Medical Ethics: Exam 2

Autonomy

The principle that individuals have the right to make decisions about their own lives and bodies, free from coercion or interference. In healthcare, this means respecting patients' choices and ensuring informed consent

Non-Maleficence

The obligation to avoid causing harm. This principle requires healthcare professionals to refrain from treatments or actions that could harm patients.

Beneficence

The duty to actively promote the well-being of others. In medicine, this means acting in the best interest of the patient, and providing treatments that benefit them while minimizing harm.

Justice

The principle of fairness, ensuring that people are treated equally and receive what they are due. In healthcare, resources, treatments, and care should be distributed fairly, with consideration for need, so that no one is unjustly denied care or given preferential treatment based on factors like wealth, race, or social status.

Paternalism

When a healthcare professional or authority makes decisions for a patient, overriding their autonomy, on the belief that it is in the patient's best interest. Cases can be controversial.

Duty of Truthfulness

The presumed duty of providers not to deceive patients or withhold relevant medical information from them.

Confidentiality

Concerns patients imparting information to health professionals who promise, implicitly or explicitly, not to disclose that information to others.

Obligation of physicians, nurses, etc. to keep secret the personal information of patients unless they consent to disclosure

What is confidentiality?

Absolute or prima facie

Physicians also take seriously their duty to protect patient privacy, though they may differ on whether the duty is:

Absolute

Apply in all cases

Prima Facie

Allowing exceptions when other duties obtain

Informed Consent

The action of an autonomous, informed person agreeing to submit to medical treatment or experimentation.

1. Competence

2. Adequate Disclosure

3. Comprehension

4. Voluntariness

5. Consent

Informed consent exists if and only if there is:

Competence

The patient is competent to decide.

Adequate Disclosure

The patient gets an adequate disclosure of information, and should be able to ask questions.

Comprehension

The patient understands the information.

Voluntariness

The patient decides about treatment voluntarily.

Consent

The patient consents to the treatment

Competence

Defined as the ability to render decisions about medical interventions.

-Mental Disability

-Dementia

-Psychosis

-Alcoholism

-Being underage

Patients are often judged incompetent in cases of:

-Overwhelmed by fear or pain

-Lacking one or two particular mental capacities

Patients may also be judged incompetent when:

Global or total; particular aspects of life

Incompetence is not necessarily ________________; it may be specific to ______________________.

Someone who was involuntarily institutionalized for mental illness may still be able to make decisions regarding their medical treatment.

Give an example of incompetence not necessarily being global or total.

The burden of decision-making falls on a surrogate

What occurs when a patient is deemed incompetent and hence cannot give informed consent?

Most of the time, people are presumed to be competent, unless there are good reasons to think otherwise.

How is incompetence determined?

If it allows patients to weigh intelligently the risks and benefits of available choices

When is disclosure considered adequate?

Physician-Based, Patient-Based, and Subjective

List the three standards on how to achieve adequate disclosure.

Physician-Based Standard

Physicians should be the arbiters of adequate disclosure

Patient-Based Standard

Adequate disclosure is whatever satisfies the information needs of a hypothetically reasonable person

Subjective Standard

Disclosure is supposed to be based on the information needs of a particular patient.

-Emergencies

-Incompetence

-Waivers

-Therapeutic Privilege

List some cases where physicians are allowed not to obtain informed consent:

Waiver

The authority to decide medical issues is turned over to the physician or surrogates.

Coercion and Manipulation

Undue pressure from others

Therapeutic Privilege

When a doctor withholds relevant information from a patient because the physician believes disclosure of information would likely do harm (controversial)

Only when it is given voluntarily

How can the consent of an informed, competent, and understanding patient be legitimate?

Voluntarily

Without undue pressure from others

Autonomous

What type of choice is a waiver?

Coercion

The intentional use of a credible and severe threat of harm or force to control another.

Threatening to abandon a patient unless they accept treatment

Give an example of coercion.

Manipulation

Refers to many noncoercive ways of controlling someone's action

Giving false or misleading information or withholding relevant facts

Give an example of manipulation.

Cognitive Enhancement

The use of interventions, such as drugs, genetic modifications, or other technologies, to improve mental processes like memory, attention, reasoning, problem-solving, and overall intellectual capacity beyond the normal human baseline.

Ritalin or Modafinil (ADHD or nacolepsy meds) are sometimes used to improve focus, attention, and alertness in healthy individuals

Give an example of cognitive enhancement.

