Midterm Flashcards
ethics
a field of study that reflects on human morality; sustained and intentional reflection on morality and the moral life with analysis, discernment, reasoning, and argument
bioethics
an interdisciplinary field of applied ethics that engages the complex moral problems emerging from developments in medical science, biotechnology, and health care
utilitarianism
greatest good for the greatest number of people; consequences, not intentions
deontological ethics
humans can reason for themselves, moral rules should be articulated and binding for everyone regardless of context
few moral dilemmas, deductive
Kantian
categorical imperative
Kant’s unbreakable moral rules
- Universal maxims guide actions (moral rules should be able to be applied to others
- Use people as ends, not means
- No suicide, must save other people if you can, no lying ever, no killing the innocent
natural law
moral standards are embedded in nature, all reasonable people can discover and affirm them; nature is teleological; universal moral principles
only way morality exists (to these theorists)
rights theory
people have justifiable claims for or from something; protects individuals from government and larger communal society
anything legal is inherently ethical; based on norms
casuistry/ethical pragmatism
focuses on actual examples and cases instead of abstract concepts; use precedents to determine morality in other situations
divine command
God gives shape of morality as an expression of his will; dominant for religious people
considered binding for everyone, no extenuating circumstances
revelation
God communicates plan for human flourishing socially and spiritually
covenant
God formed covenant with Jewish people to bring flourishing to human societies. God and humans have rights and responsibilities.
prophets
humans who received and communicated word of God to rest of the world
Torah
first five books of Bible; only recognized “constitution” for Jews
Talmud
fundamental core of Jewish tradition
compilation of Mishna (written texts and oral traditions), Rabbinic commentary and decisions
halakhah
Jewish law as applied to Jewish living, used to apply to new circumstances
divine body ownership
Body is on loan from God, does not belong to oneself. In Judaism, humans have responsibility to look after their bodies through good hygiene and protection from injury and illness.
Jesus of Nazareth
In Christianity, considered the Son of God, died to pay for human sins. In Judaism, has not arrived yet. In Islam, was just another prophet.
creation
process where God created planet, sun, nature, and all living beings
redemption
Humanity is inherently flawed and in need of redemption in the form of connection with God through the Holy Spirit. Under Christianity, must accept Jesus as Lord and Savior to be redeemed and saved from Hell.
image of God (imago dei)
Christian idea that humans are created in God’s image, have ability for reflection and creation and are given authority over other living beings.
human dignity
Christian idea that dignity comes from concept that God created us. Cannot be taken away, regardless of individual sins.
graced self-transcendence
God’s original intention for people. Always planned for humans to join him in supernatural afterlife and transcend our human bodies.
Islamic five pillars?
Shahadh, Salat, Zakat, Ramadan, and Hajj
Shahadh
Islamic declaration of faith
Salat
daily prayers
Zakat
Islamic charity
Ramadan
Islamic fasting
Hajj
Islamic pilgrimage to Mecca
Qur’an
God’s final commands under Islam, dictated to Muhammad
Shari’a
Islamic law governing behavior; Qur’an + Sunnah + qiyas + ijma
fiqh
human judicial decisions of Islamic scholars
Islamic Juridical Council’s bioethics fatawa
Council that discusses critical issues in medical ethics and publishes fatwas and studies in journal
Under Organization of Islamic Countries
the common morality
commonly accepted, abstract moral rules irrelevant to particular subgroups; applicable to all people in all places, rejects relativism
moral dilemma
when moral obligations demand that a person adopt two or more alternative but incompatible actions, so that they cannot perform all required actions; not practical conflicts with self interests or generally hard decisions
balancing/weighing
reasoning about which moral norms should prevail when two or more conflict
prima facie commitments
commitments that must be fulfilled unless they contradict with an equal or stronger obligation
moral residue
regret when a prima facie obligation overrides another commitment
moral divergence
when moral people come to different conclusions about the same situation due to differences in balancing
autonomy
when individuals act freely to a self-chosen plan with intentionality, understanding, and without controlling influences that determine their action
types of autonomous consent
- Express/explicit
- Implicit/implied - based on actions
- Tacit - based on lack of objection
- Presumed - form of implicit consent based on info about individual’s choices
nonmaleficence
principle that one should not harm others
standards of due care
taking appropriate care to avoid causing harm
negligence
intentional or careless departure from standards of due care
beneficence
all norms, dispositions, and actions with the goals of benefiting or promoting the well being of others
obligatory beneficence
necessary beneficence to maintain morality; not extreme
ideal beneficence (“the Good Samaritan”)
beneficence that exceeds ordinary morality, extreme generosity
medical paternalism
the intentional overriding of one person’s preferences or actions by another person, where the overrider justifies the action by appeal to goal of benefiting or preventing harm to the overridee
soft medical paternalism
paternalistic agent intervenes to prevent nonvoluntary conduct (ex. poorly informed consent or refusal)
hard medical paternalism
paternalistic agent intervenes, even when a person’s choices are informed, voluntary, and autonomous
stigmatization effects
targeting of acts or people who engage in certain conduct; can lead to discrimination against people
antipaternalism
opposition to hard paternalistic interventions; belief that rightful authority resides in individuals, not states or groups; usually coincides with strong rights theorists
suicide intervention ethics
Failure to intervene communicates lack of communal concern. Many suicidal people are mentally ill. Many suicidal people fantasize about rescue.
antipaternalist stance on suicide prevention
temporary restraint, but nothing more; shouldn’t assume suicidal people are without their autonomy
nudge theory
idea that choice architecture should be beneficially arranged to encourage people to make choices they want to make without coercion or mandates; argues about existence of value and action gap
individual cognitive heuristics
grids in which people encounter the world; 7 reasons people are not individually good decision makers
includes anchoring, remembrance, confirmation, individualistic, framing, implicit, and group mentality heuristics
value/action gap
difference between stated values and ideals and what actually occurs
mandatory seat-belt laws case study
When the seat belt laws were being considered, the majority were against them because they were considered antidemocratic.
