Bioethics - Philos 2D03 Exam Review Readings

Define Distributive justice

Justice concerning the fair distribution of society's advantages & disadvantages.

Norman Daniels

Health care needs VS wants, preferences

health care needs - necessary for normal species functioning and to lead a normal life

wants/ preferences - beyond what is essential for normal functioning

Norman Daniels

adventitious needs VS course of life needs

Adventitious needs - from accidents or illnesses (needed to pursue life goals)

Course of life needs - normal functioning & development of an individual throughout their life (needs we all have throughout our life)

Norman Daniels

Define Normal species functioning

Level of functioning that is typical for a species & necessary for leading a normal life

Norman Daniels

Relationship b/w equal opportunity and health care?

Equal opportunity (requires providing individuals with the health care) needed to achieve a normal species functioning, ensuring a fair opportunity to lead a normal life

Norman Daniels

Define Social Determinants of Health (SDOH)

external factors such as socioeconomic status, education, living conditions that significantly impact an individual's health

Socially controllable, have larger effect on distribution of health status across society

Gopal Sreenivasan

Whitehall study? Role in Sreenivasan's argument?

research project that found a strong correlation between social class and health outcomes

Sreenivasan highlights the impact of social determinants on health and argues for addressing these inequalities

Gopal Sreenivasan

How does Sreenivasan object to Daniels' argument?

Sreenivasan emphasizes the role of social determinants in health and arguing that equal access to healthcare alone is insufficient. He argues that addressing broader social inequalities is crucial for achieving true equality of opportunity in health

Healthcare is not the only socially controllable factor that contributes to health

i. Opportunity is relative - need to reduce inequities too not just providing healthcare

Gopal Sreenivasan

Define social determinants of health

SDOH factors - gynecology, obstetrics' white supremacist origins, medical racism (clinicians' racial biases against Black pregnant people), social inequities (income, housing access), weathering (biological and physiological effects of stressors)

Keisha Ray

How do the white supremacist origins of obstetrics/gynaecology, medical racism, weathering, and social inequities play a role in hospital births being unsafe for Black people?

Contributed to high rates of death among Black pregnant people

Weathering, cumulative biological effects of stressors further the situation

Historical abuses of Black pregnant people's bodies (experimentations), provider bias, inequities in housing & income, impact of stressors on obstetric health (not using anaesthesia etc.)

Keisha Ray

How does the sordid history of Black women's reproduction connect to present day negative health outcomes for Black birthing people?

Government control of Black people's reproduction during slavery and eugenics movement made lasting impact

Stereotypes about Black woman's sexuality, reproductive autonomy, harmful government interventions (forced sterilizations)

Legacy of these beliefs reflected in clinicians' attitudes/ behaviours today (affecting survival of Black pregnant people)

Keisha Ray

What does Ray suggest should be done to improve birthing outcomes?

Suggests addressing the historical framework behind Black birthing mortality & intersecting social determinants

Enacting legislation targeting provider behaviour & institutional policies against Black pregnant people, implementing policies at individual institutions, supporting advocacy groups, offer safe alternatives to giving birth in hospitals

Keisha Ray

What are three arguments against paying plasma donors?

Panitch & thorne

1. paying results in exploitation

   1. decpetion or coercion

   2. fairness prinicple: paid vs unpaid donation

2. Paying causes harms to social norms

   1. corruption: plasma is a mere commodity

   2. crowding out argumet: crowds out altrism and public spiritedness

3. Plasma is a public resource

   1. paying donors vs profit seeking are two different issues

What is Panitch & Hawthorne’s main argument?

Should be asking who should be playing plasma donors, argue that donors should be paid by a public agency to ensure self sufficiency as current plasma-derived medicine relies on paid American donations

What was the 1980’s blood scandal? How is it relevant?

