PHIL 235 BIOMEDICAL ETHICS UPDATED LATEST
NEW QUESTIONS AND ANSWERS SURE A+
✔✔An individuals right to control access to viewing and touching intimate aspects of
their bodies and revelation of intimate personal information at their own discretion.
- Bodily privacy
- Information privacy
- Communication privacy
- territorial privacy - ✔✔Privacy And confidentiality:
✔✔- Traditional notion of confidentiality does not exist, its systematically breached. A
patient yelled at Siegler to ensure his confidentiality. Siegler then investigated and found
that 100s of HCPs reviewed the patient's records including therapists students etc.
- This cant be reversed because better care is evolving and needs it
Siegler suggests
1. Need to know protocols for hospital staff
2. Patients should be informed confidentiality is changing
3. Patients should be given input on what may be shared.
- better care is perhaps bought at the expense of diminished confidentiality
more worried about people they know, not random staff finding stuff out -
✔✔Confidentiality According to Mark Siegler
✔✔When can truth telling be suspended?
,- Veracity/truth telling is a prima facie duty, not an absolute obligation
- Default you must tell the patient but what conditions should you not?
1. Culture
2. Fragile emotional state
3. Patient wouldn't understand
4. Benevolent deception (blissful ignorance)
LIPKINS POSITION
- Physicians should tell most patients the truth if they can understand and process it.
- A good physician can sense when they don't want to know
- Placebo truth/lies should be employed with caution (was the deception well intended)
- deception may be justified in dr-patient relationships so long as it is to the benefit of
the patient - ✔✔Telling the Truth to Patients - MACK LIPKIN
✔✔-Telling the truth is the default, yet veracity is a secondary value and can be
suspended in favor of other values such as survival and well being
- Thomasma focuses on
1. Context
2. Secondary nature of value of truth
3. Truth is necessary at some point to reach a cure
4. Withholding truth is temporary
5. Truth is default
- truth as a right, a utility, and a kindness to the patient
truth is only a secondary good, may be set aside to promote the survival of the patient,
community the ability to absorb the full impact of the truth at a particular time -
✔✔Telling the Truth to Patients - David C. Thomasma
✔✔recognize that genetic privacy is importantly different from the privacy of other
medical info because the info obtained may be indirectly relevant to the quality and
even length of someones life - ✔✔genetic privacy - Patricia Roche & George Annas
✔✔one's genetic privacy may be morally breached in a order to protect the well being of
family members who likely share a portion of that genome - ✔✔genetic privacy - Lacroix
et al
✔✔- children developing capacities along a sliding scale
o infants and young children (no capacity)
o primary school aged children (capacity to assent)
o adolescents (at times reaching a full capacity to consent) - ✔✔Involving Children in
Medical Decisions - Christine Harrison, et al.
✔✔-The story of the elderly Korean patient in Hawaii
-"there is something to be said for mindfully striving to treat vulnerable patients with
dignity and respect, even when their values are hateful"
, -deep importance of ensuring that the decision that is made "makes sense against the
background of the patient's reasonably stable personal values" - ✔✔"Quality care and
the wounds of diversity" - Kenneth Kippins
✔✔- respect for individual autonomy can conflict with cultural sensitivity
o perhaps individual autonomy cannot be universalized
o all principles should be open to revision
o western emphasis on autonomy in a reaction to paternalism
o cultural norms on disclosure and medical decision-making are very different in
different cultures
- HCPs should explicitly ask patients about how they would like information to be
distributed - ✔✔"Ethical Relativism in a multicultural society" Ruth Macklin
✔✔o Only accommodate when a practice or request poses no threat to others
o Negative talk in medical services for Navajo patients
o Patient demands for procedures considered immoral "here" but that are required in
the patient's home culture
- two extremes that should be avoided: intolerance (where practices that pose no threat
are refused due to a lack of respect) and over-tolerance (such as when an HCP allows
a family's culturally based request to override the autonomy of the patient). -
✔✔intolerance vs over-tolerance
✔✔- "to what extent can the patient's family legitimately be asked or required to sacrifice
their interests so that the patient can have the treatment he or she wants"
o Family is broadly understood to mean "those close to the patient"
o Autonomy vs responsibility in medical decision-making
o More than a mere utilitarian calculation ...
o Fidelity vs fairness
o Who should decide?
o How might this relate to the ethics of care
- According to Hardwig, there are situations in which the family in fact has more at stake
than the patient in the decision concerning treatment, and when this is the case, he
argues, these interests need to be taken into account in medical decision making, even
sometimes over-riding the patient's preferences. - ✔✔"What about the family?" - John
Hardwig
✔✔- Discussing what counts, as health requires consideration of proper human state,
which is caught up with value judgments explicit and implicit. (Tristan Englehardt, JR)
-Illness, Disease, health and treatment are social constructs. There are no illnesses or
diseases in nature. (Peter Sedgewick) - ✔✔Health as a Social Construct - Englehardt &
Sedgewick
✔✔Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.
criticism: Well being to ambiguous - ✔✔world health organization definition of health
NEW QUESTIONS AND ANSWERS SURE A+
✔✔An individuals right to control access to viewing and touching intimate aspects of
their bodies and revelation of intimate personal information at their own discretion.
