studying for midterm Flashcards
Utilitarianism - Bentham
This provided him with what he called aprinciple of utility,whichis, in effect, a theory of the good. In brief, Bentham thought it is good to maximize pleasure and minimize pain. Bentham suggested a kind of calculus.
Utilitarianism - Mill
he thought that we might want to differentially rank pleasures. He famously wrote, “It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied. And if the fool, or the pig, is of a different opinion, it is only because they only know their own side of the question.
Act utilitarianism
An act is right if and only if there is no other action I could have done instead which either (a) would have produced a greater balance of utility over disutility; or (b) would have produced a smaller balance of disutility over utility.
Rule utilitarianism
An act is morally right if and only if it conforms with a set of rules whose general observance would maximize utility.
Kant ethics
demonological, believed that we could figure out what our duties are on the basis of reason alone. Called the principle the Categorical Imperative: entails a set of duties, or moral laws, that are intrinsically good.
kant = formula of universal law
suggested that when considering an action, we should articulate themaximthat describes that action—basically, the rule we would be following were we to act in this way - could everyone follow it?
kant = formula of humanity
“So act that you use humanity, as much in your own person as in the person of every other, always at the same time as an end and never merely as a means.” Values rationality, freedom and autonomy — often referred to as respect for persons
ross ethical pluralism
Ross suggests that we acquire particular duties when we make promises.
ross three types of duty?
duties of fidelity, reparation and gratitude.
Duties of fidelity
duties to be trustworthy and keep our promises.
Duties of reparation
come into effect when we have harmed or wronged someone. They are duties to repair a situation or otherwise make amends.
Duties of gratitude
arise when others help or support us. Through their actions, we acquire a duty to reciprocate or, at least, be grateful for their benefiting us.
ross forward-looking duties?
non-maleficence(not harming others),beneficence(improving the well-being of others), self-improvement, andjustice.
ross other useful idea?
duties are oftenprima facie. Prima facie simply means “at first glance.” The idea ofprima facie duties, then, is that each duty is requiredunlessthere is some other competing duty that outweighs it in moral force
aristotle virtue theory
Aristotle believed that what we pursue is happiness and a happy life is the ultimate good that humans seek. Although we have used the term “happiness,” this isn’t a perfect translation. The Greek term Aristotle used is “eudaemonia,” which is variously translated as happiness, flourishing, and well-being
feminist ehtics
focus on relations, developed in reaction to the ethical traditions of Europe—especially Utilitarianism and Kantianism and, to a lesser extent, Aristotelianism. The feminist critique was twofold. First, ethics needs to address the importance of personal relationships in our lives. Second, humans are, in fact, thoroughly relational beings and the idea that anyone isself-madeis simply a myth — gave rise to care ethics:
feminist - care ethics?
Care ethics recognizes that relationships of care—for instance, parents caring for young children—cannot be captured by the ethical theories that have dominated European and European settler societies. Not autonomous, very vulnerable, emotional relationships
rights theory
????
straight-forward application model
The ethical theory is the starting-point, and we apply the theory to the case at hand in order to reach a conclusion about what should be done.
straight-foward application model example
Utilitarianism is the leading example of an ethical theory that might be thought to solve bioethical problems by the straightforward application of its ideas. Utilitarianism says that in any situation we should do what will have the best overall consequences for everyone concerned
physics/car-mechanic model
The relation between ethical theory and bioethics is like the relation between physics and automobile repair. Mid level principles
physics/car-mechanic model example
So, like the car mechanic, the bioethicist will rely on mid-level principles
- baby theresa
- ebola nurse
biology/medicine model
To deal with the difficult problems, she might find herself turning to scientific researchers for help, or even turning temporarily to more fundamental research herself. And what she learns from the cases she encounters in her practice might, in turn, have significance for the further development of the sciences.
arras will vs interest theory
On closer inspection, however, these two rival conceptions of the function of rights might well agree on the importance of a right to health-related goods.
arras four theories of health related goods?
libertarianism, utilitariansm, liberal egalitariansim, communitarianism
libertarianism
Advances an absolutist conception of negative rights, denies any positive rights, and claims that the right to health care is actually an unjust claim to the resources of others.
utilitariansim
Utilitarians believe that morality exclusively has to do with improving human welfare; they are not fundamentally interested in agents’ motivations, natural rights, or the will of god.
liberal egalitarianism
iberal egalitarianism will be committed to at least two things: Fair equality of opportunity and the least privileged among us should benefit from however we structure out societies. Limited right to health care and benefits from social determinants
communitarianism
ommunitarians do not believe that the rights or values of individuals matters. Aras thinks you can view this more loosely, look that historically Canadians have committed to this level of healthcare
health commodity?