Panitch & Thorne

• around a thousand canadians infected with HIV and 50 000 with hep c

• resulted in 1997 review

  • five important principles

  • blood is a public resource

  • donors should rarely be paid

  • whole blood, plasma & platelets must be collected to meet domestic needs

  • canadians should have access to blood & blood products

  • safety of this blood is paramount

• canada cannot currently source sufficient plasma donations voluntarily and must import them, paid - is not self sufficient

• worries that paid donation will prioritize quantity of quality

• canada’s decision is between paying americans and canadians - cannot rely on unpaid donations now or in the forseeable future

• plasma is purified to an extend where risk is very low - concerns about the tainted blood scandal

  • was not a result of paying donors

Should health care rationing depend on a patient's behaviour and (good/bad) lifestyle choices?

Consider a patient's responsibility for their choices, responsibility for behaviour plays a role in determining access to health care

Alexander Cappelen

Backward-looking VS Forward-looking responsibility based arguments for health care

Backward-looking perspective - distribution of burdens/ benefits based on how individuals contributed to the creation of these burdens/ benefits in the past

Forward-looking perspective - distribution of costs/ treatments to behaviour to influence future conduct and create incentives/ disincentives

Alexander Cappelen

What normative and practical objections might be raised against responsibility-based rationing?

Normative objections -

i. humanitarian concerns (wrong to deny their needs even if it's their fault)

ii. liberal objection related to collateral effects (denying health care due to bad choice undermines basic rights and freedom)

iii. fairness objection that factors outside an individual's control can influence outcomes (luck and genetics play a role in health, partly dependent on external factors)

Practical objections -

i. Information asymmetries - patients lie, physicien-patient relation undermined

ii. Establishing cause and effect relationship - hard to tell the relationship between past behaviour and need for treatment (difficulty determining the precise cut between controllable and uncontrollable factors)

iii. Non-neutrality - what risky behaviours do we penalize people for

Alexander Cappelen

Define principles of responsibility and equalization. How do these principles play a role in author's argument

Principle of responsibility - holds individuals accountable for their choices, importance of personal responsibility

Principle of equalization - treating individuals who make the same choices as if they were identical in factors outside their control

Authors proposed taxation approach to hold individuals responsible without holding them accountable for the actual consequences of their choices (based off these principles)

Alexander cappellen

benefits and burdens associated with their proposal (Cappellen)

Benefits - avoids humanitarian concerns, the liberal objection and fairness objection by implementing taxes on certain behaviours rather than denying treatment

Burden - potential challenges in implementing tax policies, informational problem of determining controllable factors, possibility of non-neutrality in identifying behaviours of special concern.

Alexander Cappellen

Limiting factors to allocating health care resources during a pandemic

Limiting factors - scarcity of medical equipment and interventions (ventilators, ICU beds leading to need of rationing)

Increasing demand for medical resources during pandemic - challenges health care infrastructure

Ezekiel

Ethical values useful to rationing scarce medical resources by Ezekiel

4 fundamental ethical values for resource allocation (guides the fair distribution of resources in a pandemic):

i. Maximizing benefits

ii. Treating people equally

iii. Promoting and rewarding instrumental value

iv. Giving priority to worst off

Ezekiel

Ezekiel recommend resources be allocated during pandemic by:

Recommendation 1 - value of maximizing benefits is paramount. Priority given to saving the most lives and maximizing improvements in individual's post-treatment length of time

Recommendation 2 - prioritized for front-line health care workers and essential workers due to their instrumental value in pandemic response

Recommendation 3 - patients with similar prognoses, equality should be achieved through random allocation such as lottery system

Recommendation 4 - prioritization guidelines should differ by intervention and respond to changing scientific evidence

Recommendation 5 - research participants should receive some priority for covid-19 interventions, recognizing their contributions to future patients

Recommendation 6 - should be no difference in allocating scarce resources between patients with covid-19 and those with other medical conditions

Ezekiel

Why does Scully argue maximizing benefit is discriminatory?

Maximizing benefit (in the context of clinical care triage in a pandemic) can be discriminatory because of the disablist assumptions embedded in the decision-making process

Maximizing benefit often relies on criteria like overall health status, predicted quality of life, social utility which can disadvantage those with disabilities

Discriminatory aspect arises when criteria is applied without due consideration to individual differences within the disabled population

Jackie Scully

three disablist assumptions and how do they impact rationing protocols?

