Bioethics Exam Study Guide

According to the medical model, what is a disability?

functional deficits resulting from a person’s impairment

According to the social model, what is a disability?

prejudice and discrimination that a person faces because of a real (or perceived) impairment

According to the social model, what is an impairment?

lack of psychological function

From the perspective of the social model, sex is to gender as ___ is to ___.

impairment is to disability

By whom was the social model primarily developed?

disabled people in the UK

What slogan is now widely associated with the disability rights movement?

“Nothing about us, without us”

Explain the concern that the societal model does not pay enough attention to impairment

Impairment can, by itself, be disabling, example, such as pain from arthritis

Barnes offers a single response to both of these criticisms of the social model, what is this response?

The social model is primarily a political tool. The goal of the social model is to bring about policy changes and it’s been very effective.

How do Chan and Harris define “enhancement?”

anything that improves function

What assumption do Chan and Harris make about the relationship between function and well-being?

Assume that improved function entails higher quality of life.

It is widely accepted that taking vitamins, glasses, prosthetic limbs are all morally permissible. How do Chan and Harris argue from this to the permissibility of enhancement?

These are already enhancements with which we are comfortable. We all think these enhancements are permissible, so we all already think that there’s nothing wrong with enhancement.

Chan and Harris argue that we cannot use “species typical function” to draw a moral line between treatment and enhancement. Explain their argument.

Species typical function changes over time. It was not wrong to feed your kids enough (and healthy) food in the medieval ages, which would have counted as enhancement, which shows that species typical function does not establish a morally important distinction between treatment and enhancement.

Chan and Harris argue that, if non-genetic enhancement is permissible, genetic enhancement is permissible as well. Explain their argument.

There is no important difference between genetic enhancements and non genetic enhancement. Genetic enhancements just involved moving chemicals around the body. Which is the same thing that happens when someone takes a vitamin/drinks protein shake

It has been argues that germline genetic modifications are particularly morally problematic because we will not be giving future generations a choice about whether to have the genetic modification. How do Chan and Harris respond to this argument?

Kids do not have a say one way or the other, even if it is an autonomy violation, the violation will be the same whether or not you get the enhancement. Furthermore, if your kids did have a choice, presumably they’d choose the enhancement

How do Chan and Harris respond to the objection that genetic enhancement is “unnatural?”

Lots of things are unnatural such as vaccines, herbicides on crops, we do not think that the fact that something is “unnatural” makes it wrong

How do Chan and Harris respond to the concern that genetic enhancement will lead to an increasingly unjust social oder?

People should be able to spend their money however they want to, there’s no difference in sending your kids to a private school, hiring an ACT tutor

According to the welfarist account, what makes something an enhancement/disability?

enhancement - stable physiological feature that improves QOL under relevant circumstances, disability - stable physiological feature that decreases QOL under relevant circumstances

What problem do functionalist accounts of disability face regarding the connection between disability and value?

functionalists define disability in terms of loss of function and defines enhancement in terms of improved function. but improved function does not have any straight forward connection to QOL

How does the welfarist account of disability solve the value problem faced by functionalist accounts of disability?

Welfarist defines enhancement/disability in terms of QOL

What is the mislabeling objection to welfarist accounts of disability?

The welfarist account has to say that, in a racist society, being non-white is a disability, sexist society, BUT race and sex are not disabilities/enhancements

How do welfarist accounts try and solve the mislabeling objection?

Introduce the exclusionary clause ‘an enhancement is a stable physiological feature that typically improves QOL under the relevant circumstances excluding the effects of prejudice and discrimination

From the perspective of many disability rights activists, what is especially morally problematic about selective abortion after a prenatal disability diagnosis?

It promotes the idea that life with a disability is not worth living (strong version), it devalues life with a disability (weak version)

Present and explain an example of the non-identity problem

A mother is deciding whether to get pregnant now or to wait. If she gets pregnant now, her child will be born with a disability but if she waits a year, then the child will not be born with a disability. Intuition, she should wait because that is better for the child, But, it is not better for any specific child because it is the choice between two different lives, not choice between two trajectories for a single life

What is the difference between a person affecting harm principle and a non-person affecting harm principle?

Person affecting HP - requires that there be some particular individual who is made worse off for something to count as a harm. Non-person affecting HP - allows for something to count as a harm because it makes the world worse than it might otherwise have been, even if there is no particular individual who is made worse off

How does Brock use a non-person affecting HP to respond to concerns about selective abortions?

selective abortions need not express the idea that life with a disability is not worth living, instead it can be based on a non person affecting HP where the decision to get a selective abortion does not rely on the idea that any particular person is harmed

What is the difference between the strong form of the expressivist objection and weaker forms of the expressionist objection?

strong - selective abortion expresses that life with disability is not worth living, weak - selective abortion devalues life with a disability

What is a transformative experience?