Suggested that when something is regarded as a commodity, it typically implies that it is something that can be bought and sold and enjoys a value that the market can bear
heath market?
The Canadian health care system more closely resembles what is often described as a quasi-market or a public market. There is public and private funding
heath 3 responses to moral incentives?
- First, this is clearly not how our health care system currently works. So if there is something wrong with treating health care as a commodity, then there is something gravely wrong with the organization of our present health care system.
- highly doubtful that a system based purely on moral incentives would be more effective at delivering health care to the population than the current one.
- Finally, turning back momentarily to the analogy with the police force, while no one doubts that personal security is a basic human right in our society, not a commodity, no one has ever suggested that this should prevent people from purchasing more of it, above and beyond the baseline established by the state.
two forms of queue jumping?
- There is no question that, if there is a line-up, and some people are allowed to buy their way to the front of the line, then that worsens the condition of everyone else in the line, because it bumps them all back. That is genuinely objectionable.
- The case is quite different when people are able to jump the queue by leaving it entirely. Suppose someone who is on the waiting list for an MRI gets impatient and goes to the United States to have the test done.
which is worst queue-jumping?
first one more morally problematic
Armstrong five determinants of health?
social environments, physical environments, psychological environments, productivity and wealth and finally health care
social environments?
Studies have demonstrated that social relations and support are critical to health — people with more social contacts and friends tend to live longer than those with fewer
physical environments?
This is straightforward — nutritional food, clean water and clean heads are essential to good health. Difficult to remain healthy if homes and workplaces are dirty, crowded, noisy, lack facilities or are poorly ventilated
psychological environments?
Growing evidence that mental health influences physical well being
Our healthcare systems do not do well with mental health — it is SO important
productivity and weath?
Not only secure employment but also secure income that is important to health — greater wealth (socioeconomic status) is associated with greater health; poorer and middle income people appear to be more vulnerable than wealth people to a variety of ailments
health care?
Clearly favour an explicit linking of health care to the determinants of health
They don’t dispute calls to recognize that there should be a limit to what is publicly spent on healthcare
armstrong four challenges of health
Medicine is scientific, Medicine as a cure, The engineering model, Health as mainly biological
Medicine is scientific
Considerable evidence to suggest that not all drugs, devices and procedures have been rigorously and systematically tested — evidence to suggest that doctors do not always know or portly apply the information that is available
Medicine as a cure
The assumption that medicine provides treatment and cure rests on the assumption that science has determined cause and cure
Note that many passing through the healthcare system are not cured:
The engineering model
Engineering approach — looking for symptoms in an in vivo model (prof does not support this), you have to induce strokes in mice they do not have strokes
For Armstrong the “parts” approach to patients is associated with high prescription rates and short visits
Fee-for-service and specialization come up agin in relation to the “parts” approach
It can encourage iatrogenic problems, patients must travel from doctor to doctor, none of whom is likely to have a full view of the patient
Health as mainly biological
The challenge to the assumption that illness and disability are primarily the result of readily identified biological causes is directly linked to the fact that people are not simply collections of parts to be fixed
reading tree metaphor
proximal = canopy
intermediate = trunk
distal = roots
proximal determinants
early child development, income and social, education and literacy, employment, occ health, physical health - at individual level
intermediate determinants
link proximal and distal - includes health promotion and health care, education, social supports
distal determinants
deeply embedded represent historical, political, ideological, economical and social foundations from which all determinants evolve
reading relationship between determinants?
all levels are interconnected, not straight forward which one is impacted
reading indigenous health in canada
chronic stress linked to systemic oppression has shown to diminish immunity, lack of potable water, health care, residential schools, etc.
