Lecture 3 - Methodologies

Question 1

Paternalism

Answer 1

Interfering with someone’s liberty for their own good.

Question 2

Utilitarian view on paternalism.

Answer 2

Unencumbered persons known their own interests best. People are meddlesome by nature. So, since interference with unencumbered persons will produce more harm than good, it’s best to have a rigid rule against paternalistic interference with the unencumbered.

Question 3

Ethical decision making involves identifying these 3 things…

Answer 3

1. An ethical problem.
2. The courses of action that are available.
3. The course of action that has the weightiest reasons in its favour and acting on those reasons.

Question 4

If the non-moral facts are clear and the principles point to the same course of action there is….

Answer 4

no ethical problem

Question 5

How to identify if there is a moral problem (5 steps).

Answer 5

1. Ask “are the non-moral facts clear and do the moral principles all agree on an action?”
2. If answer is yes, there is no moral problem.
3. If answer is no, then:
   3a) Are there unclear or disputed non-moral facts?
   3b) Do the moral principles conflict or is anything unclear?
4. If yes to 3, explain and assess.
5. Ask “What is the course of action with the weightiest reasons and why?”

Question 6

Disadvantages of strong paternalism.

Answer 6

Interferes with autonomy and encourages meddling.

Question 7

Advantages of strong paternalism

Answer 7

Prevents some tragedies.

Question 8

Disadvantages of weak paternalism

Answer 8

Permits preventable tragedies.

Question 9

Strong paternalism in biomedical ethics.

Answer 9

Interfering with someone for their own good whether or not they are encumbered.

Question 10

Prima facie

Answer 10

Based on the first impression; accepted as correct until proved otherwise.

Question 11

Are principles of biomedical ethics prima facie principles or absolute principles?

Answer 11

Prima facie principles

Question 12

Weak paternalism in biomedical ethics

Answer 12

Interfering with persons in their own interest only if they are encumbered, or they would be at risk to themselves, or we can intervene without causing more harm than is prevented, and the least intrusive means are used, and our action is not discriminatory.

Question 13

Kantian ethics

Answer 13

What is right is to treat people as ends never merely as means (respect absolute value by respecting their autonomy).

Question 14

What are the four topics?

Answer 14

Clinical issues, quality of life/death, preferences, and contextual features.

Question 15

If the non-moral facts are unclear or the principles conflict or there is uncertainty about their meaning/application, there is a….

Answer 15

ethical problem

Question 16

Kant’s argument for weak paternalism.

Answer 16

We cannot override a person’s autonomous choices, because that treats them merely as a means.

Question 17

Method for making ethical decisions in clinical care (4 steps)

Answer 17

1. Identify relevant facts using the Four Topics
2. Identify the relevant moral principles and explain their relevance.
3. Identify if there is a moral problem(s), and what it is.
4. Resolve the moral problem by identifying evidence favouring one action over others.

Question 18

What information should one include under “quality of life/death”?

Answer 18

What the quality of life/death of the patient would be with and without available treatments.

Question 19

Fidelity

Answer 19

Living up to trust relationships with others; being faithful to institutional and professional roles.

Question 20

Advantages of weak paternalism

Answer 20

Minimizes unwarranted interference. Respects dignity.

Question 21

What are examples of clinical issues?

Answer 21

Diagnosis/prognosis, risk/benefits of treatment, goals/values of patient, and best clinical judgement.

Question 22

What information should one include under “preferences”?

Answer 22

What the patient wants. If the patient is competent or not. If the patient is incompetent, do they have a surrogate? Is there informed, voluntary consent? What the HCP wants.

Question 23

“The Four Topics” consist of which category of facts?

Answer 23

Non-moral facts.