
community members= participate democratically, flourish= human development and create community
74
moral salience of SC research from religious perspectives
jewish- abortion is OK if it is risky, must be performed if it threatens the life of the woman; technology is morally neutral depending on what it is used for; life requires fertilization and implantation so IVF is always OK
catholic- medical science can work with religion; some are for and some are against- issues= will lead to abortion for use of SC research, incentivized abortion, and embryo is person (opposition is the opposite of this with laws made to prevent incentivizing)
protestant- embryos are the most vulnerable people and must be protected- just cause for research but need alternatives
islamic- 40 day development periods- abortion is OK before 4 months (ensoulment= quickening), SC research is OK
75
problems with animal debate
reliance on high theory (util, deon) which are countered by their imperfections, also taking the biocentric vs anthoropocentric view alienates argument
76
3 commonsense principles for animal research arg
- killing, harming, or causing suffering in an animal is wrong when there is no good reason
(biomedical debate is the same applied to research)
77
4 ways animal experiments are harmful to humans
false positives- harmful to animals not humans
false negatives- not harm to animals, harm to humans
false efficacies- work in animals, not humans
false inefficacies- don't work in animals work in humans
1 and 4 are worst
78
alternatives to animal research
stem cells and in vitro tissue
| -even if no alternatives, animal research does more harm than good and should be stopped
79
autonomy argument against genetically engineered children and its failure
that engineering children removes their autonomy to determine their own selves, but they can't change their genetic code anyways
80
competitive fairness argument fail with GMO muscles
arg= this will provide unfair advantage in sports, BUT this already exists (talents/ genes)
81
class based memory argument
enhancing memory will create two classes based on socio eco
| -BUT we could tax the modification
82
arms race for height argument
we could tax this too and people are already naturally taller than others
83
pro life objection to sex selection
incorrect bc these are not living cells- new tech could select for sperm with X or Y
84
danger of hyperagency in enhancement
"master of nature" or "self made man" compromises what it means to be human and have virtue and morals
85
enhancement and sports
undercuts effort and natural talent by enabling people to be "deserving of a certain medal" by their genetic code and not effort (would also lead to despair if they did not live up to their code- like in GATTACA)
86
enhancement with parenting
compromises the core parental value of unconditional love for offspring no matter what= removes "openness to unbidden"
87
3 key moral features threatened by widespread enhancements
humility, responsibility (you are different and its your fault), and solidarity (no cooperation or community bond/ differences across groups will become pronounced and empathy will be reduced)
-lack of understanding bc lack of exposure (enhancement removes diversity)
