Bioethics Midterm

Provide a brief overview of the history of bioethics as a professional ethic

Bioethics can be summed up as issues of life and death, and autonomy versus morality. It started as far back as with the philosopher Hippocrates with the Hippocratic Oath in 400-300 BC, which is still referenced today by physicians. The field gained prominence in the 20th century, particularly after World War II, with the establishment of ethical guidelines following medical experiments. The Belmont Report in 1979 further shaped the standards of research ethics and informed consent.

autonomy

Autonomy: Respect an individual’s rational capacity for self-governance. An example would be respecting an individual’s choice not to have surgery or refusing treatment.

beneficence

Beneficence: the act of doing something that will benefit the patient. An example would be doing beneficial treatments, such as not doing surgeries that would not benefit someone

non-maleficence,

Non-maleficence: Do no harm

justice

Distributing limited resources fairly, making sure everyone gets equal access to care.

Why has autonomy become the most emphasized principle in bioethics since 1980

The Belmont Report was put into place to:

• Prevent future ethical abuses in research.

• Establish clear moral principles for protecting participants.

• Serve as a foundation for U.S. research ethics policies (e.g., the Common Rule).

What is paternalism? Provide one case where it may be ethically justified and one where it may not.

  A time where it would be justified to give treatment against patient wishes

where a mom refused cancer treatment for her child because she didn’t understand it.

a doctor forcing a woman with children into treatment she doesn’t want because of her status as a mother, or forced sterilization.

 What does the Harm Principle state, and how does it limit autonomy?

The harm principle states that individual autonomy must be respected so far as it does not harm another person. Autonomy can be restricted to prevent harm to others. "The right to swing my fist ends where the other man's nose begins.”

What is the Nuremberg Code and why does it matter for bioethics?

a set of research ethics for that were drafted because of World War II trials. It is important in regard to bioethics because it outlines basic ethical principles that must be followed for human experimentation that relate to beneficence and autonomy.

What ethical failures were exposed in the Tuskegee syphilis study?

Failures exposed by the Tuskegee syphilis study were that researchers never informed participants of what disease they had, prevented participants from receiving proper treatment, and prevented them from receiving the newly discovered penicillin to cure their disease.

Why was the Belmont Report written in 1978? List its three core principles

The Bellmont Report was written in response to the Tuskegee syphilis study. Its three core principles are respect for persons, beneficence, and justice.

Define consequentialism

the level of wrongness of an action is determined by its consequences or outcomes

identify specific types of consequentialism ethics. Why do these approaches matter for healthcare?

Three types:

1.     Ethical egoism – it's all about you. An action is morally right if the consequences of that action are more favorable than unfavorable only to the agent performing the action.

2.     Ethical altruism – it's about everyone else. An action is morally right if the consequences of that action are more favorable than unfavorable to everyone except the agent.

3.     Utilitarianism: let’s weigh everyone’s interests equally

Define deontology and why it matters for healthcare.

Deontology is the idea that morals are more important than the consequences of the action

this matters for healthcare because it establishes ethical duties and prioritizes the patient.

What is virtue ethics? Give an example of how each might guide a medical decision.

Emphasizes the importance of the morals of the action rather than the morals of the consequences

How does Kantian ethics differ from utilitarianism in approaching end-of-life decisions

Utilitarian is the opposite of Kantian ethics – The consequences take priority over the moral values of the actions take

Which ethical frameworks underlie Peter Singer’s animal ethic and Tom Regan’s rights-based approach?

Utilitarianism: Both Singer and Regan advocate for actions that maximize the overall good or happiness, with a focus on reducing suffering for animals and protecting their rights, respective
Equal Consideration of Interests: Both Singer and Regan argue for the equal consideration of interests, advocating for animals to have interests that are equal to human interests, which includes their own rights and welfare.

Why might egoism be considered an inadequate ethical foundation for medical decision-making?

it promotes self-interest over compassion, fairness, and patient welfare, which are essential to the moral practice of medicine.

Distinguish between active euthanasia and passive euthanasia

Active: involves taking deliberate steps to end a patient’s life

Passive: entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life.

Define physician-assisted suicide. How is it ethically distinct from euthanasia

Physician assisted suicide is when a physician is present and overseeing a person who euthanizes themself. Euthanasia is inducing death by a medical professional or third party. The ethical distinction is who performs the act: the patient or a third party

What is James Rachels’ argument about the moral distinction (or lack thereof) between active and passive euthanasia?

there is no moral difference between killing and letting die, because both involve the same moral intention and lead to the same result

How do paternalism and beneficence sometimes come into conflict?

Paternalism is when you override a patients choice for their own good, although this benefits the patient it can damage their mind since it violates their autonomy

Provide a case where honoring patient autonomy may conflict with non-maleficence in end-of-life care.

in end-of-life care is when a terminally ill patient refuses life-sustaining treatment

Which bioethical principles support physician-assisted suicide? Which oppose it?

