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MCDB 60- Bio Ethics > Final Exam > Flashcards

Final Exam Flashcards

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1
Q

Norman Daniels

The Big Question-

A

Do individuals have the right to be provided with some level of health care, regardless of their ability to pay (or access to private insurance coverage)?

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2
Q

Norman Daniels

Secondary Questions-

A

To what types and levels of health care are individuals entitled? How are limits to health care entitlements determined?How equal must access to health care be?

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3
Q

Norman Daniels

Preliminary Questions-

A

What is a right, conceptually? How can/should we argue for the existence of certain rights, but not others?

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4
Q

___________________ are those rights which are enshrined and protected by a system of laws.

A

Individual rights

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5
Q

_________________ Implemented country-by-country with variations in structure of provision, coverage levels, and relevant exclusions.

A

Legal Rights:

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6
Q

________________ An individual right is a claim or demand that others have a duty to respect, based on the truth of moral reasoning, and regardless of the content of existing law.

A

Moral Rights:

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7
Q

___________________ establish a zone of liberty protection around an individual, and require that others not impede liberty within that zone. Beyond non-interference, negative rights do not incur additional duties upon third parties. Examples: Privacy, Religion, Free Speech, Basic Right to Life

A

Negative rights

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8
Q

____________ are rights which require the active assistance of third parties for their fulfillment. They thus incur upon others a duty to provide certain goods and services to those demanding the rights. Examples: Education, Housing, Welfare and Basic Income, right to an attorney.

A

Positive rights

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9
Q

_____________________ Distributive equality is a necessary condition of a just society. But what must we be equal in? conditions/outcome/something else? And “how equal” must we be? strictly equal? some other pattern?

A

Egalitarian Theory-

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10
Q

__________________ A just society requires equality of opportunity among all members. What exactly is equality of opportunity? Our life prospects should not be limited by the accidents of our birth – like race, class, our natural talents, and presumably, our susceptibility to disability and disease

A

Daniels’ Answer-

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11
Q

Name some social theories:

A

Libertarianism
Utilitarianism
Basic and Human Rights Approaches
Equality of Opportunity – Daniels’ Approach

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12
Q

Daniels’ Argument – The Equality of Opportunity Approach to Health Care
A just society is an egalitarian one ________________________________________

A

– that is, it is an equal one, in the importantly relevant ways.

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13
Q

A just society has the obligation to ensure equality of opportunity. among members.

A

Equality of opportunity requires “normal” functioning. Disease and disability disrupt “normal” functioning for some members, and thus impede equality of opportunity.
A just society has the obligation to provide health care to members, in order to mitigate the effects of disease and disability, ensure equality of “normal” functioning, and thus (partially) safeguard equality of opportunity.

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14
Q

Daniels’ Argument

A

– The Equality of Opportunity Approach to Health Care

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15
Q

________________________ Basic included services should be provided to all with equal access and without regard to ability to pay, via a BASIC TIER of provision.

A

Access and Ability To Pay-

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16
Q

what is the [SOURCE/CAUSE and OUTCOME/EFFECT]-

A

Explains what should and shouldn’t be included in government funded health care.

Excluded services are those that are not “medically necessary” to treat disease or disability, or those that would treat diseases or disabilities that do not substantially detract from normal functioning. (Cosmetic surgery; some Prozac use; symptomless immunological conditions…)

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17
Q

Included and Excluded Services- _________________________

A

Services included are those that are “medically necessary” to prevent or treat diseases or disabilities that impede normal functioning, and thus disrupt equality of opportunity.

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18
Q

_____________________ Rejects Straightforward Cost-Benefit Analysis. Rejects Market-Based Approaches

A

Constraints, Limits, and Scarce Resources-

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19
Q

__________________ Accountable and Open-Ended Decision Procedure- Equality and The Existence of a Second Tier. Canada and Norway – No Supplementary Insurance Allowed. Britain – 10% Buy Private Insurance for Faster/Extra Services

A

Argues For Publicly-

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20
Q

3 options for society

A

Option 1: Accept most of his view,but challenge the applied details.
Option 2: Accept egalitarianism, but challenge the equality of opportunity requirement, or the relationship of disease and disability to equality of opportunity.
Option 3: Reject egalitarianism, and proceed from a different starting place/theory in political philosophy, that may or may not generate alternate applied recommendations.

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21
Q

What Are the Ethical Obligations of Health Care Providers? (Norman Daniels)

A

Three Ethical Questions for Physicians, Given an Unjust Status Quo
Must Physicians Treat the Uninsured and/or Unable to Pay?
The Status Quo: These Requirements of Justice Are Not Being Met. Does This Fact Incur Special Ethical Obligations on Providers?

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22
Q

Must Physicians Treat the Uninsured/Unable To Pay? Must Physicians Practice In Underserved Geographical Areas? Must Physicians Practice In Underserved Medical Specialties?

A

Daniels’ Thesis: Just health care is a requirement of just social institutions, and not an ethical requirement incumbent upon individual choices.

