Bioethics exam 1

Morality

final say in decision making, guiding principles for right and wrong.

Fallacy

bad arguments that are logically unsound or misleading.

Legal fallacy

just because something is illegal, it doesn’t mean it is immoral. (illegal to help runaway slaves)This type of reasoning overlooks the distinction between legal standards and ethical principles, implying that legality does not inherently equate to morality.

Is/ought gap

What is currently doesn’t mean it shoud be like that

ad hominem

fallacy where you attack the other person NOT their argument. (someone is wrong becasue of their mustache)

Bandwagon fallacy

majority of people think smth is true —> doesn’t mean it's actually true. (if all your friends jumped off a bridge)

slippery slope

one step will lead to a lot that are worse outcomes or extreme situations (NOT INEVITABLE)

Intrinsic good (Aristotle)

good that can’t be reduced to other good or valued merely as a means to an end; it is good in itself.

• utilitarian = hapiness and pleasure

• Kant = reason

Moral principles (thomas nagel)

gratitude, benficence, non-maleficence, fidelity, justice are guidelines for ethical behavior that govern how individuals should act in various situations, ensuring respect and fairness among people.

Moral values

obligations, rights, utility, perfectionist ends, and private commitments, irreducible cuz they are values at diff viewpoitns

four principles approach in bioethics

A framework for ethical decision-making in healthcare that includes autonomy, beneficence, non-maleficence, and justice to guide practitioners in resolving moral dilemmas. By Tom beauchamp and James Childress

Autonomy

ability to make choices by themselves

Beneficence

acting to improve someone/help someone

Non-maleficence

not harming someone

Justice

fairness, equal consideration, proper distrubtion of benefits/burdens

Meta ethics

study of the boundaries of moral inquiry. It explores the nature, status, and foundations of ethical principles, asking what they mean and how we can know them.

tsujigiri

the practice of testing a new sword by killing a passerby.

ethical/cultural relativism

each culture has their own moral rules and codes ONLY in that culture (others outside can’t judge)

Problems with cultural relativism

• no criticism/praise of other cultures (are all cultures morally equal?)

• What counts as a culture (geography? ethnicity? can you choose)

• Majority rule (MLK jr in the US doesn’t make them bad, being majority doesn’t make it right)

• Tolerance is non-relativism (problems arise in defining tolerance across different cultures, as what is acceptable in one may not be in another.)

subjectivism

no objectively right or wrong judgements —> up to individual, moral statemetns are only about approval and disapproval

• can’t account for moral disagreements

• undermines claims of moral truth, leading to conflicts in ethical debates.

• can never be wrong even if we used to disagree

problematic cuz if honesty is moral then we can never have moral growth

Emotivism

moral statements are expressions of attitude or persuasive statements to sway the listener

• it emphasizes feelings over facts, suggesting that ethical discussions are subjective and based on emotional reactions.

• trying to get you on my team

SOLVES subjectivism cuz you can explain your disagreement

BUT no room for reasons

moral Nihilism

No morally right or wrong viewpoints —> moral values are baseless and do not exist, leading to the conclusion that ethical claims lack objective significance.

Moral skepticism

there may or may not be morality but will never know, however, this confuses ontology (what exists) with epistemology (what we can know), since not knowing something exists doesn't mean it doesn't exist.

Moral realism

there is an objectivity to morality (TRUE AND CORRECT ANSWERS)

• hard to accept because diff people accept different things

• misses that better and worse reasons can exist

Ignorance

just becasue you don’t know the answer doens’t mean there isn’t one

Divine command theory

is the ethical view that moral values and duties are commanded by God, meaning that what is right or wrong depends on God's will.

Positives of Divine command theory

don’t have to worry about figuring out right or wrong, Solid objectivity, clear consequences

Downsides of divine command theory

athetists won’t be swayed, you can either be high or braintumor if you hear god speaking

Ethyphro dilemma

is a philosophical question that explores whether something is good because God commands it or if God commands it because it is good, raising issues about moral objectivity.

Hippocratic mandate

concern is to minimize harm to the pateint (patient = focal point)

what makes something a benefit vs harm?

health can conflict with other values (like eating a donut = happiness), extending someone’s life will improve health but not reduce suffering

Case-by-case decisions

Evaluate every situation independently, but decisions risk becoming arbitrary or inconsistent. (doesn’t matter if you did whatever in other cases)

rule based decision making

A method of ethical decision-making that relies on established rules or guidelines to determine the right course of action, ensuring consistency across similar cases. (SOMETIMES WILL FAIL SOME CASES)

Utilitarianism

we should maximize good overall (patient might not be the primary concern)

Act utilitarianism (bentham)

always maximize NET social utility (happiness) subtract the negative from the positive MATHH

Positives of act utilitarianism

Consistency (math so no contradictory outcomes), moral motivation clear = utility, no stress cuz its just formula

Act utilitarianism problems

1. Impossibility: need to perform calculus for everything —> doesn’t maximize happiness

2. Evil pleasures: 1000 romans happy for killing 2 christians, it would be good cuz maximum

3. never ending consequence: too early to tell what the outcome is to decide (nuclear explosion —> led to guidlines so it was better )

