PHI 015 Midterm 1 Questions With Complete Solutions

When did bioethics emerge? correct answer: → Bioethics emerged in the 50s and 60s following the Nuremberg trials Issued Nuremberg code: 1st code of ethics in this field Coincided with Civil Rights movement - when parental, academic, political, medical, and military authorities were challenged Invention of life-saving technology such as ventilator or AED What did the patient-physician relationship look like before the emergence of Bioethics? correct answer: Less focus on patient autonomy, more on doctors as authority figures "Physician-dominated" not patient-centered - Paternalism Patients would not challenge physician's authority because they were the only appropriate decision makers Less scientific advances and control over facilitation of reproduction, modifying behavior, early infant mortality, and understanding genetics What disciplines are involved in bioethics? Be able to name a few. correct answer: Interdisciplinary: science, religion, law, economics, public health (course focus is here) What are some technologies that led to new bioethics questions? -- Dialysis machines, artificial ventilators, and organ transplants (keep patients alive that otherwise would have died) - were very expensive at first Modern contraceptives, safe abortions, prenatal screenings = increased choices in number of kids and kinds of kids What is relationship of bioethics to medical ethics? Define/describe each. correct answer: Bioethics- refers the growing issue of ethics in health and biomedical sciences. more overtly critical and reflective enterprise Biomedical science- combines the fields of biology and medicine in order to focus on the health of both animals and humans Traditionally, medical ethics has focused primarily on the doctor-patient relationship and on the virtues possessed by the good doctor. "Bioethics, on the other hand, is a more overtly critical and reflective enterprise. Not limited to questioning the ethical dimensions of doctor-patient and doctor-doctor relationships, it goes well beyond the scope of traditional medical ethics in several ways. First, its goal is not the development of, or adherence to, a code or set of precepts, but a better understanding of the issues. Second, it is prepared to ask deep philosophical questions about the nature of ethics, the value of life, what it is to be a person, the significance of being human. Third, it embraces issues of public policy and the direction and control of science. In all these senses, bioethics is a novel and distinct field of inquiry. Nevertheless, its history must begin with the history of medical ethics." What principles does the Oath of Hippocrates establish? Make sure you know, briefly, what they mean correct answer: Oath of Hippocrates -- very foundation of Western ethics "I will use dietetic measures to the use and profit of the sick according to my capacity and understanding. If any danger and hurt threatens, I will endeavor to avert it," Doctors must act so as to benefit their patients Doctors must seek to prevent harm Establishes principles of beneficence and nonmaleficence What is an ethics of care characterized by? correct answer: It is characterized by a view that sympathy and care play a central role in the doc-patient relationship John Gregory, a prominent eighteenth-century Scottish doctor-philosopher, drew on prevailing Enlightenment philosophies to articulate his view that doctors must be "sympathetic," in the sense developed by the great Scottish philosopher David Hume → the doctor was to develop "that sensibility of heart which makes us feel for the distresses of our fellow creatures, and which, of consequence, incites us in the most powerful manner to relieve them" Care and sympathy as central role for doctors- patients relationship Played a role in feminist and nursing approaches to ethics This questioning by nurses of their traditional role and their relationship with doctors and patients eventually converged with a movement by feminist philosophers that challenged the traditional (and therefore male-dominated) view of ethics as a matter of abstract, impartial, and universal principles or rules. Instead of this conception of ethics, feminist philosophers like Nel Noddings (1984) conceived of ethics as a fabric of care and responsibility arising out of personal relationships. Building on this "female" approach to ethics, both philosophers and nurses sought to construct a new ethics for nurses based on the concept of care What is the 10/90 gap mentioned in the reading. Though not explicitly called this, you should be able to find it. correct answer: As Michael Selgelid points out in his contribution to this volume (chapter 36), 90 percent of medical research resources are spent on diseases that account for only 10 percent of the global burden of disease - the diseases that people in rich countries are likely to suffer from. not a lot of research done on diseases that affect a greater population do the people of the rich nations, through their governments or through private philanthropy, have an obligation to reverse this imbalance? much more attention is being paid to bioethical issues raised by infectious diseases, including, but not limited to, HIV/AIDS. In this revised edition, we have also increased the number of articles dealing with global bioethical issues and issues that particularly face developing countries. It remains true, unfortunately, that the majority of articles dealing with specific issues focus on bioethical issues in affluent countries. Three main constituents of utilitarian theory. Know what each are and how to define each. correct answer: Consequentialism: The consequences of an act are what make it right