UVA Theological Bioethics (RELG 2650) Midterm IDs Questions With Complete Solutions

bioethics correct answer: The study of ethics related to issues that arise in health care. ethics correct answer: sustained and intentional reflection on morality and the moral life with analysis, discontent, reasoning, and arguments moral rules or principles of behavior that should guide members of a profession or organization and make them deal honestly and fairly with each other and with their custom utilitarianism correct answer: 1 fundamental moral good-to maximize outcomes of "utility" -greatest good for the greatest number of people-the greatest aggregate happiness outcome deontological correct answer: -concerned with universal/general and impartial rules or responsibilities of moral conduct -absolute rule derived from ostensibly universal principles of reason, done solely out of sense of duty categorical imperative correct answer: A concept developed by the philosopher Immanuel Kant as an ethical guideline for behavior. In deciding whether an action is right or wrong, or desirable or undesirable, a person should evaluate the action in terms of what would happen if everybody else in the same situation, or category, acted the same way. -tells us what must be done irrespective of our personal desires or goals natural law correct answer: Thomas Aquinas -right actions are those that conform to the moral standards embedded in nature and all reasonable people can discover and affirm them through human reason -nature itself is telological rights theory correct answer: -derived from modern democratic thinking casuistry/ethical pragmatism correct answer: -focus on analyzing specific cases and then analogical reasoning from them -claims confidence in circumstances vs broad general moral principles divine command theory correct answer: -view of ethics by most people who follow religion -source of long-standing moral code -morality is an expression of gods will 10 commandments-the symbol Difficulties: -problematic in pluralistic societies because depends on religious agreement -authoritarian and not autonomously motivated -too focused on the next/spiritual life revelation correct answer: God will communicate to people the basis of moral life through written and living heritage of the church (depositum fidei) convenant correct answer: (berit) the special partnership that god forges with this special figure of Abraham and then his decendents; and then the people at large -there are mutual rights and responsibilities; but always initiated by god (asymetric in that sense) -with specific people, but the purpose is to overflow into the rest of humanity (universal dynamic/significance) prophets correct answer: People who are said to receive messages from God to be taught to others - Torah correct answer: -"teaching/instruction" -says very little about medical care -God is the healer The first five books of Jewish Scripture, which they believe are by Moses, are called this -the code Talmud correct answer: compilation of Mishna combined with Rabbinic commentary and decisions 2 versions 1.Palestinian 2. Babylonian halakhah correct answer: Jewish laws as applied to jewish living -responsorial, ongoing engagement; return to sources and apply them to new issues in modern society -highly conversational, debate and questioning is part of the processes -causist-it does focus on specific cases and how they would relate to ones that have clear presence in the Torah -highly porous/open-ended -extended beyond what is clearly stated in the Talmud divine body ownership correct answer: in Jewish law the body is on loan from God for the duration of life, so there is a duty not to harm the body tikkun olam correct answer: respect for life is fundamental -responsibility to health and healing of the social order and the created order Jesus of Nazarath correct answer: (c. 4 BCE-30BCE) Israel's messiah, crucified and risen from the dead (Christos) -who was wandering teacher in the 1st century Palestine, he is the communication of God -Israel's promised messiah, fulfills Gods revelation to Israel religion and healthcare correct answer: anthropology correct answer: the study of human societies and cultures and their development. -the study of human biological and physiological characteristics and their evolution. creation correct answer: God originally created good (world and us) redemption correct answer: the action of saving or being saved from sin, error, or evil. Image of God (Imago Dei) correct answer: humanity is created in God's image; human dignity as a gift of God human dignity correct answer: -the value and worth that we share because God created us in his image and likeness -shape of catholic bioethics-fundamental principles is _________ graced self-transcendence correct answer: this is what we are destined for. Part of who we are intrinsically/human dignity. Beginning is that you are created in God's image (your purpose). You are destined for relationship/communion with God and that creates a basis for a strong view of human dignity. Protestant ethics correct answer: -revelation=scripture alone -salvation-faith alone, ethical actions do not affect salvation (salvation is a gift) -Interpretive authority-the believer themselves inspired by the Holy Spirit/in context of the local church community -found on all sides