Who is worthy of moral concern? Flashcards
What is moral concern?
having rights, duties or obligations
What are the 6 grounds for moral concern?
sentience human autonomy personhood potentiality patient
What is ‘sentience’?
- ability to feel painful/pleasurable stimuli
- if we can feel pain - assumption that we don’t want to, therefore interest in not feeling pain
- if they have the capacity to feel pain then we have the obligation to prevent pain
What is ‘human’?
- what we believe humans are
- sanctity of human life - something special about being human?
- prohibits abortion, euthanasia, and often withdrawal of life saving treatment, DNR orders etc.
- may be seen as murder
What is ‘autonomy’?
- respect autonomous wishes - wrong to frustrate autonomy because patient can’t make decision/be responsible
- having mental capacity to have autonomy of thought/will/action
- many make logical request but if it weren’t for mental illness they wouldn’t be asking –> request not compatible with autonomy (e.g. getting all teeth pulled out)
What is ‘personhood’?
- being a person is not just a biology matter, its the ability to have certain continuous mental states, like desires for the future, rational thoughts etc. These provide a right to life. If mental states are no longer possible, the patient may no longer be a person.
- how should be diagnose and treat patients who are no longer persons?
What is ‘potentiality’?
- although the patients present state lacks a criteria for moral concern, they are likely to develop in the future
- provides reasons for not harming the foetus
- provides justification for continuing with life-supportive therapies until clinical improvement or futility reached
What is ‘patient’?
- Drs have duties to all their patients, irrespective of the philosophical status of a patient
- grounded in professional duties and obligations
- provides justifications for contuinuing care when other grounds are missing - but legal limit
- if no benefit from treatment –> battery, even if you believe in sanctity of life
Does moral concern change when a patient dies?
When is death conventionally declared?
What two clinical states challenge this?
- Moral concern (having rights, duties and obligations) changes when a patient dies
- conventionally, death is declared the cardio-pulmonary arrest irreversible
- persistent vegetative state and brainstem death
What is biological death?
What is biographical death?
Biological death - brain stem death, requires ventilation
Biographical - loss of personhood, e.g. PVS
What is brain stem death?
- death of vital biological functions of the brain - repsiration, tempurature control, fluid balance. Heart continues to beat if oxygen delivered (ventilation)
- this is termed biological death - legally recognised diagnosis
- patient suitable as organ donors
What is persistent vegetative state?
- death of upper brain, brain stem intact
- irreversible loss of consciousness and all higher mental states
- vital biological function continue
Who was Tony Bland?
in PVS following crush injury at hillborough
family campaigned for his right to die
- euthanasia is illegal so can not treat infections or remove feeding tube
How is PVS diagnosed?
- exclude all other causes of persistent coma
Observe the following lack of clinical signs for 6-12 months - no awareness of self or environment
- no response to visual, auditory, tactile or noxious stimulus
- no evidence of language comprehension
- sleep/wake cycles still maintained
What is minimal awareness state?
When a personal who is thought to be in PVS, has PET imagery and is found to have upper brain function - up to a quarter of PVS diagnosed patients have this
