Christian Bioethics Final Exam

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

Normative ethics

The study of the meaning and justification of moral beliefs

Meta-ethics

The use of moral norms and concepts to resolve practical moral issues

Applied ethics

Characteristics of moral norms

Normative dominance, universality, impartiality, reasonableness

Moral obligations concern our

Duty/actions (right or wrong)

Moral values concern things

We judge to be morally good, bad, praiseworthy, or blameworthy - character or motives (good or bad)

Applies without exceptions

Absolute principle

Applies in all cases unless an exception is warranted

Prima facie principle

A person’s rational capacity for self-governance or self determination

Autonomy

Asks us not to intentionally or unintentionally inflict harm on others

Non-maleficence

It says that we should do good to others

Beneficence

We should produce the most favorable balance of good over bad (or benefit over harm) for all concerned

Utility

Refers to people getting what is fair or what is their due

Justice

The view that right actions are those sanctioned by a person

Subjective relativism

The view that right actions are sanctioned by one’s culture

Cultural relativism

The view that there are moral norms or principles that are valid or true for everyone

Moral objectivism

An argument intended to give logically conclusive support to its conclusion

Deductive argument

An argument intended to give probable support to its conclusion

Inductive argument

Moves forward—you accept the cause, then conclude the effect

Modus ponens 

Moves backward—you reject the effect, then conclude the cause didn’t happen

Modus tollens

When an argument is distorted or exaggerated so it can be easily refuted rather than engaging with the actual position

Straw man

Dismisses an argument by criticizing the person making it rather than responding to the reasoning or evidence

Appeal to the person

Claiming a belief is true or ethical just because there is no evidence against it, or claiming it is false because there is no evidence for it

Appeal to the ignorance

Where the argument’s conclusion is assumed in the premise rather than demonstrated with reasoning or evidence

Begging the question

Argument suggests that permitting one limited ethical exception will inevitably lead to more dangerous or immoral practices

Slippery slope

An explanation of why an action is right or wrong or why a person or a person’s character is good or bad

Moral theory

Asserts that the rightness of actions depends solely on their consequences

Consequentialism

Asserts that the rightness of actions is determined partly or entirely by their intrinsic value

Deontology

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

Utilitarianism

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

Act-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

Rule-utilitarianism

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

Contractarianism

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

Casuistry

Jeremy Bentham

Famous utilitarian who made act vs. rule

John Stuart Mill

Famous utilitarian

Immanuel Kant

Made kantianism

Aristotle

Made virtue ethics and thinks the universe is made of earth, air, fire, and water

Tells you what to do always, because it is your duty, not because it benefits you or helps you reach some goal

Categorical imperative

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

Natural law theory

A moral theory that focuses on the development of virtuous character

Virtue ethics (virtues falls between two extremes)

Attributes of feminist ethics

• Women’s moral concerns are not as important as men’s

• Women are morally inferior to men (less mature or rational)

• The moral issues that arise from domestic or private life (the area traditionally relegated exclusively to women) are inconsequential

• The concepts or virtues traditionally associated with women in western cultures (community, nature, interconnectedness, caring, feeling, sharing, etc.) are not central to morality

The overriding of a persons actions or decision-making for his or her own good

Paternalism

The alleged pointlessness or ineffectiveness of administering particular treatments

Futility

Paternalism directed at person’s who cannot act autonomously or whose autonomy is greatly diminished (people who can’t make decisions for themselves)

Weak-paternalism

The overriding of a persons actions or choices although he or she is substantially autonomous (gets you legally in trouble)

Strong-paternalism

The courts has established the principle that a competent patient has a right to…

Reject recommended treatments, even life-saving ones

The right to refuse treatment is problematic when..

The patients are “mature minors” and parents rejecting medical treatment for their minor children

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

Physician autonomy

Moral conflicts in nursing

Must come to terms with beneficence vs. patient autonomy, patient-provider confidentiality, truth-telling, refusal of treatment, informed consent, and futile treatment

Issues is nurse-physician relationships:

• the traditional notion of a nurse as subordinate to physicians vs. the idea od nurse as patient advocate

• The nurse’s obligation to follow doctor’s orders vs. the nurse’s duty of beneficence toward patients

• What is the nurse’s duty to physicians when their orders seem clearly to be in error, likely to harm patients, or obviously in violation of patients autonomy?

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

Do not resuscitate (DNR) order

(T or F) The primary aim of the hippocratic oath asserted patients rights to decide about their own medical care?

False

The case of Elizabeth Bouvia concerned

Refusal of treatment

The case of Helga Wanglie concerned what some have referred to as

Medical futility

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

Main argument in favor of truth-telling

The action of an autonomous, informed person agreeing to submit to medical treatment of experimentation

Informed consent 

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

Confidentiality

Hippocratic oath and truth-telling or disclosure

Emphasizes a physician’s duty to act in the best interest of patients

Kantain ethics; act-utilitarianism; rule-utilitarianism (truth-telling)

Kantian - moral duty

Act - depends case to case - wants greatest overall good 

Rule - supports this general rule

In the landmark 1976 case, the court held that duties of patient-pyschotherapist confidentiality can be overridden when “a patient poses a serious danger of violence to others”

Tarasoff v. Regents of the University of California

In this case, the physician’s duty of confidentiality is challenged when Carlos, who is HIV positive, refuses to tell his sister Consuela even though she is caring for his wounds. Some argue confidentiality should be preserved since the risk is low, while others argue she has a right to know to make an informed choice. The resolution is that Carlos must either disclose his status or decline her care.

