long answer qs Flashcards
basic categories of abortion
therapeutic
spontaneous
what is spontaneous abortion
miscarriage, abt half of all fertilized eggs are aborted spontaneously
types of induced abortion
elective (not medically necessary)
therapeutic (medically necessary)
what is the violinst thought experiment
director of music attached you to a dying person while you were sleeping. your kidney is keeping him alive (against your will). unplugging yourself will kill him.
what premise does the violinist TE address
- a right to life outweights a right to decide what is done to one’s body
what does the violinist TE show
shows that this infringement on a pregnant person is a violation of their bodily auronomy, especially bc it is done without consent (ie. rape)
can those who oppose abortion on the ground make an exception for rape?
certainly. however ends up wiht the conclusion that those who came into existence because of rape has less of a right to life than others. people who oppose abortion do not make this exception
pregnant persons right to defend their life from a life threatening pregnancy
the fetus, being a person, has a right to life, but as the mother is a person, she has the right to life. presumably they have an equal right? we are told preforming the abortion would be directly killing the fetus, wheres doing nothing would only be ‘letting the mother die’
TE raframed: pregnant persons right to defend their life from a life threatening pregnancy?
imagine you are told you will be dead in a month because of the musician. but you have to stay where you are because unplugging yourself would be directly killing an innocent person, which is murder and is impermissable.
- however, it is not murder nor impermissable
permissability of third parties to secure abortion
in most cases a right to abortion may hinge on Drs willingness to perform it
TE: permissability of third parties to secure abortion
imagine you are in a tiny house with a rapidly growing child. in minutes you will be crushed. this child wont be crushed to death, it nothing is done it will be hurt but a free man.
- concedes that a third party cannot make the choice, both are innocent. but the person threatened can.
the mother OWNS the house, therefore no third party has a personal obligation however they can because it is the mothers choice since it is her house
what are virtue ethics
emphasizes the role of character/virtue in moral philosophy, as opposed to duty
thomson virtue ethics: non-rights based discussion of virtue and vice (two TE)
revisited violinist TE: suppose you only have to be connected for one hour. there was NO consent given, however it would be indecent to refuse. in fact, you ought to allow it to remain
revisited fonda TE:
fonda now in room. you had no right against him to fly in from the west coast and put his hand on your brow, but if you are in the same room he ought to
ought/right discourse
A ought to do something for B, follows that B has a right against that A do it for him. this makes the right turn on how easy it is to accomplish - this seems morally unacceptable
ought vs. right other example
if candy is only given to the older brother. the younger brother does not have a right to it, but it would be cruel if he doesnt share (in fact, he ought to). but in not sharing he is not being unjust.
decency vs rights conclusion
no one is morally required to make large sacrifices for 9 months in order to keep someone alive; in not doing so they may be self-centred but not unjust.
two non rights based dicussions of thomson?
- virtue and vice – rights vs. ought
- good vs. minimally decent samaritan
about ‘right’ to abortion (virtue ethics)
we must grant there may be cases where it would be morally indecent to abort, yet not a rights violation (eg. for a trip)
good vs. minimally decent samaritans
good samaritans = act altruistically, out of their way -> not morally required
minimally decent samaritans = act at no cost to themselves -> morally required
good vs. minimally decent samaritans connection to abortion
legal restrictions on abortion seem to require pregnant people to be good samaritans - if you think this way, you must require all people to be good samaritans otherwise this is an unjust burden on pregnant people.
- on the contrary, no one is even required by law to be a minimally decent samaritan
should pregnancies that require people to be a minimally decent samaritan be carried thru (according to thomson)
yes. you cannot abort to go on vcation for example
does thomson think all abortions are morally permissable
no.
what kind of abortion does marquis focus on?
elective abortion
what is marquis argument
argument that vast majority of deliberate abortions are seriously immoral.
How does Marquis critically discuss
some of the ambiguities and philosophical vulnerabilities of some common arguments in both
“pro-life” and “pro-choice” camps?
by focusing on public reasons, other reasons are either over or under inclusive
marquis: issues with pro-life/anti-abortion argument
will assert life is present from conception, fetuses ‘look like babies’, or possess characteristics necessary for being human.
will always have prima facie wrong to take a human life.
will have trouble bridging gap between biological/moral person.
marquis: issues with pro-choice argument
fetuses are not persons, rational agents or social beings.
only prima facie wrong to take the life of a member of human community.
will have trouble bridging gap between psychological/moral person.
pro life vs. pro choice final argument issues
pro life will want a principle that is far too broad (ie. wouldnt permit death of cancer cells).
pro choice will want a principle that is far too narrow (ie. doesnt explain why killing an infant is wrong)
what does marquis think about prolife and prochoice arguments (similarity)
all claims being made are accidental generalizations and do not touch on the essence of the matter.
what argument does marquis favour?
wrongfulness of killing.
what is wrongfulness of killing argument. (and what does it escape?)
killing is wrong because killing inflicts (one of) the greatest possible losses on the victim – what makes killing any adult wrong is the loss of future.