From the autonomy perspective, they argued that wearing a seat belt should be a person’s decision. They thought a law enforcing them would violate constitutional rights.
From the beneficence perspective, the decision to wear seat belts does not just protect individuals. Others are affected in the crash, including other passengers, doctors, paramedics, lawyers, and insurance systems. The autonomous decision is overriden because people want to be safe during a crash; they just didn’t know it. The autonomous decision is overriden on basis of cumulative social benefit. They performed studies proving how seat belts reduced the harm during car crashes and prevent deaths.
veracity
honesty, connected to respect for autonomy
staged/limited disclosure
disclosing medical truths slowly, over the course of several sessions, instead of immediately
justification of nondisclosure
violation of obligations to beneficence and nonmaleficence (ex. anxiety, prompting suicide, destroying hope), fear of legal consequences, concerns about harming patients or public trust, lack of genuine patient desire to know truth
medical error
leading cause of death in US hospitals, leads to responsibility to disclose promptly with specificity (does not occur often)
privacy
state or condition of limited access to a person; includes informational, physical, decisional, proprietary, and relational
Griswold v. Connecticut led to right that shields info from others and protects decisions from government intervention
confidentiality
prevents redisclosure of information within relationship where confider expects confidant to not further disclose without authorization; subset of informational privacy
compromised through systematic medical care
virtue ethics
teleological subset of ethics of care that originated in feminist writings; argues that morality of actions is partially dependent on moral character; traits valued in intimate personal relationships, including sympathy, compassion, fidelity, and love; emphasis on emotional responsiveness
eudaimonia
happiness or flourishing holistically; includes virtues necessary for a satisfying life
moral habits
patterns of disposition entrenched in moral actor; part of existential way of being in the world
compassion
attitude of active regard for another’s welfare combined with sympathy, tenderness, and discomfort at another’s misfortune or suffering; expressed in acts of beneficence that try to alleviate misfortune or suffering
can be a weakness when it prevents impartial reflection and blinds reason
trustworthiness
quality of warranting another’s confidence in one’s character and conduct
integrity
soundness, reliability, wholeness, and integration of moral character; objectivity, impartiality, and fidelity in adherence to moral norms
conscientiousness
mental faculty of and authority for moral decision making
moral excellence (heroes/saints)
exceptional virtue in altruism and benevolence to the point of realizing a moral ideal consistently or by accepting extraordinary risk
characterized by
- worthy moral ideal
- motivational structure allowing them to forgo advantages in service of moral ideal
- exceptional moral character
- great integrity
supererogatory acts
a morally praiseworthy, but optional act that exceeds the demands of common morality and intends to promote the welfare interests of others
principle of qasd
Muslim principle that intention of actor, not action itself, is important; means don’t justify the ends
principle of yaqin
Muslim principle of certainty; argues all medicine is permissible unless certainly haram; need compelling evidence (not just doubt) to disregard “known” facts
principle of darar
Muslim principle that injury should be relieved; justifies medical intervention; harm should be avoided and must be outweighed by the good
principle of darura
allowance to override haram actions to save a life
principle of ‘urf
Muslim reference to custom and predominant cultural consensus when actions are not otherwise specified
exoticist bioethics
bioethical attitude that focuses on specific and unusual cases, ignoring the mundane
heroic ordinary/everyday
mundane actions of medical providers are more important than actions in extreme, unusual cases
ethics of care
theory modeled on maternal caring, not masculine mode; places moral weight on mutual interdependence and emotional responsiveness; argues humans have a natural capacity for empathy; heavily influential in nursing, way to fight against exoticist bioethics; argues caring is a moral response
processes of ethics of care
moral attention, sympathetic understanding, relationship awareness, and harmony and accommodation
empathy
complex of emotional and conditioned responses to suffering and proactive constraint on behavior that would inflict harm; central emotion in care ethics
maternalism
attempt to collaborate and participate to push someone towards a good end, even if it contradicts with their stated desire, referenced in ethics of care
moral attention
attention paid to the situation in all its complexity; awareness of all details that allow a sympathetic response to a situation
sympathetic understanding
openness to sympathizing and identifying with persons in a situation; attempt to be aware of how the people in the situation would like them to respond and what’s in their best interests
relationship awareness
awareness of network of relationships that connect humans, care for preserving and nurturing these relationships
accommodation
consideration of the needs of all involved with hope of preserving harmony
special relations
considers the moral actions and adjustments it take to make relationships flourish, referenced in ethics of care
Black Church
historically independent, organized institution under total Black control; typically Protestant in belief and personal ethics, but progressive socially; sects of Christianity blended with traditional African spiritual practices; Established by Free African Society of 1787 during revivals of First Great Awakening in 1730s-1750s; grew rapidly after Civil War; not consulted in bioethical deliberation;
structural racial discrimination
form of discrimination with roots in Aristotle’s scala naturae, Malthus’s arguments on population control, and Herbert Spencer’s social Darwinism; all of which led to elimination and forced sterilization based on strict categories
medical tacit racial bias
unconscious racial biases among physicians that results in extra paternalism, negative emotional tones, less patient-centered care, and subsequent distrust by AA patients
Henrietta Lacks
Black woman with cervical cancer whose immortal cells were taken without informed consent
Chester Southam experiments
Dr. Southam injected patients unknowingly with HeLa to see how their systems would react to cancer. Justified with paternalism and utilitarianism. Reported by 3 Jewish residents. Convicted of fraud and unprofessional conduct, but was elected president of American Association of Cancer Research later
“HeLa bomb”
when Stanley Gartler claimed that many scientific experiments were compromised because HeLa cells were spreading unintentionally
Michael Rogers’ Rolling Stone essay (1976)
first public explanation of Henrietta Lacks’s identity; discussed her Blackness, how she didn’t consent, how white cultures were “contaminated” by Black ones, how uncredited HeLa became one of most important medical tools
Moore v. University of California case (1990)
Moore sued to legally claim the cell line that had emerged from his cancerous tissues. Judge used HeLa as precedent.
