PHIL 225 study guide

What is the distinction between therapy and enhancement, and what factors complicate that distinction?

Therapy is the idea that one is below average to average. Enhancement is average to above average. The distinction is now the normal average is now pathological

How can the line between therapy and enhancement change over time?

The line changes over time between therapy and enhancement bc if everyone take drug enhancing drugs the average will increase leading to overmedication of certain diseases

What is diagnostic bracket creep, and what factors can drive it?

as the old normal becomes below normal, what used to be the low end of normal now falls into the category of the pathological

What are Sandel’s worries about certain employments of technology?

we will lose appreciation for random giftedness, appreciation of talent/ hard work, loss of sympthy, loss of compassion and solidarity, burden of RESPONSIBILITY

What does he mean by the things Sandel flags as ethical worries?

explosion of responsibility on the parent know the child has to live up to the expectation of the parent as many parents see their child as an extension of them and they have less control over who they want to be.

What’s a famous case we considered involving clinical trials conducted in developing countries, and what were the ethical concerns about it?

This has to do with HIV transmission and how testing for cheaper HIV drug alternatives when there is knowingly an effective medication already. The reason for the clinical trials was to see if they could make the medication cheaper but less effective in lower income countries. There are two ethical concerns: 1) placebo: people are getting 0 benefit when there’s medication already out there. 2) coerision: the people in the trial are going to say yes due to desperation.

Explain the distinction we developed in class between the post hoc perspective and the ex ante perspective. How might this distinction come in to the analysis of certain bioethical issues involving disease or disability?

post hoc is having had the disability that you look back, and they can still appreciate the disability or not regret having it. The ex ante perspective is when a parent BEFORE having a child (think reverse PGD). This distinction is important because it brings in the idea of the oversimplied dichotomy between a disability (loss of a skill) and a mere difference (variation of function)

In particular, how might this distinction help us to see the compatibility of certain claims about procreative moral responsibilities or norms, on the one hand, and values such as the moral equality of persons, on the other hand? Which authors were centrally concerned with those issues?

The most important author is Bonnie Tucker who believed that as a parent it should be your obligation from an ex ante perspective that you ensure that your child has an many opportunities opened in the future. Although Robert Couch believes that from a post hoc perspective that people don’t need to get the implant surgery, they can have a disability and still thrive and flourish in life.

What were the legal arguments (in the 1997 Supreme Court cases) for and against a constitutional right to physician assisted suicide (PAS)?

Washington v Glucksberg: PAS should be allowed to have PAS due to the 14th amendment in the due process clause.

How does Cruzan respond to the Washington case? How does Requist respond?

Cruzan says that we have the right to autonomy which gives us the right to refuse treatment. Requist responds to this and says that we do have the right to withdraw from treatment due to the principle of autonomy but it is more about the right against battery, so PAS is wrong because it doesn’t align with the 14th amendment

How have some argued (on moral grounds) that a right to PAS for terminal patients would equally imply a right to active euthanasia, and that both should then also be extended to non-terminal patients?

Quil: we, by not letting non terminal ppl die, we are discriminating against these ppl who are helpless (the ethical principle principle are compassion and authority)

In class we distinguished 5 different ways in which a physician might be involved in some way in a patient’s death. What are they?

withdrawal of aid, death-healing pain control, terminal sedation, PAS, active euthanasia.

withdrawal of aid

ceasing/ stopping aid/ life sustaining treatment and patient’s demands. This is perfectly legal to do now and required if the patient demands/ wants this (legal everywhere)

Death-Hastening Pain Control (DHPC)

administer pain control as necessary, though this level hastens organ failure. Legal everywhere. Just have to justify that you aren’t going to kill the patient (that would be euthansia), but rather that it is just to help w pain even if it might lead to organ failure but the aim was the pain

Terminal Sedation (TS)

i.e., induce and maintain unconsciousness + #1, and patient dies of underlying disease or dehydration/starvation; But there is no (eessential) intention of death (though maybe there is if nutrition/ hydration withheld)

Physician-Assisted Suicide (PAS)

Note: not just any loose ‘enabling’ of suicide, as by providing moral support or holding the patient’s hand while she kills herself, or controlling her pain while she refuses nutrition and hydration and dies from that (e.g., BB). Rather, PAS is enabling suicide by providing the deadly means the patient uses to kill herself, e.g., giving her a lethal prescription, which she then uses to kill herself. (Only legal in 13 states, it’s not abt the plan, it is the idea that the physician just giving them support, it is enabling them by providing them a lethal prescription that they could use to (for example be ingested) for them to die). Intention os self-killing

Active Euthanasia (AE)

Legal in canada and more common than PAS in canada. This is when the intention is death and is active bc the physian is administering something like a lethal overdose when the patient dies. In each case, identify which of the following are essentially involved: (a) killing (or aiding in killing) (b) letting die (c) intention of death. Illegal and the intention is there

What is the difference between death-hastening pain control and active euthanasia? Why does the Catholic Church allow one but reject the other?

