PHI Final

Euthanasia

Directly or indirectly brining about the death of another person for that person’s sake

Active euthanasia

Performing an action that directly causes someone to die;”mercy killing'.’

Passive euthanasia

Allowing someone to die by not doing something that would prolong life

Voluntary euthanasia

Euthanasia performed when competent patients voluntarily request pr agree to it

Nonvoluntary euthanasia

Euthanasia performed when patients are not competent to choose it for themselves and have not previously disclosed their preferences

Involuntary euthanasia

Bringing about someone’s death against her will or without asking for her consent while she is competent to decide

Active voluntary

Directly causing death (mercy killing) with the consent of the patient

Active nonvoluntary

Directly causing death (mercy killing) without the consent of the patient

Passive voluntary

Withholding or withdrawing life-sustaining measures with the consent of the patient

Passive nonvoluntary

Withholding or withdrawing life-sustaining measures without the consent of the patient

Physician-assisted suicide

A patient’s taking her own life with the aid of a physician

* AMA has denounced PAS
* Many people (including some physicians) support its use
* Legal in Washington D.C., California, Colorado, Hawaii, Oregon, Vermont, Washington, Montana

Managed care

A system for providing health care to a particular group of patients (members of the system) using restraints to control costs and increase efficiency

Distributive justice

Justice regarding the fair distribution of society’s advantages and disadvantages

Libertarians theories of justice

Doctrines holding that the benefits and burdens of society should be distributed through the fair workings of a free market and the exercise of liberty rights of noninterference

What matters most is individual freedom and a person’s right to direct their own life for themselves

Utilitarian theories of justice

Doctrines asserting that a just distribution of benefits and burdens is one that maximizes the net good (utility) for society

What matters most is not individual liberty but the common good, what’s best for the community as a whole

Egalitarian theories of justice

Doctrines affirming that important benefits and burdens of society should be distributes equally

Triage

The sorting and allocation of treatments to patients in an emergency to maximize the number of survivors in medical emergencies

Epidemic

The phenomenon in which a disease occurs in larger numbers than expected in a particular population and geographic area

Pandemic

An epidemic that has spread worldwide

Quarantine

The separation from others of people who have been exposed to disease

Self-isolation

the practice of asking people who are sick with a contagious disease or have symptoms to stay home and go out only in an emergency

Racism

The belief that some races are inferior in important ways or are otherwise deserving of dislike or hostility

Individual racism

Person-to-person acts of intolerance or discrimination

Institutional or structural racism

Unequal treatment that arises from the way organizations, institutions, and social systems operate

Racial prejudice

Antipathy towards a racial group based on a faulty view of that group

Racial discrimination

Unfavourable treatment of people because of their race

Implicit bias

A negative attitude toward a group of people that operates unintentionally or unconsciously

Rachels claims that since physicians withhold treatment during passive euthanasia, and are therefore responsible, this situation is open to moral assessment. Callahan disagrees with Rachels on this point. Explain both of their respective positions.

Callahan proposes that ‘unbearable suffering’ is not enough on its own to justify active euthanasia. What is his argument? Do you agree with his position? Defend your answer.

What moral distinction does Thomson rely on to argue that we do not always have an obligation to keep even a person alive in certain situations? Does this distinction always help her position, or does it sometimes hurt her position?

Warren has to provide an argument displaying why infanticide is morally wrong, since her position on abortion seems to sanction such an act.Explain her argument.Do you agree with her argument?

Active vs. Passive euthanasia

Active euthanasia is killing

Passive euthanasia is letting die

* AMA has sanctioned the distinction
* Some argue that there is no morally significant difference between mercifully killing a patient and mercifully letting the patient die

Traditional view of death

Cessation of breathing and heartbeat

Standard in law and medicine view of death

Whole brain view: An individual should be judged dead when all brain functions permanently stop

Alternative notion view of death

Higher brain standard: individuals are dead when the higher brain functions responsible for consciousness permanently close down

Active voluntary euthanasia: arguments for autonomy

Respecting people’s inherent right of self-determination means respecting their autonomous choice about ending their lives

Active voluntary euthanasia: arguments for beneficence

If we are in a position to relieve the severe suffering of another without excessive cost to ourselves, we have an obligation to do so

Active voluntary euthanasia: arguments against - moral difference between killing and letting die

Killing is worse than letting die, so giving a patient a lethal injection to effect an easy death is wrong, but disconnecting his feeding tube may be permissible

Active voluntary euthanasia: arguments against - moral difference between intending someone’s death and not intending but foreseeing it

The former is wrong; the latter is permissible

Coronaviruses

cause respiratory illness in humans, (SARS, MERS, the common cold, and COVID-19)

COVID-19 (SARS-CoV-2)

Causes mild symptoms in most people but severe illness and death in others

Ezekiel J. Emanuel et al.’s four fundamental values that should govern resource allocation

* Maximizing the benefits
* Treating people equally
* Promoting and rewarding instrumental value
* Giving priority to the worst off

Criteria should not be used to decide who has access to a limited or scarce resource

* Wealth
* Fame
* Political power
* First-come, first-served
* Moral worth
* Social utility

Allocating pandemic resources, unreasonable assumptions might bias decisions, including:

* Health status: disability does not always indicate compromised health
* Quality of life: disabled people do not necessarily have lower quality of life
* “Social utility”: disabled people are no less valuable members of society

