medical ethics exam 2

thomson main argurment

Some abortions are not unjust killings, some are (permissibility). Believes that some abortions are permissible, is NOT pro-abortion

thomsons first step

Set aside the debate about whether or not a fetus is a person, and grant, for the sake of argument, that a fetus is in fact, a person

thomsons premises

* Every person has a right to life
* The fetus is a person from the moment of conception
* Therefore, the fetus is a person
* It is always wrong to kill something that has a right to life
* Abortion is the killing of a fetus
* Therefore, abortion is always morally wrong

thomson classic liberalism perspective

You have the right to control what happens to and inside your own body

what does thomson say about: abortions where the patient is a rape victim?

Abortion is permissible because the mother has not given the fetus the right to use her body

what does thomson say about: abortions where the patient will lose her life?

Abortion is permissible because you have a right to defend yourself against the fetuses’ threat to your life, even if it kills them

what does thomson say about: abortions where precautions were taken to prevent the pregnancy?

Abortion is permissible because precautions were taken to keep them out of their mothers body

what does thomson say about: abortions where the patient willingly engaged in sex?

If the patient did not take precautions, then abortion is not permissible

what does thomson say about: a violinist only needs your body for an hour, at no harm to you?

It would be morally indecent of you to not allow the violinist the use of your body

what does thomson say about: abortions of convenience?

Abortion is not permissible because it is morally indecent

what does thomson say about: late term abortions?

Abortion is not permissible because it is morally indecent

what does thomson say about: killing someone in self defense?

Not an unjust killing, you can kill someone justly in self defense

thomson key distinction

* It is UNJUST to withhold from you that which you have a right to
* It is MORALLY INDECENT to withhold from you that which you want/need if there is no significant
harm to the withholder

thomson: the good samaritan

Person that does MORE than what is morally required

thomson: the minimally decent samaritan

Person that does what is morally decent, NOT MORE

thomson: samartian conclusion

* We all ought to be at least minimally decent samaritans
* Law that would outlaw abortions would force women to be good samaritans

tooley main argument

Abortions and infanticide are permissible, only because self conscious persons have a right to life

tooley what properties must something have in order to be a person?

The Self Consciousness Requirement: An organism possesses a serious right to life only if it possesses the concept of a self as a continuing subject of experiences and other mental states, and believes that it is itself such a continuing entity

what does tooley say about: the right to life?

Should not be categorized as the right to continued bodily experience, but rather the right to continue as a subject of experiences. If you do not meet that requirement, then you are not a person and only persons have a right to life.

what does tooley say about: permissible killings?

If the only things that have a serious right to life are things that meet the self consciousness requirement, then anything which doesn't MAY be permissibly killed

tooley key idea

Humanity is NOT required for personhood (ex: dolphin, gorilla, etc)

tooley possible implications

Torture and infanticide

finnis main argument

all abortions (intentional killings) are impermissible

finnis premises

* The fetus is a person
* Therefore, direct abortions are always wrong and anything else should not be called an abortion
* Every living human individual is equal with the respect to right to life
* The unborn are not aggressors, nor unjust
* Double effect procedures are permissible

finnis double effect

it is sometimes permissible to cause serious harm as a side effect (or “double effect”) of bringing about a good result, even though it would not be permissible to cause such a harm as a means to bringing about the same good end

* Self defense vs. murder
* Punching someone unconscious vs. letting them drive drunk
* Hysterectomy vs. abortion

finnis what constitutes a human person?

* Any entity which, remaining the same individual, will develop into a paradigmatic instance of a substantial kind already is an instance of that kind
* When a sperm penetrates an ovum, the resulting one cell organism which will become a human person, already is one

what does finnis say about: the ordinary view of personhood?

persons are nothing more than living human individuals

what does finnis say about: abortions where the patient is a rape victim?

abortion is not permissible because the innocent fetus should not be punished for their fathers attack. the patient may take medical precautions to prevent conception but once cpnception occurs, an abortion is not permissible

what does finnis say about: abortions where the patient will lose her life?

An abortion is permissible due to the double effect

principle, the fetus may die as an effect of saving the mothers life, where such life saving is the only

intention, and not the direct killing of the fetus

what does finnis say about: prenatal screening

Permissible in cases where there is no significant risk to the child or in an effort to ensure a safe pregnancy/delivery. Impermissible if such screening is done with a view to abortion, in which case the parent has conditionally already violated the two moral principles

what does finnis say about: embryonic experimentation

permissible only if the intention is to benefit the embryo itself

finnis two main ethical principles

* Non-maleficence: do no harm
* Justice

marquis main argument

Abortion is morally impermissible because it is depriving someone of a future like ours

marquis first steps

General logical constituents of all abortion arguments...

