Final Exam - Medical Ethics (Kantin)

what is an argument

a set of propositions which function as premises, and are intended to jointly support another proposition, which functions as a conclusion

what is a valid argument

- an argument where the conclusion actually logically follows from the premises

- if all the premises are true then it would be impossible for the conclusion to be false

can a valid argument have a false premise or false conclusion

- yes, the facts can be false

- validity is about structure, not content

can invalid arguments have a true premise or true conclusion

- yes, but the premises would not guarantee the conclusion

sound argument

valid argument with true premises and a true conclusion

relationship between soundness and validity

- valid arguments do not have to be sound

- sound arguments have to be valid

modus ponens structure

1. if P, then Q

2. P

3. therefore, Q

modus tollens structure

1. if P, then Q

2. not Q

3. therefore, not P

beneficence

physicians have a duty to benefit those in their care by actively promoting health and preventing or removing harm

example of a case where beneficence is violated

when a doctor fails to use the best available means to benefit a patient

difference between medical well-being vs general well-being

medical well-being refers to the patients health status, whereas general well-being is a broader concept and has to do with their personal lives

nonmaleficence

obligation to do no harm or cause unnecessary harm to those in their care

example of a case where nonmaleficence is violated

a doctor negligently prescribes a patient a medication they know the patient is severely allergic to

autonomy

- "self-governance"

- the ability to make free, rational, and informed decisions

what is the basic motivation/justification that doctors should respect patients autonomy

it is rooted in the idea that autonomy is about "my body, my choice" and the same thing should be applied to medical practice

under what conditions is a choice autonomous

- intention

- free from influence or constraint

- made with a sufficient understanding of the relevant information

what does it mean for an autonomous decision to be intentional

one knows exactly what they are doing/agreeing to

prima facie principle vs absolute principles

- prima facie principles have exceptions or factors that can affect the principle

- absolute principles are set and have no exceptions

is it wrong/immoral for a physician to violate one of the prima facie principles of medical ethics

no, because they have exceptions and in certain cases one principle must be prioritized over another

give an example where the principle of beneficence and respect for patient autonomy conflict

a fully competent patient chooses to opt out of chemo because they value quality of life and know how their life will end regardless of treatment. the physicians need to promote health and respect the patients refusal of treatment conflict

give an example where a physicians duty to act justly conflicts with their duty of beneficence

A patient requires a rare, life-saving organ transplant, but there is only one organ available, and another patient is higher on the standardized allocation list (a system based on justice/fairness). The physician's duty of beneficence to their own patient encourages them to argue for giving the organ to their patient, but their duty of justice (to ensure fair distribution of scarce resources) requires them to follow the established, impartial rules, which means giving the organ to the patient higher on the list.

principle of justice

physicians, researchers, and public health officials have a duty to distribute medical resources fairly, and without bias

give an example of a case where a physician violates the principle of justice

a doctor consistently allocates less time and attention to patients from a specific background

principle of utility

actions and policies should aim to maximize the most favorable balance of good over bad for all relevant parties

example when the principle of utility was violated

during flu season the doctor only administered flu shots to their family and not the general public on a utility based system

paternalism

overriding an individuals autonomy in the name of that persons own good

weak paternalism

taking control of a person or their choices on the basis that they temporarily lack autonomy or are substantially non-autonomous

example of weak paternalism in medicine

when a doctor makes a choice for a guy in shock from a car accident

strong paternalism

overriding the autonomous choice/action of an autonomous person

example of strong paternalism in medicine

when a fully competent patient refuses a treatment but the doctor does it anyway

what is philosophical ethics

a systematic study about what is morally right and wrong

what sort of issues/questions do philosophical ethics address

- fundamental or foundational issues

- they often concern what we ought to believe or do

- involve analyzing concepts and ideas, resolving ambiguities, and drawing distinctions

what is an ethical theory/what does it aim to do

- an explanation of what makes an action right or wrong or what makes a person or thing good or bad

goal of a theory of right action

to determine what fundamental general moral principles is/are correct

utilitarianism

a fundamental ethical principle that believes that the right action is the action that maximizes net happiness

what are the conditions under which utilitarians think an action is morally right