Misinformation

A falsehood, a statement that is factually incorrect

Disinformation

A deliberate falsehood, a statement that is factual incorrect on purpose (a lie)

Deliberate deceivers

Knowingly traffic in lies to score partisan points, show support for their tribe, troll the opposition, exact revenge, or make a buck

Self-deceivers

Motivated to hold false beliefs despite contrary evidence

Bullshitters

Don’t care whether what they say is true or false, but intend to deceive their audience about their motives

Read critically

1) Accept claims hat are supported independently by reliable authorities, evidence, or claims that you know to be true

2) Accept claims that are adequately supported by the source itself through citations to other credible sources (experts, research, reports, etc.) or through references to supporting facts

3) Reject claims when there is good reason for believing them false

4) Suspend judgment on claims that you are unsure of, for it is unreasonable to accept a claim without good reasons, and the only cure for uncertainty about a source’s claims is further research ad reflection

Racism involves:

* Inherency
* Inferiorization
* Racial antipathy

Inherency

The notion that certain traits of mind, character, and temperament are inescapably part of a racial group’s nature

Inferiorization

The treatment of certain groups as inferior to other groups

Racial Antipathy

General racial bigotryy, hostility, and hatred

Racism is empirically wrong

* The consensus among scientists and scholars is that the traditional view of races- that there are distinct groups of peoples sharing significant biological characteristics- is false
* Race has no physical scientific bases
* Race is a social construction, an idea we endow wth meaning through daily interactions

Scientific Racism

The attempt to prove there are spirit races, race explains basic differences among people, some races are superior to others

Scientific Racism Discredited

Based on obvious biases, faulty assumptions, methodological errors, and motivated reasoning

Why not discard the concept of race?

Race-based social grouping has led to real differences in resources, opportunities, and well-being

The concept of race must be conserves in order to facilitate race-based social movements or policies

Racism is morally wrong: Respect for persons

Persons posses inherent worth and have rights- the rights of free expression, choice, and privacy, the right not to be coerced, enslaved, cheated, or discriminated against

Racism is morally wrong: Principle of justice

Equals should be treates equally unless there is a morally relevant reason for treating them differently- and racial difference is not morally relevant

Racism is morally wrong: Utility

We should produce the most favourable balance of beneefit over harm for all concerned and racist beliefs, words, and actions can do harm or lead to harm that is magnified when operating through institutions, corporations, governments, and the law.

Health disparities and race: Infant mortality

The number of infants who die before their first birthday per 1000 live births

* In 2013, the infant mortality rate among African Americans (11.1 per 1000 live births) was double the rate among whites (5.06 per 1000 live births)
* American Indians/ Alaska Native and Puerto Ricans also experienced higher infant mortality rates (of 7.61 and 5.93 per 1000 live births, respectively) than whites

Health disparities and race: Life expectancy

A measure of the overall health of a population, typically expressed as the average number of years a newborn would be expected to live

* In 2014, the life expectancy for white males was 7.65 years, African American makes was 72.0 years, Latino males was 79.2 years
* In the same year, life expectancy was 78.1 years for African American females, 81.1 years for white females, and 84.0 years for Latina females

Health disparities and race: Age-adjusted death death rates

Sum of deaths in a population from all causes except old age

* The age-adjusted death rate per 100 000 (for the years 2012-2014) was 729.1 for whites and 858.1 for African Americans
* The death rate due to heart disease was 165.9 deaths per 100 000 for whites and 206.3 deaths for African Americans
* For cancer the death rate was 161.9 for whites but 185.6 forAfrican Americans; for diabetes, 19.3 for whites, 37.3 for African Americans

Reasons for Race-Based health disparities

Laying the blame on socioeconomic status (SES) is too simplistic:

* Chronic exposure to racial discrimination has deleterious effects on the physical and mental health of individuals
* Residential segregation can exacerbate the rates of disease among minorities and reduce the sense of urgency about the need to intervene
* Implicit bias and prejudice leads to widespread differences in health car by race and ethnicity

Race-Based Medicine

Using race as a factor in determining appropriate treatment for patients

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Problems:

* Drug treatment based on a population-level study ignores interracial differences
* It assumes that race is the best predictor available, but the rate at which a drug is metabolized varies as a result of many factors, including environment and lifestyle
* There is no reason to treat race as an independent variable that causes or explains differences in treatment response

Preference utilitarians

Holding that rights actions are those that satisfy more of a person’s preferences overall

Doctrine of double effects

Permits actions that have unintentional results

Kant’s theory on euthanaisa

Suicide is prohibited because it treats the persons as mere thing and obliterates personhood (it degrades human nature below the level of animal nature and so it destroys it)

* Competent persons must not killed or permitted to die

Recommendation in COVID-19 resource allocation

1. The value of maximizing benefits is most important
2. Testing, PPE, ICU beds, ventilators, therapeutics and vaccines should go first to front-line health care workers and others who care for ill patents and who keep critical infrastructure operating and are difficult to replace
3. Of similar prognoses, equality should be invoked and happen through random allocation
4. Prioritization guidelines should differ by intervention and should respond to changing scientific evidence
5. People who participate un research to prove the safety and effectiveness of vaccines and therapeutics should receive some priority for COVID-9 interventions
6. There should be no difference in allocating scarce resources between patients with COVID-19 and other medical conditions