Health Care Ethics Final Exam Study Guide (Spring 2026)

Aristotelian Virtue Ethics

The goal of all actions is to achieve happiness. Virtue is the mean state of feelings and actions between its excess and deficiencies.

Natural Law

argues that we can determine what is good and bad based on observing what humans seem designed to pursue and avoid (human nature)

Utilitarianism

An action is right so long as it promotes the most happiness in a situation for the greatest number of people

Kantian Deontology

What matters is the intention of the action. Good will is good because it has a good intention

Categorical Imperative: Commands us to perform an action for its own sake, not as a means to an end. These are unconditional, universal, and necessary (we are all obligated to perform them regardless of our desires and aversions) Ex: I ought not to lie even if it might benefit me

Four principles of biomedical ethics

1. Patient Autonomy

2. Beneficence

3. Nonmaleficence

4. Justice

Patient Autonomy

the right to make decisions about one’s own life and body without coercion by others

Beneficence

helping others-it is both a principle and a virtue (compassion)

Nonmaleficence

not harming others 

Justice

patients should be treated fairly and equally with equal access to healthcare 

Euthanasia

the killing of one person by another for merciful reasons

Assisted Suicide

When a physician assists a patient end their own life by providing them with means to end it

Palliative Care

Medical care that aims to relieve the pain and suffering of terminal patients (ex: hospice)

What’s the difference between refusing medical treatment and actively ending a life?

Refusing treatment means a terminal patient is choosing to forego further treatment likely leading to death (which is not ‘suicide;’ the disease ends the life not a person). Actively ending a life includes cases where a competent adult without a terminal illness causes his or her own death (which is ‘suicide’)

SUPPORT Study

Discovered that competent people do not accurately predict what they will later find unacceptable as quality of life. People who predicted that they would rather die than go on a ventilator most often did not choose to die, but chose to live on a ventilator.

Adaptation Effect

It may take 6 months or longer for patients to adapt to new circumstances. Moreover, with adequate resources, adaptation can be made easier.

How might poor quality of life conditions for disabled people be due to social prejudice and inadequate accommodations?

Consider the social idealization of youth, beauty, sex, athleticism, fitness, and wealth. Films such as Annie Hall, The Elephant Man, Whose Life Is It Anyway, and Million Dollar Baby often depict suicide as a rational decision in the face of miserable conditions, however with sufficient accommodations, disabilities need not imply a significantly lower quality of life (Americans with Disabilities Act of 1990). This is reflected by the different kinds of aid offered per state. 

Who was Elizabeth Bouvia?

Elizabeth Bouvia was a 25 y/o woman who was totally paralyzed from cerebral palsy with no use of her legs. She also had degenerative arthritis and only had the ability to use her right hand and her facial muscles. She moved from Oregon to Riverside General Hospital in California and was admitted as a voluntary suicidal patient. She wanted to be treated, but not fed, so she could starve to death, but not be in pain. Donald Fisher, her doctor, force-fed her since he did not want to be sued or charged with murder. He claimed she may change her mind and also felt we do not need to condone suicide but rather change as a society in how we view disabilities. 

How is the case of Brittany Maynard different from that of Elizabeth Bouvia and Larry McAfee?

Larry McAfee was a C-2 paraplegic after a motorcycle accident, he only had the use of his eyes, mouth, and head. He would sometimes choke, unable to clear his throat. He requested assisted suicide and was approved. He did not end his own life but died from a catheter problem. Brittany Maynard unlike McAfee and Bouvia went through with her suicide. She suffered from glioblastoma, a painful terminal brain cancer. She was told she could expect death in 6 months and confusion and headaches. She moved to Oregon where suicide was legal and ended her own life. She has a terminal difference which is another major difference.

Who is Dr. Anna Pou?

Dr. Anna Pou worked at the memorial hospital where they got surrounded by water during Hurricane Katrina. Pou allegedly said it would be better to euthanize the patients since they were without fresh water, electricity, supplies, and in 105^oF heat. She allegedly killed 9 patients so they wouldn’t die in a long drawn out and painful way. She denies all these claims. Unfortunately, LifeCare was on the way unbeknownst to her and the rest of the patients and staff were saved shortly after.