of issues -Sickness/suffering can be seen as God's providence and as redemption (theology of the cross) but also something to be care for and alleviated -theology of medicine-> humanity's creation mandate Roman Catholic ethics correct answer: -believe (generally) natural law -they are against euthanasia of any sort -preserve life at all costs Islamic five pillars correct answer: 1. shahada-declaration of faith 2. salut-daily prayers 3. zakat-charity 4. Ramadan-fasting 5. hajj-pilgrimage Qur'an correct answer: the sacred writings of Islam revealed by God to the prophet Muhammad during his life at Mecca and Medina Shari'a correct answer: Body of Islamic law that includes interpretation of the Quran and qiyas (valid analogical reasoning) and ijma (interpretive consensus) fiqh correct answer: human judicial decisions of Islamic scholars tawhid correct answer: The oneness and unity of God (Allah) Islamic Juridicial Council's bioethics fatawa correct answer: the common morality correct answer: moral dilemma correct answer: different, justifiable moral norms are in conflict -> must be distinguished from 1. hard decisions 2. practical conflicts with self interest 3. moral self-deception specification correct answer: balancing/weighing correct answer: interplay between the four principles and the process of deciding which one prevails prima facie obligations correct answer: an obligation that can be overridden by a more important obligation -must be fulfilled unless it conflicts with an equal or stronger obligation; meaning that there us a positive presumption for them, but it is also possible to justify their infringement by other sufficiently weighty considerations moral residue/regret correct answer: ways in which (even if the ethical decision is sound) that requires post-decision moral action moral divergence correct answer: B and C try to determine how do bioethicists in a pluralist society (framework for America) on how to work through conflicts based on our differences -the deeper disagreements that their framework cannot help. It can only handle so much. Where you can't appeal to the process of weighing and balancing -more community culture versus the individual (individual is more moral dilemma) autonomy correct answer: self-decision that is free from controlling interference by others and from limitations that prevent meaningful choice. B and Cs 3 condition theory: 1. intentionality 2. understanding 3. Noncontrol -can be overridden: autonomous decisions that harm innocent others, threaten the public health, or require scarce resources heroic ordinary/everyday correct answer: different measures one should/could take biblical story of Jonah correct answer: son of Amittai who is sent by God to prophesy the destruction of Nineveh but tries to escape the divine mission -ship storm swallowed by giant fish intersubjective gesture correct answer: (prob not on exam)- Bioethicis rests on epistemology (how we know what we know) ethicists v. scientists have contrasting modes of knowing. -to think of oneself as the lone one trying to find knowledge is the critical fundamental error -The SPACE between people (a relational language) that about a negotiation larger than just medical data-> to medical culture ethics of care correct answer: :Grows out of natural capacity for empathy -strong motivation to do the right thing 4 processes: 1. Moral attention 2. Sympathetic understanding (maternalism) 3. Relationship Awareness 4. Harmony and Accommodation (watch out for oppression/ "superficial harmony") -Is situated in relationships -principles can provide a moral minimum but one must act directly on motive to care - empathy correct answer: care ethics grows out of a natural capacity for _____ ->reflection can strengthen, generalize, and extend _____ ->>> a complex of emotional responses, conditioned responses, and reflective judgements and how one ought to respond Maternalism (sympathetic understandin) correct answer: -sensitive attention to the best interest of others; balancing conflicts of wants and best interests that requires sympathetic dialogue --preserving the confidence/dignity of the person by working out the problem together sympathetic understanding-ability to emphasize with the people in the situation (one of the four processes of care ethics) moral attention correct answer: one is attendant to a situation in all its complexities to allow for a sympathetic response -to really understand our obligations we have to know all the details that will impact our response -very dynamic (one of the four processes of care ethics) relationship awareness correct answer: -being aware of the networks of relationships and how different relationships form together and caring about nurturing and extending these relationships -be aware the type of relationship you are in (one of the four processes of care ethics) accommodation (and harmony) correct answer: -people are gonna want different things so how do you best respond to these differences -we have a desire to accommodate the needs of all but that is not always possible/wise -having relationship awareness will help -even if we are not helping everyone we need to give them a sense of being involved/considered and they will still feel that they are being cared for -some harmony is not worth preserving (one of the four processes of care