Rule utilitarianism ( John stuart mill)

always follow a rule that if generally followed will maximize net utility, instead of deciding moment to moment you follow a rule + care about quality of the happiness (noble pleasures)

—> ask someone who tried both to see which is a better pleasure

How rule solves impossibility in act utiliarianism

we follow rules so we don’t need to constantly calculate

How rule solves evil pleasures in act utiliarianism

distinction between types of pleasures (some pleasures worth more)

How rule solves never ending consequences in act utiliarianism

worried abut rules not actions, work out, what rule leads to hapiness

Rule utilitarianism problems

1. pleasure experts: someone who bowled before AND drowned a toddler —> what if they choose toddler

2. if theres a general rule and a situation says breaking the rule will save millions we can’t break the rule

Rule utilitarianism risks either collapsing into act utilitarianism or becoming rule worship, where rules are followed even when doing so reduces overall happiness.

Statistical lives

Unidentified individuals whose lives could be saved through an intervention.

thomas Aquinas

thou shalt not kill doesn’t apply to trees and animals because no REASON —> only people

Teleology

everything has a purpose, humans were created lsat everything is for us

Ahimsa

in Jainism which is non violence, intention doesn’t matter the only thing is you can’t kill

Is it lawful to kill sinners?

According to Thomas Aquinas, while the act of killing is generally prohibited, he argues that the execution of sinners can be justified in certain circumstances, such as maintaining social order and upholding justice. (remove smth to help perform purpose —> cut fingers with gangreen)

James Rachels

argued againt how passive euthanasia is better than active, Allowing a patient to die is not necessarily morally better simply because the physician does not actively cause death.

Indirect killing

unintended but active (giving an unknown but fatal allergen to patient)

Natural law principle of double effect

An action with both good and bad effects may be justified when four moral conditions are satisfied.

1. action must be morally neutral/good

2. bad effect can’t be means of good consequence

3. intention MUST be for the good

4. good consequence must be proportionate to the bad effect.

Capital punishment

The state-sanctioned execution of an individual as punishment for a crime, typically reserved for severe offenses such as murder.

Furman v. Georgia (1972)

sentenced to death for murder during a burglary, ruled that the arbitrary and discriminatory application of the death penalty constituted cruel and unusual punishment. BECAUSE OF arbitrary and discriminatory factors

Justice Brennan's Four Principles

1. punishment must not degrade human dignity

2. Severe punishment should not be imposed randomly or inconsistently.

3. Punishment is questionable when society overwhelmingly rejects it.

4. Severe punishment should not be imposed when it is clearly unnecessary.

Gregg v Georgia (1976)

reinstated the constitutional use of capital punishment under revised sentencing procedures intended to reduce arbitrariness.

why legal standards change over time

Legal standards change over time due to evolving social values, advances in knowledge, and shifting cultural norms. These changes reflect society's growing understanding of justice, equity, and human rights.

Psychological Autonomy

mental state where people are free to choose their own life plans —> act on plans and pursue personal goals without external coercion.

Immanuel Kant

prussian deontologist, only one good without qualification = a good will

Will (kant)

our ability to formulate and follow self-imposed laws/rules, all other goods (intelligence, wit, judgement, courage, etc.) can all be corrupted IMPORTANT TO BE AUTONOMOUS, no good will without ability to choose our actions

What makes a will a good will?

acting based on your DUTY (keeping prices the name because she believes in fairness NOT becasue of personal reasons),

Maxim

a rule or principle that guides an individual's actions, serving as the foundation for moral decision-making. only motivation matters

Respect for Moral Law

following the law even if our emotions or personal inclinations may lead us otherwise. It emphasizes the importance of acting according to one's moral duties.

Hypothetical ought statements

if you want to pass then you ought to read the assignments, require you to be heading towards another end which is based on a specific desire or goal.

Categorical ought

KANT, simply follow them NOT cuz of another end (Don’t lie, don’t steal, help others) as it prescribes actions that are inherently right, regardless of personal desires or consequences.

The categorical imperative

act only on the maxim where you can, at the same time, will that it should become a universal law. It serves as a fundamental principle of moral philosophy in Kantian ethics.

• steal bike?

  • maxim = steal

  • can you will it to be a universal law? NO, everyone should steal = no property

Perfect duties (necessary)

opposite is impossible to even imagine

• to self: don’t kill yourself —> everyone die?

  • to others: Don’t lie —> everyone lies so there is no truth

Imperfect duties

possible to imagine but can’t really will it to exist

• to self: improve yourself —> don’t want a world where no one develops their talents

• To others: Help others —> opposite is no one helps anyone and you don’t want that

Kant's Second Formulation of the Categorical Imperative

treat humanity as an end, never as a means (respect their autonomy)

• suicide is using yourself as a means to an end, violating your own autonomy and dignity.

• lying is using someone as a means —> no one asks to be lied to

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perfect/imperfect duties in the second formulation

perfect duties prevent interference with someone's ability to exercise their will, while imperfect duties help promote that ability.

