Bioethics final

Normative ethics

The search for, and justification of, moral standards, or norms

Meta-ethics

The study of the meaning and justification of

basic moral beliefs.

Applied ethics

The use of moral norms and concepts to

resolve practical moral issues.

Characteristics of moral norms

• normative dominance

• universality

• impartiality

• reasonableness

moral obligations

concern our duty—our actions.

moral values

concern things we judge to be morally good,

bad, praiseworthy, or blameworthy—character or motives.

actions vs persons

Actions are morally right or wrong.

Persons are morally good or bad.

right vs wrong

It refers to whether an action should or should not be done morally.

good vs bad

It refers to the moral value or character of a person, motive, or outcome.

absolute principle

applies without exceptions.

prima facie principle

applies in all cases unless an exception

is warranted.

autonomy

Respecting a person’s right to make their own decisions.

non-maleficence

The duty to avoid causing harm.

beneficence

The duty to help others and promote good.

utility

Producing the greatest amount of good or happiness for the greatest number.

justice

Fair and equal treatment of people.

subjective relativism

The view that right actions are

those sanctioned by a person

cultural relativism

The view that right actions are

those sanctioned by one’s culture

moral objectivism

The view that there are moral norms or

principles that are valid or true for everyone

deductive argument

An argument intended to give logically

conclusive support to its conclusion

inductive argument

An argument intended to give probable

support to its conclusion

modus ponens

Method of affirming

modus tollens

Method of denying

fallacies in moral reasoning

Errors in logic or reasoning that weaken an argument.

consequentalism

Asserts that the rightness of actions

depends solely on their consequences

deonotology

Asserts that the rightness of actions is

determined partly or entirely by their intrinsic value

utilitarianism

Right actions are those that result in the most beneficial balance of good over bad consequences for everyone involved.

act utilitarianism

The rightness of actions depends solely on the relative good produced by individual actions.

rule utilitarianism

A right action is one that conforms to a rule that, if followed consistently, would create for everyone involved the most beneficial balance of good over bad.

contractarianism

Moral or political theories based on the idea of a social contract or agreement among individuals for mutual advantage

casuistry

A method of moral reasoning that emphasizes cases and analogy rather than universal principles and theories

Jeremy Bentham

Utilitarianism was devised by this English philosopher

John Stuart Mill

This philosopher gave utilitarianism more detail and plausibility

Immanuel Kant

kantian ethics was developed by this philosopher

Aristotle

This philosopher is the primary inspiration for contemporary versions of virtue ethics

Categorical Imperative

Act only on that maximum through which you can at the same time will that it should become a universal law acting in such a way that you always treat humanity, whether and your own person or in the person of any other, never simply as a means, but always as the same time as they are an end

Natural Law Theory

The view that right actions are those that conform to moral standards discern and that in nature through human reason

Virtue ethics

A moral theory that focuses on the development of virtuous character

Attributes of feminist ethics

An approach to morality ain’t at rethinking or revamping traditional ethics to eliminate aspects that they value or ignore the moral experience of women

Paternalism

The overriding of a person’s actions or decision-making for his or her own good

Futility

Interventions unlikely to provide significant benefit to a patient

Weak paternalism vs Strong paternalism

Weak: Paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished

Strong:The overriding of a person’s actions or choices although he or she is substantially autonomous

Courts

The courts have established the principle that a competent patient has a right to reject recommended treatments, even life-saving ones

Reasons for refusing treatment may be problematic when:

the patients are “mature minors”

parents reject medical treatment for their minor children

Pressures associated with clinician

- Penalties for low productivity

–Pharmaceutical companies that encourage use of expensive treatments of marginal

efficacy

–Patterns of physician reimbursement that encourage procedure-oriented

interventions and minimize counseling

Physician autonomy

The freedom of doctors to determine the conditions they work in and the care they give to patients

moral conflicts in nursing

– Beneficence versus patient autonomy

– Patient-provider confidentiality

– Truth-telling

– Refusal of treatment

– Informed consent

– Futile treatment

DNR

A directive telling the medical staff to forgo CPR on a patient if their heart or breathing stops

Elizabeth Bouvia

A competent disabled patient sought to refuse force, feeding and life sustaining treatment. The court affirmed a patient’s right to refuse medical treatment, even if refusal leads to death.

Helga Wanglie

An elderly patient in the persistent vegetative state was kept on life-support at her husband’s request the case highlighted conflicts between family wishes and physicians claims of medical futility

Main argument in favor of truth telling

We must always respect people’s autonomy—their rational capacity for self-determination. Full disclosure respects their autonomy.

Confidentiality

An obligation or pledge of physicians, nurses, and others to keep secret the personal health information of patients unless they consent to disclosure

Tarasoff v Regents of the University of California

In the landmark 1976 case Tarasoff v. Regents of the University of California, the court held that duties of patient-psychotherapist confidentiality can be overridden when “a patient poses a serious danger of violence to others.”

case of Carlos R.

A bio ethics case about balancing true telling and confidentiality when a patient Carlos R is HIV positive and does not want his partner informed raising attention between patient privacy and preventing harm to others

Arguments against full disclosure

Physicians have no duty to tell patients the truth because patients are incapable of understanding it.

Truth-telling can be injurious, evoking in patients feelings of panic,hopelessness, fear, and depression

Counter arguments against full disclosure

(1) Even if communicating the whole truth is impossible, physicians still have an obligation to try to convey to patients the essential and relevant information;

(2) conveying the “whole truth and nothing but the truth” is unnecessary.