ethics) relationality correct answer: ethical emotions correct answer: emotionality is a good thing for care and virtue ethics whereas Kantaism/deontology/utilitarianism ethics does not want emotions involved -In care ethics there are certain emotions that will be useful for us to make moral decisions. Black church correct answer: -maintained varying degrees of blending with traditional African spiritual practices -typically Protestant in belief and personal ethics, but progressive in social orientation -Integral to the intellectual infrastructure and cultural reservoirs of the Civil Rights Movement of the 1950s and 1960s hierarchy of difference correct answer: Divine Providence correct answer: God's loving and watchful guidance over his creatures on their way to their final goal and perfection Black medical mistrust correct answer: -new data suggests that subtle/unconcious ways can exert more paternalism, less patient-centered and leads to subsequent distrust among African American patients -traumatic life events can permanently affect health outcomes -self-reflection on institutional practice and biases is needed structural racial discrimination correct answer: Structural Racism in the U.S. is the normalization and legitimization of an array of dynamics - historical, cultural, institutional and interpersonal - that routinely advantage whites while producing cumulative and chronic adverse outcomes for people of color. It is a system of hierarchy and inequity, primarily characterized by white supremacy - the preferential treatment, privilege and power for white people at the expense of Black, Latino, Asian, Pacific Islander, Native American, Arab and other racially oppressed people. racial health disparities correct answer: - In the US, Whites are healthier than racial/ethnic minorities in general - Blacks, as compared to Whites, have: ◦ Higher incident rates for almost all diseases ◦ Higher mortality rates ◦ Shorter life expectancy medical unconscious racial bias correct answer: -more paternalism, less patient centered bioethical neglect of racism correct answer: Black (and other minority) voices are not being heard cultural competency correct answer: the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients disability rights movement correct answer: -high degree of historical animosity -bioethicists typically posit 'ableness' as an unchallenged norm and view deviations from that norm as 'problems' to be fixed -many utilitarian judgements about 'quality of life' that have justified bioethical decisions seem to denigrate lives that people with disabilities actually live Deaf Identity correct answer: view of deafness as a cultural identity, rather than a disability, contradicts the medical community's perception of deafness as a disease or deficiency in need of correction or elimination. Americans with Disabilities Act (1990) correct answer: Major anti-discrimination law for disabled; requires access (ramps, braille, etc.) -A law passed in 1990 that requires employers and public facilities to make "reasonable accommodations" for people with disabilities and prohibits discrimination against these individuals in employment. Baby Doe cases correct answer: parents have right to choose to allow their children to die, parents have right to make medical decisions for their children Harriet McBryde Johnson correct answer: narrative ethics correct answer: -stories + personal+ community identity -sacred stories -organizes and gives meaning to sheer occurrence -dialogic and accumulative -emphasizes story telling, listening, and careful witness to events -In bioethics : patient histories/ medical histories: attending to patients stories yields insights and meaning Henrietta Lacks correct answer: Cancer cells taken without her knowledge, became HeLa cell line. HeLa cell line correct answer: George Gey correct answer: Chester Southam correct answer: -from 1954-63 he injected various patients, most unknowingly, w/ HeLa cancerous cells to see how their systems would react and to see if her could learn new things about cancer -attempted justification: patients were medically ignorant and though the possible dramatic medical gains --gov. attempts to regulate human medical experimentation had been opposed as inhibiting the progress of science and as a 'gov overreach' (underproduction vs overprotection) -he was convicted of fraud and unprofessional conduct, in 1968 he was elected president of the American Ass. of Cancer Research 1976 Rolling Stone Michael Rogers' article correct answer: first public irruption of the story Moore v. University of California case (1990) correct answer: John Moore was treated for hairy cell leukemia by physician David Golde, a cancer researcher at the UCLA Medical Center. Moore's cancer cells were later developed into a cell line that was commercialized by Golde and UCLA. The California Supreme Court ruled that a hospital patient's discarded blood and tissue samples are not his personal property and that individuals do not have rights to a share in the profits earned from commercial products or research derived from their cells.