Utilitarian decision that patients cannot stake a claim in their own tissue once they’ve agreed to treatment
medical establishment treatment of Lacks family
Did not explain that they were not testing them for cancer, but that they were snooping around their genomes to solve the HeLa bomb problem
medicalization of death
traditional understanding that some patients were “overcome by their illness” and additional treatment is pointless
“clinical gaze”
empirical analysis of the human body allows identification and treatment of pathologies, but brackets issues of personhood, community, and meaning
hospice movement
advocates accepting death as part of cycle of life; could be used to further euthanasia
In Re Quinlan case (1976)
court case ruled that refusal of treatment is located in individual autonomy, no ethical or meaningful difference between withdrawing or withholding treatment
Catholics told parents they weren’t morally required to continue with respirator or feeding tube, but parents kept feeding tube
Cruzan v. Missouri Health case (1990)
controversial Supreme Court ruling affirmed Quinlan; ruling allows individuals to write end of life wishes
Nancy Cruzan was in permanent vegetative state, parents wanted to withdraw treatment but hospital refused; allows proxies to decide at state level; after ruling, was forced to let her die
Principle of Double Effect
natural law concept that an attempt to do good is morally permissible, even if the outcomes are negative
Action with good and bad effects is morally justified if act itself is not wrong, bad effect must not cause good effect, actor must not intend bad effect, and bad effect doesn’t outweigh good effect.
Applied by Catholics to end of life, abortion, mutilation, sterility, etc.
killing v. letting die distinction
moral correctness depends on authorization; must know motive, circumstances, patients’ preferences, and consequences; pointless distinction based on convention
killing
causal action that brings about death; widely viewed as morally wrong; act of people, not natural conditions
letting die
intentional avoidance of causal intervention so that disease, system failure, or injury causes a natural death; acceptable if medical technology is useless or if patients or surrogates validly refuse treatment
medically assisted nutrition & hydration ethics
placed under same standards as other medical treatments by US courts, but some individuals distinguish
medical futility
when irreversibly dying patients cannot be improved by further treatment; makes treatment hopeless and morally optional
restricted to when patients or surrogates request interventions that simply cannot achieve intended physiologic goal; good clinical and ethical judgement not to provide them
slippery-slope concerns
serious abuses won’t occur immediately, but will grow incrementally over time; could lead to unjustified killing and manipulation of the system; should not embark on path because of potential consequences of allowing physician-assisted death
could be deadly elderly or disabled people; could lead to low-income families allowing death rather than suffer financial burdens, could cause palliative care for all patients to suffer, potential loss of public trust
surrogate decision-making
usually closest family member; must have ability to make reasoned judgements, adequate knowledge and information, emotional stability, and commitment to patient’s interests, free of conflicts of interest and control by 3rd parties
monitored by physicians, ethical committees, and judicial system
Oregon’s Death with Dignity Act (1994)
physicians write prescriptions for lethal medications at patient’s request; patient consciously decides to use drug; physicians are not determinative step in patient death, so are not culpable
usually older white people with cancer; only 66% actually take pills
Eluana Englaro case
woman in permanent vegetative state for 17 years; father wanted feeding and hydrating tubes withdrawn because she didn’t want to be kept alive artificially
Supreme Court of Cassation upheld request (made her go to private, clinic), but Catholic Church, Health Minister, Episcopal conference, Prime Minister, and conservatives strongly opposed
virtue of prudence
practical knowledge imbued by life of grace
dependent for its reasoning on the analysis of contingent
events (not faith)
more flexible decision making than casuistry
principles of prudence
memoria, docilitas, and solertia
memoria
memory that is true to being (remembering events as they happened)
prudence principle
docilitas
open-mindedness
prudence principle
solertia
acumen, ability to act well in the face of unexpected events
prudence principle
Islamic death
loss of integrated personhood in Islam; process altered state of being; part of journey of return to God
stable life
presupposes continuation of blood circulation and or respiration because of movement and pulse
unstable life
rate of blood flow lower than level of viability, inconsistent cardiac function; heartbeat is a conclusive indication of death
whole brain death
breathing through artificial life support mechanisms that allow maintenance of heart function and breath; replacement of brain stem; considered adequate marker of death
ethics of post-comatic unresponsiveness (PVS)
if considered dead, would prevent slippery slope for terminally ill patients with active cortical brain function
justifiable to remove feeding and hydration tubes if case is irreversible (let die)
no cortical function, patient cannot see or hear, but can breathe and digest unaided; can respond to painful stimuli
withdrawal of treatment
stopping treatment that has already started; avoided by physicians because they feel as though they’re actively killing patients
Vacco v. Quill case (1997)
Dr. Quill challenged laws prohibiting physician-assisted death. Argued patients have “equal protection” right in asking for help to hasten own death by withdrawal. SCOTUS unanimously ruled there is no “right to die.”