or wrong determines the moral quality of an action Welfarism: the view that the consequences that we have to attend to are those that conduce to the welfare of those affected or the opposite welfare = "the obtaining to a high or at least reasonable degree of a quality of life which on the whole a person wants, or prefers to have." consequences that are relevant to the morality of actions are consequences that increase or diminish the welfare of all those affected Aggregationism: distribution of welfare. . It is the view that when, as usually, we have a choice between the welfare of one lot of people and the welfare of another lot, we should choose the action which maximizes the welfare (i.e., maximally promotes the interests) of all in sum, or in aggregate. We may call this constituent aggregationism. What are some objections to aggregationism and Hare's responses? correct answer: Aggregationism: Aggregationism holds that the distribution of welfare doesn't matter ... Pick the option that maximizes total sum "That is, if one outcome will produce more welfare, but distribute it very unequally, and another will produce less, but distribute it more equally, it is, according to aggregationism, the first outcome that we ought to choose." Objection 1: equality of distribution matters in itself, as an independent value, and must not be sacrificed to the maximization of the total welfare (egalitarian viewpoint) Response: if we respect their interests equally, we shall give the same weight to the equal interests of each of them "It is therefore surprising that so many anti-utilitarians, who profess to believe that we ought to show equal concern and respect to all those affected, object to aggregationism." Response: Why should equality of distribution matter if we could prefer a scenario in which welfare is maximized? Objection 2: Utilitarianism "does not take seriously the distinction between persons." Response: Utilitarianism does see the difference between people but shows them justice by treating their different interests with equal respect What are Hare's two levels of moral thinking? correct answer: Intuitive level and critical level thinking intuitive: general rules conflict at this level is source of objections from counterintuitiveness critical: much more specific and deal in detail with cases According to the theory, a person's moral decisions should be based on a set of 'intuitive' moral rules, except in certain rare situations where it is more appropriate to engage in a 'critical' level of moral reasoning. What are major contributions of Nuremburg code to bioethics? correct answer: A code of ethics (not legally binding) → Formed the basis for later ethical and legal documents Basis for informed consent requires social benefit of the experiment, preclinical testing in animals, and doctor beneficence to research subjects What are major contributions of Tuskegee syphilis study to bioethics? correct answer: Led to US feds requiring that all human research go through IRB's Brought awareness to concerns about vulnerable populations in research; the use of deception Need for informed consent to research Black people suspicious of medical research Know and be able to identify difference between normative claim and descriptive claims. correct answer: Prescriptive vs Descriptive Normative Asserts a value Not empirically verifiable Evaluative: Should, ought, good, bad Descriptive Empirical Describes the world either kind of statement can be true or false What does utilitarianism say? correct answer: The right action is that which maximizes the welfare (well-being or happiness) of all people taken together and considered impartially "the greatest good for the greatest number principle" "Maximum Welfare for all; Doesn't matter if others are harms, so long as there is net good." Bring about the most happiness Theory of right action + theory of good What is the Trolley Problem. Not just—how do you describe the relevant scenarios, but what is the problem for moral theorists? correct answer: Kill one to save five - seemingly permissible in some cases, morally forbidden in others. Why? Philosophers struggle to explain People have very strong diverging intuitions between these cases (in favor or the first, against the second kinds) Theorists have struggled for decades to properly explain the moral difference between the cases You may sometimes kill or harm in order to bring about greater good Know some objections to utilitarianism and how utilitarians would respond. (answered in previous question). What is rule utilitarianism? correct answer: the moral correctness of an action depends on the correctness of the rules that allows it to achieve the greatest good (as opposed to focusing on the outcome) follow rules even in exceptions can give common sense morality in contrast with act utilitarianism In most cases we cannot truly know the consequences. Thus, we construct rules of thumb that work the majority of the time. What is deontology? How is it defined in this class? correct answer: Incorporates constraints on maximizing good: "Increase welfare, but stop if you have to harm someone" there is reason to promote welfare; BUT we cannot harm other people to do this promote the good, but dont break any constraints in doing so Know the difference between moderate and absolute deontology—and the advantages/disadvantages of each. correct answer: Moderate: Rules need only be followed up to a certain trade off. Intuitive, but complex some threshold at which the good to be done by harming someone outweighs the wrongness of harming them says that it is wrong to deliberately kill an innocent person unless doing so is necessary to save at least 50 innocent lives. if you think harming one person to help many is ok Absolute: Loses intuitiveness, but gains simplicity if you think you may never harm one person to help many it is always wrong, whatever the consequences, to deliberately kill an innocent person. The moderate deontologist says that it is wrong to deliberately kill an innocen For each, we can generate thought experiments where the theory seems to get us the wrong answer What moral theory does Kantianism support?