[1] Following this decision, most U.S. courts have ruled against family members who sue researchers and universities over the "improper commercialization" of their dead family member's body parts 2001 visit of Deborah Lacks to Johns Hopkins correct answer: made Henrietta feel noticed for the first time- learned that they were only her mothers cancer cells still 'alive' not her normal cells -he actually spent the time to teach her, and help Deborah understand the circumstances withholding v. withdrawing distinction correct answer: 1. not starting 2. stopping medically-assisted nutrition and hydration correct answer: MANH-seen as ordinary means In Re Quinlan case (1976) correct answer: was a landmark 1975 court case in the United States in which the parents of a woman who was kept alive by artificial means were allowed to order her removal from artificial ventilation Cruzan v. Director Missouri Health case (1990) correct answer: 25 year old female car accident: PVS, sustained by MANH; reflexive to response to pain, respiration and circulation normal, progressive spastic quadriplegia -her parents sought to assert right as proxies to discontinue treatment, hospital refused -In proxy situations SCOTUS ruled 5:4 that States have a clear life interest in incapacitated patients even if the states interest weakens and the individual's right to privacy grows as the degree of bodily invasion increases and prognosis dims -States can require "clear and convincing evidence" standard about the patient's wishes -Outocomes: family gathered evidence to allow the withdrawal of MANH -carefully distinguished medical proxy from 'substituted judgement' standards in end of life cases -Precedent that US states retain control over 'life'; conditions of death, judgements go beyond a 'Due Process" conscious tight to refuse treatment -prompted support for the Patient Self-Determination Act which charged hospital with the responsibility of providing partners with advance health care directives Principle of Double Effect (PDE) correct answer: -highly influential in Catholic moral theology and bioethics -while maintaining that certain actions are intrinsically 'wrong' (ie active killing of the innocent), it tries to address situations of moral dilemma in which an act might have both good and bad outcomes -there is a morally relevant distinction between intention to be sought (finis operates) that can justify certain actions that have ambiguous outcomes Justified if it meets 4 criteria 1. the act itself cannot be intrinsically (in se) wrong bad effect must not cause the good effect 3. the actor must not intend the bad effect 4. the bad effect cannot outweigh the good effect -applied in Catholic ethics to issues of end-of-life, abortion, mutilation, sterility obligatory v. optional treatment distinction correct answer: ordinary v. extraordinary means distinction correct answer: killing v. letting die distinction correct answer: according to Islam very clear distinction (think about Callahan article) -killing- a physician administrating a lethal injection (the cause of death) -letting die-withdrawing certain life sustaining treatments such as a ventilator (patient may die-but we can't say that that action necessarily was the actual use of the patient's death-its the underlying disease itself is the cause of death) -argue what happens to that patient versus a completely healthy person medical futility correct answer: Interventions that are unlikely to produce any significant benefit for the patient slippery-slope concerns correct answer: positive/negative autonomy obligations correct answer: Negative-dont try to exert a controlling influence (restraint) Positive-providing conditions for as much autonomy as possible types of autonomous consent correct answer: Implicit (or implied) is inferable from actions. Express (explicit) refusal, usually informed consent tacit-which occurs silently or passively through omissions presumed-diff. interpretations can be implicit or tacit and it may be general or specific nonmaleficence correct answer: - "first do no harm" -standard of due care: goals pursued justify the risks harm correct answer: to damage due care/ negligence correct answer: due care standards are a specification of the principle of nonmaleficience- it is taking appropriate care to avoid causing harm, as the circumstances demand of a reasonable and prudent person negligence involves a departure from the professional standards that determine due care in circumstances. (both intentionally and unintentionally) Jehovah's Witnesses and blood transfusions correct answer: beneficence correct answer: 1. prevent and defend rights of others nt harm from occurring to others 3. remove conditions of harm to others 4. help persons with disabilities 5. resume persons in danger DO GOOD original Hippocratic oath I will use treatment to help the sick, according to my ability and judgment obligatory beneficience correct answer: basically doing good within reason ideal beneficence ("The Good Samaritan") correct answer: what goes above and beyond that Peter Singer's Solution to World Poverty correct answer: -sacrifice for people around the world who are suffering until you are suffering at the same level -as a global community we need to give more as a (obligatory) basic moral minimum medical paternalism (soft v. hard) correct answer: intentional overriding of one person's preferences of actions by another person -soft: less conflict with autonomy: because of the difficulty of determining whether a person's actions are substantially non autonomous and of determining