- Bodily privacy
- Information privacy
- Communication privacy
- territorial privacy - ✔✔Privacy And confidentiality:
✔✔- Traditional notion of confidentiality does not exist, its systematically breached. A
patient yelled at Siegler to ensure his confidentiality. Siegler then investigated and found
that 100s of HCPs reviewed the patient's records including therapists students etc.
- This cant be reversed because better care is evolving and needs it
Siegler suggests
1. Need to know protocols for hospital staff
2. Patients should be informed confidentiality is changing
3. Patients should be given input on what may be shared.
- better care is perhaps bought at the expense of diminished confidentiality
more worried about people they know, not random staff finding stuff out -
✔✔Confidentiality According to Mark Siegler
✔✔When can truth telling be suspended?
,- Veracity/truth telling is a prima facie duty, not an absolute obligation
- Default you must tell the patient but what conditions should you not?
1. Culture
2. Fragile emotional state
3. Patient wouldn't understand
4. Benevolent deception (blissful ignorance)
LIPKINS POSITION
- Physicians should tell most patients the truth if they can understand and process it.
- A good physician can sense when they don't want to know
- Placebo truth/lies should be employed with caution (was the deception well intended)
- deception may be justified in dr-patient relationships so long as it is to the benefit of
the patient - ✔✔Telling the Truth to Patients - MACK LIPKIN
✔✔-Telling the truth is the default, yet veracity is a secondary value and can be
suspended in favor of other values such as survival and well being
- Thomasma focuses on
1. Context
2. Secondary nature of value of truth
3. Truth is necessary at some point to reach a cure
4. Withholding truth is temporary
5. Truth is default
- truth as a right, a utility, and a kindness to the patient
truth is only a secondary good, may be set aside to promote the survival of the patient,
community the ability to absorb the full impact of the truth at a particular time -
✔✔Telling the Truth to Patients - David C. Thomasma
✔✔recognize that genetic privacy is importantly different from the privacy of other
medical info because the info obtained may be indirectly relevant to the quality and
even length of someones life - ✔✔genetic privacy - Patricia Roche & George Annas
✔✔one's genetic privacy may be morally breached in a order to protect the well being of
family members who likely share a portion of that genome - ✔✔genetic privacy - Lacroix
et al
✔✔- children developing capacities along a sliding scale
o infants and young children (no capacity)
o primary school aged children (capacity to assent)
o adolescents (at times reaching a full capacity to consent) - ✔✔Involving Children in
Medical Decisions - Christine Harrison, et al.
✔✔-The story of the elderly Korean patient in Hawaii
-"there is something to be said for mindfully striving to treat vulnerable patients with
dignity and respect, even when their values are hateful"
, -deep importance of ensuring that the decision that is made "makes sense against the
background of the patient's reasonably stable personal values" - ✔✔"Quality care and
the wounds of diversity" - Kenneth Kippins
✔✔- respect for individual autonomy can conflict with cultural sensitivity
o perhaps individual autonomy cannot be universalized
o all principles should be open to revision
o western emphasis on autonomy in a reaction to paternalism
o cultural norms on disclosure and medical decision-making are very different in
different cultures
- HCPs should explicitly ask patients about how they would like information to be
distributed - ✔✔"Ethical Relativism in a multicultural society" Ruth Macklin
✔✔o Only accommodate when a practice or request poses no threat to others
o Negative talk in medical services for Navajo patients
o Patient demands for procedures considered immoral "here" but that are required in
the patient's home culture
- two extremes that should be avoided: intolerance (where practices that pose no threat
are refused due to a lack of respect) and over-tolerance (such as when an HCP allows
a family's culturally based request to override the autonomy of the patient). -
✔✔intolerance vs over-tolerance
✔✔- "to what extent can the patient's family legitimately be asked or required to sacrifice
their interests so that the patient can have the treatment he or she wants"
o Family is broadly understood to mean "those close to the patient"
o Autonomy vs responsibility in medical decision-making
o More than a mere utilitarian calculation ...
o Fidelity vs fairness
o Who should decide?
o How might this relate to the ethics of care
- According to Hardwig, there are situations in which the family in fact has more at stake
than the patient in the decision concerning treatment, and when this is the case, he
argues, these interests need to be taken into account in medical decision making, even
sometimes over-riding the patient's preferences. - ✔✔"What about the family?" - John
Hardwig
✔✔- Discussing what counts, as health requires consideration of proper human state,
which is caught up with value judgments explicit and implicit. (Tristan Englehardt, JR)
-Illness, Disease, health and treatment are social constructs. There are no illnesses or
diseases in nature. (Peter Sedgewick) - ✔✔Health as a Social Construct - Englehardt &
Sedgewick
✔✔Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.
criticism: Well being to ambiguous - ✔✔world health organization definition of health
