Final exam Flashcards
What are some of the important similarities and differences between the Hippocratic Oath and more contemporary codes of medical ethics (like the CMA Code)?
Hippocratic- Paternalistic (no autonomy)
Contemporary- Autonomy based
Both- Part of a group, take oath seriously, and establish professional groups and duties
What are some of the main problems facing medical professional codes of ethics? (Explain each of these.)
- Codes don’t all have the same rules: Validity of the code
- Codes can conflict with other moral commitments: Some people are against refusal in medical field
- Codes of ethics are largely codes of professional etiquette: doctors writing own prescription
- Codes are often vague and give little detail: accepting and refusing are both forms of respect; situations where code could go either way; can’t look at every possible scenario
- Codes have principles that could easily conflict: obligations to family, patients, yourself, etc could conflict.
Explain the main models of physician-patient relations. What are some of the problems or advantages of each model?
- Engineering Model- value free; focus on medical science; values are concern of patient; concerned about facts. Disadvantages: physicians deal with life and death, morality/values are bound to be involved.
- Priestly Model- Paternalistic; benevolence; physician assumes role of moral authority (respected). Disadvantage: many doctors are bad at conversations. Doctors aren’t relatable to priests.
- Collegial Model - Physicians should be patients’ colleges; equality; shares with patient same goal of eliminating disease. Disadvantages: doctors and patients are not equals as they don’t have the same knowledge and education.
- Contractual Model- characterized by… Freedom, dignity, truth telling, promise keeping and justice. Claims to solve other models problems; very open. Disadvantages: power advantage (doctor has more power), one-way need (patient needs help, doctor is not obligated to help), going to a doctor is not a contract.
What is the difference between descriptivist and normativist conceptions of health and disease?
Descriptivism: Judgements about health don’t require value judgements. They’re objecting descriptions about disease.
Normativism: All judgements about health include value judgements as part of their meaning
Explain the concept of competence and its relationship to autonomy.
- Ability to make choices based on an understanding of the relevant consequences of that choice on oneself and others
- The level of moral agency at which a person employs no more that his capabilities(a) of making an independent choice and (b) of engaging in rational deliberation.
process standard of decision making competence: balancing autonomy and beneficence
How does competence differ from autonomy?
- minimal: focuses on autonomy (more subjective)
outcome: focuses on beneficence (more objective)
Explain Mill’s two different types of action.
Self regarding- Actions that only affect the agents or others who have given their consent.
Other regarding- Actions which affect individuals (against their consent) other than the agent.
Explain Mill’s two different types of harm.
Direct- A affects B with action X, where X is harmful.
Indirect- A does X and x causes y, where y is harmful to b. (controversial)
Explain Mill’s “harm” principle.
Sole reason for which anyone can rightfully interfere with liberty of action of any member of the community is when that persons behaviour causes other regarding harm.
What is paternalism and what is the significance of this concept for biomedical ethics?
Doing something for someone else good, without regard to the others wishes. Example: JW refusing blood transfusion for religious reason and court ordering physicians to perform transfusion.
Explain the main concepts/requirements involved in the concept of informed consent.
- Information
- Volition- using one’s will
- Mental capacity
- Legal capacity
autonomous authorization (individuals) given if patient with substantial understanding without the influence of others authorized a hcp to preform a procedure:
(a) The patient is competent enough to make a decision.
(b) The patient receives adequate disclosure of relevant information. (c) The patient understands the information.
(d) The patient makes a decision voluntarily.
(a) Competence: Clear examples of incompetent patients (those who are incapable of making informed decisions) are those who are severely psychotic, or mentally disabled or very young. But, what about these less clear cases: Those who are not thinking clearly because they are crippled by fear or pain, or even stupidity?
(b) Disclosure: The relevant information to be disclosed is generally thought to at least include (i) the nature of the proposed procedure, (ii) alternatives to the proposed procedure, (iii) their potential risks, and (iv) their potential benefits.
(c) Understanding: Obviously, one can only consent to something if they understand what they are agreeing to. But, some have argued that many patients will NEVER truly understand what they are agreeing to, unless they themselves have been to medical school, since most treatments and medical issues are incredibly complex.
1
(d) Voluntary: Obviously consent is only valid if it is voluntary. This is, for instance, why we consider contracts to be rendered invalid if signed at gunpoint. But, there are much subtler forms of coercion than being held at gunpoint.
What are the main ways of understanding the information requirement of informed consent? What are the various advantages and problems for each approach?
Full- All info that has bearing on decision on question. Problem: lots of information.
Professional- Info that a similarly place college would disclosed under same circumstances. Problem: too limiting.
Subjective- Whatever the patient wants to know. Problem: might not know what to ask or might ask too much.
Objective- Unmodified; physicians have obligation to disclose (unasked) what any reasonable person would want to know
Modified; physicians have obligation to disclosed (unasked) what an objective, reasonable person would want to know in the patients situation.
Problem; how would physicians know other cultural value (too much expectation)
Explain the main exceptions that often appear in biomedical contexts to principle that medical professionals should always seek informed consent.