Moral Enhancement

Interventions aimed at improving moral capacities, such as empathy, self-control, or a sense of justice, in order to make individuals more ethical or morally better, thereby reducing harmful behavior and promoting social cooperation.

Euthanasia

To intentionally cause or permit the death of someone, for their sake.

Passive Euthanasia

To withhold or stop medical treatment that could prolong someone's life. (Other terms: letting die, allowing to die.)

Stopping life support

Give an example of passive euthanasia.

Active Euthanasia

To take active steps with the intention of causing someone to die. (Other terms: deliberate ending of life, mercy killing.)

Giving a lethal injection

Give an example of active euthanasia.

Voluntary Euthanasia

Euthanasia at the request of a conscious patient with capacity

Non-Voluntary Euthanasia

Euthanasia performed for a patient who is not conscious or who lacks capacity.

Involuntary Euthanasia

Euthanasia performed for a conscious patient with capacity, despite their request to continue to live (wrongful killing).

Physician-Assisted Suicide

A doctor provides medical assistance to a patient to take their own life (for example, by prescribing a drug that the patient administers to themselves). (Other terms: medically assisted dying.)

Not all abortions are morally wrong:

-rape

-to save the mother's life

-faulty contraception

What are the violinist, tiny house growing child, and people seed thought experiments trying to show?

Abortion is morally permissible in cases of:

-rape

-to save the mother's life

-faulty contraception

What are the arguments for abortion?

1. A fetus has a right to life that is stronger and more stringent than the mother's right to her body.

2. Morally wrong because it puts the mother's right to her body over the fetus' right to life

What are the arguments against abortion?

1. Abortion is a direct, intentional killing of an innocent person.

2. Allowing the mother to die is an unintentional and indirect allowing of a natural process.

3. Abortion is prohibited even when the mother's life is threatened.

Explain the Killing vs. Letting Die argument.

1. Fetuses are humans.

2. It is always prima facie seriously wrong to take a human life.

Explain the standard anti-abortion argument.

1. Fetuses are not persons.

2. It is only seriously prima facie wrong to kill persons.

Explain the standard pro-choice argument.

1. Morally wrong to deny anyone a future of value

2. In most cases, abortions deny the fetus a future of value.

Explain Marquis' Loss of a Future Like Ours argument.

1. Risks are minimized

2. Benefits outweigh the risks

3. Informed voluntary consent

4. Fairly selected subjects

5. Protection of privacy

6. Reviewed and approved

When is research participation permissible?

1. People should be paid to compensate for the risks

2. Without compensation, new treatments may be delayed.

3. The quality of scientific research could suffer.

4. If it is morally permissible to participate, it is morally permissible to be paid.

5. Money does not introduce any moral wrongness.

What are the arguments for compensation for research participation?

1. Risky research exploits the poor

2. Offering too much money can cloud judgments and weaken consent

3. Offering too much money might jeapordize the study's scientific validity because patients might conceal relevant medical conditions to participate

4. People might lose trust in a profession that is supposed to cure disease rather than cause it, as some risky experiments cause death and disease

What are the arguments against compensation for research participation?

1. Instrumentally good because it helps us more effectively and reliably achieve our goals

2. Prudentially good because it improves personal well-being and quality of life

3. Good for everyone if our goals are moral

What are the arguments for cognitive enhancement?

1. What is good for you might be bad for others

2. Rapid growth in scientific knowledge and cognitive abilities could be dangerous

3. Puts us dangerously close to the point where a single malicious individual could eradicate life

4. Too cognitively advanced for our own good

What are the arguments against cognitive enhancement?

1. More effective than traditional means

2. Could counteract harmful natural tendencies

3. Potentially achieve moral progress more quickly and thoroughly

4. Potentially improve everyone, including those who lack moral motivation

What are the arguments for moral enhancement?

1. Could interfere with and threaten individual autonomy and personal freedom

2. Necessity of negative human traits

3. Imposes controversial or harmful ethical standards

4. Could be exploited for unethical purposes (risk of abuse)

What are the arguments against moral enhancement?

1. Appeal to autonomy; respects the patient's choice to end their life

2. Appeal to beneficence; obligation to relieve the suffering of another, if there isn't excessive cost to ourselves

What are the arguments for active euthanasia?

1. Actively killing/intending someone's death

2. Appeal to bad consequences

3. Can lead to heinous extensions or perversions of the original practices

4. Incompatible with the moral and professional commitment to heal and protect life

5. Weaken's society's commitment to provide optimal care for dying patients

What are the arguments against active euthanasia?