HEALTHSCI 2601

Ethics

What is the right of informed consent in research (for research subjects)?

\-You have the right to medical care

\-You don't have the right to be a research subject (Eg. you can be excluded from a trial)

\-It is your free choice to "join" but is not guaranteed to you as an inalienable right

What are the four ethical principles of the Tri-Council Code?

1) Respect for persons (autonomy)

2) Non-Maleficence

3) Beneficence

4) Justice (Eg. can not do research on the same group of people all the time as you're not creating knowledge that helps all groups of people)

What is the Tri-Council Policy Statement? What does it promote? When is it used?

\-Is a joint policy that expresses the continuing commitment of three councils to the people of Canada

\-Promotes the ethical conduct of research involving human subjects

\-Must be used when public funding is involved in research

What does the Right to Standard of Care mean?

States that every patient including those of a control group should be assured of the best proven diagnostic and therapeutic method

What is the "end goal" or aim of research?

Goal: to test new drugs/medicines and obtain new information

Note: treatment may not always be effective/work!

What is the "end goal" or aim of therapy?

Goal: to cure the patient or repair them back to health

What are three key elements to consider when distinguishing the difference between therapy and research?

1) What is the aim/end goal?

2) Is the action diagnostic or therapeutic for the patient?

3) Are actions purely scientific without implying therapeutic value to the person subjected to the research?

What is the Nuremberg Code 1947?

This code is a law that states "the voluntary consent of the human subject is absolutely essential"

What two major atrocities led to the codification of Research Ethics?

1) Nazi Science

2) Tuskegee Institute (Alabama)

Why do we need Research Ethics?

1) Correct past problems and abuses

2) Prevent new problems and abuses

3) The law is not enough

What is the purpose of conducting research involving humans?

To advance human welfare, knowledge, and understanding, and to examine cultural dynamics

Define coercion

Doing something forcibly, against your will (NOT ALLOWED in research participation/recruitment)

Define inducement

Action taken due to a reward, still ultimately your choice (are allowed in research so long as they are not “undue”)

What makes inducements “undue”?

1. Something good, a gift, reward, etc.
2. Seems irresistible
3. Causes taking of unusual risk
4. Risk-taking creates unethical or excessively risky situations

What is a “no choice” situation?

A situation where we are forced to choose the offer because the lack of decent alternatives exists (an uneven choice)

What are two purposes of informed consent?

1. Allows competent individuals to decide whether participation in research is consistent with their interests
2. Allows individuals to decide for themselves whether they should participate in a study

What are the ecological impacts of animal farming?

1) Overpopulation of cattle and methane expulsions affect the ozone

2) Fecal run-off into water supplies

3) Grazing lands for cattle cause permanent damage to land surfaces

Define xenotransplantation

The growing of human tissue in a non-human host

What is Peter Singer’s (utilitarian) concept of personhood? (7 criteria?)

A person is any creature who meets all of the following criteria


1. Feel pain
2. Make own decisions
3. Foresee a future
4. Able to communicate (doesn’t have to be in human language)
5. Ability to reason
6. Self-aware
7. Autonomous

Define speciesists

One who discriminates against another’s rights by virtue of their belonging to another (non-human) species

(most humans are speciesists)

What are Peter Singer’s beliefs about abortion?

Accepts it as humans don’t reach personhood until at least 3 months after birth

What are Peter Singer’s beliefs about assisted suicide?

He accepts and encourages it, as humans who slip below personhood should not occupy resources that could be used for people

What are Peter Singer’s beliefs on xenotransplantation and animal research?

Disallowed

Define speciesism

A form of discrimination favoring those who belong to a certain species (or group of species) against other individuals

Resource allocation is considered an issue of _______

Justice

Define distributive justice

Refers to the extent to which society's institutions ensure that benefits and burdens are distributed among society's members in ways that are fair and just

What was Aristotle’s principle of distributive justice?

Believed equals should be treated equally and those who are unequal should be treated unequally

Define discrimination

Someone behaving in a prejudiced way against someone else for no reason

Define pluralism

\-A political theory that looks at policies and laws and evaluates if the same people losing every time

Define negative consent

Assuming someone will say yes unless they explicitly say no (gets tricky)

What makes people unequal in healthcare?

1) Medical need

2) Likely benefit (E.g.. percent chance of recovery)

Describe the substantive/material question of justice?

\-Answers the question: ‘Who should receive care first?’

\-Considers need, equality (Eg. equal resources for equal need), utility (Eg. do what will yield the greatest result), liberty (Eg. you can disqualify yourself from access by your decisions), restitution (Eg. access to healthcare with a focus on those who have been historically denied to unjustly treated

Describe the procedural/process question of justice?

