Morality and Medicine Midterm Exam

Cases

Might disagree about the facts of a particular case

Rules, rights, and codes

Might disagree about basic rules, rights, or codes of ethics

Normative ethics

might disagree about principles of right action, or about values, or about virtues. Disagree about what is ethical

Metaethics

Might disagree about the source of ethics, or about how we know what is ethical

Facts

empirical evidence, science; true statements about the world, that is, statements which correspond to the way the world really

Concepts

clarify definitions, use examples and counterexamples

Values

what moral principles are being used

Logic

do the reasons/evidence support the conclusion

Arguments

Premise 1, Premise 2, therefore, Conclusion

Sound argument

conclusion has to logically follow from the premises

Valid argument

If the premises are true and the conclusion is true

Modus ponens

If A then B. A therefore, B

Modus tollens

If A then B. Not B, therefore, not A

Affirming the consequent

If A then B. B therefore, A. NOT SOUND

Denying the antecedent

If A then B. Not A, therefore, not B

Informal fallacies

Not necessarily formal deductive fallacies, but more like rhetorical fallacies.

Ad hominem

Argument against the person. Arguing against an opponent personally, rather than against the opponent’s argument/conclusion.

Ad populum

appeal to the populace. Arguing for a conclusion by appealing to public sentiments, such as patriotism, desires for status, etc.

Straw man

Mischaracterizing an opponent’s position or argument in such a way that it is easy to defeat

Red herring

Introducing an irrelevant issue to distract from the subject under dispute

Begging the question

To assume what you purport to prove. Also known as to bake your conclusion into your premises.

Slippery slope argument

Arguing that if one accepts the opponent’s position, it will be difficult or impossible to avoid further accepting increasingly extreme, undesirable positions.

Appeal to nature

arguing that since something is “unnatural” it is therefore dangerous or wrong

False dichotomy

arguing that one must accept one or the other of only two opposing positions, when in fact there are more alternatives available

Post hoc, ergo propter hoc

implying that just because two events happened successively in time, the first event caused the second event.

Beliefs

what we think the facts are. These could be true or false.

Opinions

sometimes just beliefs. However, sometimes we distinguish a matter of opinion from a matter of fact.

Moral relativism

moral statements are true or false relative to a given culture’s values. There are no absolute moral truths

Moral absolutism

there are certain universal moral principles by which all people’s actions may be judged.

Utilitarianism

actions are right in proportion as they tend to promote happiness. Wrong as they tend to produce the reverse of happiness. For a potential action, you add up the total happiness in all people that will follow, compare it to the alternatives and choose the best one.

Consequentialism

consequences count, not motives or intentions

Maximization

the number of beings affected by a consequence matters; the more beings affected, the more important the results

A theory of value

a definition of what counts as good consequences

A scope-of-morality premimse

each being’s happiness is to count as one unit of happiness up to a certain boundary.

Kantianism

Emphasizes human rights and duties. Places great moral importance on motives. emphasizes rationality: humans are rational beings, and it is through our rationality that we acquire and recognize our rights and duties.

Universalization

act according to a principle that you would want everyone to follow in the same situation. If there is a logical contradiction between your acting and everyone acting according to the principle, it is not

Respect for persons

always treat other humans as “ends in themselves",” never as “mere means.” That is, human beings have intrinsic value and must always be treated as such: never use another person as a mere tool

Advantages to Kantianism

allows leway in our actions: it’s mainly about what we ought not do. Treats all persons with equal value and dignity. Tends to accord well with our moral intuitions

Disadvantages to Kantianism

doesn’t tell us which among multiple morally acceptable actions to choose. Not responsive to suffering or other consequences. Often ambiguous about hard questions

Utilitarianism and the Trolley Problem

Switching the track would bring aboutbetter consequences, as it helps the most people

Kantianism and the Trolley Problem

Switching the track means using a person as a means to an end, rather than respecting their inherent value.

The 4 principles in principlism

Autonomy, beneficence, non-maleficence, and justice

Autonomy

respect the patient’s decision

Beneficence

act in the patient’s best interests

Non-maleficence

avoid harm to the patient

Justice

treat people equally/equitably; respect broader rights, norms, groups

Advantages of principlism

practical, flexible, pluralist: combines the best of both worlds

Disadvantages of principlism

provides little guidance on how to weigh principles against each other when they conflict

The hippocratic tradition

Naturalist, not supernaturalist; passive approach, primum non nocere

Passive approach

care for the patient to assist self-healing. Professional code of conduct

Primum non nocere

First do no harm. Suggest avoiding harm is more important than doing good.

Benefit/harm. Who decides?

Hippocratic tradition says that the doctor decides. Whether a given treatment is beneficial depends on the facts of what the consequences of the treatment will be and how those consequences are valued

Different aspects of wellbeing

Medical wellbeing, social wellbeing, economic wellbeing, legal wellbeing, religious wellbeing, etc.