-- Kantianism is the foundation for deontology What does the FUL formulation of his categorical imperative say? What does the FEH say? correct answer: Formula of Universal Law (FUL): Act in accordance with the maxim which you can at the same time will that it become universal law you are not allowed to do anything yourself that you would not be willing to allow everyone else to do as well. You are not allowed to make exceptions for yourself. For example, if you expect other people to keep their promises, then you are obligated to keep your own promise Formula of End-in-Itself or Formula of Humanity (FEH): "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 an end." Paraphrase: never treat a person as a mere means only What is a maxim? correct answer: The maxim of the act is the PRINCIPLE on which one sees oneself as acting Ex. "Even when it would be more fun to get out of a commitment, keep your promise" What does it mean to treat someone as a mere means? correct answer: To use someone as a mere means is to involve them in a scheme of action to which they could not in principle consent Treats them as a prop or tool, not as a person What does it mean to treat someone as an end in themselves? correct answer: To see that they, just like you, have their own projects and desires; that they are autonomous; they are rational May we treat someone as a means? correct answer: Means: To treat them as an instrument to you achieving your own ends You can do this (like employing a housekeeper) but not treat them as a mere means by also respecting them as an individual (paying fairly, treating with respect etc) That is, you must always also treat them as an end in themselves What does it mean when O'Neill says Kantianism has less scope than utilitarianism? correct answer: Utilitarianism tells us to look at the results of our action to see if it is morally right/wrong Kantianism tells us to look at our reasons for acting, to see if it is morally right/wrong (asks, are you using someone as a mere means?) Takeaway: Utilitarianism: Huge scope, lacks precision. Kantian: More restricted scope (can only assess intentional acts because it assesses actions by looking at maxims of agents) For Kantians, when are actions permissible, forbidden and obligatory? correct answer: Forbidden: not permitted Permissible: If they do not use others as mere means Obligatory: You MUST do the action if not doing it would mean using someone as a mere means Kantians do not try to compare all available acts and see which has the best effects. They consider only the proposals for action that occur to them and check that these proposals use no other as mere means. If they do not, the act is permissible; if omitting the act would use another as mere means, the act is obligatory What is the criticism of Kantianism that they care too much about intentions and not results say? What is O'Neill's response? correct answer: Response: Our intentions reflect what we expect the immediate results of our actions to be. What is Young's principle for respecting autonomy? correct answer: For health care providers to respect a patient's autonomy, then, there must be informed consent to treatment Respecting autonomy includes both non-interference in autonomous actions and building or maintaining others' capacities for autonomy autonomy - The patient must be able to choose what is best for him/her The basis for the requirement for competent patients' informed consent to medical treatment and research What is reasonable person standard for disclosure? correct answer: The Reasonable Patient Standard simply says the doctor has to disclose all information which would influence you, or any other reasonable person, in deciding whether or not to go ahead. What are four requirements of disclosure? correct answer: Four Disclosure Requirements Necessary (not sufficient) for Informed Consent: The nature of the procedure Risks of the procedure Alternatives to the procedure, if any Benefits of the procedure What are the three exceptions to informed consent for competent patients? correct answer: Waiver Patients have a right to waive disclosure of information Some patients who are made anxious, depressed, or even confused by having to make decisions about their health care, and for whom it will, therefore, be quite appropriate to exercise their right to a waiver. However, in order to limit the risk of well-intentioned misuses of this right, healthcare providers should not bring up waivers and should instead focus on disclosing information Therapeutic Privilege A healthcare practitioner may withhold information that would otherwise have to be disclosed if it is judged that disclosure would be likely to lead to harm to a patient (such as prompting suicidal behavior) The exception of therapeutic privilege does not apply when disclosure will merely lead to refusal of care that the physician thinks beneficial Emergency In emergencies, you can provide treatment without first obtaining informed consent because treatment is what most reasonable persons would want in an emergency situation What is "assent"? correct answer: "Assent" is a term used to express willingness to participate in research by persons who are by definition too young to give informed consent but who are old enough to understand