• imperfect to self: will lead you to have more choice in actions

  • to others: help others allows them to be a person who is autonomous

Substantive autonomy

Having enough decision-making ability for one's choices to deserve independent moral respect. —> doesn’t mean they can do whatever they want

John Stuart Mill’s Harm principle

the actions of individuals should only be limited to prevent harm to others. This principle emphasizes the importance of personal freedom as long as it does not infringe on the well-being of others.

When autonomy can be restricted

1. Harm principle

2. justice where you shouldn’t limit someone else’s freedom

3. Overall consequences matter more than unrestricted individual freedom.

4. Paternalism: good of the individual

Paternalism

Interfering with someone's liberty for their own good, often justified by the belief that it will benefit them.

• Regular = prevent someone from harming

• extreme = Forcing someone to do something beneficial for themselves.

• Weak = Restricting someone whose autonomy is limited.

• Strong = actively overriding an individual's autonomous choices in their best interest.

Moral autonomy over hippocratic mandate and utilitarianism

hippocratic = DROP THE PRINCIPLE, do whats best for the patient

Utilitariansism = drop it do what maximizes overall good

autonomy questions

1. is the patient sufficiently autonomous? —> children with mental impairments not autonomous and patients who have lost decision-making capacity.(can designate a surrogate)

2. Are there external constraints controlling choices? —> Institutional restrictions, Pressure or manipulation, Offers so attractive that they may undermine voluntary choice.

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respect principle

Do not restrict a substantially autonomous person's choices solely for that person's own well-being, generally provided those choices do not harm others.

The Tuskegee Syphilis Study (1932 —> 1972)

A controversial clinical study conducted between 1932 and 1972 where African American males with syphilis were deliberately left untreated to observe the disease's progression, raising significant ethical concerns about informed consent and exploitation.

• participants were deceived and denied information necessary for informed consent, while effective treatment was withheld.

Is it morally appropriate to override autonomy for someone's own well-being?

People who are free make dumb choices

Truth

not just what happened, but also an accurate representation of events and facts.

Quackery

use of fraudulent/dubious medicine, claiming smth cures without proof or using treatments that lack scientific backing.

Franz mesmer (1770s)

founded mesmerism where there is some form of energy that makes up life and can influence health; he believed this energy could be harnessed for healing.

Homeopathy

more you dilute the substance, the more effective the remedy will be (like cures like)

Snake oil

Products were promoted as medicinal cures without adequate evidence. Often associated with charlatans.

Hamlin’s wizard oil

mostly alchohol, ended up fined for claiming it would cure cancer

The jungle (1906)

novel by Upton Sinclair that exposed the harsh conditions and exploited lives of immigrants in the United States meatpacking industry, leading to reforms in food safety regulations.

Pure food and drug act (1906)

drugs must be pure and clearly labeled, led to the formation of the FDA in 1926

• DOESNT HAV ETO BE SAFE/EFFECTIVE

Elixir Sulfanilamide (raspberry) 1937

a lot of people died and was pulled becasue it was labeled as an elixir when it wasn’t, led to federal food, drug, and cosmetic act

Federal Food, Drug, and Cosmetic Act (1938)

legislation that established specific safety and efficacy standards for food, drugs, and cosmetics, need to prove its effective and NO TOXIC SUBSTANCES before marketing, significantly improving consumer protection.

Durham Humphrey Amendments (1951)

introduced prescription drugs

Delaney Clause (1958)

Prohibited any carcinogen to be used as a food additive (red 40?)

Thalidomide

was marketed in Europe as anti nausea —> led to birth defects

• SHOWS FDA WORKS cuz it wasn’t sold in the US

1962 amendment to FFDCA

FDA can fully approve new drugs before marketing

FDA approval process

1. Send IND application: need data on animal nad preclinical studeis on safety (can use clinical trials)

2. Three phases

   1. are there toxic side effects? (20-30 volunteers) ppl who aren’t helped by conventional treatments

   2. how does the body metabolize? (dose figured out and see how body processes)

   3. does it work? placebos can be used

3. apply for NDA: to market the drug

Why Does Medical Quackery Still Exist?

• no working knowldege of how medicine works

• placebo effect

• Assuming that because B happened after A, A caused B.

• anecdotes

• sunk costs

• no regulation of dietary and herbal supplements

Truth vs honesty

truth is whats actually true, honesty is what the person believes is true (disclosure)

David Hume

much of what we believe comes from other people's testimony.

Benevolent dishonesty

Deceiving or withholding information from someone because you believe doing so will benefit them.

The powerful placebo (1955)

is a concept in which patients experience real improvements in their condition due to their belief in the efficacy of a treatment, even if it is inert.

Moral dilemma of placebos

Placebos create a conflict between beneficence (potentially helping patients) and veracity/autonomy (the obligation to be truthful and respect informed decisions).

Placebos in practice

A doctor gives a placebo to a patient hoping to improve symptoms.

The ethical concerns include deception, withholding effective treatment, and encouraging reliance on ineffective remedies.

Placebos in research

test if a drug is really doing something

• single blind: researcher knows

• Double blind: neither the experimenter or subject knows GOOD CUZ nothing will be given away

What if an effective treatment already exists?

Giving someone a placebo instead could deprive them of beneficial care.