christian bioethics final matlock

normative ethics

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

metaethics

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

4 characteristics of moral norms

- normative dominance

- universality

- impartiality

- reasonableness

moral obligations

concern our duty and our actions

moral values

- concern things we judge to be morally good, bad, praiseworthy, or blame worthy

- character or motives

actions

are morally right or wrong

people

are morally good or bad

absolute principle

a principle that applies without exceptions

prima facie principle

a principle that applies in all cases unless an exception is warranted

5 moral principles

- autonomy

- nonmaleficence

- beneficence

- utility

- justice

autonomy

- a person's rational capacity for self-governance or self-determination

- the ability to direct one's own life and choose for oneself

nonmaleficence

the moral principle that says we should not cause unnecessary injury or harm to one another

beneficence

- an attitude of goodwill towards others

- to actively promote the well-being of others and prevent or remove harm to them

utility

ability to produce the most avorable balance of good over bad (or benefit over harm) for all concerned

justice

respecting the rights of others and giving them what is rightfully theirs

inductive reasoning

- an argument intended to give probable support to its conclusion

- specific observations to general conclusion

- a type of logic in which generalizations are based on a large number of specific observations

- bottom-up approach

- ex: all swans you have seen are white, so all swans are white

deductive reasoning

- an argument intended to give logically conclusive support to its conclusion

- starts with a general principle or theory and applies it to a specific situation to draw a conclusion

- top-down approach

- ex: all dogs have four legs, so your pet, a dog, has four legs

modus ponens

- affirming the antecedent

1. if A, then B

2. A

3. so, B

modus tollens

- denying the consequent

1. if P then Q

2. not Q

3. therefore, not P

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

straw man

a fallacy in which the misrepresentation of a person's views so they can be more easily attacked or dismissed

ad hominem (appeal to the person)

the fallacy in which the rejecting of a statement on the grounds that it comes from a particular person, not because the statement, or claim, itself is false or dubious

appeal to ignorance

- a fallacy that tries to prove somehting by appealing to what we do not know

- argues that either a claim is true because it has not been proven false or a claim is false because it has not been proven true

begging the question

- a fallacy in which someone is trying to prove a conclusion by using that very same conclusion as support

- arguing in a circle

slippery slope

a fallacy that argues erroneously that a particular action should not be taken because it will lead inevitably to other actions resulting in some dire outcome

true or false: a moral theory explains why an action is right or wrong or why a person or person's character is good or bad

TRUE -- moral theoriess explain why an action os right or wrong, or why a person or a person's character is good or bad

consequentialist theory

asserts that the rightness of actions depends soley on their consequences

deontological theory

asserts that the rightness of actions is deternined 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

immanuel kant

- german philosopher

- championed the absolute principle

- separated science and morality into separate branches of knowledge

-science could describe nature, it could not provide a guide for morality

categorical imperative

- an unconditional moral obligation which is binding in all circumstances and is not dependent on a person's inclination or purpose

- "act only on that maxim through which you can at the same time will that it should become a universal law"

- "act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as if they are an end

natural law theory

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

- associated with catholicism

virtue ethics

- a moral theory that focuses on developing virtuous character traits to guide ethical behavior

- aristotle

feminist ethics

- an approach to morality aimed at rethinking or revamping traditional ethics to eliminate aspects that devalue or ignore the moral experience of women

- generally downplays the role of moral principles and traditional ethical concepts

- moral reflections must take into account the social realities (social practice, relationships, institutions, power arrangements)

casuistry

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

aristotle

- greek philosopher

- studied with plato

- virtue ethics

- good moral character

medical futility

the alleged pointlessness or ineffectiveness of administering particular treatments

paternalism

the overriding of a person's actions or decision-making for his or her own good

weak paternalism

paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished

strong paternalism

the overriding of a person's actions or choices although he or she is substantially autonomous

true or false: the court has established the principle that a competent patient has the right to reject recommended treatments, even life-saving ones

TRUE -- this is refusing treatment. the court has established the principle that a competent patient has the right to reject recommended treatments, even life-saving ones

the right to refuse treatment is problematic when (2):

- the patients are "mature minors" (minors, prisoners, minorities)

- parents reject medical treatment for their minor children

physician autonomy

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

3 pressures of physician autonomy on physicians

- penalties for low productivity

- pharmaceutical companies that encourage the use of expensive treatments of marginal efficacy

- patterns of physician reimbursement that encourage procedure-oriented interventions and minimize counseling

moral conflicts in nursing

- beneficence vs. patient autonomy

- patient-provider confidentiality

- truth-telling

- refusal of treatment

- informed consent

- futile treatment

do not resuscitate (DNR)

a written directive from a patient (or their legal representative) to medical staff, instructing them not to perform CPR if their heart or breathing stops

true or false: the primary aim of the hippocratic oath is for a patient to decide their care

FALSE -- the primary aim of the hippocratic oath is to guide physician conduct and focus remains on the physician's ethical obligations and commitment to upholding the principles of beneficence and non-maleficence

elizabeth bouvia

- case in which the issue was whether a competent patient has the right to refuse life-sustaining medical treatment

- had cerebral palsy & arthritis (limited movement)

- wanted to commit suicide by starvation

- hospital said no, gave her liquid diet

- court decided that competent adults have a "constitutionally guaranteed right" to decide for themselves whether to submit to medical treatments

helga wanglie

- medical futility

- 85-year-old who was put on a ventilator for breathing problems

- she went into a vegetative state

- physicians told helga's family the treatment wasn't helping & that it should be stopped

- family demanded it to continue

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

truth-telling as it relates to kantian ethics

- the morality of truth-telling seems unambiguous

- treating people merely as a means to an end is impermissible, a violation of the principle of autonomy