- this argument escapes personhood.
what is in favour of wrongfulness of killing argument (3)
- explains why we regard killing as one of the biggest crimes - loss of victims future
- explains why terminal illness are bad - deprives of future
- implications: species inclusive, supports active euthanasia (on the premise they wouldnt have a FLO), explains why it is prima facie wrong to kill infants/children
issue w wrongfulness of killing – not thought by marquis
doesnt include folks w disabilities!
how does wrongfulness of killing connect with induced abortion?
elective abortions are impermissible under wrongfulness of killing because they deny a future for the victim (fetus in this case)
What accounts of the wrongfulness
of killing does he reject (describe them) and why?
- desire account
- discontinuization account
desire account: rejected
doesnt explain why killing those who lack a desire to live, however temporarily (eg. comatose, suicide) is wrong
discontinuization account: rejected
prioritizes past. future should obviously matter more.
what does marquis fail to include in his account?
doesnt talk about therapeutic abortion or the rights of the gestating person
doctrine of informed consent
patients have the right (autonomy) to make their own medical decisions, even if unadvisable
what are three justifications for doctrine of informed consent as discussed by Flanigan
- consequential
- epistemic
- normative authority
doctrine of informed consent: consequential
medical outcomes will be better if physicians are prohibited from coercing/lying to patients
doctrine of informed consent: epistemic
patients are the experts of what they want (removes paternalism)
doctrine of informed consent: normative authority
patients have normative authority to make medically inadvisable decisions, even if they are not in their best interest.
- appeal to bodily rights, dignity and commitment to moral equlity
what justification does flanigan think is strongest (she does not favour one)
normative authority
For
Flanigan, how does informed consent relate to obstetric autonomy?
if a patient is competent, she has the right to information about her treatment options and to choose in absence of coercion AND make treatment decisions even if they are medically inadvisable. pregnant people are typically more informed than most patients!
Flanigan considers four objections to obstetric autonomy
- pain undermines competence
- going against advice displays incompetence
- birth is an emergency requiring default paternalism
- complexity of situation undermines informed consent
objections to obstetric autonomy: pain undermines competence
empirical research shows that pain does not undermine deliberative competence, however, can alter decision making
objections to obstetric autonomy: going against advice displays incompetence
patients have the right to make medically inadvisable decisions, this is protected under the doctrine.
objections to obstetric autonomy: birth is emergency, therefore requires default paternalism
some births can be emergencies. however, patients retain rights in emergencies as long as they are competent to give consent. pregnant patients are more likely to have clearly communicated wishes and have designated surrogate decision makers.
objections to obstetric autonomy: complexity of situation undermines informed consent
informed consent requires all information a reasonable person would require. pregnant people are typically well informed prior and retain information
What is commercial
gestational surrogacy
an arrangement in which a woman is paid a fee for carrying a pregnancy for another person
two varieties of commercial gestational surrogacy?
- traditional
- gestational
what is traditional surrogacy
the surrogates egg + intended fathers sperm
what is gestational surrogacy
the intended parents egg + sperm
surrogate is unrelated
With what kind of gestational surrogacy does commercial
surrogacy contrast?
altruistic surrogacy = when a woman volunteers
Steinbock considers four basic arguments against commercial gestational
surrogacy
- paternalistic argument
- moral objections (2a: exploitative, 2b: human dignity)
- right of privacy
- harm to others
arguments against commercial gestational
surrogacy: paternalistic
attempts to prevent surrogate from making a choice they may regret. surrogacy does not violate autonomy, therefore, to ban surrogacy on these terms would violate respect for individual freedom for ‘any risky behaviour’
arguments against commercial gestational
surrogacy: moral objections - exploitative
the fact that surrogacy is risky does not make it exploitative. also not only risky (like selling organs), but surrogate may gain self worth
- there is a market component brought up here
arguments against commercial gestational
surrogacy - human dignity
children seem commodified. could be argued that surrogacy is analogous to slavery (huge violation of dignity). however, the money is not to buy the child only to compensate gestation.