Tells us how we apply the answer to “who goes first”

What are the seven values associated with resource allocation?

1) Maximizing benefits

2) Most lives saved

3) Most-life years gained

4) Equal treatment

5) Lottery system

6) First-come, first -served

7) Prioritize the worst off

What are typical moral objections to enhancement?

\-Cheating/unfairness

\-Harm to self, others, the institution

\-Intrinsic/extrinsic goods

\-Zero sum/non-zero sum

What are the four elements of cheating according to Stuart Green?

1. Rule must be fair and fairly enforced
2. Rule-breaking must take place in cooperative rule-governed activity (as people have agreed to compete under the same conditions)
3. The rule-breaker must intend to break the rules
4. The rule-breaker must intend to gain an advantage

Define zero-sum

Suggests there is a winner, and everyone who falls behind has lost

Define non-zero-sum

There is no single prize for one person/team to claim

What does ‘resistance is futile’ means in regard to enhancement?

Relies on historical inevitability, meaning that boundaries were shattered in the past, therefore boundaries will fall in the future

What are three arguments for enhancement?

1. Human nature as raw material (should be molded as we desire)
2. Human nature as contours of the given (some enhancements fit within the contours of our given nature)
3. Human nature as a normative guide (guides us in our choices concerning enhancement)

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What is a Baloney Detection Kit?

\-A set of cognitive tools and techniques that fortify the mind against penetration by falsehoods 

\-9 tools 

\-20 “what not to dos”

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What is Meta-ethics?

\-Foundations of your ethical beliefs

\-Talking about ethics, not about ethical issues (theory, not application)

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What are the three requirements for an ethical theory?

1) Epistemological requirements

\-Based on evidence (falsifiable or verifiable?)

2) Logical requirements

\-Consistent

3) Practical requirement

\-Must be livable

What is a false positive lie?

A false statement but the effect is positive

Eg. “Your muffins are the best ever”

What is a false negative lie?

Something false is said to have a negative effect on the person

What is a lie by commission/omission?

\-The truth but not the whole truth (factually accurate but incomplete)

What is *Occam’s Razor?*

\-A philosophical tool for “shaving off” unlikely explanations

\-When faced with competing explanations for the same phenomenon, the simplest is likely the correct one

Define descriptive ethics

Involves not judging the rightness or wrongness of these actions, simply describing them in detail to understand the context

Define prescriptive ethics

**J**udges a behaviour as ‘good’ or ‘bad, ‘ethical’ or ‘unethical’

Define realism

The idea that universal ethical truth (facts) exist outside of the mind

Eg. In science some things are true we just haven't discovered it yet (this doesn't make it any less true)

Define anti-realism

Denies that a universal ethical truth exists

What is categorical imperative?

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Our duty to act in such a manner that we would want everyone else to act in a similar manner in similar circumstances towards all other people.

What is practical imperative?

People are not to be used unjustifiably in order to obtain their goals or seek an edge or unfair advantage (do not treat people as a means to an end)

What are the four aspects of autonomy?

1) Free action

2) Effective deliberations

3) Authenticity

4) Moral reflection

What is informed consent

When we have the right to self-determination in medical matters and are free to choose whatever option we want for ourselves

What are the four elements of consent?

1) Relate to the treatment

2) Be informed

3) Be given voluntarily

4) Not be obtained through misinterpretation

What are the six items on a Legal Consent Checklist?

1. Nature of treatment
2. Expected benefits
3. Material risks
4. Material side-effects
5. Alternatives (E.g. other treatment or medication options)
6. Likely consequences

According to the Royal College of Physicians and Surgeons of Canada a physician has primary responsibility for ensuring that such communication occurs…

1. Provide patients with a reasonable data
2. Possible alternatives
3. Risk of all possible procedures
4. Without coercion
5. Should encourage patients to make their own decisions
6. Restrict your comments to your area of expertise

What are three meta-ethical approaches?

1) Ethical objectivism/realism

2) Ethical relativism 

3) Ethical non-cognitivism 

What is ethical objectivism/realism?

Ethics to these people is objective/real and truth exists even if we haven't found it yet 

Define ethical naturalism

Moral facts are observable, measurable features of the natural world 

Define non-naturalism

The belief that moral facts are not observable features of the natural world (require specialized intuitions) 

E.g.. “Morally good” is what God commands

What is ethical relativism?

The belief that ethical statements are true or false relative to a particular **person, culture** and **historical/situational context**

What is ethical non-cognitivism?

The belief that ethical utterances are not really statements that can be validated as they do not assert anything objectively true or false, they assert on your opinion on the issue (not dealing with facts) 

What is an ethical theory?

Provides moral guidance that is **clear**, **rational**, **systematic**, **defensible**