(1) Assumptions about overall health status - use disability as a proxy for compromised health even though disability itself may not necessarily impact health

i. Unfair exclusion from critical care based on generalized view of disability

(2) Assumptions about predicted quality of life - considerations about quality of life, may introduce bias against people with disabilities

i. Common societal misconceptions about the impact of disability on quality of life can influence decision-making

(3) Assumptions about social utility - shift towards considering the value of a person to society if saved

i. Social utility can lead to ethical tensions and moral distress when factors like profession or perceived productivity is taken into account

Scully

What moral distinction, if at all, can be made between cases of disconnection, non- connection, drug-provision and drug-injecting cases?

Disconnection cases - allowing natural death by disconnecting life support

Non- connection cases - allowing nature to take its course without intervention

Drug-provision cases (physician assisted suicide) - patient decides to take a lethal drug

Drug-injecting cases (euthanasia) - physician administers lethal drug

Judith Jarvis Thomson

Killing VS letting die Debate

Moral distinction between actively causing death (killing) and allowing natural death to occur (letting die). Depends on the intentions behind the decision to disconnect. Does refraining from medical intervention itself constitute to letting die and can they be perceived as act of killing. Physician's active role in patient's death compared to patient self-administering cases.

Judith Jarvis Thomson

Intending VS foreseeing debate

Do physicians have the intention to cause death or if they foresee death as an unintended consequence in the context of physician assisted suicide and euthanasia.

Judith Jarvis Thomson

Define Doctrine of double effect

Same action can have a good and a bad effect - a doctor may morally perform an act while foreseeing the bad effect, as long as they do not intend it.

Judith Jarvis Thomson

Thomson paper purpose

Aims to critically analyze and discuss moral arguments surrounding physician-assisted suicide. Explores distinctions in moral actions, ethical debates concerning intentions and consequences of different types of doctor-assisted death and application of doctrine of double effect. She challenges the existing arguments against physician-assisted suicide and offers her perspective on ethical considerations surrounding end-of-life decisions.

Judith Jarvis Thomson

define voluntary active euthanasia

why does Brock limit the scope of his paper to this topic?

Voluntary active euthanasia - competent patient making a fully voluntary and persistent request for aid in dying (physician actively administering lethal dose when patient is unable to do so)

Brock limits the scope of paper to explore ethical arguments surrounding voluntary active euthanasia.

Dan Brock

What values are commonly invoked in support of respecting a patient's decision about matters of life-sustaining medical interventions?

Individual self-determination (autonomy) - allows individuals to make decisions about their lives and deaths based on their values

Individual well-being - assessment of whether continued life is perceived as a benefit or a burden by the patient

Dan Brock

On what grounds does Brock argue for the moral permissibility of voluntary active euthanasia?

Based on the values of self-determination and well-being. If a competent patient decides that continued life is more of a burden than a benefit, the patient's autonomy should be respected, and euthanasia becomes morally justified.

Dan Brock

consequences Brock considers regarding the legalization of voluntary active euthanasia

Concern about abuse and the potential for giving individuals dominion over the lives of others

surrogate decision making, societal values, slippery slope

Dan Brock

Who should administer euthanasia and why?

Physicians (assuming euthanasia is legally permissible) should be able to partake in it. Limits practice of euthanasia to physicians, as they would play a role in procedural safeguards, ensuring patients are well-informed about their condition, prognosis, possible treatments and it provides a protection against abuse as it limits persons authority to perform euthanasia holding them accountable for their exercise of that authority.

Dan Brock

For what reason(s) does Thomson conclude abortion is morally permissible?

Abortion is morally permissible under certain circumstances due to bodily autonomy. Woman has right to her own body, right may override fetus' right to life in many cases

Judith Jarvis Thomson

What is the conservative argument against abortion and what role does it play in Thomson's paper?

Fetus is a person from the moment of conception, every person has a right to life and right outweighs pregnant person's right to bodily autonomy. The role of this is to provide a counterpoint where she challenges to defend abortion.

Judith Jarvis Thomson

How does Thomson respond to the extreme view against abortion? The moderate view against abortion?