- no type of action is inherently good or bad

- the value of the action is determined by its results (amount of happiness)

is utilitarianism a consequentialist or non-consequentialist theory of right action

consequentialist theory of right action

consequentialist theory of right action

whether an action is morally right or wrong depends entirely on the value of the consequences that result from that action

non-consequentialist /deontological theory of right action

- the consequences of an action is a consideration that partially determines whether the action is right or wrong

- the ends do not always justify the means

according to utilitarianism whose happiness counts in the assessment of an actions consequences

every sentient being's happiness is equal, one does not get more value over another

sentient meaning

an organism is able to fully feel or experience the things around them (pain and pleasure)

kants priniciple of humanity

always treat all rational and autonomous beings with respect and never use them as a mere means to achieving your ends/goals

physician-assisted suicide

refers to a practice where a physician assists a patient in ending their own life

difference between physician-assisted suicide and active voluntary euthanasia

in pas, the doctor gives the patient the means to end their life when they choose to do so (like a pill) but active voluntary euthanasia is when the the doctor directly and intentionally ends the life of a patient

first state to legalize physician assisted suicide

oregon

how many places in the us is pas legal

12

main conditions someone must meet to qualify for pas

- at least 18 years old

- capable of communicating the request/competent

- diagnosed with a terminal illness and have 6 months or less to live

- make two requests separated by 15 days

- the doctor must inform the patient of other solutions

Could a person qualify for physician-assisted dying in Oregon on the basis that they are suffering from early-stage dementia?

no, because it is not terminal

Could a person qualify for physician-assisted dying in Oregon on the basis that they are dying from dementia and have six or fewer months left to live?

no, because at that stage they may no longer be competent enough to make that decision for themselves

is active euthanasia legal everywhere in the us

no, it is illegal everywhere in the us

active euthanasia vs passive euthanasia

- active requires the physician to directly do something to the patient to take their life (ex: lethal injection)

- passive is when the physician takes away or withholds life-sustaining measures

is passive voluntary euthanasia legal in the us

yes, it is legal throughout the us

main considerations in favor of allowing PAD

- avoiding needless suffering

- value of dignified death

- patient autonomy

Is there anywhere in the world where a person may be eligible for physician-assisted suicide or active voluntary euthanasia on the basis of suffering due to a mental disorder?

yes, belgium, the netherlands, and luxembourg (canada plans to allow this in March of 2027)

whole brain death

irreversible loss of functioning of the entire brain (including the brain stem)

higher brain death/persistent vegetative state

- irreversible loss of capacity for consciousness

- loss of functioning in the "higher" brain (cerebrum and cerebellum)

under what conditions does someone qualify as legally dead in the us

- whole brain death

- NY and NJ have some religious exemptions

what prompted public health officials to revise the definition of death

they thought that the public would not be as accepting of organ transplants or willing to be donors if the doctors were allowed to take the organs of people who are technically still alive

how was death defined prior to the revision

death was defined solely by the irreversible cessation of cardiorespiratory function (when the heart and lungs permanently stopped working)

why was the invention of the mechanical ventilator relevant

the ventilator allowed for those who lost function in the brainstem to continue to breath and have functioning organs

the dead donor rule and its relevance

- in order to take organs, the donor must be dead

- by declaring a ventilator-dependent patient with a non-functioning brain as legally dead (brain dead), the DNR could be satisfied, allowing viable organs to be produced for transplantations

when is a treatment medically futile

treatment that will not achieve its intended physiological goal or will not benefit the patient

main justification for the surpreme court decision in roe v wade

a woman's decision to terminate her pregnancy is protected by the right to privacy implied by the Due Process Clause of the 14th Amendment

what was the legal result of the ruling of roe v wade? what did abortion law look like in the US after the ruling

individual states are not permitted to regulate abortions until the third trimester

how did the verdict in dobbs v jackson change abortion law in the united states

the returned the authority to regulate or prohibit abortion entirely to individual states

In her article, "A Defense of Abortion", why does Judith Jarvis Thomson assume, for the sake of argument, that a fetus is a person from the moment of conception? What is her reason for making this assumption?