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23
Q

Rawlsian Background – The Individual Duty To Secure Just Institutions.

Explain

A

There are no direct individual ethical duties to secure just outcomes, because: Individuals do not have the information or power necessary to achieve large-scale social change.As long as professional interests are opposed to private/personal obligations, a system founded on such individual choices will be unstable.

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24
Q

Introduction to Virtue Ethics

What Virtue Ethics is

A

The Theory that the right thing to do, the right act/ decision is the one that a virtuous agent would do/make
Agent Centric theory as opposed to act- centric theory

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25
Q

Virtue Ethics- Some History

A

Originated with the Ancient Greeks- Aristotle

Important Concepts in Virtue Ethics

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26
Q

____________________The totality of a person’s particular (moral) identity: including (but not limited to) intentions, goals, values, skills, reasoning capacities, emotions

A

Character:

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27
Q

_______________ Any Train that is part of a person’s character that is considered to be good. Examples: honesty, courage, compassion, etc

A

Virtue:

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28
Q

_________________ The Ability of the virtuous agent to detect which features matter in a particular context and make an appropriate decision based on them

A

Discernment:

29
Q

____________________ The methods by which the virtues are acquired and engrained

A

Habits and Education:

30
Q

Reasons for and Against Virtue Ethical Views

Three important questions for virtue theory:

A

How does Virtue ethics compare to other forms of ethical theory?
What are the reasons to adopt or reject virtue ethics as the correct form of ethical theory?
Is virtue ethics compatible with other forms of ethical theory?

31
Q

Virtues Specific to Medicine and Research

A

Are there particular virtues that are expected of and help define the roles of those in the medical field.

32
Q

The Four Principles of Medical Ethics

A

Respect for autonomy
Nonmaleficence
Beneficence
Justice

33
Q

Relating the Four Principles to a Virtue Ethics View

A

These are very general guidelines for a deeper concept.

34
Q

Review of, The Principle of Respect for Autonomy

A

To what extent do we recognize the value of autonomy

35
Q

The Principles of Nonmaleficence

A

Do no harm.

What is Harm.

36
Q

The Principle of Beneficence

A

Do good

What is the difference between harm and non beneficence or between a benefit and a non-harm

37
Q

The Principle of Justice

A

Effect positive social justice change! Or at least do not make things less just.
Do Physicians need a background theory of justice?
Individual- level vs. social level obligations.

38
Q

Case Application : The Obligation of Physicians to Tell the Truth
The Ethical Dilemma of Truth Telling in Medicine
Three arguments to no tell the truth?

A

The Technical difficulty argument
The patients do not want to hear it argument
The truth can harm

39
Q

________________Non-truth can sometimes be morally permissible (based on the harm argument, primarily), but must be a last resort and be stringently justified. Understanding when it is permissible requires careful discernment and on the part of the physician

A

Higgs thesis:

40
Q

Do Physicians Have a special Dispensation to Lie? Three arguments

A

The relevance of Technical complications
Patients’ wish to not hear bad news
The Truth can harm

41
Q

Overview of Human and Non-Human Experimentation in Scientific Research

A

Why and How are Humans and Non-Humans Used in
Scientific Research?
Ethical Arguments Generally Involve- Weighing Risk and Harm vs. Beneficence and Informed Consent as Differentiator

42
Q

The Definition of a Liberation Movement

A

Singer’s Thesis: We [ought to] extend to other species the basic principles of equality that most of us recognize should be extended to all members of our own species. (530)
Singer’s Method: Evaluate the arguments in favor of equality in prior liberation movements, and show how they must be applied to non-human animals in order to be logically consistent.

43
Q

_________________ This is Not In Fact True! All Individuals Differ In Important and Relevant Senses

A

Singer’s Response:

44
Q

Group Identity Tells Us Nothing Important About Individual Identity. Ex.: Some Men/Women Are Superior In Some Ways To Other Women/Men

A

Singer’s Response- Not The Best Way To Ground Equality – Forces Defender Into Corner

45
Q

Equality as a Moral Ideal, Rather Than Assertion of Fact

A

It Is a Prescription For How We Should Treat Relevant Beings
Its Justification/Explanation- Every being with moral status should be considered equally, and its interests should count as much as the interests of any other.

46
Q

Sentience as the Ground of Moral Status/Interest Possession

A

A Being Has Obligation-Inducing Interests (and thus Moral Status) If … It Has The Capacity for Suffering and Pleasure- “If a being suffers, there is no justification for not taking. that into consideration.” (533)
For Singer, “all other markers are arbitrary.”

47
Q

Racism/sexism involves the prioritization of the interests of one’s own

A

race/sex over the interests of another race/sex, when they conflict.

48
Q

Racism/sexism involves the prioritization of the interests of one’s own

A

race/sex over the interests of another race/sex, when they conflict.

49
Q

Speciesism involves the prioritization of the interests of

A

one’s own species over the interests of another species, when they conflict.

