Ethics and Medical Philosophy Review

Key Figures and foundational Concepts in Ethics

  • Aristotle and Virtue Ethics     * Eudaemonia: Aristotle described ultimate happiness as "eudaemonia."     * The Golden Mean: Defined by Aristotle as the "middle ground" between excess and deficiency.     * Virtue: Aristotle’s ethical system is concerned with the development of good character and virtue.     * Contemporary Virtue Ethics: Aristotle is credited with the development of contemporary virtue ethics.

  • Immanuel Kant and Deontology     * Duty-Based Ethics: Kant’s philosophy is centered entirely around the concept of duty.     * Categorical Imperative: Kant described the Categorical Imperative as a supreme moral principle.     * Universal Law: Kant proposed that acts are right if and only if they can be universal laws of nature applied to everyone equally (The Universalizability Principle).     * Enlightenment: Kant is known as the last philosopher of the Enlightenment.     * Moral Worth: Kant claimed an act has moral worth if and only if it is right and is done precisely because it is right, rather than because of the outcome or consequence.

  • John Stuart Mill and Utilitarianism     * Higher and Lower Pleasures: Mill is famous for drawing a distinction between higher (intellectual) and lower (physical) pleasures.

  • Jeremy Bentham     * Hedonic Calculus: Bentham developed the Hedonic Calculus, described as a mathematical scale or formula used to distinguish and measure pleasure.

Fundamental Ethical Definitions and Branches

  • Definition of Ethics: A moral code that an individual follows to guide their behavior.
  • Ethical Relativism: A concept suggesting that objective truths do not exist and that morality is relative to different standards. It is comprised of two types:     * Conventionalism: Morality is based on the consensus, culture, or upbringing of a group.     * Subjectivism: Morality is based on individual feelings, perspectives, and personal culture.
  • Ethical Egoism: An ethical theory focused on self-interest, asserting that individuals should put their own needs first. The goal is the benefit of the individual.
  • Psychological Egoism: A descriptive theory asserting that people naturally behave in a self-interested way; it describes what people do rather than what they should do.
  • Self-Interest vs. Selfishness:     * Self-interest: Taking actions for one's benefit without harming others.     * Selfishness: Taking actions for one's benefit that actively harm other people.
  • Hedonism: An ethical theory where the main goal is making decisions to achieve the most pleasure, benefit, or greatest good for oneself alone.

Utilitarianism and Divine Command

  • Focus of Utilitarianism: The primary focus is on what makes the largest number of people happy.
  • Act Utilitarianism: Focuses on specific actions and choosing the outcome that maximizes the most happiness for the most people.
  • Rule Utilitarianism: Focuses on whether an action aligns with a general consensus or rule that minimizes harm and maximizes happiness for the most people.
  • Divine Command Theory: The belief that it is an individual's duty to obey the commands of God.

Kantian Ethics: Reasoning and Principles

  • Reasoning: According to Kant, one must use reasoning to determine what is right. Practitioners must avoid being overly emotional when making moral decisions.
  • Universalizability Principle: The idea that if an individual has a right to something, everyone else has the same right.
  • Formula of Humanity: The principle that people should not be used as a means to an end; humans are not mere tools.
  • Autonomy: The right to govern one's own body and make decisions for oneself.
  • Human vs. Non-human Beings: Kant distinguishes human beings from non-human beings based on the human ability to think and reason.
  • Duty: Defined by Kant as a moral obligation.

Virtue Ethics and Moral Character

  • Focus of Virtue Ethics: Unlike other theories that focus on rules or outcomes, virtue ethics focuses on what a person should be (character) rather than just what they should do.
  • Motivation for Virtue: People should strive to be virtuous to live a good, fulfilling, and virtuous life by doing the right things consistently.
  • The Mean and Individual Circumstances: The "mean" for a virtue is not the same for everyone; it depends on one's life circumstances. For example, a rational person giving $10 to charity is different from a homeless person giving $10.
  • Continent vs. Incontinent People:     * Continent People: Have the same desires as incontinent people but possess the self-control to act rightly.     * Incontinent People: Lack the self-control to manage their desires and may act wrongly despite knowing better.

Applied Ethics: Case Study Analysis

  • Case 1: Having a child for bone marrow donation     * Virtue Ethics: This may be considered excessive and not virtuous because having a child for a specific utility is not "doing the right thing" for the child's sake.     * Utilitarianism: Likely acceptable if the result is that the sick child is cured and the family is happy.     * Deontology/Kantianism: The parents should not use the new child as a means to an end (Formula of Humanity). However, some may argue for the autonomy of the parents.

  • Case 2: Harvesting organs from one healthy patient to save five others     * Virtue Ethics: Generally no, as killing is inherently wrong and not virtuous.     * Utilitarianism: An Act Utilitarian might say yes due to the numbers (5 lives vs 1), but a Rule Utilitarian would say no because a society that kills healthy patients for organs would create fear and decrease general happiness.     * Deontology: No, because Deontologists do not believe in killing and would view it as a violation of the individual's rights and the rule against murder.

  • Case 3: Saving a drowning man (minimal risk, excellent swimmer)     * Virtue Ethics: Yes; it is the right and courageous thing to do.     * Utilitarianism: Yes; both Act and Rule utilitarianism would favor saving a life at minimal risk to maximize happiness.     * Deontology: Yes; it aligns with the duty to help others and does not violate moral rules.