appropriate means of protection -hard: usurps autonomy by either restricting the information available to a person or overriding the persons' informed and voluntary choices stigmatization effects correct answer: -soft paternalistic policies sometimes stigmatize conduct such as smoking -It often has psychosocial costs -may slide into stigmatizing people (not just acts) -antismoking "sin tax" leading to hostility and antipathy directed at population subgroups -because smoking is now more common among lower SES groups in some countries, stigmatization thus affects socially vulnerable members of society and may involve discrimination-a matter of moral concern from the standpoint of both beneficence and justice Antipaternalism correct answer: oppose hard paternalistic interventions for several reasons (they regard rightful authority as residing in the individual) 1. focus on the potential adverse consequences of giving paternalistic authority to the state or to physicians 2. they hold that paternalistic standards are too broad and authorities and institutionalize too much intervention when made the basis of policies suicide intervention correct answer: justified by paternalism-we should intervene to prevent suicide by substantially non autonomous person, and few wish to return to the days when suicide was a criminal act. However, if there is an autonomy right to commit suicide, then we could not legimately attempt to prevent an automous but imprudent individual from committing suicide. -moral justification must fit context Neo-paternalism (nudge theory) correct answer: attempts to influence other people toward making good decisions -more public less individual cases, you do know they have autonomy -focus on changing the circumstances in which people are in so that they can make better decisions (putting healthy options into the vending machine) veracity correct answer: generally, shifts toward higher demands of veracity in medical situations, but limited disclosure, staged disclosure, and nondisclosure can be justified staged/limited disclosure correct answer: -occasionally justified when veracity conflicts with other obligations such as those of medical beneficence justification of nondisclosure correct answer: -when it is aimed at the patient's welfare and at preventing harm from occuring -placebo effect -research medical error correct answer: harm caused to the patient that results from the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim privacy correct answer: the right of people not to reveal information about themselves; -focus on the agents control over access to himself/herself confidentality correct answer: information that an individual has disclosed in a relationship of trust with the healthcare providers with the expectations that data will not be shared with unaruherized entites virtue ethics correct answer: Who are you? -actions cannot be evaluated apart from the one who does them -no accidental -must fo good knowingly -must deliberately chose what is good because it is good -must do this reliably character, flourishing, excellence, habits, wisdom is teleological (always pointed at an end) Eudainmonia correct answer: a term used in ancient Greek philosophy to describe a life of flourishing and happiness vice of deficiency correct answer: cowardice, sloth, miserliness, deceptiveness - vice of excess correct answer: recklessness, greed, profligacy, indescretion - motivation correct answer: moral character correct answer: compassion correct answer: active regard for another's welfare together with sympathy, tenderness, and discomfort at another's misfortune (part of virtue ethics) discernment correct answer: sensitive insight, astute judgement, and understanding brought to bear an action (virtue ethics) trustworthiness correct answer: to warrant another's confidence in one's character and conduct (virtue ethics) integrity correct answer: soundness, reliability, wholeness, and integration of moral character combined with objectivity, impartiality, and fidelity in adherence to moral norms (virtue ethics) conscientiousness correct answer: motivated to do what is right...worked with due diligence to determine what is right, intentions, and appropriate effort (virtue ethics moral excellence correct answer: supererogatory acts correct answer: acts that go beyond the call of duty-for utilit. an example of a difficulty is that there is no differentiation between basic moral minimums and supererogatory acts principle of qasd correct answer: Intention -all affairs are judged by their intention --means do not justify the end (therefore immoral methods used to achieve beneficial medical purposes are deemed impermissible) (part of the qawa id fiqhiyya or the 5 Islamic legal maxims-from Mustafa) principle of yaqin correct answer: Certainty -evidence based medicine -sound medical judgement -Sub-principle: that certainty is not removed by doubt -Sub-principle: that all medical procedures are deemed permissible unless their prohibition os certain (procedures related to reproductive functions) (part of the qawa id fiqhiyya or the 5 Islamic legal maxims) principle of darar correct answer: Injury -Injury should be relieved, thus providing justification for medical intervention -sub-principle: any harms of a therapy should be minimized; side effects should always be less in magnitude