physician-assisted dying
patient request for physician to withdraw treatment; ruled illegal by Vacco v. Quill
surrogate euthanasia
passive non-voluntary death; when people cannot choose for themselves whether they want to be supported with machines and their wishes; their decisions are made by a surrogate
assumes there’s good faith basis for the surrogate’s decision
involuntary euthanasia
when a physician actively decides a patient should die; “mercy killing”
“right to die” movement
people who support physician-assisted death under the right circumstances
human personhood
according to pro-lifers, something all people begotten to human parents have for the duration of their existence, regardless of capacities; term is currently used to describe set of capabilities and does not describe all living human beings; people have the right to have their life protected
punctualist accounts of personhood
fetuses are people the moment they are conceived, when the sperm fertilizes the egg
gradualist accounts of personhood
fetus becomes a person after conception
Roe v. Wade case (1973)
- landmark 7-2 decision overturning absolute state laws restricting abortion
- gives women fundamental right to decide on abortions in first trimester
- based on protection of “personal privacy” extended to include right to bodily integrity
pro-life feminism
in line with first wave feminists who believed abortion was infanticide; motivated by empathy fo child and for women driven to abortion by powerless position and by male sexual selfishness; driven out of feminist movement in 1960s
communitarianism
view of personhood situated within our relationships with communities; relationships come with obligations that are necessary for the survival of individuals in the community
often pushes back on individualist, Western bioethics
species membership
tracks human potential closely; animal with active or internally directed potential to exhibit distinctively human ways of behavior and thinking is a person and, therefore, entitled to rights when it first comes to be; concept makes abortion homicide
conscientious refusal
the right of physicians to refuse to perform a procedure based on conscience, argued on coherent, rational grounds
used in abortions
animation/quickening
idea that fetus becomes person when it moves during pregnancy
traditional formed embryos
Aristotelian biological idea of when embryos take on human personhood
traditional unformed embryos
Aristotelian biological idea that an embryo is not a person yet (hasn’t hit the threshold)
similar to Islamic ensoulment
Jewish “breath of life” view
babies become human when they breathe air through their lungs after being born
“fellow fetuses”
pro-life Christian idea that all humans have no achievements they can boast about before God; to Him, the difference between being born and having fetal potential is negligible
life-at-conception view
the moment an egg is fertilized and a fetus is conceived, that fetus is alive and has independence; argument for pro-life movement
gestating motherhood prochoice view
belief that pregnancy is beginning of unique, gestational stage of motherhood (not precursor to motherhood) during which the mother should have moral authority to decide to abort or keep the baby; only pregnant women and mothers have authority to make motherly decisions based on obligations
motherly fetal authority/power
because the gestational mother alone has the obligation thrust upon her to
decide whether to continue the pregnancy or not, she therefore has the primary
authority to decide
prochoice Marian interpretation
Mary’s choice was free of all male authority; she was not forced to give birth to Jesus, but decided to cooperate in her own redemption (was not a passive object); did not immediately accept, but spent time considering the ramifications before deciding to proceed → affirms women’s decision making about their bodies
the Wa’d paradigm
when Arabs buried their baby girls alive, right after birth to avoid disgrace or poverty; before Islam was introduced - prohibited several times in Quran
Islamic ensoulment
moment soul enters fetus, 120 days in this religion
Islamic jurisprudence schools on abortion
- Maliki and Hanbali - abortion only permitted up to first 40 days with consent of both parents
- Shafi and Hanbali - kahhara payment is obligatory for abortion
- Hanafi and Maliki - kahhara payment is optional act of devotion, not obligation
Simone Landrum’s narrative
Black woman pregnant with 3rd child. Complaints of pain and swelling brushed aside. Told to calm down, didn’t report hypertensive episode during appointment. Pre-eclampsia caused abruption, baby was stillborn. Almost bled to death
When pregnant with 4th child, enlisted help from a doula who stood up for her rights in face of callous and mocking medical practitioners.