the proposed research in general, its expected risks and possible benefits, and the activities expected of them as subjects. Must be accompanied with informed consent from parent or guardian What is the decision-making hierarchy for making decisions about medical treatment for incompetent patients? correct answer: Advanced directives or expressed desires about treatment Substituted judgement: someone else (usually a designated person who is close to the patient) makes the choice based on what they think the person would want Best interest standards - for those who have never had the ability to make judgements Go with what is "objectively medically best" Often no evidence of personality choices for subject What is substituted judgment? correct answer: when no AD, requires surrogate to use his or her knowledge of the patient to attempt to make the decision that the patient would have made if competent What is a moral dilemma? correct answer: Occurs when it seems that no matter which of 2 (or more) actions a person takes, she acts wrongly eg: Tarasoff case: Choice between violating patient confidentiality and potentially preventing serious harm/death Theories should help work out conflict What is principlism? What are the main principles? correct answer: Principlism: More general, abstract. top-down approach: starts from broad ethical theories good for providing some basic ethical boundaries, and a framework or structure in which to organize one's thoughts, observations, and intuitions. not so good when it comes to resolving issues and making specific decisions. Four Major Principles of Morality (Main Principles) correct answer: Respect for autonomy Nonmaleficence Beneficence Justice What does autonomy mean? Paternalism? correct answer: Autonomy: A person chooses his/her own life plans without having them imposed on him/her from the outside- by others or circumstances. S/he is able to live in accordance to those plans. Paternalism: when the clinician decides what is best over the patient What are the conditions for informed consent? correct answer: Competence Understanding includes appreciation of information Voluntariness Free of coercion, undue influence, manipulation What is coercion? How does it differ from undue influence? correct answer: Coercion: threat of harm if one fails to do what another wants Undue Influence: prospect of great benefit if one does what another wants Difference: Coercion is a THREAT, undue influence is a BRIBE What is the relationship between principles and rules? correct answer: Both derive norms from Common Mortality! Principles: most abstract level Rules: derivable from principles, more specific What is specification of principles? Give an example correct answer: Specification makes norms more applicable Examines the scope of norms (assesses if they apply broadly or narrowly by asking questions like when, why, how, to whom?) Principles need to be specified to particular contexts in order to gain concrete guidance; need to narrow the scope of norms to determine how, why, what means an action needs to be avoided can help dissolve conflicts of norms and dilemmas ex. "do no harm" is not very helpful when we're trying to figure out whether it's permissible to help a terminally ill person die Example of specification General rule: "always obtain informed consent" Specification: "always obtain oral or written informed consent for medical interventions with competent patients, except in emergencies, in forensic examinations, in low-risk situations, or when patients have waived their right to adequate information." What is balancing of principles? correct answer: Balance the weight or priority of conflicting norms; takes into consideration many competing concerns about this patient or this family Happens at the case level ex. respecting autonomy vs. beneficence It's not just intuitive: There are guidelines (provided by Beauchamp and Childress) Good reasons can be offered to act on the overriding norm rather than on the infringed norm The moral objective justifying infringement has a realistic prospect of achievement No morally preferable alternative actions are available The lowest level of infringement, commensurate with achieving the primary goal of the action, has been selected Recap: Beauchamp and Childress' Principlism Four Principles: Respect for Autonomy Nonmaleficence Beneficence (+ Utility) Justice Each must be specified into rules In any particular case, we must weigh/balance the rules that are in conflict. What is casuistry? correct answer: "The resolving of moral problems by the application of theoretical rules to particular instances." Casuistry helps us determine how to balance principles in cases of conflict longstanding approach in Christian ethics that involves case-based reasoning similar to methods of interpretation by appeal to precedent in Jewish and Islamic law. Advantages of Casuistry Fits well with practical reasoning and medicine: doctors are familiar with case-based reasoning No need for deep theory Well-suited for consensus in a pluralistic society; the aim is to reach overlapping consensus Deciding cases at case-level doesn't threaten people's deeply held higher level principles What does top down approach mean vs bottom up approach? correct answer: Top-down: Start from ethical theories, from there figure out what to do with concrete cases eg: Principlism Bottom-up: Start from real, concrete cases, from there we can derive norms eg: Casuistry What is the casuist method that Arras lays out? What are the main steps? correct answer: Steps of Arras's casuist method: Describe a case in rich detail and categorize the case into a "broad taxonomy" Eg "Termination of life case" "refusal of treatment case" Fit into a