- for this to be true, surrogates must be paid in full during still births
arguments against commercial gestational
surrogacy - right to privacy
state cant enforce a contract that stops abortion, then how enforce a contract that requires a surrogate to give up a child after gestation? removing children from parents does seem like an ‘intolerable invasion of privacy’
- complicated w/ bio father
arguments against commercial gestational
surrogacy - harm to others
surrogate children cannot claim because otherwise they would not exist. bio children of surrogate mother only have minimal clim to harm.
steinbock conclusion
could outlaw, but much better to just enforce regulations
What are the core details of the Tuskegee Syphilis Study
1932-1972
400 black men, syphilis was well-studied before hand and there were cures. study was not therapeutic in nature and was bad science. was a natural terminal experiment. government enforced + various black professionals. only offerings to participants: aspirin, iron tonic, burial (in exchange for autopsy), $1 per year, certificate.
goal was to compare untreated syphilis in white vs. black populations. concerns raised mid 60s by Buxtun. story finally published in 1972. class action law suit settled out of court, survivors giving penicilin treatment
Nuremberg Code summarized
- voluntary consent
- yield fruitful results for good of society
- based on results of animal experimentation, knowledge of disease
- should avoid all unnecessary physical/mental suffering and injury
- not be conducted if thought death/disabling injury could occur
- risk should never exceed humanitarian value
- preparations should be made in case of injury/disability/etc.
- only conducted by qualified scientists
- participant can withdraw
- scientist must terminate if any possibility of death
- voluntary consent: violation?
no consent given
- yield fruitful results for good of society: violation?
was bad science! given treatments, not to cure but make them noninfectious. this effectively ruined the study
- based on results of animal experimentation, knowledge of disease: violation?
?
- should avoid all unnecessary physical/mental suffering and injury: violation?
likely led to 100 deaths + insanity
- not be conducted if thought death/disabling injury could occur: violation?
was a terminal experiment
- risk should never exceed humanitarian value: violation?
degree of risk far too high
- preparations should be made in case of injury/disability/etc.: violation?
death was the goal
- only conducted by qualified scientists: violation?
?
- participant can withdraw: violation?
didnt even know this wasn’t therapeutic
- scientist must terminate if any possibility of death: violation?
did not
Mosby discusses nutrition research conducted between 1948 and 1952 involving Canadian
Indigenous child research subjects. Describe the studies
1942-1944: study of 300 malnourished aboriginal subjects, 125 given supplements
1947-1948: james bay survey - did some investigations of diets at residential schools. had some fucked up food ideas (blood sausage)
- 1947 lionel pett conceives of natural experiment beginning fall of 1948 w approx 1000 indigenous children
lionel pett 6 studies
- alberni: highest incidence of riboflavin deficiency. measured baseline for 2 year while given 8oz milk then tripled to 24oz
- schubenacadie (Experimental): tested for vitamin c (absorbic acid deficiencies) - students were divided into two groups, control (placebo) and experiemental (100mg absorbic tablet daily) - measured gingivitis
- blood school: thiamine (B1) deficiency, baseline for 2 yrs then diet was supplemented with vitamin B flour
- st marys: riboflavin (b2) deficiency, consumed newfoundland flour mix (had bonemeal in it)
- cecelial jeffrey: students had option to eat whole wheat bread + staff/children were given education
- st. pauls: no changes, acted as control (despite malnourishment!!)
Mosby claims that these studies would
not pass ethical review today. Why is that?
totally fucked up. kept malnourished, didnt have access to dental care, goal was cultural assimilation for economic reasons. when NFLD didnt have intended results they decided to try agin. no consent. no explanation. not even aware they were being studied
did nuremburg code come into effect for research in canada immediately
published in 1947. non therapeutic research may have even increased post war.
mosby: commitments or imperatives in the Nuremberg Code
✓1. voluntary consent
2. yield fruitful results for good of society
✓3. based on results of animal experimentation, knowledge of disease
✓4. should avoid all unnecessary physical/mental suffering and injury
✓5. not be conducted if thought death/disabling injury could occur
✓6. risk should never exceed humanitarian value
✓7. preparations should be made in case of injury/disability/etc.