- she makes the assumption to demonstrate that her main argument does not depend on when personhood begins

- she does this because she is trying to stress that even if the fetus is a person it does not mean that the mother is morally obligated to keep the pregnancy

does thompson think that it is morally permissible to unplug from the violinist

yes because you did not volunteer the use of your body in this case and the burden is not negligible

With respect to abortion, what claim does Thomson use this thought experiment to defend?

it shows that abortion is permissible at least in the case where the pregnancy results from rape

what does it mean for an act to be supererogatory

an action that is EXTRA good and goes above and beyond the general call of duty and morality

true or false: thompson claims that it would be supererogatory for you to stay plugged into the violinist for 9 months

true

"having a right to life entails the right to whatever you need to sustain your life" does thompson think this statement is true or false

false

according to don marquis, killing is one of the worst crimes because _____.

it deprives the victim of their valuable future

what does marquis mean by "a future like ours" (FLO)?

the full set of experiences, activities, projects, and enjoyments that would have otherwise constituted a valuable future for an individual

why does marquis say that abortion is "prima facie" immoral? what does this mean?

- he is claiming that it is wrong unless it can be justified by an equally strong moral consideration (ex: death of the mother)

- the wrongness of the act is established, but it is not absolute

does marquis claim abortion is never permissible?

no because he views abortion as a prima facie principle, marquis does believe that there are cases that override the justifications of abortion

where does pain occur?

in the brain, not where the actual damage is

does pain always indicate tissue damage in the body part where the patient feels it

no because the fact that pain exists in the brain is because we can feel pain in places that appear to have nothing wrong with them

can a patient feel as if they have pain in a phantom limb

yes because the pain is in the brain

in what two ways is pain subjective

- epistemic access (goes beyond the surface)

- its existence depends on its being felt

why does the subjectivity of pain cause problems for doctors

it gives them issues with regards to verification of diagnosis and understanding the patient to the fullest extent

does using the pain scale eliminate subjectivity

no

what makes something an opioid

its molecular relationship to either the opium poppy plant or to the human body's opioid system

how do opioids work in the body

- blocks pain (endorphins)

- produces euphoria

- sedate the body's systems (respiratory system and bowels)

positive effects of opioids

very strong and effective pain killer

negative effects of opioids

- over-dosing

- constipation

- addiction or dependence

- withdrawls

what happens in the body when someone overdoses on opioids

the opioids slow the persons respiratory system and gets them to stop breathing

explain rieders metaphor of the swinging pendulum with respect to regulation and opioid use

the way that the public/the government reacted to the open use of opioids (open use vs prohibition)

what is oxycontin

continuous release oxycodone

what was problematic about the claims Purdue Pharma made regarding oxycontin

- they offered no real evidence/no real trials for FDA approval

- they (falsely) claimed that oxycontin was not addictive because the continuous release technology led to less intense highs and lows

why does the FDA hold some responsibility for the problems false claims that were made in marketing oxycontin

- they fell to levels of bribery and monetary benefits

what does it mean to be physiologically dependent on opioids

- that when the person is not taking the opioids they induce withdrawal symptoms

- the brain and the body become dependent on opioids for normal functioning

relationship between addiction and dependence to opioids

one can be dependent without being addicted to the drug but dependence often leads to addiction

what does it mean to be addicted to a substance

a strong and habitual want that significantly reduces control and leads to significant harm

are addicts completely powerless to resist relapsing behavior of drug use

no addicts are not completely subject to their addiction

what is a harm reduction intervention

an aim to minimize the harm caused by a practice or action by making it such that people who are going to engage in it anyway will be harmed less than they would have without it

what medication-assisted therapies (MAT) are used for opioid use disorder

- opioid agonists

- partial opioid agonists

- opioid antagonists

what is a opioid agonist and give an example

ex: methadone

- long half-life

- evens out highs and lows

- still has a chance for overdose

- will leave a person dependent but will recover from addiction

what is a partial opioid agonist and give an example

ex: buprenorphine

- has a ceiling on how much it stimulates opioid receptors

- will leave a person dependent but will recover from addiction

- cannot overdose

what is an opioid antagonist and give examples

ex: naltrexone (vivtrol), naloxone (narcan)

- naltrexone blocks the effect of opioids and is long acting

- narcan is an overdose reversal drug

why does the prescription for MAT qualify as a harm reduction intervention

- it is not a therapy of cold turkey but it is a solution that takes steps towards recovery and diminishes harm from the drugs