veatch risky behaviours
smoking, skiing, sun bathing, contact sports
veatch five models of risky behaviour
voluntary, medical, psychological, social structural, multicausal
veatch voluntary model
considers the individual as personally responsible for his health
veatch voluntary model
considers the individual personally responsible for his health
veatch medical model
external and uncontrollable causation is central, but we do not escape responsibility
veatch psychological model
implying a determining cause for choice and behaviour outside control of the agent
veatch social structural model
even when there is choice in risky behaviour, these choices may be severely constrained by structural or social inequalities
veatch multicausal model
combines the best of the other models without their weaknessess
veatch favoured model
multi causal
veatch conclusion “it is fair, it is just, if persons in need of health services resulting from true, voluntary risks are treated differently from those in need of the same services for other reasons”
argument of justice???
persad eight principles - category one
treating people equally
1. lottery principle
2. first come first served
persad lottery principle
pros: if fair not corruptible and practical
cons: ignores relevant considerations
verdict: good enough
persad first come first served
pros: fair equality of opportunity
cons: ignores relevant differences, favours those who are well off, vulnerable to corruption
verdict: its out
persad eight principles - category two
favouring worst off - prioritariansim
3. sickest first
4. youngest first
persad sickest first
pros: intutively obvious, effectively favours worst off, reflects triaging
cons: mostly based on how sick someone is at the time, favours acute over progressive illness
verdict: its out
persad youngest first
pros: does not treat people unequally, prioritizes worst off based on years not otherwise lived
cons: could end up favouring infants, ignores prognosis, excludes old people
verdict: could work
persad eight principles - category three
maximising total benefits - utilitarianism
5. saved most lives
6. prognosis or life-years
persad save most lives
pros: all equal, avoids comparison
cons: some have greater claim to a longer life than others
verdict: could work
persaf prognosis or life-years
pros: maximizing life-years has intuitive appeal, used in disaster triage
cons: could have justice issue
verdict: could work
persad eight principles - category four
promoting and rewarding social usefulness
7. instrumental value
8. reciprocity
persad instrumental value
pros: reflect practice, recognizes those who are helpful
cons: can be abused, will be disputes
verdict: could work
persad reciprocity
pros: repays socially valuable contributions, pays for risky service
cons: time consuming deliberation
verdict: could work
persad favoured principles
lottery, youngest first, saved the most lives, prognosis or life-years, instrumental, reciprocity
persad four multi-principle allocation principles
UNOS points, QALY, DALY, complete lives
persad united network for organ sharing (UNOS) points
combines sickest first, first-come and prognosis
pros: flexible
cons: contains two flawed principles (sickest first and first come), vulnerable to abuse
verdict: reject
persad quality-adjusted-life-years (QALY)
quality of life x length of life
cons: folks adjusted to a disability may experience it differently than ranked, doesnt discriminate by age
verdict: out
persad disability-adjusted-life-years (DALY)
mortality + morbility
cons: as with QALY, doesn’t consider interpersonal distribution, fails to adequately reflect lived experince
verdict: out
persad complete lives system
incorporates five principles: youngest first, prognosis, save most lives, lottery, instrumental value
pros: favours adolescent over infants, doesnt discriminate based on privledge, lottery can be used
verdict: favoured
why does persad favour complete lives
everyone treated similarly, not disrciminary, committed to just allocation of scarce resources
mackay types of influence
coercion, rational persuasion, manipulation
mackay coercion
attaching sanctions to the performance or nonperformance of particular actions that are significant enough to leave with no reasonable alternatives
mackay rational persuasion
offering factual information or giving reasons to act (opposite end of spectrum from coercion)
mackay manipulation - types
- reason by-passing non argumentative influence
- reason-countering non argumentative influence
- omission
mackay reason by-passing non argumentative influence
bypasses a persons rational capacities without their awareness
mackay reason-countering non argumentative influence
influence that works to counter peoples rational capacities (appeal to emotion)
mackay omission
influences people by withholding information from them
mackay respect for autonomy
respect autonomy by engaging with peoples rational capacities through rational persuasion, not restricting options
mackay four organ donation policies
opt-in
voluntary active choice (VAC)
mandatory active choice (MAC)
opt-out
mackay opt-in
present people with positive option to register as organ donor - default rule
mackay VAC
presents people with a choice, doesnt force a decision - default rule
mackay MAC
presents people with a choice, requires a decision
mackay opt-out
automatically registers everyone as an organ donor, provides option to opt-out - default rule
mackay thoughts on organ donation
use of these reason-bypassing argumentative tactics is pro tanto wrong because of disrespect to personal autonomy
