biomed ethics chap 1-6 combined

What is euthanasia?

Bringing about the death of a person in their INTEREST. Death is considered to be in the benefit of the patient

what is active euthanasia?

doing something deliberately to cause death ex: administering a lethal injection

what is passive euthanasia?

Withholding or discontinuing life support (e.g., DNR) WLST

how is assisted suicide considered different from euthanasia?

in suicide the person is causing their own death vs euthanasia another person is causing it. Assisted suicide does not legally require a death to occur, rather it is when one provides another person with the means to death, regardless of that person using those means

What is voluntary aid in death?

PAD + WLST done with consent of the pt/sub decision maker

what is nonvoluntary aid in death?

PAD + WLST done without consent of the pt/sub decision maker

what is involuntary aid in death?

PAD + WLST done contrary to the request of the pt/sub decision maker (ex: in the rasouli case)

What are Dan Brock's 2 central arguments to legalizing PAD?

1. Individual self-determination 2. Individual well-being.

Believes if we have a moral right to determine our own life path, and a moral right to minimize our own suffering = we have a moral right to PAD from a Dr willing to provide it

What is the constitutional argument for legalizing PAD?

Claims that prohibiting violates charter rights, as it infringes on life, liberty and security of person

Why does the hippocratic tradition suggest that PAD is intrinsically wrong?

values that drs are healers, therefore must promote health + protect life, so PAD is considered to be wrong

What is terminal sedation?

considered good med. prac. drs unable to relieve suffering with a non-lethal dose of medicine, are permitted to administer a lethal dose.

what is the doctrine of double effect (DDE)

the principle that a proposed action will have benefits, but will also cause harm = this is permissible if the action itself is morally appropriate and the foreseen harm is not intended

What are possible problems with the doctrine of double effect?

it can be challenging to identify the intentions behind actions, must distinguish between direct and oblique intentions, and lies upon the view that drs should never intentionally kill patients.

What does Brock argue in respect to PAD and the possible negative consequences of it?

Can individuals ever be competent, informed and fully able to make decisions regarding PAD, and the legalization of PAD would be a slippery slope

the supreme court of BC found that legislation cannot prohibit competent adults to access to PAD in what 2 circumstances?

1). they clearly consent to the termination of life 2). have a grievous medical condition that is irremediable (cannot be alleviated by means acceptable to the individual) and causes suffering that is intolerable + enduring

what are legal limitations/considerations to the access of PAD

1). defining who has PAD access 2). possible safegaurds against misuse/abuse 3). Are accomodations for conscientious objection permitted?

what does Callahan argue in respect to PAD?

Argues against euthanasia. Argues legalizing euthanasia distorts the moral boundaries of medicine, undermines respect for life, and risks turning killing into a form of medical treatment.

What does Boyle argue in respect to terminal sedation?

Argues terminal sedation is permissible under the double doctrine effect. The intended and foreseen consequences of terminal sedation are not the same as euthanasia.

What does Rachel's argue in respect to active and passive euthanasia?

Argues that no moral difference exists between active and passive euthanasia. Active euthanasia should be permitted for compassionate reasons. Belief that "letting die" in passive euthanasia might prolong suffering.

What does Brock argue in respect to the permissibility of voluntary active euthanasia?

Argues that self-determination and well-being are grounds for the legalization of voluntary active euthanasia. Autonomy should be permitted for pts to choose when and how they will die.

what is the conservative theory?

that the fetus has a right to life from the point of conception onwards.

what is the liberal theory?

the fetus lacks a right to life sufficient to compete with a woman's right to control her body at all stages of development

what is the middle theory?

the fetus lacks a right to life up to a particular point, after which it has a right to life.

What is the priority of a woman approach?

even if a fetus is ascribed a right to life, abortion is still justifiable in a wide range of circumstances

what does Don Marquis argue in "Why Abortion is Immoral"?

abortion is wrong in most cases as it deprives a fetus of a "future like ours" = argues that it is comparable to killing a human being

What does Warren argue in "On the Moral + Legal Status of Abortion"?

Being genetically human does not automatically confer full moral rights, rather personhood relies on a criteria of traits. Thus, a fetus's right to life can never override that of a woman's right to her body.

What does Thomson argue in "A Defense of Abortion"?

Argues that a right to life does not equate to the right to use someone else's body to sustain that life. No person is morally required to make large sacrifices to sustain the life of another person.

What is professional autonomy?

healthcare professionals have a right to say "no" when asked to act in ways that conflict with their professional obligations

What are professional responsibilities/ethics?

Duties that providers owe to patients, colleagues and their profession

What is futility?