than the benefits -"lesser of two evils approach" where the public interest takes priority over individual interest, and confidentiality can be superseded by public health concerns (part of the qawa id fiqhiyya or the 5 Islamic legal maxims) principle of darura correct answer: Necessity -that cases of necessity can render an otherwise prohibited action as permissible -ex: steralization which is absolutely prohibited in Islam, but which may become permissible if a potential pregnancy severely threatens a woman's life -when necessity finishes it becomes prohibited agian (part of the qawa id fiqhiyya or the 5 Islamic legal maxims) principle of 'urf correct answer: Custom -thus by the custom (provided it does not contradict the shari'a -customary practice must be the predominant and widespread practice of medical practitioners in order to be rendered valid. exoticism bioethics correct answer: Zoloft's article-> fixation on problems that effect very few people. Zoloft proposes to invert that ratio (spending 75% of time on 5% of the population) surrogate decision making correct answer: an agent who acts on behalf of a patient who lacks the capacity to participate in a particular decision Oregon's death with dignity act (1994) correct answer: dr. kevorkian assisted to give people suicide that had illnesses that lead them to no longer want to live they would film the assessment and family interviews to verify the valid reason for death he was charged with murder anyone can go to switzerland and have an assisted suicide Eluana Englaro Case correct answer: -had been in a PVS for 17 years her father wanted her MANH removed -emphaisis on individual choice and concerns about the slippery slope -right to die vs right to life virtue of prudence correct answer: practice wisdom, a sense cultivated in how to apply moral rules in unclear situations (and posts on character of who is making decisions) (Drummond article) divine Sophia correct answer: -argument to fellow Christians/Catholics-a type of wisdom that manifests God's wisdom. Virtue Person=God. and should take the valuable insight to make new decisions that could be unclear to you. follow the divine Islamic death correct answer: occurs upon the separation of the spirit/soul from the body, resulting in the loss of integrated personhood -as an altered state of being-a station in the journey of the return to God nafs/ruah correct answer: the entity that infuses human body with life -when it departs the human body ceases to exist as a part of an integrated person/ "soul-nafs" or "spirit-ruh" stable/unstable life correct answer: (mustaqar): presupposes the confutation of blood circulation and or respiration because of movement and pulse (like everyday normal life) (ghayr mustaqar) rate of blood flow lower than level of viability, inconsistent cardiac function, Heartbeat conclusive indication of life. halal correct answer: (Islam) meat from animals that have been slaughtered in the prescribed way according to the shariah haram correct answer: forbidden by Islamic law whole brain death correct answer: irreversible cessation of all brain functions higher brain death correct answer: the irreversible loss of higher brain function; lower brain stem continues to provide respiration, blood pressure, and a heartbeat without the assistance of a respirator -permanent loss of consciousness cardio-pulmonary death correct answer: If the heart stops pumping and there is no respiration, then the person is considered dead Vaco v Quill case (1997) correct answer: -Quill a PAD advocate who wrote an article in 1991 about deciding to help his patient Diane -brought a constitutional challenge against the laws of New York that prohibits PAD asserting that patients have an equal protection right in asking for help to hasten their own death in withdrawal of treatment -SCOTUS ruled 9-0 that there is NO constitutional right to death -according to SCOTUS there is a morally revenant distinction between refusal of treatment (when the physician may contribute indirectly to the death of a patient) and requests for suicide assistance-direct -Upheld the Killing v Letting Die distinction aa a matter of US law and morality physician-assisted dying correct answer: surrogate euthanasia correct answer: involuntary euthanasia correct answer: when there has been an expression of opinion against it; overriding their autonomy "right to die" movement correct answer: dying people, rather than doctors, should decide when, where, and how people die Jack Kevorkian correct answer: Also known as, Dr. Death - Developed machine to administer doctor assisted sucide. -1990-Dr. Jack Kevorkian assists in the death of Janet Adkins, a middle-aged woman with Alzheimer's disease. Kevorkian subsequently flaunts the Michigan legislature's attempts to stop him from assisting in additional suicides. -1998-Dr. Kevorkian assists the suicide of his 92nd patient in eight years. His home state, Michigan, passes new law making such actions a crime; the law take effect on September 1, but Kevorkian carries on helping people to die, getting to 120 by November. -Dr. Kevorkian sentenced to 10-25 years imprisonment for the 2nd degree murder of Thomas Youk after showing video of death by injection on national television. Protestnats correct answer: personal experience of the reception of the Word in one's own life