50
Q

Speciesism In Practice –

A

Moral Obligation to Desist: Eating Animals (Our Tastes Override Their Suffering) Experimenting on Animals. Contemporary Philosophical Practices

51
Q

Experimenting on Non-Human Animals

A

Theoretically justified by cost/benefit analysis. But … not all experimentation is for vital medical purposes: example of shampoo/cosmetic testing.
Costs to animals outweigh benefits to humans.

52
Q

What about “vital medical research” in universities? Singer’s Approach,

A

Animals regarded as “laboratory equipment.” Gains to humans are minimal, losses to animals are great. (Psychology experiment using dogs.) But what about other, arguably truly vital research?

53
Q

Singer’s View on The Role of Philosophy in Public Life

Singer’s View of the Role of Philosophy in Public Life-

A

Why Haven’t Philosophers (and Others) Abandoned Their Speciesism In Light of The Difficulty of Finding An Appropriately Explanatory View of Moral Status?

54
Q

The Problem of Moral Status, Revisited and Summarized
Do infants have moral status, whereas animals don’t?
Defenders of contemporary practices must find a ground for moral status that encompasses ALL/ONLY humans.

A

The Potentiality/Future Value View-(But… abortion…)
The Capacity to Enjoy the Good Life View- (But… apes, dolphins, dogs…)
The “Intrinsic Dignity” View- (But… why?… And Hitler/Stalin…)
The “Human Norms” View (Benn’s Position)- (Consistent, but could be used to justify racism/sexism, despite overlaps

55
Q

Principles of the Belmont Report

A

beneficence
justice
respect for other persons

56
Q

Common Rule

A

Do Animals Have Moral Status/ Interests That Constrain the Acts of Others?
Is So, What Are Those Interests, and Under What Conditions Must They Be Respected? Does Contemporary Scientific Research Do This Sufficiently?
Are All Non-Human Animals Equal In The Consideration (if Any) They Demand? Can We Prioritize the Interests of Some Non-Human Animals Over Others, and If So, Why?

57
Q

Recap of singer’s argument against (some case of) animal experimentation

A

The grounds of moral status is sentience- non human animals are due equal consideration
Equal consideration of Interests would prohibit many species practice including most animal experimentation

58
Q

Potential responses to singer

A

Protection for animal subjects- animal welfare acts- does not apply to the vast majority of animal subjects

59
Q

Principles of the Belmont report

A

Written in response to terrible forms of ethical misconduct in research that took place in alabama during the tuskegee syphilis study. The study used poor black men that were positive for syphilis. Informed consent was not given and the subjects were kept from treatment.
Also based on nazi experimentation

60
Q

Background on the common rule

A

Informed consent
Socially Worthy Research
The Risk/ Benefit Assessment
The Minimal Risk Requirement

61
Q

Hwang Gate-

A

The korean cloning fraud (Saunders and Savulescu)

62
Q

Woosuk Hwang-

A

focused on using SCNT to generate human blastocysts for stem cell lines

63
Q

Details of hwang scandal:

A

Claimed successful creation to generate human blastocysts for stem cell lines. He claimed successful creation of patient specific stem cell lines. A very big deal at the time! Now superseded by IPSCs
With collaborators, claimed successful cloning of monkeys and a dog. Revered as a national hero in korea- image on stamps public transport.
Indicted on Fraud and embezzlement of research funds and violation of korean bioethics laws
Violations of Human Subjects Protections- (and declaration of helsinki: world medical association, 1964.
Donors of Oocytes (eggs): some were paid for their eggs/ illegally traded for, some donors were junior researchers, (informational consent, and risk issues)
Donors of somatic cells: All had spinal cord is orders but treatments were not designated to help them

64
Q

3 research misconduct of hwang

A

Violations of Human Subjects Protections (Declaration of Helsinki)

Conflict of Interest Concerns
Co-authorship and funding support to collaborations who later ended up on regulatory boards (Weakened regulatory oversight)
Unclear sources of funding for Hwang, In addition to heavy governmental funding (pressure to serve the national interest)

Fraudulent and Falsified Data
Both science papers retracted
Much of the data was admittedly fabricated. Monkey and dog clones were real.
Human, Patient matched SCNT Generated Blastocysts were not. Although Hwang is believed to have had the relevant appropriate technology to do so.

65
Q

Violations of Human Subjects Protections

A

(Declaration of Helsinki)

66
Q

Conflict of Interest Concerns

A

Co-authorship and funding support to collaborations who later ended up on regulatory boards (Weakened regulatory oversight)
Unclear sources of funding for Hwang, In addition to heavy governmental funding (pressure to serve the national interest)

67
Q

______________________
Both science papers retracted
Much of the data was admittedly fabricated. Monkey and dog clones were real.
Human, Patient matched SCNT Generated Blastocysts were not. Although Hwang is believed to have had the relevant appropriate technology to do so.

A

Fraudulent and Falsified Data

68
Q

How common in research misconduct

A

1.5% admit to falsifying/ plagiarizing data

Arguably common practice withhold results that do not work in PIs or funders interests

MCDB 60- Bio Ethics (3 decks)

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