- lying to patients & breaking confidentiality are violations that have no exceptions; there would be no allowances made for extraordinary circumstances

- arguments that truth-telling could be injurous to patients and must therefore be done with an eye to medical consequences would carry no weight

- there would be no place for the notion that confidentiality may be set aside if there is a conflicting "duty to warn"

confidentiality

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

therapeutic priviledge

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

true or false: the hippocratic oath does not mention truth-telling & disclosure

TRUE --the hippocratic does not mention an obligation of truth-telling or disclosure

true or false: the hippocratic oath has physicians vow to keep everything their patient says a secret from others

TRUE - the hippocratic oath has the physician swear that whatever they see/hear, professionally/privately, which ought not be divulged, will be kept secret and they will tell no one

act utilitarianism

- the morality of truth-telling/confidentiality must be judged case by case, the right action being the one that maximizes the good for all concerned

- physicians must decide carefully what to disclose to a patient, calculating the impact that nay disclosure would have on the patient & anyone involved

- physicians must weight the effect of the choice on the patient, the physician-patient relationship, third parties who may be harmed by maintaining confidentiality, and themselves

rule utilitarianism

- tries to regulate actions by rule that, if generally followed, would result in the best consequences, everyone considered

- the greatest amount of good is produced by a rule stating that a physician should, with care and sensitivity, tell patients the truth about their condition

- it would be beneficial to patients and help foster trust in patients for their physicians and medicine- the best rules are those that require less than full disclosure to patients and less than absolute confidentiality

- the best confidentiality rule might demand full respect for a patient's privancy, except when maintaining confidentiality could put someone's life in danger

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"

- 1976 court case

- a boy said he wanted to a kill a girl & authorities let him go

- the boy killed the girl like he said he would & the family sued

- therapist is under the authority to disclose/breach confidentiality if someone could be seriously harmed

duty to warn

many believe that exceptions to confidentiality are justified when confidentiality must be weighed against other duties, such as the duty to prevent serious harm to the patient to others

carlos r

- carlos came to the hospital for treatment of gunshot wounds

- carlos told his physician that he was hiv positive

- physician advised carlos to have daily visits from a nurse to tend his wounds

- carlos was uninsured, and his sister consuela was going to take care of him

- carlos would let consuela be his nurse, but he didn't want her to be told about his hiv status

- she was unaware of his homosexual activity & he didn't want his father to know either

- physician has to choose between preserving carlos' confidentiality or breaching it to warn consuela of the risks involved in caring for an hiv-positive patient

arguments against full disclosure

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

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

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

counterargument in favor of full disclosure

- 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

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

- even if communicating the whole truth is impossible, physicians still have an obligation to try to convey to patients the essential and relevant information

- conveying "the whole truth and nothing but the truth" is unnecessary

4 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

2 conflicts in confidentiality

- is the obligation to respect confidentiality absolute (applying in all cases)?

- or is it prima facie (allowing exceptions when other duties obtain)?

informed consent

the act of an autonomous, informed person agreeing to submit to medical treatment or experimentation

legal case in which informed consent was first reported

salgo v. leland stanford junior university board of trustees (1957)

5 conditions of informed consent

- the patient is competent to decide

- they get an adequate disclosure of information

- they understand the information

- they decide about the treatment voluntarily

- they consent to the treatment

true or false: only the court can determine if a patient is incapable of making global healthcare decisions

TRUE - only the court can determine if a patient is incapable of making global healthcare decisions

true or false: when assessing for decision-making capacity, it is determined if a patient is psychologically or legally capable of decision-making

TRUE - assessing for "decision-making capacity" involves determining whether a patient or subject is psychologically or legally capable of adequate decision-making

true or false: if decision-making capacity is intact, generally the physician should respect the patient's choices

TRUE - if decision-making capacity is intact, the physician generally should respect the patient's choices

competience

the ability to render decisions about medical interventions

incompetent, surrogate

individuals who are ___________________ cannot give their informed consent, in which case the burden of decision-making falls to a _______________ (often a court-appointed guardian or a proxy selected through the patient's advance directive)

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

4 things 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

placebo

an inactive or sham treatment

single blind experiment

a technique in which the subject doesn't know whether they are receiving a treatment or a placebo

double blinding

the act of blinding both the subjects of an experiment and the researchers who work with the subjects

5 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 dfairly to avoid exploiting or unjustly excluding them

- the subjects' privacy must be protected, and the confidentiality of the reserach data must be preserved

- before the research is conducted, it must be reviewed and approved by an independent panel

institutional review board

a committee at each institution where research is conducted to review every experiment for ethics and methodology

3 moral principles that apply to human research

- autonomy

- beneficence

- justice

therapeutic trials

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

nontherapeutic trials

trials that are often justified by significant potential good to society

tuskeegee syphilis study

- study conducted between 1932 and 1972 to observe the natural history of untreated syphilis

- recorded syphilis history in black people

- when a penecilin cure became available, the participants were not given it

- took place in tuskegee, alabama

nuremberg code

- a set of minimal ethical principles meant to govern all scientific experiments involving humans

- emerged after world war 2

belmont report

- a set of ethical principles that guide research involving human subjects

- respect for persons, beneficence, justice

- written in 1979 by the national commission for the protection of human subjects

- developed in the 1970s by the us congress

declaration of helinski

- a set of ethical principles for medical research involving human particpants

- developed in 1964 by the world medical association (wma)

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 the woman's husband demands and the court allows.

psalm 139:13

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

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.

luke 1:44

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

dobbs v. jackson womens's health organization

- 2022 case that overturned roe v. wade

- ruled that the constitution does not confer a right to abortion, and returned the authority to regulate abortion to the states

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

- used kidnapping analogy

fetus

the unborn from the end of the eighth week until birth