The catholic church rejects all forms of euthanasia (killing innocent people is never okay) but stopping of treatment and admin of pain meds is okay because it doesn’t intend death—for the catholic church it is all about intention; as long as death is not intended that hastening a death in some way is okay—euthanasia is worse because it intends death

What complications arise in connection with DNR orders or advance directives, and how might they be addressed? E.g., problems of interpretation; problems of past wishes vs. present interests. What further information can be very useful in helping to avoid problems of interpretation (apart from having a proxy involved, which is also helpful)?

it is important to include rationale. In an advance directive, never put me on a vent, but most likely mean, but mean doesnt put me on for years when im in a vegetative state, but put me on a vent after surgery because it runs into the idea of during times of whether you shoudl undertreat or overtreat

What are the central ethical issues that arise in connection with ‘genetic abortion’? What are Kass’s slippery slope arguments and how might one respond to them?

If we allow genetic abortion this will erode our attitudes and behaviors toward fellow human beings in the world who have the genetic defects or diseases that we abort for, aka imply that ppl w genetic defects are second class citizens. Kass’s slippery slope argument is if we allow genetic abortion, this will unavoidably lead to the erosion and abandonment of the belief in the radical moral equality of all human beings, the belief that all human beings possess equally and independent of merit certain fundamental rights. To respond to the slippery slope, by saying that it is morally justifiable to prevent people from coming into being with great genetic defects in favor of bringing healthy people into being and that all humans deserve love and respect.

Would his arguments against genetic abortion equally apply to the use of PGD for similar purposes, and is such an argument against PGD plausible?

No, in genetic abortion, the child already exists while for PGD, you would choose the one without a disability, so PGD happens before fertilization. But on the substance of applying the principle, yes, the argument is the same bc there’s a belief against certain possible lives on the basis of genetic traits.

What is Purdy’s view about using PGD or, if necessary, genetic abortion for very serious cases of genetic problems? What is her support for this?

avoid bringing ppl into the world w/ disability/ severe genertic disease that you can know abt w testing. She thinks that PGD and genetic abortion are justified and/ or bligatory

What were the key features of Roe v. Wade? What were the principles underlying the decision?

1) right to privacy (sphere of influence on women’s right), 2) The state’s (increasing) interest in protecting potential life. This is why each state has diff policies (to protect women’s health and to protect potential human health which is why some states dont allow abortions after the first trimester)

What was the major source of controversy surround embryonic stem cell research?

considers blastocyst human because it is totipatent so it has the potential to become a human organism.

How did one family we read about and discussed use PGD not just to ensure the health of the child they were creating but also to serve a medical purpose for someone else? What was the name of the girl with Fanconi anemia who was successfully treated with umbilical cord blood from her sibling who was created using PGD?

Case where the child was created to help her sister live (so with medical use). creening for histocompatibility with an existing child, to select an embryo to be a good HLA match so that the resulting baby can serve as an umbilical cord blood donor for the existing sick sibling. Person’s name is molly nash

What are some ethical issues that could arise in some hypothetical variants of this case that we considered?

brought child to life to help with sick daughter. The child has never consented to donating. What if the embryo that was selected was a match but also put the person for a different disease at a higher risk. Also look at dead donor rule: Whole brain death (dead but still circulating), Irreversible cessation of circulation and respiratory function. (recent push to have 2-5 mins after cardiac arrest)

What famous court case did we discuss involving informed consent, where a young man (who wound up paralyzed) was found to have been denied information about risk that he should have been given in order to have been able to provide truly informed consent to his surgery? What principle did the court articulate in that decision?

Canterbury v Spence. Doc didn’t tell Canterbury that there was a 1% chance of being paralized bc it was such a small percentage and it would prevent him from taking the surgery. Docs are required to tell you material risks “when a reasonable person , in what the physician knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether or not to forego the proposed therapy”

Are we human organisms? Were we once blastocysts?

human organisms are embodied minds. We were never blastocysts.

How would McMahan answer the question of what we are and abt blastocysts

he would say we are organisms after 2 weeks. would bring up the twin example and the transplantation of the brain and the conjoined twin example. WE ARE EMBODIED MINDS.

What moral status does a blastocyst have or lack, and why?

25 weeks. Local moral status b/c they’re dividing cells. Need Personhood and the realization and enjoyment of the many human goods that typically make living a human life rewarding and give it meaning for us

How might considerations of cloning technology be used to cast doubt on the moral significance of totipotency?

Cloning technology shows that even ordinary body cells (like skin cells) can potentially become full organisms under the right conditions. But we do not think skin cells are people with rights. So just having the potential to become a human being (totipotency) cannot be enough to make something a full moral person. This weakens the argument that embryos are persons simply because they are totipotent.

What implications might this have for end-of-life decisions? (cloning and totipocy)

would say that based on the life-centered view, so they have to keep treating even in a veg state.