taxonomy of other cases: "A structured reservoir of responses to similar cases that contain various paradigm cases of conduct judged to be manifestly right or wrong" When we have moral certainty, it comes from cases, not in the abstract "It comes from looking at how decisions were made in other cases.... Not in abstract (as in theory). Here we look at moral certainty in familiar cases" Locate the present case on the spectrum, from unacceptable to acceptable conduct Draw a conclusion: Is it more like the unacceptable or the acceptable cases? What does it mean to say that casuistry is fundamentally conservative? correct answer: Fundamentally conservative because it is not going to be progressive in the sense of moving us forward in novel ways It is insufficiently critical; starts with judgments we already have and analogizes from them But what if those judgments were wrong to begin with? What is the physics/car mechanic model and how does that relate to bioethicists and their relation to ethical theory, according to James? correct answer: Essentially: Like the car mechanic, the bioethicist will rely on mid-level principles, ignoring the lofty but unhelpful pronouncements of high-level theory. Context: Straightforward application bioethical controversies are too complicated to be resolved by the simple application of a theory. Theories are general and abstract, while real life is messy and detailed. Case-study approach: "The physics/car-mechanic model." Case study: detailed investigations of specific cases that make use of whatever analytical ideas and principles seem most promising in the circumstances at hand. A benefit of doing case studies is that they help us to identify the intuitive principles that influence people. Does Rachel's ultimately accept this model or reject it? What model does he accept? correct answer: Essentially: We have seen that the physics/car-repair model won't do, because case studies cannot be conducted independently of theoretical concerns. Context: "Without the resources of ethical theory, we could make little progress in dealing with such matters. It is also an illusion to think that mid-level principles can, by themselves, yield definitive answers to ethical questions." Case of Baby Theresa: Bioethicists used midlevel principles: "It is unethical to kill in order to save" Compared to the abstract pronouncements of ethical theory, mid-level principles are much more like everyday moral rules. Derived from or justified by higher level principles The chief danger of the case-studies approach is that it can degenerate into nothing more than a systematic description of what people happen to believe. Assessments of mid-level principles require a conversation of the more abstract matters of ethical theory Better model: The biology/medicine model. The relation between ethical theory and bioethics is like the relation between biology and medicine. A physician who knew nothing of biology, but who approached her patients in the spirit of a car mechanic with a kit-bag of practical techniques, might do a generally serviceable job. But she would not be as good as the physician who did know the relevant sciences. The difference would come out when new or tricky problems arose, requiring more than the rote application of already familiar techniques. To deal with the difficult problems, she might find herself turning to scientific researchers for help, or even turning temporarily to more fundamental research herself. And what she learns from the cases she encounters in her practice might, in turn, have significance for the further development of the sciences What does it mean to say the physician-patient relationship has moved from paternalism to shared-decision making? correct answer: a new, more important role for patients in decisions about their treatment paternalism - physician seen as the principal decision-maker because of his or her superior knowledge, training, and experience regarding the patient's medical condition and prognosis shared decision making - promoting the patient's well-being, and respecting his or her self-determination For previously competent adults, what are the three relevant principles for making medical decisions? (this is a repeat of a previous question) correct answer: Advance directives principle requires the surrogate to follow any instructions or preferences in the patient's AD Substituted judgment principle—when no AD, requires surrogate to use his or her knowledge of the patient to attempt to make the decision that the patient would have made if competent Best interests principle—when the above not possible, e.g. no one available who knows patient's competent desires, what would most reasonable persons want in these circumstances? What is Brock's view on the distinction between killing and allowing someone to die? correct answer: His view: killing is in itself no more seriously wrong than allowing to die difference between acts and omissions that result in death A person kills if he or she does an action that causes someone to die who otherwise would not have died A person allows someone to die if he or she has the ability and opportunity to prevent someone from dying, knows this, but does not act to prevent the death, and the person dies Brock: Imagine if a son removed his mother's breathing tube in order to gain her inheritance Should we call deaths with good intentions "permissible killings" instead of letting die "Transparent Sophistry": Playing around with words to get the result you want. Transparent because you can see through it. Branding: Letting die is really permissible killing. Know the basic issues of the Karen Ann Quinlan case correct answer: Became comatose at 21 after taking a combination of