Experience that give you access to knowledge that you could not have had prior to the experience, ex- cancer, giving birth , going to an OSU football game

There is a wealth of testimony from people with disabilities attesting to the fact that the disability does not make their lives worse. Why should we believe this testimony?

Being disabled is a transformative experience, only disabled people know what it is like, unique access to this QOL with a disability

How does Kitty respond to the claim that, even if having a disability does not decrease subjective well being, it may still seem to decrease objective well being?

If a disability decreases objective well being, it is only because of prejudice and discrimination. We do not think that prejudice and discrimination are good reasons to bring a person into existence.

Kitty argues that, even if we suppose that having a disability does in fact decrease a person’s QOL, it does not follow that a world without disabilities is better than a world with disabilities. Briefly present and explain her argument.

Even if life with a disability is worse for the person, it can still be good for the world as a whole, David Foster Wallace - “This is Water”, his disability made his life worse but the world a better place

How does Kitty explain our intuition that the women who chooses to have baby with a disability, rather than delaying her vaccination, did the wrong thing?

We should not make serious decisions like this one based off of flippant reasons

Despite the fact that the US pays more per capita for healthcare than any other country in the world, we have __.

very poor health outcomes

What were the three primary goals of healthcare reform discussed by Obama?

increase access to health care, lower cost, not destabilizing healthcare

Why did Obamacare require that employers offer insurance coverage and that individuals get insurance coverage?

in order to increase the number of healthy people paying into the insurance system (which helps keep cost down)

Why does covering pre-existing conditions pose a problem for a core tenet of capitalism?

Choices no longer look like they are made freely because one’s choice of employment is often made under coercive conditions because loss or change of employment can lead to lack of insurance

In what way does healthcare present a challenge for standard economic models of the consumer?

Standard models assume that: the consumer is fully rational, fully informed, (shops around for best deal), when we are sick, we normally do not do these things

According to Daniels, what is the special moral importance of healthcare?

Health is required for equality of opportunity, healthcare helps secure health

In light of the foundational role health plays in equality of opportunity, what kind of healthcare policy does Daniels support?

Everyone should have access to free or very low cost healthcare, but also, people should be able to buy access to higher quality healthcare

Why does Daniels think healthcare policy should guarantee access to treatment, but not enhancement?

Access to treatment being people back to typical function which supports/provides equality of opportunity. Enhancement brings someone above typical, which is not supporting/providing equality of opportunity

Wealth is a powerful predictor of __.

health outcomes

The greater the wealth inequality in a country, the worse the __.

life expectancy

What does Kawl’s “difference principle” require?

Any policy or intuition that introduces inequality must most benefit the least well off

Why must there always be limits to the amount of resources a society dedicates to healthcare?

You need to spend money on other things like schools, police, road, education

What does the social contract theory try and explain about government?

tells us what governments are supposed to be doing

According to Trotter, what is the difference between “justice as equality” and “justice as reciprocity?”

Justice as equality - equal access to basic goods, justice as reciprocity - people who work hard deserve the benefits of their labor

Most of our healthcare expenditures are spent on conditions that are sometimes referred to as “lifestyle relaed illness” Why does this pose a challenge for proponents of healthcare reform?

people do not want to pay for other people’s poor choices

Why does healthcare reform pose potential challenges to liberty and privacy?

people are not going to be willing to pay for health conditions that could have easily been prevented and in order to make that happen, there eould need to be monitoring of people’s habits but this would interfere with privacy and human rights

According to Trotter, what form should healthcare reform take?

everyone should have access to free healthcare, but if you can afford it, you can pay for better h

Using white health outcomes as the standard for comparison is racist because __.

It treats white health outcomes as the standard for health. Seems to say that white health outcomes are what counts as being healthy.

How does treating white health outcomes as the standard harm both white people and non-white people?

We do not end up asking “What factors lead to non-white populations having better health outcomes on certain metrics?”

Biological race does not explain health disparities. Instead race based health disparities are best explained by __.

racism

According to Braddock, how should we change SOFA scores in order to make their use more equitable?

adjust them based on race

Describe 3 examples of clinical algorithms that include race -based adjustments

1 - black neonates need to be sicker before they are recommended to get tested for UTI, 2- Black patients are assumed to have a lower heart function so they have to be sicker to receive treatment, 3 - black patients are less likely to be able to be approved for a vaginal birth after c section

What is an RVN?

what counts as normal physiological function for some particular measure (for some particular population)

What is a CPG?

takes the best available evidence and distill it into what a provider should do when they encounter a specific situation/scenario in the clinical contt