What is death, for McMahan? How do the distinctions he makes complicate use of the dead donor rule for organ transplantation decisions? Should the dead donor rule be modified?

alue human life contextually, as part of valuing the human person, as opposed to focusing on the human organism as such. This complicates the use of the dead donor rule bc which says organs can only be taken from someone who is already dead, but the problem is that modern tech has diff def of death. For ex: So McMahan’s view suggests the DDR may be too focused on organismic death rather than personal death

What is and is not meant by claims of disability or impairment or pathology?

disability: sig effect on skills, impairment: minor loss and can be fixed, pathology: below average

What are some ways in which people might sometimes be talking past each other in this debate, as discussed in class? How might the distinction between ex ante and post hoc perspectives help here? Would blindness be an impairment and disability in a non-human animal that normally has the capability of sight, e.g., in a fox? How about in a human? To what extent do cultural factors make a difference (or not make a difference) here?

people like Crouch like their disability and believe that they flourished (post hoc). Blindness is a disability, harms everyday life. Mere difference doesn’t play a role (something like hair color)

How is a slippery slope argument supposed to work? What would you need to show in order to make a slippery slope argument compelling? How might one try to refute such an argument?

Embracing X will put us on a ‘slippery slope’ to Y (which is bad), because the rationale R for X would equally justify or commit us to Y. To make it compelling you have to allow or lead to some other morally reprehensible thing. to refute it, all you have to do is think of one way in which that inevitability would not happen (for ex: w genetic abortion: one critique of this is that it relies upon the assumption that fetuses are human beings and have the same rights as human beings and sau it wouldn’t happen

In class we looked at a number of ethical complications that arise in connection with potentially rationing scarce life-saving resources such as ventilators during a pandemic. What are they? More generally, what roles do structural injustices or inequities (past and present) play in explaining the disproportionate impacts of the pandemic on minority communities (higher rates of infection, hospitalizations, deaths)?

Who gets them? measured through focus on years rather than lives (young and not old- ageist). The main approaches are QALY (adjust by quality of life but can be ableist). NY used the imminent benefit. The last one was SOFA which can be seen w medical benefits most effectiently. But some ppl’s scores might be lower due to past injustices. Lack of housing, edu, environment

Suppose we adopt a policy of allocation based simply on degree of medical need for the ventilator together with likelihood of benefit from it (in terms of at least surviving the current health crisis and going home from the hospital): how might even this objective policy, which does not directly consider factors such as age or disability, wind up indirectly discriminatory against members of racial minority groups?

The greater way to make this fair is the Multi-Principle Allocation Framework- where the lowest score is the highest priority, look at health outcome, end stage condition, etc. Takes into account multiple things

What are the fundamental ethical values that help determine the proper goals of a health care system? How do some authors we read argue from certain basic ethical values to conclusions about what a health care system should look like in a decent society?

Nielsen: To meet the health care needs of everyone [in the society] and meet them…equally. Daniels: people have a right to basic health care, though this right has limits

What are the key features of a just health care system according to such arguments?

Axiom of Equality: A decent society is premised on the idea that each of its members possesses a basic human dignity or worth such that each person (or each person’s life) matters and matters equally (in terms of intrinsic value): we are a society of equals.

How does the U.S. health care system (both prior to the Affordable Care Act and since its passing) compare to health care systems in various other developed, capitalist countries? How do we compare in terms of spending? In terms of access, efficiency and equity?

more spending, decreased access, less efficient, and less equitable. People are required to get healthcare, but the prems can still be too expensive (ppl will pay the fine to not have it)

What are some of the central features of the U.S. system that differ from features common in other countries? (As one illustration: what happened to someone featured in one of the films we watched, who had lupus?)

girl died bc they sent her mail that said she didnt have insurance anymore, but could have been curable. Since she waiting she got worse and had to get a million dollar procedure. two days after she died they said jk she was insured.

What basic changes were made by the ACA? Was it a “government takeover of healthcare”? What is the main argument behind imposing an individual mandate in the ACA (or in any system where insurance companies are required to cover all who apply, i.e., “guaranteed issue”)?

mandatory, insurance could not say no. Not a gov takeover just a baseline. Since have private insurance from employers, just mandated to have healthcare. this led to risk pooling (prev only unhealthy ppl got it so free loading)

What are some of the main options for trying to move closer to the goal of universal, high-quality coverage, and what are some of the advantages and challenges of each?

pro: everyone have healthcare. medicare for all and doesn’t have to be one-payer, but if everyone as healthcare, it would be more cost efficient, but not policitically feasible. Con: not everyyone can still pay.

What are the economic and moral worries about a largely private system that includes guaranteed issue without a mandate?

economic: w standard quality control, it’ll offer low vs expessive policies for healthy ppl vs non healthy ppl → sky rocket price for not health. Morals: everyone needs healthcare.

What is health care rationing? Do we ration health care now? Should we? If so, on what basis? What are Peter Singer’s views on this?

prices are already high so we are. healthcare rationing for those who can afford healthcare or at least are employed to have healthcare. Prev, insurance companies could reject you for having minor health issues. Peter Singer says we should ration bc its inevetiable and it is currently unfair, but if it was regulated it would be a little less unfair.

What are QALY’s? What ethical problems arise for focus on QALY’s?

bias against those who are disabled. They have worse quality of life