8. only conducted by qualified scientists
✓9. participant can withdraw
✓10. scientist must terminate if any possibility of death
Neal Dickert and Christine Grady explore “three models of payment”
- market payment
- wage payment
- reimbursement
market payment model
participants paid market value, eg. the riskier the research, the more money. has potential for high completion bonuses.
market model: advantages
ensure sufficient # of participants
large completion bonuses to ensure participation, if incentive is required
participants could make profit - reduces financial sacrifice
market model: disadvantages
high payment may undermine free/informed consent
participants could lie/deceive their way in
generates competition between researchers
high payment may specifically attract vulnerable groups
wage payment model
small completion bonuses, research akin to unskilled labour (therefore payment is fairly low, standardized hourly wage)
wage model: advantages
doesnt undermine informed consent, not exploitative
reduces competition between researchers
reduces financial sacrifice of participation
wage model: disadvantages
if incentives are lower than market it my not attract subjects
may be especially attractive to those @ a lower socioeconomic level
my be seen as inappropriately commercializing participation
reimbursement model
payment simply covers expenses, should be revenue neutral
1. only expenses covered
2. expenses + wage reimbursed
reimbursement model: advantages
unlikely to undermine consent, unlikely to encourage deception
does not preferentially include vulnerable popultions
lessens financial sacrifice
reimbursement model: disadvantages
may yield insufficient #s - lacks incentive
could get radically different compensation, despite same contribution to research
will either increase cost of research or encourage researchers to target lower income groups
market vs. wage model: differences
- market = fluctuating value on demand, wage = stagnant
- market = subject to change, wage = standardized
market/wage model vs. reimbursement: differences
- prevents making profit
- does not use money to compensate discomfort
- payment not dependent on external causes (market value/going wage for unskilled labour)
Which model do they favor and why?
wage payment
why is wage payment favoured?
- avoids concern of undermining consent
- reduces cost of research, encourages researchers to minimize risk
Selgelid provides several reasons for thinking that bioethics (or health care ethics)
should include a better focus on infectious diseases. What are they?
- consequences
- complicated ethical issues
- justice
bioethics on infectious disease: consequences
consequences have been and will be enormous: worlds largest killer of kids and threatens global security
bioethics on infectious disease: complicated ethical issues
raises serious, complicated ethical issues of their own: public health measures my infringe on human rights. balancing utilitarian measure of greater good against libertarian protection of privacy
bioethics on infectious disease: justice
pathogens prey on poor, they suffer from diseases that we have cures for. most deaths occur in countries with least money to spend on healthcare (10/90). tropical diseases = diseases of poor
Selgelid also provides
several reasons for why this area has been neglected in bioethics (or health care ethics). What are
they?
- high tech medicine
- optimism in medicine
- ‘the other’
- complexity
- apparent ease
- religious hijacking
high tech medicine
medical ethics only came into its own in last four decades w advent of new tech – leading to unprecedented moral dilemnas that took forefront
optimism
coincided w optimism that infectious diseases would soon be eradicated
‘the other’
infectious diseases are a problem of the other (ie. poor, black, drug users etc) and not of white/straight who are focusing on issues at hand for them – this is explanatory not excusatory
complexity
have to be highly skilled in science and philosophy in order to begin to tackle these issues - requires challenging empirical work
apparent ease
these problems seem easy to solve - challenges like african not receiving meds because of big pharma greed compared to abortion/euthanasia
religious hijacking
much of debate has been dealing with misinformation spread from religious, ie. abortion/blood transfusion and bioethicists had to shut that down first
The WHO
foregrounds six considerations that should guide relevant policy-makers when deciding on
whether to implement a mandatory vaccination policy. What are they
- necessity and proportionality
- sufficient evidence of vaccine safety
- sufficient evidence of efficacy
- justice in access/availability
- public trust
- ethical process of decision making
Which
of these considerations are present in Wilkenfeld and Johnson’s discussion?
- sufficient evidence of vaccine safety
- justice in access/availability
what is the
mandatory vaccine policy that Wilkenfeld and Johnson defend? How do they defend their policy
at “a governmental level”?
argue that same logic of a deontological right to consent, or not to bodily infringements that is antivax can apply to not requiring people to be necessarily exposed to covid19
- involves a tradeoff of rights that will speak in favour of vaccine mandates
- necessity and proportionality
should only be necessary if it achieves an improvement in societal advancement (ie. reduces mortality/protects vulnerable pop) – should be balanced w protecting autonomy/individual liberty. intro. sunset clauses, frequently reevalute with facts on the ground
- sufficient evidence of vaccine safety
if not, would be innately unethical. should be implemented with no fault compensation schemes
- justice in access/availability
populations affected by mandate should be able to access vaccine easily.
- public trust
high priority of resources should be given to groups with historic distrust. allow dissent. people will lose trust if not even is done (when we have a viable plan) - therefore there is a tough balance to keep. done badly = global loss of trust
- ethical process of decision making
must be explained in a way that general pop can understand; transparency, willingness to change with facts on the ground.