alcohol and benzos Higher cognitive brain functions were destroyed = vegetative state A respirator was used to keep her alive (this was new technology at the time) Family wanted to remove life support, doctors disagreed (feared malpractice, violation of code of ethics) First court: Ordered her to stay on life support Second court: Ordered in favor of removing life support Despite this, she stayed on life support for 10 years, ended up dying of pneumonia What is the Do/Allow distinction? How does it apply to removal of life support? correct answer: Asks the question: Is there a moral difference between actively causing a death or merely allowing a death to occur when everything else is equal: Intentions Motives Consequence The medical and legal community agree that removing life support = permissible allowing of a death to occur What is an advance directive? correct answer: An advance directive is a statement made in advance of an illness about the type and extent of treatment one would want, on the assumption that one may be incapable of participating in decision-making about treatment when the need arises. Advance directives are usually written, though an oral declaration may also suffice; they may name a person to make decisions on one's behalf, give instructions on what treatments should or should not be provided under specified circumstances, or do both. What is a problem with substituted judgment? correct answer: Is supposed to reflect what the patient would have wanted, but this is easily confused with what the family member wants Is there a fundamental conflict of interest here? Also, family members are typically under a lot of stress and emotional duress Are they the best party to be undertaking such a difficult decision? Also legal issues: Because a person who has become incapable of making his or her own decisions has also lost the ability to discharge an agent or alter his or her instructions, the common law provides that all agents are automatically discharged by operation of law when their principal becomes incompetent, lest a person be bound by the decisions of an agent whom the person was incapable of countermanding. Applied to the medical context, traditional agency law renders instructions in a living will non-binding at the very moment when they are intended to go into effect. What is difference between experiential interests and critical interests (according to Dworkin?). How is this relevant to advance directives? correct answer: Experiential interests: Common, everyday experiences do not carry any intrinsic value of their own other than the fact that they are either painful or pleasurable Critical interests the kinds of values, choices, and patterns that guide our lives and how we perceive the worth of our lives "Critical interests concern difficult and sophisticated problems that cannot be examined or revised by people who are incompetent, such as a person who is minimally conscious or who suffers from advanced Alzheimer's disease." Dworkin says that if autonomy is to be respected, we must respect the critical interests of persons, because those are the important core values of a person's life; experiential interests, while certainly not irrelevant, must take a back seat. it makes sense to satisfy a formerly competent person's critical interests, such as the interest in avoiding the indignity of dementia, for her sake, even if she has ceased to understand those critical interests now. What is the problem of personal identity related to advance directives? correct answer: The personal identity problem expresses the worry that due to disrupted psychological continuity, one person's advance directive could be used to determine the care of a different person. "Some have argued that it is inappropriate to rely on an advance directive in making decisions about patients who have suffered severe and permanent injuries, such as those in a persistent vegetative state, because these patients are no longer the persons they were at the time the directive was executed. This shift in personal identity makes it wrong to dictate the treatment of the patient in the bed by the wishes of the person that formerly occupied this body; rather, treatment should be guided by an assessment of what would be in the best interests of the present patient" How is total disability defined? correct answer: universal (encompassing all of one's abilities) and irreversible disability What is the authors' view about the badness of death? correct answer: Total disability explains the wrongness of killing Killing humans is immoral because of the ability we have So what only matters in death is loss of ability They talk about the standard moral rule against killing. What do they think of this rule? How do the propose to modify this? correct answer: They think "don't kill" should be replaced by "don't disable" because disability explains all that is wrong with killing. why then are humans (or sentient animals)singled out for moral protection?The natural answer is that humans (and sentient animals) have greater abilities than plants,and those abilities give human lives more value. Humans can think and make decisions as well as feel (an ability that they share with sentient animals). But if these abilities are what make it immoral to kill humans (but not weeds), then what really matters is the loss of ability when humans (but not weeds) are killed. And then the view that human life is sacred does not conflict with and might even depend on the view that what makes life sacred (if it is) is ability, so the basic moral rule is not 'Don't kill 'but is instead 'Don't disable'. The authors think they should have a rule of "do not kill" and "do not disable", not just one over the