Medical wellbeing: compromise different aspects

prevent death, cure disease, relieve suffering, promote general health

Benthamite calculus

aka utilitarian summation: pick the treatment that produces the largest net benefit

Ratio method

pick the treatment that produces the largest ratio of benefits to harms

Do no harm

don’t do anything that causes harm, regardless of benefits

Paternalism

When actions are taken to benefit a patient against their will or without their consent; more generally, “the overriding or restricting of rights or freedoms of individuals for their own good.”

Argument for paternalism

Information about conditions or treatment risks can frighten patients and lead them to bad decisions or outcomes. Therefore, disclosing information can be bad for patient’s health. Medical health is the ultimate priority for patients. Therefore, worsening health is contrary to patient’s won true values. Doctors may override patients’ rights to information about risks and treatments or about their own conditions for their health.

Strong paternalism

Doctor makes decisions without the consent of a patient who is capable of exercising autonomy

Weak paternalism

The doctor makes a decision because the patient is not in a state where they can consent, because they are unconscious

Hard paternalism

The doctor makes the decision they think is best for the patient without their consent

Soft paternalism

The doctor tries to persuade, convince, or even incentivize the patient to make the choice the doctor thinks is best.

Paternalistic model of physician-patient relationship

The physician uses their authority to control patient decision-making. There is a provider focus on the principle of beneficence.

Consumer model of physician-patient relationships

The patient is a consumer of a medical service provided by the physician. The patient has autonomy in choosing to engage with the medical service, subjecting themselves to the authority of the physician

Shared decision-making model

The patient and physician work together to make medical decisions. The patient’s autonomy is increased when the physician informs the patient, allowing them to make sound decisions about their own health. Thus, there is a provider focus on the principle of autonomy.

Autonomous decisions

rational decisions made freely by oneself for oneself, reflecting one’s own values, preferences, and motives

Capacity for autonomy

When a person is capable of making autonomous decisions

Principle of autonomy

The ethical principle of respecting individuals’ autonomy. Stems from liberal philosophy, Kantian ethics.

Individualistic ethic

prioritizing the rights of individuals to be free from control by authorities

Rights and duties

If a person has a right, that means others have a duty to respect or uphold that right

Positive rights

Oblige others to provide one with support or resources

Negative rights

oblige others not to interfere with or obstruct one’s freedom or autonomy.

Professional standard of informed consent

what physicians generally think patients should know

Reasonable personal standard of informed consent

Patients want to know much more than doctors think they need to know

Subjective standard of informed consent

poses a practical challenge, since a doctor would need to learn a lot about a patient to know what is particularly relevant to them

Hippocratic confidentiality

The doctor is obligated only to keep potentially harmful information private

The principle of fidelity/respect for persons confidentiality

The doctor is obligated to keep all information private. It is a promise established at the outset of the doctor-patient relationship.

Situations where violation of confidentiality are considered justified

When keeping secrets would pose risks to others, or when laws are violated

The hippocratic view of information

often means witholding distressing information from patients

Two possible reasons for a shift to truth-telling

1. Doctors have begun to think that telling the truth is ultimately better for patient outcomes. 2. The change resulted from the general shift toward respect for persons in medicine during this era.

Physician-assisted death

All forms of euthanasia and physician-assisted suicide

Euthanasia

Ending the life of a person who is suffering, and who otherwise would not die at that time.

Suicide

Ending one’s own life, whether or not one has a terminal illness

Forgoing treatment

not accepting life-prolonging medical treatments and thus inducing death at an earlier time than it would have occurred with treatment

Active euthanasia

Giving the patient a life-ending treatment

Passive euthanasia

Taking the patient off life-preserving treatment.

Voluntary euthanasia

Patient consentI

Involuntary euthanasia

No patient consent

Argument for PAD from principle of autonomy

Patients have a right to autonomy, therefore patients have a right to refuse treatment, patients have a right to request euthanasia or assitance in committing suicide. Patients have a right to compel doctors to assit them with suicide or to euthanize them.

Right to die

If it is a negative right, the doctor only has a moral dity to perform passive euthanasia. If it is a positive right, the doctor has a moral duty to perform passive euthanasia, active euthanasia, and assisted suicide.

Principle of avoiding killing

It is inherently wrong to kill a person. This is a component of respect for persons, like the principles of fidelity, veracity, and autonomy.

Argument against PAD from principles of beneficence/nonmaleficence

Harms the patient, destroys opportunity for future happiness, unintended spillover deaths, a slippery slope

Argument for PAD from principles of beneficence/nonmaleficence

Ends suffering

Rachel’s 1st argument for PAD

Active euthanasia can ease suffering. On the principle of nonmaleficence, active euthanasia is sometimes prefereable to passive euthanasia

Rachel’s 2nd argument for PAD

The distinction leads to morally baseless decisions

Rachel’s 3rd argument for PAD

There is no moral difference between killing and letting die. For instance, if his decision was wrong, the decision would be equally regrettable no matter which method was used to carry it out.

Rachel’s 4th argument for PAD

Arguments for the distinction are flawed.

Slippery slope arguments

Arguing that if one accepts the opponent’s position, it will be difficult or impossible to avoid further accepting increasingly extreme, undesirable positions

In order for a slippery slope argument to succeed

Gives strong empirical evidence and/or logical reasons why the move from one stop to the next down the slope is likely