Extreme view against abortion response - questions arguments that directly killing an innocent person is always impermissible

Moderate view against abortion response - questions whether others have the right to intervene on behalf of the pregnant person

Judith Jarvis Thomson

good Samaritan VS minimally decent Samaritan? How does this distinction relate to Thomson's argument?

Moral duty is to be minimally decent Samaritans rather than necessarily good ones. Difference is the level of moral obligation - pregnant person may not have an absolute duty to provide their body for the fetus but should at least act in a minimally decent manner.

Relates to her argument as the duty to the fetus is not absolute and unrestricted emphasizing the importance of bodily autonomy.

Judith Jarvis Thomson

On what grounds does Warren problematize Thomson's argument?

Warren addresses the assumption that if a fetus is a human being, then abortion is morally wrong. This assumption needs to be questioned; it is possible to justify abortion without necessarily determining the humanity of the fetus

Mary Anne Warren

characteristics required for moral humanity?

Personhood rather than genetic humanity, is the basis for membership in the moral community with full and equal moral rights. Fetus cannot be considered a member of moral community due to lack of personhood characteristics (consciousness, reasoning, self-motivated activity, capacity to communicate, self-awareness)

Mary Anne Warren

How does Steinbock respond to the disability perspective on abortion?

The disability perspective argues disabilities are forms of variation that should be affirmed, similar to gender or race. Abortion for disabilities discriminatory

Her view - opposes aborting fetuses likely to have a disability

Disabilities discriminatory (even if they're pro-choice)

Bonnie Steinbock

Are "disabilities" neutral forms of variation? Are "disabilities" medical problems or social constructs?

Disability - forms of variation (counters oppressive and stereotypical views about disability in society, counters disability is inherently bad/ disadvantageous/ problematic (social construct)

Disabilities are socially constructed

Bonnie Steinbock

Are attempts to reduce the incidence of disability permissible? Are certain means of reducing the incidence of disability permissible?

Attempts to reduce incidence of disability through prenatal testing, selective abortion

Consider factors: societal arrangements, effectiveness, cost, potential stigmatization in assessment of prevention programs

Permissible as long as they are done in a manner to consider

Bonnie Steinbock

moral difference between selective abortion and therapeutic interventions to prevent a person from developing a disabling condition?

Selective abortion - concern for discrimination (disabled individuals - society values the lives of disabled individuals less)

Therapeutic interventions - preventative intent (to avoid potential hardships associated with conditions)

Bonnie Steinbock

selective abortion contribute to the discrimination of disabled people

It may - terminate pregnancy based on presence of disability sends message society values lives of disabled individuals less

Bonnie Steinbock

Does selective abortion contribute to the discrimination of disabled people?

Yes - cultural pressures, availability of prenatal testing can lead to significant reduction of people with certain disabilities born

Elizabeth Dietz

2 harms Dietz argues

a. Harms associated with the use of prenatal genetic testing for disabling conditions

i. Harms of elimination - elimination of potential disabled people (societal/ cultural factors/ prenatal testing can lead to decrease in birth of individuals with disabilities)

ii. Harms from simplification (perpetrator perspective) - negative consequences from simplifying complex issues into individual choices within socio-legal systems

Elizabeth Dietz

What is wrong with designer babies?

Genetic enhancement for non-medical purposes (intelligence, memory, physical) is problematic.

Alters human nature to serve personal desires threatens the moral status of nature

Michael Sandel

real problem with genetic enhancement in Sandel's view

Form of hyperagency, a promethean aspiration to remake nature (human nature) to serve individual purposes and desires. Drive to master and control rather than appreciate gifted character of human powers and achievements

Michael Sandel

Why would Sandel disagree with Savulescu

Savulescu looks at moral permissibility of selecting traits to maximize well-being, Sandel looks at this drive for mastery and control over nature.

When designing children, threatens appreciation of life as a gift and loss of humility

Michael Sandel

Why does Julian Savulescu think there is a moral obligation to employ technologies to enhance human capacities?

Some non-disease genes affect the likelihood of leading the best life. Believes individuals have a moral duty to use available genetic information in reproductive decision making to select child to have best life

Julian Savulescu

define principle of procreative beneficence

Couples should select the child, among the possible children they could have, who is expected to have the best life or at least as good a life as others

Julian Savulescu

On what grounds does Savulescu argue we can extend his argument to non-disease genes?