- paternalistic cases
- impracticality
- medico-legal emergencies
- legal
In what circumstances does Kipnis argue that health care professionals should accommodate a patient’s culturally based beliefs or values?
Duty to provide best care for a patients pressing health care needs and prohibition on becoming instrument of injustice. In the circumstance where a man didn’t want to be be treated by a japanese man because of trauma from war and a KKK member not wanting an african american man treating him. Both are morally the same because one need to put best health care for patients pressing needs before injustice and controversial issues.
What are the implications of Kipnis’s view for patient autonomy?
- Focusing on patients health needs first informs entire practice of hcp
- Hcp training is ill equipped to provide training in racism, sexism, and other forms of discrimination
- no moral difference. there is a differnce
What difficulty (or difficulties) does Macklin see when a perspective that respects cultural diversity adopts a strong form of ethical relativism?
Is standard focus on autonomy in western biomedical ethics consistent with multiculturalism?
What obligations do physicians in north america have toward patients with different cultural beliefs/ practices?
Multiculturalism is not relativist.
He argues that multiculturalism is incoherent, so clinicians have no obligations to follow it’s requirements and treat all cultures are equal. It’s possible to respect cultural diversity without having to accept every feature.
Explain why Siegler maintains that confidentiality is a “decrepit” concept.
- It is worn out and useless
- No longer exists
- Comprimised in actual medical practices; Not everything is 100% confidential as Many people have access to medical records
Records can be used in court
xplain the three main reasons why Lipkin argues that it is not always morally right for a physician to tell the truth to patients.
(1) Understanding is Impossible: Medicine is so complex, and patients are so ill- informed about the nature of the human body, and sickness, that they are incapable of true understanding, or assessing information accurately. For instance, when they hear the word “cancer”, some will assume this means they are going to die in a few weeks, while others will think it is nothing serious. Similarly, “arthritis” may make one patient think of their completely incapacitated grandmother, and make another patient think of their grandfather who complained just a little. These broad labels are not very informative, but the narrower labels or any in-depth explanation would be too confusing for them.
(2) People Don’t Want to Know: Lipkin claims that, while people may SAY they want to know the truth, they really don’t. For instance, someone might ask, “Do I look fat?” and SAY they want the truth—but when you tell them they DO, you quickly learn that they did not really want the truth. What they WANTED was a “No”, whether it is true or not. Doctors face similar questions. “Am I dying?” or “Is it bad?” What they WANT is a “No”, whether or not this is true (even if they claim otherwise).
(3) Placebos: Placebos are obviously permissible. These are a form of suggestion, which is a direct or indirect presentation of an idea, followed by an uncritical, i.e., not thought-out, acceptance. These are treatments where the physician CLAIMS to be giving the patient something to treat their illness, when in fact it has no medicinal effects at all (e.g., sugar water). The goal is to improve the PSYCHOLOGICAL state of the patient, which often leads to a visible improvement in their actual physical health. Benefit of deception in the patient’s regaining of his or her health
Identify and explain any of the following terms:
- voluntary active euthanasia- actively assisting death; involves a deliberate action which intentionally causes the death of a person
- voluntary passive euthanasia- respecting request to refuse treatment; involves withholding or withdrawing life-prolonging or life-sustaining measures in order to allow for the death of a person (ex. pulling the plug)
- nonvoluntary active euthanasia- person can’t consent; Cannot express his or her will & it is decided life will be taken;
- involuntary active or passive- murder; Person can give their consent but doesn’t, the decision is made against their will
- euthanasia physician-assisted suicide- have a happy, pain free death; another person is involved to some degree in another person’s suicide
- the doctrine of double-effect-not non-consequential; excusing; what you intend to do is what is good and bad; action must intend only good, the bad effect can be foreseen but not intended and the bad effect can’t weigh out the good.
- terminal sedation- patient in end of life situation and death is proximate and painful- person could be sedated even though it may end their life- patient refusal of nutrition and hydration.
- medical futility-three kinds: physiological (futile if no chance it will achieve direct objective), relation to patients goal (futile if no chance it will achieve patients goal, and relation to professional integrity (futile if won’t achieve goals compatilble with professional integrity.
Wrong to refer to notion of futility to help with medical decisions; futility not valid as it’s not value charged.
What is the difference between pre-emptive, pre-surcease, and surcease euthanasia?
Surcease-way of ending suffering; the only way to end it is death
Pre-surcease- at the beginning of surcease
Pre-emptive surcease- before suffering starts
Explain how Joseph Boyle argues that terminal sedation, as an act of the withdrawal of treatment, when considered in the light of a revised principle of double-effect, is not morally equivalent to active euthanasia.
Morally wrong to intentionally kill or shorten ones life. Terminal sedation involves foreseeing patient may be killed but not intending it. Because of double effect terminal sedation is okay.
Active Euthanasia: argues that euthanasia is not double effect as it is intentionally killing.
Why does James Rachels reject the AMA’s interpretation of the active/passive distinction?
- PE leads to decisions made on irrelevant grounds-Question is quality of life.
- Active more humane than Passive- PE requires more suffering than AE.
- No moral difference between active/ passive- Contrast of two cases with smith and jones