Black maternal/infant mortality crisis
- US currently ranks 32 out of 35 wealthiest nations in infant mortality; driven by deaths of Black babies
- Black infants are more than 2x more likely to die than white infants
- Wider disparity than in 1850, during slavery
- Not impacted by education and income
- Black infants are more than 2x more likely to die than white infants
- Mother mortality - Black women are 3-4x more likely to die from pregnancy-related problems than white women
- US one of only 13 countries in the wold whee rate of maternal mortality is worse than it was 25 years ago
- Preventable near deaths rose 200% between 1993 and 2014
- most exacerbated in lower class Black women, but even college-educated, married Black women are 2x more likely to have infant mortality
- Dr. Arline Geronimus - weathering theory that stress of living under white supremacy damages Black women’s bodies
- Greatest experiences of racism → higher levels of preterm births
- Accumulation of persistent insults and traumatizing life experiences → frequent flood of stress hormones → wear and tear on cardiovascular, metabolic, and immune systems → increased vulnerability to illness and early death
a field of study that reflects on human morality; sustained and intentional reflection on morality and the moral life with analysis, discernment, reasoning, and argument
ethics
an interdisciplinary field of applied ethics that engages the complex moral problems emerging from developments in medical science, biotechnology, and health care
bioethics
greatest good for the greatest number of people; consequences, not intentions
utilitarianism
humans can reason for themselves, moral rules should be articulated and binding for everyone regardless of context
few moral dilemmas, deductive
Kantian
deontological ethics
Kant’s unbreakable moral rules
- Universal maxims guide actions (moral rules should be able to be applied to others
- Use people as ends, not means
- No suicide, must save other people if you can, no lying ever, no killing the innocent
categorical imperative
moral standards are embedded in nature, all reasonable people can discover and affirm them; nature is teleological; universal moral principles
only way morality exists (to these theorists)
natural law
people have justifiable claims for or from something; protects individuals from government and larger communal society
anything legal is inherently ethical; based on norms
rights theory
focuses on actual examples and cases instead of abstract concepts; use precedents to determine morality in other situations
casuistry/ethical pragmatism
God gives shape of morality as an expression of his will; dominant for religious people
considered binding for everyone, no extenuating circumstances
divine command
God communicates plan for human flourishing socially and spiritually
revelation
God formed covenant with Jewish people to bring flourishing to human societies. God and humans have rights and responsibilities.
covenant
humans who received and communicated word of God to rest of the world
prophets
first five books of Bible; only recognized “constitution” for Jews
Torah
fundamental core of Jewish tradition
compilation of Mishna (written texts and oral traditions), Rabbinic commentary and decisions
Talmud
Jewish law as applied to Jewish living, used to apply to new circumstances
halakhah
Body is on loan from God, does not belong to oneself. In Judaism, humans have responsibility to look after their bodies through good hygiene and protection from injury and illness.
divine body ownership
In Christianity, considered the Son of God, died to pay for human sins. In Judaism, has not arrived yet. In Islam, was just another prophet.
Jesus of Nazareth
process where God created planet, sun, nature, and all living beings
creation
Humanity is inherently flawed and in need of redemption in the form of connection with God through the Holy Spirit. Under Christianity, must accept Jesus as Lord and Savior to be redeemed and saved from Hell.
redemption
Christian idea that humans are created in God’s image, have ability for reflection and creation and are given authority over other living beings.
image of God (imago dei)
Christian idea that dignity comes from concept that God created us. Cannot be taken away, regardless of individual sins.
human dignity
God’s original intention for people. Always planned for humans to join him in supernatural afterlife and transcend our human bodies.
graced self-transcendence
Shahadh, Salat, Zakat, Ramadan, and Hajj
Islamic five pillars?
Islamic declaration of faith
Shahadh
daily prayers
Salat
Islamic charity
Zakat
Islamic fasting
Ramadan
Islamic pilgrimage to Mecca
Hajj
God’s final commands under Islam, dictated to Muhammad
Qur’an
Islamic law governing behavior; Qur’an + Sunnah + qiyas + ijma
Shari’a
human judicial decisions of Islamic scholars
fiqh
Council that discusses critical issues in medical ethics and publishes fatwas and studies in journal
Under Organization of Islamic Countries
Islamic Juridical Council’s bioethics fatawa
commonly accepted, abstract moral rules irrelevant to particular subgroups; applicable to all people in all places, rejects relativism
the common morality
when moral obligations demand that a person adopt two or more alternative but incompatible actions, so that they cannot perform all required actions; not practical conflicts with self interests or generally hard decisions
moral dilemma
reasoning about which moral norms should prevail when two or more conflict
balancing/weighing
commitments that must be fulfilled unless they contradict with an equal or stronger obligation
prima facie commitments
regret when a prima facie obligation overrides another commitment
moral residue
when moral people come to different conclusions about the same situation due to differences in balancing
moral divergence
when individuals act freely to a self-chosen plan with intentionality, understanding, and without controlling influences that determine their action
autonomy
- Express/explicit
- Implicit/implied - based on actions
- Tacit - based on lack of objection
- Presumed - form of implicit consent based on info about individual’s choices
types of autonomous consent
principle that one should not harm others
nonmaleficence
taking appropriate care to avoid causing harm
standards of due care
intentional or careless departure from standards of due care
negligence
all norms, dispositions, and actions with the goals of benefiting or promoting the well being of others
beneficence
necessary beneficence to maintain morality; not extreme
obligatory beneficence
beneficence that exceeds ordinary morality, extreme generosity
ideal beneficence (“the Good Samaritan”)
the intentional overriding of one person’s preferences or actions by another person, where the overrider justifies the action by appeal to goal of benefiting or preventing harm to the overridee
medical paternalism
paternalistic agent intervenes to prevent nonvoluntary conduct (ex. poorly informed consent or refusal)
soft medical paternalism
paternalistic agent intervenes, even when a person’s choices are informed, voluntary, and autonomous
hard medical paternalism
targeting of acts or people who engage in certain conduct; can lead to discrimination against people
stigmatization effects
opposition to hard paternalistic interventions; belief that rightful authority resides in individuals, not states or groups; usually coincides with strong rights theorists
antipaternalism
Failure to intervene communicates lack of communal concern. Many suicidal people are mentally ill. Many suicidal people fantasize about rescue.
suicide intervention ethics
temporary restraint, but nothing more; shouldn’t assume suicidal people are without their autonomy
antipaternalist stance on suicide prevention
idea that choice architecture should be beneficially arranged to encourage people to make choices they want to make without coercion or mandates; argues about existence of value and action gap
nudge theory
grids in which people encounter the world; 7 reasons people are not individually good decision makers
includes anchoring, remembrance, confirmation, individualistic, framing, implicit, and group mentality heuristics
individual cognitive heuristics
difference between stated values and ideals and what actually occurs
value/action gap
When the seat belt laws were being considered, the majority were against them because they were considered antidemocratic.