Treatments that are considered medically useless, therefore providers can refuse to offer it

What is physiological futility?

A treatment that is considered to have no chance of benefit

What is gatekeeping?

A role played by healthcare providers in determining who has access to healthcare.

What is negative gatekeeping?

The obligation of providers to prevent patients from receiving treatments/tests

What is positive gatekeeping?

Obligations of providers to get patients through the gate and into the system to enable them to receive care

What is the tragedy of the commons?

when each individual seeks to maximize personal benefit from a scarce resource so that demand overwhelms supply and the resource is no longer available to some or all.

What does Milton Weinstein argue in respect to professional ethics?

Doctors act in the interest of their pts always = overuse of resources.

Solution: impose constraints (rules) instead of relying on drs bedside cost-benefit analysis.

What is the societal reciprocal obligation?

Society must support and compensate providers. To ensure adequate resources, compensation in the event of injury

What is conscientious objection/refusal?

Healthcare providers can refuse on moral grounds to provide a treatment that is permitted by standards of their profession.

What did Pellegrino argue in respect to patient and physician autonomy?

Argues that drs. have moral and professional obligations, both dr + pt autonomy must be balances via a shared decision making process

What did Truog argue in respect to medical futility?

The definition of what is "futile" is problematic, and often lies on moral judgements about quality of life/amount of suffering, rather than on medical physiological fulility. Decisions should be made with values + goals of pt in mind

What does Schuklenk + Smalling argue in respect to conscientious objection

Drs should not have the ability to refuse treatment as it bars access of pts to care, puts the dr's values above the pts.

what is the traditional model of access to information?

(theraputic model) Dr. controls all info. Patients may be denied full/accurate info. Condones lying + withholding if it prevents harm

what is the modern model of access to information?

drs must disclose, full, accurate info to competent pts. No lying or withholding. Essential for informed decision-making about treatment and life choices (esp. with terminal illnesses).

what is the definition of lying?

communicating something false with the intention to deceive.

what is the definition of withholding?

not disclosing something true, effectively leaves the person ignorant

What is Immanual Kant's stance on lying?

Believes that lying is ALWAYS wrong with no exceptions, regardless of consequence/intent. Lying undermines trust. If 1 lie is told, how can one believe that anyone is telling the truth? This is a maxim.

In what events may it be considered right to lie?

In the event of preventing harm (medical, psychological, emotional) it may be justified.

What does the traditional model say in respect to access to medical information?

patients are denied access to own records, as they contain professional notes/opinions that may cause unnecessary worry + technical jargon that may be confusing/misunderstood by pts.

What does the modern model say in respect to access to medical information?

access to records are essential for informed decisions. Supports pt autonomy + participation in one's own care

What is the definition of confidentiality?

Providers cannot reveal medical info without the pt's consent. Includes what a pt discloses during treatment, drs conclusions during examination/assessment, all medical records, direct communication btwn patient + dr.

What is the hippocratic oath?

Originated in ancient greece. Drs pledge to remain silent about things seen/heart in treatment that should not be shared. Still used in modern day to emphasize respect for pt privacy.

What are some possible exceptions to the duty of confidentiality?

Professional codes and laws may permit disclosure without pt consent in certain cases. Ex: canadian psychologists can disclose if confidentiality would cause serious harm/loss of life to others/oneself.

What are the 2 policies on confidentiality?

Unqualified (absolute) confidentialiy + Qualitifed confidentiality

What is unqualified (absolute) confidentiality?

Info is never shared without pt consent. Argues absolute confidentiality = better consequences than any other alternative.

What is qualified confidentiality?

Some info obtained during treatment will be passed to others under some circumstances, even w/o pt consent. Ex: disclosure prevents serious harm to others, disclosure req. by law, disclosure benefits public (research, stats).

What is primary use of medical information?

Medical information that is used to benefit the patient and their treatment

What is secondary use of medical information

Any use of medical info that does not benefit the pt and their treatment. Ex: medical research, stats, management of care cost, commercial uses

This can be permitted under qualified conf. even w/o pt consent

What is de-identification of pt information?

Standard practice to strip records of name/identifiers b4 secondary use. Protect privacy. However, with other available data individuals can often be re-identified.

What is genetic exceptionalism?

The concept that genetic information is special, and must be treated with greater care. ex: prevent discrimination by insurance companies/employers based on genetic tests

Why is genetic information unique from other medical information?

can reveal information about relatives (not just the pt.) can predict future health outcomes (prophetic).

What was hippocratic tradition?

emphasized paternalism, doctors acted in the patient's best interest, even if it went against their wants

What is patient/family centered care?

modern day, care is autonomy based. Focuses on the decisions and wants of the patient and family

What 3 factors need to be true for a patient to make their own decisions?