Some non-disease genes affect likelihood of leading best life - reason to use information about genes in reproductive decision making

Should select embryo based on available genetic information even for non-disease such as intelligence even if it can maintain/ increase social inequality

Julian Savulescu

objections Savulescu considers against his view? How does he respond?

Moral obligation to test for genetic contribution to non-disease states to make decisions.

Unfairness better genetically endowed; class inequality rich can already buy what poor cannot; collective action problem race could make everyone better off; discrimination technology could be regulated to avoid this; undermines achievement many gifts are pre-assigned, praise nonetheless

Julian Savulescu

Define libertarianism

Political philosophy affirms the rights of individuals to liberty, acquire, keep and exchange their holdings.

Believe each individual is provided with an extensive set of strong rights against interference in personal and economic decisions

Jason Brennan

four assumptions does Brennan make at the outset of his paper? Why?

4 assumptions made:

i. Vaccines are highly effective

ii. Have low incidence of side effects

iii. Protect against serious illness

iv. The evidence for A-C is strong and widely available

Assumptions made to establish a foundation for the argument and focus the discussion on ethical aspects of mandatory vaccination within a libertarian framework.

Jason Brennan

Rights trumping during catastrophes argument and why is it insufficient for Brennan?

Rights trumping during catastrophes argument - individual rights can be overridden to prevent disasters

i. Insufficient argument for mandatory vaccination - situation does not quality yet as rights-trumping disaster, threshold for rights infringement not reached.

Jason Brennan

Paternalism argument and why is it insufficient?

Coercive policies for individual's own good - insufficient by Brennan

Libertarians typically reject coercive paternalism

Vaccine refusal not self-inflicted, extends to others, more necessary to address collective unjust harm than focusing on individual well-being

Jason Brennan

clean hands principle? How does Brennan use this principle to reach the conclusion that he does?

Clean hands principle - people who refuse vaccination violate this principle in collective imposition of unjust harm/ risk

i. Within libertarian framework - pressured to accepting certain vaccines because anti-vaxxers are wrongfully imposing undue harm upon others

Individuals should avoid participating in collectively harmful activities, justifies pressure to prevent participation

Jason Brennan

How do the authors' (Euzebiusz) limit the scope of their argument

Limit the scope to focusing on moral responsibility of individuals who choose to opt out of vaccination for non-medical reasons. Narrow discussion to moral implications of decisions and resulting harm to others in context of infectious diseases (eg. Measles)

Euzebiusz

How do the authors reach the conclusion that those who opt out of vaccination for non- medical reasons are morally responsible and morally blameworthy for their decision?

Emphasize the foreseeable harm caused by their actions - argue that the decision not to vaccinate contributes to the spread of preventable diseases and can harm vulnerable individuals

Individuals have a moral duty to contribute to herd immunity, failure to fulfill this duty makes them morally responsible and blameworthy for the resulting harm

Euzebiusz

Morally responsible VS morally blameworthy

Morally responsible - individuals have a duty to consider the potential harm their decisions may cause to others and take steps to prevent such harm

Morally blameworthy - individuals can be assigned blame/ culpability for their actions - their decisions are seen as contributing to avoidable harm

Euzebiusz

What objections do the authors (Euzebiusz) consider and how do they respond to each?

Consider objections related to individual autonomy, freedom, perceived legitimacy of coercive measures

i. Response - individual liberties must be balanced with the responsibility not to cause harm to others

ii. Emphasize importance of collective action for public health, certain limits on individual autonomy are justified when the consequences of individual actions pose significant harm to community

Euzebiusz

CRISPR-cas9

CRISPR-Cas9 is a powerful gene-editing tool that allows scientists to make precise changes to DNA. It is based on a natural defense system in bacteria and consists of two key components: the Cas9 enzyme, which acts like molecular scissors to cut DNA, and a guide RNA that directs the Cas9 enzyme to a specific DNA sequence. By using this system, researchers can add, remove, or alter genetic material in living cells, with potential applications in treating genetic diseases