From the autonomy perspective, they argued that wearing a seat belt should be a person’s decision. They thought a law enforcing them would violate constitutional rights.
From the beneficence perspective, the decision to wear seat belts does not just protect individuals. Others are affected in the crash, including other passengers, doctors, paramedics, lawyers, and insurance systems. The autonomous decision is overriden because people want to be safe during a crash; they just didn’t know it. The autonomous decision is overriden on basis of cumulative social benefit. They performed studies proving how seat belts reduced the harm during car crashes and prevent deaths.
mandatory seat-belt laws case study
honesty, connected to respect for autonomy
veracity
disclosing medical truths slowly, over the course of several sessions, instead of immediately
staged/limited disclosure
violation of obligations to beneficence and nonmaleficence (ex. anxiety, prompting suicide, destroying hope), fear of legal consequences, concerns about harming patients or public trust, lack of genuine patient desire to know truth
justification of nondisclosure
leading cause of death in US hospitals, leads to responsibility to disclose promptly with specificity (does not occur often)
medical error
state or condition of limited access to a person; includes informational, physical, decisional, proprietary, and relational
Griswold v. Connecticut led to right that shields info from others and protects decisions from government intervention
privacy
prevents redisclosure of information within relationship where confider expects confidant to not further disclose without authorization; subset of informational privacy
compromised through systematic medical care
confidentiality
teleological subset of ethics of care that originated in feminist writings; argues that morality of actions is partially dependent on moral character; traits valued in intimate personal relationships, including sympathy, compassion, fidelity, and love; emphasis on emotional responsiveness
virtue ethics
happiness or flourishing holistically; includes virtues necessary for a satisfying life
eudaimonia
patterns of disposition entrenched in moral actor; part of existential way of being in the world
moral habits
attitude of active regard for another’s welfare combined with sympathy, tenderness, and discomfort at another’s misfortune or suffering; expressed in acts of beneficence that try to alleviate misfortune or suffering
can be a weakness when it prevents impartial reflection and blinds reason
compassion
quality of warranting another’s confidence in one’s character and conduct
trustworthiness
soundness, reliability, wholeness, and integration of moral character; objectivity, impartiality, and fidelity in adherence to moral norms
integrity
mental faculty of and authority for moral decision making
conscientiousness
exceptional virtue in altruism and benevolence to the point of realizing a moral ideal consistently or by accepting extraordinary risk
characterized by
- worthy moral ideal
- motivational structure allowing them to forgo advantages in service of moral ideal
- exceptional moral character
- great integrity
moral excellence (heroes/saints)
a morally praiseworthy, but optional act that exceeds the demands of common morality and intends to promote the welfare interests of others
supererogatory acts
Muslim principle that intention of actor, not action itself, is important; means don’t justify the ends
principle of qasd
Muslim principle of certainty; argues all medicine is permissible unless certainly haram; need compelling evidence (not just doubt) to disregard “known” facts
principle of yaqin
Muslim principle that injury should be relieved; justifies medical intervention; harm should be avoided and must be outweighed by the good
principle of darar
allowance to override haram actions to save a life
principle of darura
Muslim reference to custom and predominant cultural consensus when actions are not otherwise specified
principle of ‘urf
bioethical attitude that focuses on specific and unusual cases, ignoring the mundane
exoticist bioethics
mundane actions of medical providers are more important than actions in extreme, unusual cases
heroic ordinary/everyday
theory modeled on maternal caring, not masculine mode; places moral weight on mutual interdependence and emotional responsiveness; argues humans have a natural capacity for empathy; heavily influential in nursing, way to fight against exoticist bioethics; argues caring is a moral response
ethics of care
moral attention, sympathetic understanding, relationship awareness, and harmony and accommodation
processes of ethics of care
complex of emotional and conditioned responses to suffering and proactive constraint on behavior that would inflict harm; central emotion in care ethics
empathy
attempt to collaborate and participate to push someone towards a good end, even if it contradicts with their stated desire, referenced in ethics of care
maternalism
attention paid to the situation in all its complexity; awareness of all details that allow a sympathetic response to a situation
moral attention
openness to sympathizing and identifying with persons in a situation; attempt to be aware of how the people in the situation would like them to respond and what’s in their best interests
sympathetic understanding
awareness of network of relationships that connect humans, care for preserving and nurturing these relationships
relationship awareness
consideration of the needs of all involved with hope of preserving harmony
accommodation
considers the moral actions and adjustments it take to make relationships flourish, referenced in ethics of care
special relations
historically independent, organized institution under total Black control; typically Protestant in belief and personal ethics, but progressive socially; sects of Christianity blended with traditional African spiritual practices; Established by Free African Society of 1787 during revivals of First Great Awakening in 1730s-1750s; grew rapidly after Civil War; not consulted in bioethical deliberation;
Black Church
form of discrimination with roots in Aristotle’s scala naturae, Malthus’s arguments on population control, and Herbert Spencer’s social Darwinism; all of which led to elimination and forced sterilization based on strict categories
structural racial discrimination
unconscious racial biases among physicians that results in extra paternalism, negative emotional tones, less patient-centered care, and subsequent distrust by AA patients
medical tacit racial bias
Black woman with cervical cancer whose immortal cells were taken without informed consent
Henrietta Lacks
Dr. Southam injected patients unknowingly with HeLa to see how their systems would react to cancer. Justified with paternalism and utilitarianism. Reported by 3 Jewish residents. Convicted of fraud and unprofessional conduct, but was elected president of American Association of Cancer Research later
Chester Southam experiments
when Stanley Gartler claimed that many scientific experiments were compromised because HeLa cells were spreading unintentionally
“HeLa bomb”
first public explanation of Henrietta Lacks’s identity; discussed her Blackness, how she didn’t consent, how white cultures were “contaminated” by Black ones, how uncredited HeLa became one of most important medical tools
Michael Rogers’ Rolling Stone essay (1976)
Moore sued to legally claim the cell line that had emerged from his cancerous tissues. Judge used HeLa as precedent.
