Bioethics Study Notes

Bioethics Midterm 1 Review Notes

Midterm Format

• Question Types:

  • 5 fill-in-the-blank questions (total of 8 blanks)

  • these test basic understanding of moral principles discussed.

  • If regularly attending class, these should be manageable.

  • 15 multiple-choice questions.

  • 6 short answer questions provided.

  • Students must answer 3 from the available options.

Utilitarianism

• Definition: The most renowned consequentialist theory.

  • Consequentialist Moral Theories:

  • A group of moral theories assessing actions based strictly on outcomes.

  • Judgement of right or wrong is based solely on consequences.

  • Value Theory Dependency:

  • Relies on a concept of value that defines what is deemed good or bad.

  • Core Principle:

  • Aims at achieving the greatest good for the greatest number.

  • Concept of Good:

  • Traditionally, good is equated with happiness or pleasure, which are intrinsically good (desirable in themselves).

  • Items like money are instrumentally good (means to an end) since they can procure happiness.

  • Maximizing Doctrine:

  • Moral duty involves ensuring the maximum good is produced.

Act vs. Rule Utilitarianism

• Act Utilitarianism:

  • Evaluates individual actions based on their consequences for the greater good.

• Rule Utilitarianism:

  • Advocates for adherence to rules structured to maximize overall good if adopted universally.

  • Example: Traffic laws function as rules that support collective good.

  • Consideration: Practicing minimal harm without rules may lead to chaos and harm.

Deontological Moral Theories

• Definition: A group of theories that assess right or wrong based on duty, rules, or principles irrespective of consequences.

• Kantian Ethics:

  • Prominent deontological theory, grounded in the categorical imperative.

  • Essential Formulations of the Categorical Imperative:

  • Formulation 1:

    • "Act only according to that maxim whereby you can at the same time will that it should become a universal law." (Kant, Groundwork of the Metaphysics of Morals)

  • Formulation 2:

    • "Act in such a way that you treat humanity, whether in your own person or in the person of any other, never merely as a means to an end, but always at the same time as an end." (Kant, Groundwork of the Metaphysics of Morals)

Features of Moral Norms

• Normative Dominance: Moral norms take precedence over others.

  • Example: Injustices, such as segregation laws, can override legal obligations, justifying civil disobedience.

• Universality: Norms should uniformly apply across similar circumstances.

  • Consistency is essential to maintain meaning in morality.

• Impartiality: Equal consideration should be given unless significant differences exist.

  • Example: Traits like skin color do not justify discrimination.

  • Morally Relevant Differences:

    • Triage in emergencies prioritizes based on severity, representing justifiable differences.

• Agent-Neutrality:

  • Moral standards must apply to all equally; no individual should have preferential treatment.

• Agent-Relativity:

  • Some relationships warrant stronger obligations based on personal connections (e.g., parental responsibilities).

• Reasonableness: Valid moral judgments must be supported by sound reasoning.

  • Definitions:

  • Obligatory: A duty that must be fulfilled.

  • Permissible: Actions that are not obligatory but may be performed.

  • Supererogatory: Actions deemed praiseworthy but not required for moral standing (e.g., donating organs or significant financial support).

• Peter Singer's Views: Referenced in the context of supererogation in his TED talk.

Absolute vs. Prima Facie Moral Duties

• Absolute Principles: Exceptionless rules (e.g., prohibition against torture).

• Prima Facie Principles: Apply generally but allow exceptions when conflicting principles arise.

  • Example scenarios of conflicting duties:

  • A physician's opposing decisions regarding euthanasia.

  • Parental decisions on organ donation versus the ethical ramifications of killing.

Moral Principles

• Autonomy:

  • Definition: Respecting rational self-determination rights.

  • Informed Consent: Crucial in medical ethics, but can be restricted via the harm principle or paternalism.

• Non-Maleficence:

  • Guiding precept: “Do no harm” to patients within care.

• Beneficence:

  • Duty to do good and enhance well-being, beyond simple professionalism.

Principle of Utility

• Definition: Emphasizes maximizing overall benefit while minimizing harm.

  • Core motto: achieving “the greatest good for the greatest number.”