* Claims characterizing fetuses
* General moral principle
* Then apply (2), given (1), and assert the conclusion

what does marquis say about: what makes killing wrong?

only because the loss of life harms the victim by depriving them of a future

what does marquis say about: the focus of abortion arguments?

should be focused on the real essence of the problem

what does marquis say about: what does not make killing us wrong?

the brutalizing effect on the murderer or the fact that we are connected in a special way to others, we will be missed

what does marquis say about: the problem with contraception?

it is permitted because no subject has lost its future

why should we accept marquis’s view

* Explains why death is such a terrible thing, to be avoided
* Allows for the wrongness of killing some non-humans
* Permits active euthinasia
* Does not allow for the killing of infants
* Avoids personhood/potentiality pitfalls

marquis conclusion

Since a fetus possesses a property, the possession of which in adult human beings is sufficent to make killing an adult human being wrong, abortion is wrong

harris two main arguments

The anti-ageist argument and the fair innings argument

harris: anti ageist argument

* States that life has an absolute value to all those who value it
* 20 years = 5 years = 70 years

harris anti ageist argument premises

* Life is absolutely precious to all those who wish to go on living
* Life is just as precious (if not more so) to those with less time to live

harris anti ageist argument conclusion

It would be a great injustice to deny someone in this condition the rest of their life

harris: fair innings argument

* States that there is a certain amount of time which constitutes a reasonable lifespan or “fair innings”
* Harris says it is 70 years

harris: fair innings argument premises

* Before you reach a fair innings, you are entitled to reach it
* Once you reach a fair innings, you are living bonus time

harris: fair innings argument conclusion

\- After you reach a fair innings, you can be fairly denied treatment or resources in favor of younger patients

rescher two stages of criteria for ELT

* Criteria of Inclusion/Exclusion
* Criteria of Selection

rescher criteria of inclusion/exclusion

Decides who the candidates for ELT selection will be

* Constituency Factor: hospitals can exclude a patient who isn't a “client”
* Progress of Science Factor: hospitals can exclude patients based on staff research interests
* Prospect of Success Factor: hospitals can exclude those which wont be helped

rescher criteria of selection

Decides who actually gets the ELT

* Relative Likelihood of Success Factor: individuated
* Life Expectancy Factor: does the patient have a long life ahead?
* Family Role Factor: is the person a mother/father? Or a loner?
* Potential Future Contributions Factor: will the patient be valuable to society?
* Past Services Rendered Factor: has the patient been valuable to society?

rescher criteria for model selection

* Simple (all parties understand)
* Plausible (patently reasonable)
* Rationally defensible (fair)

rescher conclusion

* There is no “best” system of ELT selection
* Many systems are possible, but none are optimal
* Suggested implementing a point system, with randomness for those with the same number of points

moss and seigler main proposal

we propose, as a general guideline, that patients with ARESLD should not compete equally with other candidates for a liver transplantation”

moss and seigler two kinds of liver disease

* ARESLD: alcohol related end stage liver disease
* ESLD: end stage liver disease

What do moss and siegler say about: isn’t alcoholism a disease?

Alcoholism is a chronic disease, but effectively treatable through programs such as Alcoholics Anonymous

What do moss and siegler say about: Why is it reasonable to attribute responsibility with ARESLD?

Because it takes 10-20 years of hard alcohol use to develop ARESLD, thus a personal health risk behavior

moss and seigler: why do we treat ARESLD patients differently than all other patients whose behaviors put them at risk?