other because both doings are wrong may be simpler to have one rule for both, but both rules needed to explain and justify certain moral judgements rule against disabling explains all that is bad and wrong with the act of killing and no need to add separate rule against killing How would their view change our practice of vital organ donation? correct answer: It would allow the harvesting of organs from patients that are not actually dead, but "totally disabled" (something that is actually routinely done anyway) "Although not dead, these patients are as good as dead in view of their total disability. Consequently, no harm or wrong is done to them by vital organ procurement, after which they will become dead" "it is not ethically necessary for vital organ donors to be dead. It suffices for them to be totally disabled,with no prospect of recovery of any human abilities or experience. According to this standard, our current practices of vital organ transplantation are ethically justified" cannot donate organs unless the donor is already dead the dead donor rule is routinely violated in the contemporary practice of vital organ donation. Know what kind of case the Terri Schiavo case was. What condition did she have and what was the debate about? correct answer: severe brain damage from cardiac arrest 2 ½ months in coma, then persistent vegetative state husband wanted to remove feeding tube but parents opposed debate about what she would have wanted (advanced directives), who gets to decide what happens to her What are the two medical/legal ways to be declared dead? correct answer: cardiopulmonary death: irreversible cessation of cardiopulmonary function (circulation and breathing) Quickly leads to brain death For the longest time this is what we died from (until ~60s → external respirators etc) brain death: irreversible loss of brain function, including involuntary functions needed to sustain life This concept arose in the 60s with life support Know difference between persistent vegetative state, coma, brain death. correct answer: persistent vegetative state: alive but with severely impaired consciousness needs supportive technology no awareness of the environment coma: patient is alive, could have brain stem responses, spontaneous breathing and motor functions if a coma is long enough it could turn into a vegetative state brain death: patient is no longer alive, irreversible cessation of activity in both the brain and the brain stem What does Richards' presumption in favor of procurement mean? correct answer: anyone who regards the preservation of life by transplantation as intrinsically desirable must recognize an a priori presumption in favor of removing any policy that restricts, or probably restricts, the acquisition of organs for that purpose What is her argument for a default opt-out policy? (And know the difference between opt-in and opt-out) correct answer: organs should be used only if you have expressed a positive wish to donate (opted in to the donor register), or merely failed to refuse (not opted out). The question is only about the direction of default if you fail to express a preference you need to claim that it is overwhelmingly more important to protect the possible posthumous interests of people who are unaware of the need to opt out (and therefore will never know anything of the matter) than to save the lives of living people. it is CURRENTLY assumed that everyone is set to be an organ donor unless they opt out 3 Options: Opt in (express positive wish to donate) Opt out (refuse to donate) Fail to refuse → In cases where no preference has been expressed, is it better to take the organs or not? What is directed donation? correct answer: Donor has a choice in who gets the organs they donate "Supply might increase if potential donors thought that their organs would go to people they particularly cared about, rather than being taken by an anonymous establishment for use by strangers" What is the private goods/public goods problem with the fundamental principle guiding organ donation, according to Richards? correct answer: the application of any general principle of distribution - distribution on the basis of need, or merit, or age, or anything else - presupposes that the goods being distributed are to be regarded as public goods. the essence of private goods is that they are not available for general distribution, and it means that the first thing that advocates of the "fundamental principle" need to establish is that donated organs should indeed be regarded as public goods At present, deceased donation is typically anonymous, with donors having no say in the destination of their organs, and recipients not knowing who the donors were This means, in effect, that your organs are being treated as private goods to the extent that you can choose whether to donate them or not, but that if you do choose to donate them, your only option is to offer them as public goods for general distribution. In no other context does anyone seem to recommend that the only option for private goods is to make them public or waste them altogether. "In the absence of considerable further argument, the so-called "fundamental principle" ruling out directed donation must be recognized as arbitrary, anomalous, at odds with all our other ideas about altruistic giving, and difficult to defend in any terms whatever. More specifically, it is totally incompatible with our procedures for living donation, which is almost always directed. Nobody suggests that if your sister desperately needs a kidney, all you can do is offer yours to whoever is at the top of the waiting list." What is the Dead Donor Rule? correct answer: Vital organs may be taken only from a person who is declared dead