The case of Carlos R

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

Counter: many exaggerate the harm done to patients by full disclosure, underestimate the beneficial effects of truthfulness, and fail to recognize that misleading or lying to patients can also do damage

Argument: patients do not want to know the truth, especially if the prognosis is grim

Counter: data from surveys suggest that most patients really do prefer to be told the truth about their diagnosis

Argument: physicians have no duty to tell patients the truth because patients are incapable of understanding it 

Counter: (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

In the 1957 case, the court introduced the term “informed consent,” ruling that physicians must disclose all facts necessary for patients to make an intelligent decision about treatment. Later cases in the 1960s expanded this, establishing that valid consent requires physicians to inform patients about their illness, proposed treatments, risks, benefits, and available alternatives, including no treatment.

Salgo v. Leland Stanford Junior University Board of Trustees 

Components of informed consent

• The patient is competent to decide

• She gets an adequate disclosure of information

• She understands the information

• She decides about the treatment voluntarily

• She consents to the treatment

Courts and legislatures have mandated the disclosure of 

• 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

Who can determine a patient as being incapable of making global health-care decisions?

Court

(T or F) Only a court can make decisions of global health care decisions

True

Decision-making capacity 

• Determining whether a patient or subject is psychologically of legally capable of adequate decision-making

• Relates to the specific medical decision at hand and does not imply a global ability to make any or all decisions about health care or other matters 

• Lacking decision-making capability may result in decisions contrary to one’s best interests 

• If decision-making capacity is intact, the physician generally should respect the patient’s choices 

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

Wavier

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

Therapeutic privilege

The ability to render decisions about medical interventions

Competence

Katian ethics (informed consent)

Moral requirement

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

Clinical trial

A procedure for ensuring that subjects and researchers do not know which interventions the subjects receive

Blinding

An inactive or sham treatment

Placebo

The assigning of subjects randomly to both experimental and control groups 

Randomization

Only one doesn’t know

Single-blind study

Both don’t know

Double-blind study

Phases of clinical trial

• Blinding (1st and 2nd)

• Placebo

• Randomization

Ethical requirements for clinical trials

• Subjects must give their informed voluntary consent to participate 

• The study must be designed to minimize risks to subjects and offer an acceptable balance of risks and benefits 

• Subjects must be selected fairly to avoid exploiting or unjustly excluding them 

• The subjects’ privacy should be protected, and the confidentiality of research data must be preserved 

• Before the research is conducted, it must be reviewed and approved by an independent panel 

A committee that reviews research involving human subjects to ensure ethical standards, protect participants’ rights, and oversee informed consent before studies can proceed

Institutional review board (IRB)

Moral principles that apply to human research

Autonomy, beneficence, justice

Usually justified by the potential good to the subjects and to future patients or society 

Therapeutic trials

Trials are often justified by significant potential good to society 

Non-therapeutic trials

1947, created after the Nazi war crimes trials, established that the voluntary consent of human subjects is essential in medical research. It requires participants to have the legal capacity and freedom to choose without coercion, as well as sufficient knowledge of the study’s purpose, risks, methods, and potential effects to make an informed decision. Responsibility for ensuring valid consent rests personally on the researchers conducting the experiment.

Nuremberg code

First adopted in 1964 by the World Medical Association, built on the Nuremberg Code by establishing global ethical principles for research with human subjects. It emphasizes informed consent, independent ethical review of research protocols, and special protections for those unable to consent. It also addresses the use of placebos and asserts that the well-being of research participants must take priority over the interests of science or society.

Declaration of Helsinki 

In 1974 Congress created the commission to provide guidance on the ethical issues that arise in research on human subjects. The result of the commission’s work is this report, which lays out a general approach to thinking about research ethics and elucidates the three most relevant moral principles—respect for persons, beneficence, and justice.

Belmont report

1932, the U.S. Public Health Service withheld diagnosis and treatment from African American men with syphilis in order to study the disease’s natural progression. Even after penicillin became the standard cure, participants were denied treatment. The study’s exposure led to public outrage and major reforms.

Tyseggu syphilis study

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

Genesis 1:27

If men strive, and hurt a woman with child, so that her fruit depart from her, and yet no mischief follow: he shall be surely punished, according as the woman's husband will lay upon him; and he shall pay as the judges determine.

Exodus 21:22

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

Psalm 139:13

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.

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

Luke 1:44

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

Aristotle (abortion)

Believed it could be permitted before the fetus was fully formed or was ensouled

A landmark U.S. Supreme Court case that established a constitutional right to abortion under the right to privacy implied by the Fourteenth Amendment

Roe v. Wade 1973

Supreme Court case that upheld a Mississippi law banning most abortions after 15 weeks of pregnancy. In its decision, the Court overturned Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), ruling that the U.S. Constitution does not protect a federal right to abortion. As a result, the authority to regulate or ban abortion was returned to individual states.

Dobbs v. Jackson Women’s Health Organization