Autonomy and Benefice agree, non-maleficence and justice do not

Define confidentiality and explain how it differs from privacy

Confidentiality is defined as healthcare professionals not disclosing patient information to anyone. This is different from privacy because privacy is more a personal choice, where the patient can choose what information they want to share or not share

Provide two arguments for maintaining confidentiality

Patients will trust the healthcare workers so the healthcare workers will be able to do their job. Not maintaining confidentiality would break the non-maleficence principle

Identify one ethically acceptable reason for breaching confidentiality

If the patient is in possible danger to themselves or others, harm principle.

How does confidentiality support trust in the physician–patient relationshi

Confidentiality supports trust in physician-patient relationships because if the patient trusts the physician, the patient will feel confident in telling the physician information that would help the physician help the patient.

Which scenario represents a violation of both confidentiality and informed consent? Explain why.

A doctor shares a patient’s HIV-positive status with the patient’s employer without the patient’s permission, and the patient was never informed that this information might be disclosed.

List three conditions for valid informed consent. Why are they all necessary

-          The patient is competent to decide - capacity

-          There is adequate disclosure of information – disclosure

-          The patient consents to the treatment – voluntariness
These are necessary to ensure all relevant information is explained to patients, that the patients have the capacity understand the information, and that once they understand they give their consent.

What is the difference between informed consent and understood consent

-          Informed consent: the patient was informed of the details of the procedure before they consented to it, focuses more on obtaining consent from the patient

-          Understood consent: Involves catering to a patient’s level of understanding and facilitates the patients understanding of the details of the procedure, such as using a language in which the patient is fluent and at an appropriate level of reading

Who determines patient competence, and what factors are considered?

The primary physician or other healthcare provider involved. Factors such as mental fortitude are considered in such events

Give one example where informed consent is difficult to achieve. Suggest an ethically acceptable solution

Informed consent could be difficult to achieve in emergency situations when the patient may not be conscious or might be lacking capacity. An ethical solution would be implied consent and medical professionals prioritizing beneficence. Also, if a third party to the patient is present, they can be consulted.

How might AI in healthcare create new challenges for confidentiality and privacy

They collect data on patients in order to function properly. This data can easily be accessed by AI companies if no precautions are taken.

Why might bias in AI systems be considered a violation of beneficence and justice?

violates beneficence by failing to promote the well-being of all patients and justice by producing unequal and discriminatory outcomes, reinforcing systemic inequities instead of correcting them.

Which ethical principle is most directly challenged when AI systems in healthcare make recommendations without patient understanding

Justice because some patients may not be treated fairly by an AI model, as the AI may  not understand the scope of the situation in the same way a doctor does 

What are the 3Rs in animal research? Why are they ethically significant

·       Replacement – chose methods that avoid or replace the use of animals in research

·       Reduction – use methods that enable researchers to obtain comparable levels of information from fewer animals

Refinement – use methods that alleviate or minimize potential pain, suffering or distress, and enhance animal welfare for the animals used

These principles are significant because it outlines rights for animals and how to uuse them for research ethically. It makes sure we’re not abusing them and only using them if needed.

13.  Summarize Singer’s utilitarian argument for animal ethics.

Singer said that it’s ok to replace animals if overall they are living a good life. He argued that animal research is justified if the suffering of the animals outweighs the long-term benefits.

Summarize Regan’s rights-based argument for animal ethics

“all experiencing subjects of a life” and should be thought of as possessing inherent worth and thus moral rights

How does Bernie Rollin argue for a new ethic toward animals in research?

“If we have dealings with animals we need to respect their needs and desires”

What critiques are commonly raised against utilitarian approaches to animal experimentation in medical ethics?

Utilitarianism requires weighing animal suffering against potential human benefits, but this calculation is highly uncertain and subjective

Should animals be considered “subjects of a life”? Why or why not?

Yes, animals should be considered subjects of life. Factually, they are living, and they experience pleasure and pain.

Why is scientific validity essential for clinical trials, according to Emanuel et al.?

To be ethical, “research must be conducted in a methodologically rigorous manner.” To be scientifically validated means to be logically sound in obtaining information and for the procedures to be proven efficient and effective.

What does Emanuel et al. mean by social or scientific value? Provide an example of a trial that lacks value

Social or scientific value is a measure of whether something benefits the public or society at large. In class we talked about the case where Pfizer tested a drug for meningitis on African children, and 11 children died. You could argue this did not provide social value because there was already a treatment for meningitis, and they were only intending to use this treatment in the U.S. They (Pfizer) argued that they were responding to a medical emergency, but the treatment they provided was experimental and not proven to work, so we think it should not have been considered benefitting society

Why is fair subject selection ethically necessary

It protects vulnerable populations and it provides more accurate testing rather than targeting populations more likely to make what you are testing true

What is a favorable risk–benefit ratio, and why is it required

Favorable risk-benefit ratio is when the potential benefits for a treatment outweigh the potential negatives. It is required to ensure that trials line up with beneficence and protects the safety of the patients.

How does respect for enrolled participants extend beyond informed consent

It extends into the trial meaning that patients are able to withdraw whenever they want, they must be educated on any new information regarding their trial as well as continued privacy over their information