What is Velleman’s position on physician-assisted suicide (what he calls ‘euthanasia’)?  Who should have final say concerning Physician-Assisted Suicide?  Why?

Velleman argues that there shouldn’t be a law or rule that doctors have to respect a patient’s desire to want to die. He says this because the patients’ choice can harm themselves if they are not conscious enough to make the choice. He says the patients should be allowed to request suicide, but ultimately the doctor has the final say on the issue. This will allow the doctor to make the best conclusion if continuing to live would harm the patient more. 

Velleman provides four examples of how we can actually be harmed by being given more options. What are they?

1. Negotiations

2. The Robbery

3. The Invitation

4. Offering Remedial Instruction

Explain Negotiations

Having fewer options can give you more bargaining power. Ex: Labor Union-we either get 10% or we strike versus we either get 10%, 5%, or we strike. Employees are more likely to get what they want with fewer options. 

Explain The Robbery

Having more options can make you more useful to others and more vulnerable. A night cashier with the knowledge of the code to the safe is more likely to get robbed. 

Explain The Invitation

giving an option may force us to choose between the status quo and the alternative and we then can no longer have the status quo without choosing it. Someone influential throws a party and you get invited once you receive the invitation you have to go in order to avoid the negative consequences.

Explain Offering Remedial Instruction

Offering an option may imply something negative to the recipient whether intentional or not. If a student is offered remedial instruction and loses confidence for the next exam then the offer may cause the student to perform worse on exams.

How can giving patients the right to physician-assisted suicide (or ‘euthanasia’) harm them? (3)

1. It deprives us of the possibility of staying alive by default, requiring us to justify why we continue to choose to live.

   1. You may have to justify your continued existence 

   2. Justifying one’s existence might make existence unbearable 

2. If others do not perceive your decision to live to be justified, they may resent you or perceive you to be irrational and not worth engaging with, depriving you of the social support that would otherwise make life worth living 

   1. Because of financial and emotional stress loved ones may not even need to suggest PAS for a patient to conclude that they would wish it

3. Dying patients may feel obligated to request physician assisted suicide 

   1. If PAS weren’t an option they and others would feel the matter to be out of their hands rather than something in their power to control.

Embryo

After sperm meets egg

Fetus

From 9 weeks until birth

Baby

when born. Murder of a baby not a fetus, can be subject to homicidal charges

What was the Supreme Court’s ruling and justification for Roe v. Wade?

Jane Roe (Norman McCorvey) v. Henry Wade (Dallas County District Attorney)

The Supreme Court ruled that the right to privacy (or liberty) included a women’s right to decide whether to stay pregnant or not (or rather banned states from prohibiting abortion).

What is viability?  When does it likely happen?

Viability was defined during this case as the point at which the fetus is able to live outside the mother’s womb, which initially was placed between 24-28 weeks. Since the fetus was unable to live on its own until this time abortion would not be considered murder. 

What is the Cognitive Criterion of Personhood argument?

To be a person is to be able to think and to be capable of cognition:

• Reasoning 

• Self-awareness 

• Consciousness 

• Use of language 

• Agency (free will)

What is the Deprivation argument, and how does it relate to the role potentiality plays in morality?

The deprivation argument explains how “if cognition makes people valuable, is it wrong to deprive beings of potential cognition. For example what is wrong about killing a person-such as a college student-is depriving them of future cognitive experiences. Therefore what is wrong about killing an adult matches what is wrong about killing a fetus. Thus, abortion is wrong. 

What are the Criticisms of the Deprivation argument?

The first premise may be true but is the second? Can a being like an early on fetus without an already existing self or identity have a personal future to be deprived? 

Is God as wrong not to create a second universe with potential people (with potential cognitive experiences) as Satan would be to destroy this universe?

In traditional moral, political, and legal discourse, how do we typically define a person?  How does this definition of personhood not work in cases of the mother and fetus?