* Due to the extreme scarcity of the resource needed to treat it (donor lives)
* Resources needed to treat other conditions caused by risky health behaviors are only moderately scarce

moss and seigler: how do we determine allocation? SUPPORT

treatment according to personal effort

moss and seigler: how do we determine allocation? REFUTE

an equal share of the treatment to all, similar treatment for similar cases, or treatment according to ability to pay

moss and seigler: debates about their proposal

* Alcoholism is the result of free choice


* However, the disease results in a chemical dependency, a biological need
* So after that point, is the decision to drink really a free choice?

rawls: main argument

Believes we should distribute resources equally so that it is fair to everyone

rawls: fairness/equality main idea

justice requires a fair distribution of resources, such that some members of society do not disproportionately benefit without a net benefit for all members

rawls: fairness/equality thought experiment

You are a character in society. You do not know if you will be a rich individual or a poor individual. The rules you make will decide what is moral or immoral. In this experiment, most people choose to distribute resources equally to ensure access to societal goods. So why is this not the norm?

nozick main argument

Believes in the defense of property, meaning that it is wrong to take resources that rightfully belong to someone \n

nozick protecting entitlements main idea

no person or government has any right to a resource properly owned by any individual (libertarian view)

nozick protecting entitlements implication

you may be selfish or cruel not to work to ensure the common good, but you are not acting unjustly by doing so; justice lies in the defense of property, not in the equality of distribution of property

positive rights

entitlements to perform certain actions or to be in certain state

negative rights

entitlements that others not perform certain actions or not be in certain states

right to life

others have a duty not to unjustly kill you

right to free speech

others have a duty not to silence you

unjust killings

a death caused by a wrongful act

morally indecent

an action that is inconsistent with generally acknowledged moral standards in society

morally impermissible

morally wrong, not permissible

ELT

exotic life saving treatments, essentially any number of life saving treatments where demand is greater than availablity

ARESLD

alcohol related end stage liver disease, caused by alcohol use/abuse

ESLD

end stage liver disease, various causes not alcohol related

ageism

prejudice or discrimination based on age

the anti-ageist argument

life has an absolute value to all those who value it

the fair innings argument

there is an amount of time in which constitutes a reasonable life span or “fair innings” (70 years)

the good samaritan

person that does what is morally required

the minimally decent samaritan

person that does what is morally decent

contraceptives

preventative measures against pregnancy such as birth control

self consciousness requirement

an organism possesses a serious right to life if and only if it possesses the concept of a self as a continuing entity of experiences and other mental states, and believes that it is itself as a continuing entity

double effect

it is sometimes permissible to cause serious harm as a side effect of bringing about a good result, even though it would not be permissible to cause such a harm as a means to bringing about the same good end

infanticide

the killing of an infant

euthinasia

intentionally ending a life without harm to the patient, in an effort to stop suffering

anti-ageist argument PROS

* -  All ages are considered equal
* -  No life is more valuable than another
* -  Elderly aren’t denied treatment

anti-ageist argument CONS

* Waste of resources
* Selfish
* Unfair

fair-innings argument PROS

* Better allocation of resources


* Grants each individual a reasonable

life span
* More treatment available to the young

fair-innings argument CONS

* Elderly are denied treatment
* Morally wrong
* Unfair
* Infringing on one’s right to life?

justice as fairness/equality PROS

* Fair to everyone


* Net benefit for all members
* Ensures the common good
* Resources available to all

justice as fairness/equality CONS

* Not justified to take rightfully owned property
* Benefits only the less fortunate

justice as protecting entitlements PROS

* Serves justice in the defense of property
* Protects personal belongings
* Does not allow infringement upon

rightfully owned goods

justice as protecting entitlements CONS

* Disproportional benefits
* Selfish/cruel
* Hypocritical (thought experiment)

ARESLD patients should be treated differently than ESLD patients PROS

* Gives priority to ESLD patients


* Punishment for a personal choice
* Fair allocation of resources
* Narrows down selection criteria
* Alcoholism is the result of free choice, effective treatment programs are also available


* Categorized by 10-20 years of hard alcohol use/abuse, not a single instance

ARESLD patients should be treated differently than ESLD patients CONS

* Alcohol disease develops into a dependency, an uncontrollable biological need
* Is the decision to drink a free choice?

ARESLD Patients Should Be Treated Differently Than ESLD Patients PROS

* Prevents discrimination against all other risky health behaviors
* does not punish someone for their past actions if they are in recovery

ARESLD Patients Should Be Treated Differently Than ESLD Patients CONS

* punishes patients who did not choose to participate in health risk behaviors
* unfair criteria for selection

abortion argument 1: thomson

some abortions are not unjust killings, some are PROS

* Prevents ectopic pregnancies
* Allows right to defend yourself
* Ensures a patient’s autonomy
* Grants an individual the right to their

own body

abortion argument 1: thomson

some abortions are not unjust killings, some are CONS

Can be morally indecent not to allow the use of your body if there is no harm to the withholder