  • Case 4: Lying to ICE officers to protect a housekeeper     * Virtue Ethics: Might suggest telling the truth (B) because lying is often considered a vice, though protecting someone might be considered a competing virtue.     * Utilitarianism: Act Utilitarianism would likely favor lying (A) to prevent the harm of deportation; Rule Utilitarianism might vary depending on whether lying to legal authorities is seen as beneficial to society long-term.     * Deontology: Traditionally, Kantian deontology forbids lying (B), but some modern interpretations might prioritize protecting the person's values or safety (A).

  • Case 5: Torturing a terrorist to find a ticking time bomb     * Virtue Ethics: Would likely say no, because torture is not ethical or virtuous behavior.     * Utilitarianism: Act Utilitarians would likely say yes to save thousands. Rule Utilitarians might allow it if government officials are specified as having that authority for the greater good.     * Deontology: No; it is immoral and violates the Formula of Humanity by using the suspect as a mere means.

Medical Ethics: Principles and Terms

  • Four Basic Principles of Medical Ethics:     1. Justice: Treating patients fairly and distributing resources equally.     2. Autonomy: Respecting the patient's right to make their own healthcare decisions.     3. Nonmaleficence: Do no harm; avoiding evil or harmful actions.     4. Beneficence: Acting in the patient’s best interest and promoting good.
  • Informed Consent Requirements: Patients must be informed of the diagnosis, specific risks, total benefits, costs, alternatives, and be given the opportunity to ask questions.
  • Paternalism: When a healthcare provider makes decisions for a patient for their own good, even if the patient does not want it. The risk is the violation of patient autonomy.
  • Priority of Beneficence over Autonomy: This occurs in emergency situations where a person is incapacitated or unconscious. Saving the life (beneficence) overrides the need for immediate consent (autonomy).
  • Principle of Double Effect: Allows a person to perform an action that has both a good and a bad effect, provided the bad effect is not intended and specific conditions are met.
  • Health Surrogate: A designated decision-maker for a patient who cannot advocate for themselves.
  • Disease: A deficit in physical, physiological, or psychological functions based on individual or societal expectations.
  • Microallocation: The distribution of medical resources at the local level (hospitals, clinics, individual patients). Decisions are usually made by doctors, patients, and institutions.
  • Bases of Resource Distribution: Need and contribution are the two main factors.

Euthanasia and End-of-Life Care

  • Active vs. Passive Euthanasia:     * Passive: Stopping treatment to allow death to occur naturally (e.g., stopping life support).     * Active: Taking a direct action to cause death, such as a lethal injection.
  • Voluntary, Non-voluntary, and Involuntary Euthanasia:     * Voluntary: The patient chooses death themselves.     * Non-voluntary: The patient cannot decide (e.g., in a coma), and someone else decides for them.     * Involuntary: Euthanasia performed against the patient's wishes.
  • Withdrawing vs. Withholding Care:     * Withholding: Not starting a treatment for a patient.     * Withdrawing: Stopping a treatment that has already been initiated.
  • Oregon Physician-Assisted Suicide (PAS) Requirements:     1. Patient must be at least 18 years old.     2. Patient must be competent.     3. Patient must be diagnosed with a terminal illness (6 months or less to live).     4. Two verbal requests and one written request are required.
  • Advance Directives: Legal documents (e.g., living wills, power of attorney) that communicate a person's healthcare preferences when they can no longer communicate for themselves.
  • Psychological Dimensions of End-of-Life (Kübler-Ross Stages): Denial, Anger, Bargaining, Depression, and Acceptance.

Abortion and Reproductive Law

  • Roe v. Wade (Trimester System):     * First Trimester: Abortion is a decision between the woman and her doctor; states cannot interfere.     * Second Trimester: States can regulate abortion to protect the mother's health.     * Third Trimester: States can ban abortions except when necessary to protect the life or health of the mother.
  • Planned Parenthood v. Casey (1992): The Supreme Court upheld the core right to abortion established in Roe but replaced the trimester system with the "Undue Burden Standard," allowing states to regulate abortion as long as they do not place a substantial obstacle in the woman's path.
  • Broader Implications of Roe v. Wade: The case is fundamentally about the constitutional right to privacy and personal decision-making, including control over one's own body and family planning.
  • Additional Rights Protected by Privacy Rulings: The right to alternative medicines and the right to die.
  • Types of Abortion Procedures: The pill, vacuum aspiration, herbal mixtures (historical/non-clinical), and "triceps" (likely referring to D&E/D&X surgical components).

Physician-Assisted Suicide (PAS) Reflection Cases

  • Incoherent/Coma (uncertain recovery): PAS is not justified because the patient cannot consent and is not definitively terminally ill. Actions should not go against the dignity of the individual.
  • Irreversible Coma/Persistent Vegetative State: While some may argue it is justified due to a lack of quality of life, legally it would require a previous directive as the patient cannot currently consent and is not necessarily "terminal" in the 6-month sense.
  • Irreversible Brain Damage (otherwise healthy): Not justified; the patient is functioning, healthy in other respects, and not terminally ill.