Arguments for confidentiality

- Without respect for confidentiality, physicians would have a difficult time fulfilling their duty of beneficence.

• Without respect for confidentiality, trust between physician and

patient would break down.

• Disclosure of confidential medical information could harm

patients.

• Persons have a right to privacy.

Salgo v. Leland Stanford Junior University Board of Trustes

A landmark court case that first introduced the term informed consent establishing that physicians have a duty to disclose risk, benefits, and alternatives so patients can make informed about their care

Components of Informed Consent

The patient is competent to decide.

2.She gets an adequate disclosure of information.

3.She understands the information.

4.She decides about the treatment voluntarily.

5.She consents to the treatment.

Information that must be disclosed to obtain informed consent

The nature of the procedure

• The risks of the procedure

• The alternatives to the proposed procedure, including the

option of no treatment

• The expected benefits of the proposed treatment

Decision making capacity

Assessing for “decision-making capacity” involves determining whether a patient or subject is psychologically or legally capable of adequate decision-making.

Waiver

The patient’s voluntary and deliberate giving up of the right to informed consent

Therapeutic privilege

The withholding of relevant information from a patient when the physician believes disclosure would likely do harm

Clinical trial

A scientific study designed to systematically test a medical intervention in humans

Blinding

A procedure for ensuring that subjects and researchers do not know which interventions the subjects receive (standard treatment, new treatment, or placebo)

Placebo

An inactive or sham treatment

Randomization

The assigning of subjects randomly to both experimental and control groups

Single blind study

Double blind study

Phase 1, phase 2, phase 3 clinical trails

Phase I trial—Tests the drug in a few people for safety and adverse reactions and ascertains safe and unsafe doses (nontherapeutic).

Phase II trial—Investigators give the drug to larger groups of subjects to get a preliminary indication of its effectiveness and to do more assessments of safety.

Phase III trial—Researchers determine whether the drug is effective, how it compares with other proven treatments, and how to use it in the safest way

Ethical requirements for clinical trials

1. Subjects must give their informed voluntary consent to participate.

2. The study must be designed to minimize risks to subjects and offer an

acceptable balance of risks and benefits.

3. Subjects must be selected fairly to avoid exploiting or unjustly

excluding them.

4. The subjects’ privacy should be protected, and the confidentiality of

research data must be preserved.

5. Before the research is conducted, it must be reviewed and approved

by an independent panel

Institutional Review Board (IRB)

An independent committee that reviews and approves research involving human subjects to ensure ethical standards are med and participants rights are in welfare are protected

Moral principles that apply to human research

Autonomy, beneficence, and justice

Therapeutic studies vs Non-therapeutic studies

Therapeutic trials are usually justified by the potential good to the subjects and to future patients or society.

• Nontherapeutic trials are often justified by significant potential good to society.

Nuremberg code

A set of ethical guidelines for human research developed after World War II, emphasize in voluntary informed consent, avoidance of unnecessary suffering, and the right to subject to with research

Belmont report

A US ethics guideline for research with human subjects that outlines three core principles respect for persons autonomy, beneficence, and justice

Declaration of Helisinki

A set of ethical principles for medical research involving human subjects developed by the world, medical association, emphasizing informed consent, protect protection of vulnerable groups, and independent ethical review

Genesis 1:27

“So God created mankind in his own image,
in the image of God he created them;
male and female he created them.”

Exodus 21:22

“If people are fighting and hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever

Jeremiah 1:5

“Before I formed you in the womb I knew you, before you were born I set you apart;
I appointed you as a prophet to the nations.

Psalm 139:13

“For you created my inmost being;
you knit me together in my mother’s womb.”

Luke 1:44

“As soon as the sound of your greeting reached my ears, the baby in my womb leaped for joy.”

Judith Jarvis Thomson

argues that even if the unborn is a person from the moment of conception, abortion may still be morally justified in some cases.

Mary Anne Warren

asserts that five traits are central to personhood. Any being that satisfies none of these traits is certainly not a person. A fetus satisfies none and is therefore not a person.

Roe v. Wade

A 1973 Supreme Court decision that established a constitutional right to abortion in the United States before fetal viability, later overturned in 2022 by the Dobbs decision.

Dobbs v. Jackson Women’s Health Organization

A 2022 Supreme Court decision that overturned Roe v. Wade and returned the authority to regulate abortion laws to individual states.

Fertilization

The union of sperm and egg to form a new organism

Zygote

The single cell formed at fertilization the earliest stage of development

Blastocyst

An early stage of development a few days after fertilization when the embryo is a hollow ball of cells

Embryo

The developing human about 2 to 8 weeks after fertilization

Fetus

The developing human about eight weeks after fertilization until birth

Spontaneous Abortion

An abortion resulting from natural causes such as a birth defect or maternal injury

Induced Abortion

The intentional termination of a pregnancy through drugs or surgery

Therapeutic abortion

Abortion performed to preserve the life or health of the mother

quickening vs viability

Q-A pregnant woman’s experience of fetal movement inside her (at about 16-20 weeks)

V-The development stage at which the fetus can survive outside the uterus

slippery slope

The idea that one action will lead to a chain of events ending in something extreme or undesirable

speciesim

The belief that one species is more important than others

fallacy of equivocation

A mistake in reasoning, where a word is used in two different meanings in the same argument

categorical imperative

A moral rule from Kant that says you should act only in ways that could be universal laws for everyone

doctrine of double effect

The idea that an action with both good and bad effects can be morally acceptable if the bad effect is not intended