• Healthcare Implications:

  • Requires balancing benefits against risks in treatments and policies.

  • Examples of Application:

  • Vaccinations promoting collective health despite individual risks.

  • Prioritizing patients based on recovery potential in emergencies.

  • Cost-benefit analysis of expensive treatments against resource allocation.

Other Philosophical Concepts

• Reductionism:

  • The perspective that complex phenomena can be explained by breaking them down into simpler component parts.

  • Considers personhood as biological, potentially neglecting psychological or moral dimensions.

• Phenomenology:

  • Focuses on studying first-person experiences and how individuals encounter the world through lived experience.

Truth Telling & Informed Consent

• Joseph Collins's Position: Advocates for lying, postulating that patients may not be capable of handling the truth.

• Robert Higgs's Position: Opposes lying, emphasizing a duty to tell the truth.

• Importance of Communication Quality:

  • Investigating how the truth is conveyed is vital from both moral and practical angles.

• Utilitarian vs. Kantian Ethicists: Varied stances on lying and truth-telling depending on their philosophical orientation.

• Distinction between Moral and Legal:

  • Vital in maintaining stringent informed consent protocols.

Informed Consent: Challenges & Difficulties

• Demanding Criteria: Full disclosures may be overly stringent, risking patient apprehension.

• Insufficient Criteria: Simple consent forms may blur understandable consent versus coercion.

• The informant’s challenge is to ensure sufficient knowledge while avoiding overwhelming patients.

Broad vs. Adequately Informed Consent

• Broad Consent:

  • Definition: Consent granted for a general scope without detailed future uses.

  • Common Usage: Found in large-scale projects like biobanks and genetic studies.

  • Challenges: Patients might not comprehend all potential future applications.

• Adequately Informed Consent:

  • Definition: Consent predicated on detailed information regarding risks, benefits, and specific uses.

  • Strengths: Enhances autonomy through clarity and reduces the risk of misuse.

Distributive Justice

• Egalitarianism:

  • Advocates for equal distribution of resources and opportunities.

  • Exemplified by universal healthcare initiatives.

• Libertarianism:

  • Stresses autonomy over equity, often manifesting in private healthcare systems.

John Rawls – A Theory of Justice

• Justice as Fairness:

  • Proposes societal principles agreed upon through a social contract.

  • Adopts the Veil of Ignorance:

  • No knowledge of personal circumstances or preferences when deciding justice principles.

• Two Principles of Justice:

  • Equal Liberty Principle: Equal rights for extensive liberties compatible with others' liberties.

  • Difference Principle (Equity):

  • Inequalities are only acceptable if they benefit the least advantaged.

  • The Maximin Rule: Opt for systems where the worst outcome is better than alternatives.

Care Ethics

• Ethical Overview:

  • Differentiates between obligation-based ethics (traditionally structured like utilitarianism or deontology) and responsibility-based ethics.

• Responsibility-Based Ethics:

  • Centers on relational responsibilities rather than detached duties.

• Impartial Reflection vs. Situational Context:

  • Care ethics emphasizes the significance of individual contexts rather than applying rigorous impartiality.

Tronto’s Four Phases of Caring

• Caring About: Recognizing someone’s needs (e.g., Mr. Jones in pain).

  • Main Element: Attentiveness.

• Taking Care Of: Accepting the responsibility to help.

  • Main Element: Responsibility.

• Caregiving: Acting decisively to meet the need (e.g., contacting a physician).

  • Main Element: Competence.

• Care Receiving: Assessing the effectiveness of the care provided.

  • Main Element: Responsiveness.

Pandemic Ethics & Ethics of Infectious Diseases

• Considerations:

  • Differences between clinical medicine and public health responsibilities.

  • Challenges posed by moral distress; recognizing the balance between duty to care and the right to protection.

Peter Singer’s Famine, Affluence, and Morality

• Core Argument: Advocates that aid to the less fortunate constitutes a duty rather than an act of charity.

  • Emphasizes the necessity of giving over excessive consumption.

  • Notions of preventing starvation as a moral obligation rather than optional altruism.

  • Quoting Singer: "To do so is… wrong not to do so.” (Page 8)