Utilitarian decision that patients cannot stake a claim in their own tissue once they’ve agreed to treatment
Moore v. University of California case (1990)
Did not explain that they were not testing them for cancer, but that they were snooping around their genomes to solve the HeLa bomb problem
medical establishment treatment of Lacks family
traditional understanding that some patients were “overcome by their illness” and additional treatment is pointless
medicalization of death
empirical analysis of the human body allows identification and treatment of pathologies, but brackets issues of personhood, community, and meaning
“clinical gaze”
advocates accepting death as part of cycle of life; could be used to further euthanasia
hospice movement
court case ruled that refusal of treatment is located in individual autonomy, no ethical or meaningful difference between withdrawing or withholding treatment
Catholics told parents they weren’t morally required to continue with respirator or feeding tube, but parents kept feeding tube
In Re Quinlan case (1976)
controversial Supreme Court ruling affirmed Quinlan; ruling allows individuals to write end of life wishes
Nancy Cruzan was in permanent vegetative state, parents wanted to withdraw treatment but hospital refused; allows proxies to decide at state level; after ruling, was forced to let her die
Cruzan v. Missouri Health case (1990)
natural law concept that an attempt to do good is morally permissible, even if the outcomes are negative
Action with good and bad effects is morally justified if act itself is not wrong, bad effect must not cause good effect, actor must not intend bad effect, and bad effect doesn’t outweigh good effect.
Applied by Catholics to end of life, abortion, mutilation, sterility, etc.
Principle of Double Effect
moral correctness depends on authorization; must know motive, circumstances, patients’ preferences, and consequences; pointless distinction based on convention
killing v. letting die distinction
causal action that brings about death; widely viewed as morally wrong; act of people, not natural conditions
killing
intentional avoidance of causal intervention so that disease, system failure, or injury causes a natural death; acceptable if medical technology is useless or if patients or surrogates validly refuse treatment
letting die
placed under same standards as other medical treatments by US courts, but some individuals distinguish
medically assisted nutrition & hydration ethics
when irreversibly dying patients cannot be improved by further treatment; makes treatment hopeless and morally optional
restricted to when patients or surrogates request interventions that simply cannot achieve intended physiologic goal; good clinical and ethical judgement not to provide them
medical futility
serious abuses won’t occur immediately, but will grow incrementally over time; could lead to unjustified killing and manipulation of the system; should not embark on path because of potential consequences of allowing physician-assisted death
could be deadly elderly or disabled people; could lead to low-income families allowing death rather than suffer financial burdens, could cause palliative care for all patients to suffer, potential loss of public trust
slippery-slope concerns
usually closest family member; must have ability to make reasoned judgements, adequate knowledge and information, emotional stability, and commitment to patient’s interests, free of conflicts of interest and control by 3rd parties
monitored by physicians, ethical committees, and judicial system
surrogate decision-making
physicians write prescriptions for lethal medications at patient’s request; patient consciously decides to use drug; physicians are not determinative step in patient death, so are not culpable
usually older white people with cancer; only 66% actually take pills
Oregon’s Death with Dignity Act (1994)
woman in permanent vegetative state for 17 years; father wanted feeding and hydrating tubes withdrawn because she didn’t want to be kept alive artificially
Supreme Court of Cassation upheld request (made her go to private, clinic), but Catholic Church, Health Minister, Episcopal conference, Prime Minister, and conservatives strongly opposed
Eluana Englaro case
practical knowledge imbued by life of grace
dependent for its reasoning on the analysis of contingent
events (not faith)
more flexible decision making than casuistry
virtue of prudence
memoria, docilitas, and solertia
principles of prudence
memory that is true to being (remembering events as they happened)
prudence principle
memoria
open-mindedness
prudence principle
docilitas
acumen, ability to act well in the face of unexpected events
prudence principle
solertia
loss of integrated personhood in Islam; process altered state of being; part of journey of return to God
Islamic death
presupposes continuation of blood circulation and or respiration because of movement and pulse
stable life
rate of blood flow lower than level of viability, inconsistent cardiac function; heartbeat is a conclusive indication of death
unstable life
breathing through artificial life support mechanisms that allow maintenance of heart function and breath; replacement of brain stem; considered adequate marker of death
whole brain death
if considered dead, would prevent slippery slope for terminally ill patients with active cortical brain function
justifiable to remove feeding and hydration tubes if case is irreversible (let die)
no cortical function, patient cannot see or hear, but can breathe and digest unaided; can respond to painful stimuli
ethics of post-comatic unresponsiveness (PVS)
stopping treatment that has already started; avoided by physicians because they feel as though they’re actively killing patients
withdrawal of treatment
Dr. Quill challenged laws prohibiting physician-assisted death. Argued patients have “equal protection” right in asking for help to hasten own death by withdrawal. SCOTUS unanimously ruled there is no “right to die.”