We typically define a person in terms of physical separation: one individual body, one distinct person. When determining how we ought to act, we usually start by assuming 1) individuals are separate, and only then 2) determine how these separate individuals should exist together in relationships and communities.However, a mother and a fetus are not separate but rather physically intertwined with each other. If the fetus is considered a person, the mother-fetus relationship is conceived of either as the relationship between two strangers or between a ready-made duty-bound mother and child. The relationship needs to be defined as an intertwinement and enmeshment, since neither the mother nor fetus has a clear sense of identity and autonomy is blurred. 

If the question of abortion is assumed to be one of determining whether the fetus is or isn’t a person, what two options could the fetus be?  What do each imply about the permissibility of abortion?

If the fetus is not a person, abortion is not considered murder and it is morally permissible. If the fetus is considered a person, abortion is considered murder and abortion is not morally permissible. 

What’s the difference between weighing rights and circumscribing rights?  How does it apply to abortion?

Rights are often spoken in terms of who has more of a right over another (weighing rights). Technically, rights have circumscribed boundaries. My right to extend my fist ends at your nose, it is not that my right to punch you is being weighed against your right not to be harmed. In terms of abortion, you could say that a fetus’s right to life circumscribes a woman’s right to bodily autonomy. You could also say that a person’s right to life is circumscribed at the point at which that life involves occupying and using another’s body to do so. 

Little considers many risks of pregnancy, including possible medical risks and potential social costs.  But she is more concerned with the intimate occupation of one’s body by another being due to fetal enmeshment.  Explain this, how it relates to consent, and whether the State has the right to ban abortion on its basis.

To mandate that the women remain pregnant is to mandate that she remains in a state of intertwinement against her consent. Pregnancy can feel like a violation or invasive occupation. If the mother wants to be pregnant that is a wonderful experience if not it can feel unpleasant. Therefore the state saying a woman must be occupied by another being against their will, would be against their liberty rights. 

If the personhood of the fetus is not the deciding factor in the abortion debate, what, according to Little, is?  Explain the ethics of intimacy (relationship-based responsibilities). 

We may need an ethics of parenthood to adequately address abortion. Parenthood has different layers (biological, legal, and personal). Different moral responsibilities correspond to different layers or kinds of relationships. The more a lived personal relationship between a parent and a child the more responsibility that is born by the parent for the child.

What obligation does a mother have to her fetus based solely on a biological connection? 

A mere biological correlation (‘thin parenthood’) only obliges a parent to be open to a deeper relationship with their child. The obligation to be open to a relationship is not the same as the obligations that follow from being in one. The mother should be open but does not have an obligation to bring the fetus to term.

What alters the level of that obligation?

The meaning the mother ascribes to the pregnancy determines the degree of obligations. The more meaningful the perceived connection the more significant the reasons must be to terminate. 

Research Embryos

Embryos created specifically for research

Spare Embryos

Embryos left over after successful IVF (in vitro fertilization)

Embryonic Cloning

Cloning Embryonic Material

Reproductive cloning

Cloning embryos and gestating them into babies 

What are stem cells?

Stem cells are primordial cells that can develop into any kinds of differentiated cellular tissue: bone, muscle, nerve, and so on

How can stem cells be used?

They could be directed to form new bones, neural cells, cardiac tissue, and cure diseases. They can be found in bone marrow, embryo, or umbilical cord.

What is the ethical controversy regarding stem cell research and development?

Stem cells can help to produce cures however they are considered to exploit vulnerable desperate patients and maiming patients. (may cause strange mass growths on the spine, blindness, blood, and joint infections)

What are induced pluripotent stem cells (and progenitor cells), and how do they mostly remove that controversy?

A May 2019 review found that adult stem cells, rather than embryonic stem cells or induced pluripotent stem cells, so far have shown the greatest regenerative potential, especially in matching the characteristics of the target-tissue and not creating tumors. This removed the controversy since embryos were no longer being used. 

Bonnie Steinbock and Moral Value

there are good reasons for protecting it or being concerned about it (ex: wilderness)

Bonnie Steinbock and Moral Status

limited to beings ‘who [desire and thus] have interests’

how does Bonnie Steinbock’s moral value and moral status definitions apply to embryonic research.

One of the most basic desires is to avoid pain. Embryos can not feel pain at 14 days (nor for quite some time after that), so they don’t have ‘interests.’ This would mean they do not have moral status, however they do have moral value. 