1. have the capacity to make decisions 2. voluntary decision 3. informed consent.

what happens when a pt. cannot decide for themselves?

A substitute decision maker is used. Usually someone who knows the pt. well, or a court/doctor-appointed person

what are the two types of substitute decisons?

1. substituted judgement 2. best interest judgements

What is a substituted judgment?

is based on the decision the pt would have made for themselves. Based on their values, beliefs + preferences

What is a best interest judgment?

the decision that a reasonable person in the patient's circumstances would make. This is typically a last resort.

what is the capacity for decision making?

the ability to understand decisions and consequences without being distorted. (ex: illness, mental states)

what are the degrees of capacity?

the required level of capacity relies on risk. High risk = higher standard, low risk = lower standard.

what is a voluntary decision?

a decision that is not the result of undue influence. (ex: coercion, manipulation, adverse conditions)

what is the feminist perspective of voluntary decsions?

women/vulnerable groups make decisions based on oppressive conditions. we should not limit autonomy, but instead should remove those oppressions and support those vulnerable in decision making

what is an informed decision?

when the pt knows everything that they would reasonably want to know when making a decsion

what are the 4 basic requirements of what physicians must tell pts?

1. diagnosis/prognosis 2. treatment options (including none) 3. nature of treatments (surgery, meds, etc.) 4. risks/benefit -- serious risk, even if rare, must be disclosed

what are the two senses of informed consent?

1. Autonomous authorization 2. effective authorization

What is autonomous authorization?

patient has given consent if they have a substantial understanding, free of control from others, has given authorization to medical team to perform intervention

What is effective authorization?

consent of pt is valid if the rules + regulations defining the institution's practice of informed consent are completed (ex: waiting periods, forms, witnesses)

What are the conflicts with the senses of authorization

the senses may negate/overshadow each other, therefore making them invalid.

what is giving assent to something?

not refusing, but not necessarily giving full, informed consent either

what is theraputic health vs public health?

something for the patient's own interest, vs. for the interest of the collective community (ex: immunity via vaccines)

what is an advance directive?

legal documents that reflect a pt's health decisions, if they become unable to make the choice for themselves.

What are some possible benefits of an advance directive?

honors autonomy, reduces family + provider burden, reduce costs by limiting unwanted treatments, typically endorsed by medical orgs.

What are the two types of advance directives?

1. proxy directives 2. instructional advance directives

What is a proxy directive?

the patient designates WHO will make decisions. In absence of a PD law uses a priority line (ex: spouse -> adult children). Can be useful if one desires someone other than the default legal sub.

What is an instructional directive?

the patient specifies WHAT treatment they would/wouldn't want. If valid + legally clear --> carries full authority of the Pt's wants.

If vauge + invalid --> requires a sub. dec maker

What are some possible cons of an advance directive?

It can be hard for one to imagine future medical conditions and how they would adapt, can be rigid and hard to interpret, preferences may change overtime

What is the goal of a best interest judgment?

To give patients the healthcare they would have chosen for themselves if they were able to.

Can children make their own healthcare decisions?

In the family-centered model, everyone's views are considered, but the child's best interest must come first. The child's interests are always paramount.

Doctors may withdraw/hold life-sustaining treatment to a child if….(CPS)

1. death imminent + irreversible 2. ineffective/harmful treatment 3. life will be severely shortened regardless of treatment, but stoping = better comfort care 4. life would involve intolerable, unpreventable suffering

Doctors may withdraw/hold life-sustaining treatment to a child if….(AMA)

belief that parents should have the final say in desperate cases, even if drs advise otherwise

what are the key conflicts in respect to religion and culture with best interest judgments?

Respecting culture + religion vs. western medical standards of best interest. Courts + hospitals often side with protecting health/life. Deeper philosophical justifications remain unsettled with this approach

What are standards of competence?

3 different ways to balance patient well-being (harm protection) and self-determination (autonomy)

what is the minimal standard of competence?

A patient only needs to be able to express a preference.

What are problems with the minimal standard of competence?

based on pt preference. Doesn't check for flawed reasoning, if decision matches pt's views, or protect well-being. Weak standard--autonomy is respected, but well being is not.

what is the outcome standard of competence?

the decision is competent only if it matches what a reasonable/rational person would choose

what are the problems with the outcome standard of competence?

competent if matches what a reasonable person would want, overvalues other people's opinion, denies pt individuality, based on objective ideas of well being. Too strict--erases pt autonomy

What is the process standard of competence?

focuses on the reasoning process, not outcome. Well balances self-determination and well-being.