Vacco v. Quill case (1997)
patient request for physician to withdraw treatment; ruled illegal by Vacco v. Quill
physician-assisted dying
passive non-voluntary death; when people cannot choose for themselves whether they want to be supported with machines and their wishes; their decisions are made by a surrogate
assumes there’s good faith basis for the surrogate’s decision
surrogate euthanasia
when a physician actively decides a patient should die; “mercy killing”
involuntary euthanasia
people who support physician-assisted death under the right circumstances
“right to die” movement
according to pro-lifers, something all people begotten to human parents have for the duration of their existence, regardless of capacities; term is currently used to describe set of capabilities and does not describe all living human beings; people have the right to have their life protected
human personhood
fetuses are people the moment they are conceived, when the sperm fertilizes the egg
punctualist accounts of personhood
fetus becomes a person after conception
gradualist accounts of personhood
- landmark 7-2 decision overturning absolute state laws restricting abortion
- gives women fundamental right to decide on abortions in first trimester
- based on protection of “personal privacy” extended to include right to bodily integrity
Roe v. Wade case (1973)
in line with first wave feminists who believed abortion was infanticide; motivated by empathy fo child and for women driven to abortion by powerless position and by male sexual selfishness; driven out of feminist movement in 1960s
pro-life feminism
view of personhood situated within our relationships with communities; relationships come with obligations that are necessary for the survival of individuals in the community
often pushes back on individualist, Western bioethics
communitarianism
tracks human potential closely; animal with active or internally directed potential to exhibit distinctively human ways of behavior and thinking is a person and, therefore, entitled to rights when it first comes to be; concept makes abortion homicide
species membership
the right of physicians to refuse to perform a procedure based on conscience, argued on coherent, rational grounds
used in abortions
conscientious refusal
idea that fetus becomes person when it moves during pregnancy
animation/quickening
Aristotelian biological idea of when embryos take on human personhood
traditional formed embryos
Aristotelian biological idea that an embryo is not a person yet (hasn’t hit the threshold)
similar to Islamic ensoulment
traditional unformed embryos
babies become human when they breathe air through their lungs after being born
Jewish “breath of life” view
pro-life Christian idea that all humans have no achievements they can boast about before God; to Him, the difference between being born and having fetal potential is negligible
“fellow fetuses”
the moment an egg is fertilized and a fetus is conceived, that fetus is alive and has independence; argument for pro-life movement
life-at-conception view
belief that pregnancy is beginning of unique, gestational stage of motherhood (not precursor to motherhood) during which the mother should have moral authority to decide to abort or keep the baby; only pregnant women and mothers have authority to make motherly decisions based on obligations
gestating motherhood prochoice view
because the gestational mother alone has the obligation thrust upon her to
decide whether to continue the pregnancy or not, she therefore has the primary
authority to decide
motherly fetal authority/power
Mary’s choice was free of all male authority; she was not forced to give birth to Jesus, but decided to cooperate in her own redemption (was not a passive object); did not immediately accept, but spent time considering the ramifications before deciding to proceed → affirms women’s decision making about their bodies
prochoice Marian interpretation
when Arabs buried their baby girls alive, right after birth to avoid disgrace or poverty; before Islam was introduced - prohibited several times in Quran
the Wa’d paradigm
moment soul enters fetus, 120 days in this religion
Islamic ensoulment
- Maliki and Hanbali - abortion only permitted up to first 40 days with consent of both parents
- Shafi and Hanbali - kahhara payment is obligatory for abortion
- Hanafi and Maliki - kahhara payment is optional act of devotion, not obligation
Islamic jurisprudence schools on abortion
Black woman pregnant with 3rd child. Complaints of pain and swelling brushed aside. Told to calm down, didn’t report hypertensive episode during appointment. Pre-eclampsia caused abruption, baby was stillborn. Almost bled to death
When pregnant with 4th child, enlisted help from a doula who stood up for her rights in face of callous and mocking medical practitioners.
Simone Landrum’s narrative
- US currently ranks 32 out of 35 wealthiest nations in infant mortality; driven by deaths of Black babies
- Black infants are more than 2x more likely to die than white infants
- Wider disparity than in 1850, during slavery
- Not impacted by education and income
- Black infants are more than 2x more likely to die than white infants
- Mother mortality - Black women are 3-4x more likely to die from pregnancy-related problems than white women
- US one of only 13 countries in the wold whee rate of maternal mortality is worse than it was 25 years ago
- Preventable near deaths rose 200% between 1993 and 2014
- most exacerbated in lower class Black women, but even college-educated, married Black women are 2x more likely to have infant mortality
- Dr. Arline Geronimus - weathering theory that stress of living under white supremacy damages Black women’s bodies
- Greatest experiences of racism → higher levels of preterm births
- Accumulation of persistent insults and traumatizing life experiences → frequent flood of stress hormones → wear and tear on cardiovascular, metabolic, and immune systems → increased vulnerability to illness and early death
Black maternal/infant mortality crisis