What are some ethical issues with reproductive cloning?

• Is cloning against the will of God?

• Do we have a right to a unique genetic identity?

• Is cloning unnatural and is the desire for it perverse?

• Is it right to genetically ‘design’ your children to your preferred specifications? Does this deprive a child of self determinations? Does it run the risk of prejudicial selection? Might it make parents more likely to reject children that show traits they wanted eliminated?

LD-50 Test

Determines ‘what amount of a substance will kill 50 of 100

Draize Tests

Estimates whether products irritate human eyes by testing rabbits

three alternative forms of testing

1. Replacement

2. Refinement

3. Reduction

Replacement

Using tissue culture instead of animal skin, or a mouse instead of a dog, or even computer model simulations 

Refinement

Improving the quality of life of research animals as well as the methodology 

Reduction

Reducing the number of animals used, for example LD-10s rather than LD-50s

Speciesism

The prejudicial belief that humans are superior by nature to other species. 

according to Peter Singer, determines whether a being is morally significant

The capacity to feel pain and pleasure makes a being morally significant.

Why does Singer argue that animal testing is unethical?

Singer argues that a medical experiment using animal subjects must be speciesist, unless humans would be willing to substitute irreversibly comatose human subjects. Most people would accept using a chimp as research and would cringe at using an encephalic baby. The only argument for why the chimp should be used is that they are not human, which is a speciesist.

What is Tom Regan’s argument against animal testing?

Reagan argues that an animal should be treated as an ‘end to itself’ as having inherent value rather than just instrumental value. 

The official view on why animal testing is necessary is that many species are physiologically similar to humans, making them more ethically and practically ideal test subjects than humans themselves.  What three criticisms challenge this view?

1. It is inherently wrong to use animals for human benefit especially if such testing is painful or fatal. Also, doesn’t implying they are similar also imply a similar moral value? 

2. Animal Testing is bad science (they may not predict harm to humans as accurately). Also, there are better testing sources like embryonic cells. 

3. How can “the meager overall results for humans justify the immense suffering to millions of research animals?”

What are the options for Scarce Resource Distribution?

1. An Impersonal Lottery (Kantian)

2. Maximizing Years Lived per Machine or Organ (Utilitarianism)

3. Focusing on Personal Characteristics of Recipients (which many exclude one class or identify the most deserving)

4. The Rule of Rescue (giving scarce resources to those known (i.e. personally) rather than anonymously (i.e. impartially)

What is the God Committee?

The King County Medical Society decided that an anonymous 7-member committee (The Admissions and Policy Committee or God Committee) composed of a minister, a lawyer, a housewife, a labor leader, a state government official, a banker, and a surgeon would decide who would receive the dialysis treatment. They were advised by 2 physicians familiar with dialysis that screened applicants for medical unsuitability.

What are the dangers of using ‘social worth’ criteria for organ and resource allocation decisions?

Using social-worth criteria could lead to unequal and unjust resource allocation.

What is Rescher’s ‘Two-Tiered’ (actually Three-Tiered) Allocation Approach (or Point System)?  Know how to apply it to choose one patient over another.

1. The Basic Screening Stage

i. The Constituency Factor

ii. The Progress-of-Science Factor

iii. The Prospect-of-Success Factor

2. The Selection Stage

i. The Relative-Likelihood-of-Success Factor

ii. The Life-Expectancy Factor

iii. The Family-Role Factor

iv. The Potential-Future-Contributions Factor

v. The Services-Rendered Factor

3. The Random Selection Stage

What is a QALY?

QALY: Quality-Adjusted Life Year 

QALY takes a year of healthy life expectancy to be worth one, but regards a year of unhealthy life expectancy worth less than one. Death is zero and the negative score implies the quality of life of someone is worse than being dead. Ex: a 30 y/o paraplegic might live longer than a 60 y/o with a healthy life if they receive a heart transplant, but their QALY is likely lower than the 60 y/o QALY number.

How can a QALY-based selection approach be biased and unfair?

This approach is biased against the disabled, elderly, and possibly racists and sexists (assuming prejudice reduces the quality of life).