Bioethics Final Exam

Four Principles of Bioethics

1) Respect for autonomy - Autonomous persons should be allowed to exercise their capacity for self-determination

2) Beneficence - Duty to benefit the patient

2) Nonmaleficence - Do no harm intentionally through acts of omission or commission

4) Justice - There should be a fair distribution of healthcare resources

Elements of Informed Consent

Threshold Elements (preconditions)

1.  Competence (can you make a decision)

2. Voluntariness (Free from controlling influence)

Informational

3. Disclosure (Of information)

4. Recommendation (Of a plan)

5. Understanding (of 3 & 4)

Decisional Elements

6. Decide (On a plan)

7. Authorize (a plan)

Medical Model

disability is something wrong with an individual body, an impairment or dysfunction and it’s the job of medicine to fix that impairment as best as possible. 

Social Model

disability isn’t a property of a body, it is social discrimination that limits the opportunities of persons of difference

Harm Paradox

You can’t use prenatal testing or abortion to protect the fetus. The fetus is either going to be born with the impairment/disorder or it’s not going to exist at all. You can’t harm a non-existent being

Exploitation

When there is a choice between unfairly bad options to the advantage of the exploiter. A person can still be exploited even if they are better off than they would be if the choices were not given.

Exploitation example

A low income worker’s rent is due tomorrow, but they don’t get their paycheck until next week. They could be homeless or take out a loan to cover the rent. However, the loan the lender offers them will be due in 2 weeks and has a 400% interest rate.

Strong Paternalism

Purposely limiting decision making in a fully autonomous person to benefit them

Weak Paternalism

Limiting decision making in a fully autonomous person to benefit them

3 Important Skills Needed for Autonomous Decision Making

1. Form a stable preference according to values

2. Understand procedure & one’s situation

3. Reason through the consequences of an action

Sliding Scale

says that if risks of a medical treatment increase for patients, so should the level of ability required for a judgment of competence to elect or refuse the treatment. As the consequences for well-being become less substantial, we should lower the level of capacity required for competence.

The problem with the Sliding Scale Model

it confuses competence with the level of evidence needed to assess competence. Competence is an ability a person has, and that ability does not change based on how risky a decision is.

“harm” criteria

The harm must be severe, probable, irreversible

“Why Doctors Should Intervene” Thesis

“If serious constraints upon autonomous behavior are intrinsic to the state of being ill, then noninterference is not the best course, since the patient's choices will be seriously limited.”

• If a patient’s autonomy is compromised by illness, then doctors should not just step back. Instead, they should actively support and assist the patient’s decisions to reflect what they truly want

cooperation

Cooperation is when the physician actively understands the patient’s psychological and social situation and works with the patient

Three standards for disclosure

1) professional practice standard

2) reasonable person standard

3) subjective standard

therapeutic privilege

Not disclosing information to avoid doing harm to the patient or their family

three standards of surrogate decision making

1. Substituted Judgment: Surrogate should make decisions based on what the incompetent person would have decided if competent - only if there was once competence

2. Pure Autonomy: Applies only to formerly competent patients - do what they explicitly ask for when competent

3. Best Interest: prioritizes the well-being of an individual who cannot make decisions for themselves, such as a child or incapacitated adult

wrong

violation of someone’s rights

harm

an adverse effect on someone; defeating some party's interests

Why do Beauchamp and Childress think doctors have discomfort about withdrawing life-sustaining treatments?

Doctors have discomfort about withdrawing life-sustaining treatments because it makes them causally responsible and morally or legally culpable for the patient’s death, whereas not starting the treatment never makes them feel responsible in the same way

Why do they question the distinction between withholding and withdrawing life-sustaining treatment?

The distinction between withdrawing and withholding treatments is morally irrelevant and potentially dangerous because it can lead to overtreatment by continuing burdensome, non-beneficial treatments  because clinicians fear “withdrawing” care. It can also cause undertreatment because patients, families, and clinicians may avoid starting potentially helpful therapies if they believe that once begun, they can never be stopped. This distinction can make clinicians morally blameworthy for the negative outcomes it produces.

Misfit

when the environment does not sustain the shape and function of the body that enters it

material anonymity

A predominantly unrecognized way of being in the world that is ordinary, allowing them ease in public spaces

neutrality thesis

the view that disabilities are mere differences that do not inherently reduce a person’s well-being once discrimination and social struggles are removed

not-very-bad thesis

in a reasonably just and accepting society, many lifelong disabilities like deafness or dwarfism have at most a small to moderate negative impact on well-being

Why, according to Marquis, is abortion wrong?

Abortion deprives a fetus of a valuable future and that it would be wrong to take away

Explain the violinist analogy and what JTT thinks it shows about abortion?

The violinist analogy says to imagine being kidnapped and forcibly connected to an unconscious violinist who needs your kidneys for nine months to survive. Unplugging him would kill him. Thomson argues that even if the violinist is a person with a full right to life you are not morally obligated to remain connected to him. It would be generous to stay plugged in, but not required.

JTT thinks this shows that even if a fetus is a person, its right to life does not automatically override the pregnant person’s right to control their own body.

When is it ethical for researchers from developed countries to conduct research in developing countries?

the research must offer the potential of actual benefit to the inhabitants of that developing country

What are the three moral criticisms of clinical trials and what are Brody’s responses to each?

1.  subjects who received placebos were treated unjustly

2. subjects’ dire circumstances coerced them into agreeing to participate in the trials

3. the developing countries in question were exploited insofar as they would not have access to the AZT regimens under study even if they proved effective

“hardiness narrative”

the idea that Black people were able to tolerate more pain than White people because of their physical characteristics and biology

“hardiness narrative” studies

• Ray introduces the 19^th century “hardiness narrative” to explain the historical roots of racism in pain management, identify and explain 2-3 contemporary studies that provide evidence that some of these ideas still implicitly inform medical professionals. ‘

1. White medical students and residents, who were both responsible for patient care, were asked whether they agree with a series of beliefs about the biological differences between Black people and White people. Each of these beliefs are false and have no scientific support, yet about 50 percent of the participants believed that at least one of the false beliefs were possibly, probably, or definitely true. Also, participants were given mock medical cases with Black patients and White patients as the subjects and using a pain scale they were asked to rate the individuals' pain. The participants that accepted more of these false beliefs also rated the Black patients as feeling less pain than the White patients.

2. In a study White participants were shown videos depicting hands of Black, White, and Asian actors.  In each video the hands were shown being touched by an eraser and a needle. The White participants had greater emotive reactions to the White actors being touched by a needle than to the other races being touched by a needle

3. A journal published an article that said Black people's thicker and darker skin may protect them from mosquito bites

Respect for Motherhood

pregnancy transforms a woman into a mother, reshaping her identity, commitments, and responsibilities

responsibility in creating human life

taking seriously the moral weight of initiating a life value