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Bioethics Final preparation

1/2 multiple choice / true false. 

5 free response. we’ll choose 3. 

Equipoise: state of equilibrium. 

Reproductive Technology
Key Terms and Cases:
	Assisted Reproductive Technology (ART): Any non-normal method of procreation. 
	In Vitro Fertilization (IVF): manually implanting a sperm into an egg, and placing it in the uterus. 
	Pre-implantation Genetic Diagnosis (PGD): During in vitro, they select only embryos (fertilized eggs) that don’t appear to have genetic defects. 
	Traditional Surrogacy: man and surrogate’s embryo.  
	Gestational: man and women’s embryo. 
	Cloning: asexual production of genetically identical thing. 
	Baby M: Surrogate lady wanted her baby back, court originally said “no” but then she appealed and got it mostly reversed. She just got visitation rights (for other reasons) and was the natural and legal mother. 
	Commodities: property/goods. The market is appropriate to do what it pleases. When money is changed hands, people argue that they make babies “commodities”, in that by “selling” the baby you are violating the norms of parental love (guided by genetics). 
	Important Questions:
		-Anderson: wrong with applying market norms to human reproduction? It fails to value the baby in an appropriate way. It reduces children’s status to a commodity. It degrades women. 
		-Anderson: how treat children and labor like commodity? Why bad? bad because degrades women and children. mainly because bought, used, sold without consideration for product (like an inanimate object would be)
		-Anderson: why important retain connection between genetics/obligation to children? Mainly the benefits such as children are respected because parents naturally care about continuing their genes. And other distant genetic relatives will care for them if the parents can’t (grandparents). 
		-Brock: central arguments in support of cloning (human rights, individual/societal benefits)? right to reproductive freedom, infertility. (no social?) 
		-Brock: central arguments against cloning (human rights, individual/societal)? no real violated right. psychological distress, risks to clones (death), commercial interests (selling clones). 

Genetic Choices
Key Terms and Cases: 
	Genetic testing: Testing someone’s DNA for genetic disorders. Typically a newborn. Could be an IVF egg. 
	Genetic Discrimination: the fear that people, or companies, may discriminate against individuals if they know their DNA (due to probabilities of future illnesses that could reduce productivity, for instance). 
	Gene Therapy: fixing genetic disorders by altering genetic codes. 
	Eugenics: modifying a person’s genes (using gene therapy) to improve an individual. Negative is preventing disease and positive is enhancing. 
	Stem cells: cells that have the potential to turn into other cells. There are embryonic stem cells, which can turn into any cells (but must be harvested from an embryo). 
	Important Questions:
		-Robertson: why difference selection sex for first vs second child? Choice of first child is likely due to sexism (desiring a male for financial reasons), choice of second child is likely due to desiring some variability. 
		-Robertson: view on using PGD for perfect pitch? Essentially, it’s okay so long as they give reasons for it. That they wouldn’t reproduce if they couldn’t guarantee. They have the right after birth, why not before?
		-Standard: what is standard view against PGD? not sure. Probably is that it disrespects disabled people by saying that the world would be better without them. Could also be that that people shouldn’t play God. 
		-McMahan: how use sexual enhancement drug to show okay to screen for disability? If deaf is not bad, then should be treated like eye color. If is bad and not okay to stop it, then would be okay for woman to take drug that 
			        increases pleasure but increases chance of disabled baby. So, don’t think induce is okay —> at least okay to prevent having disabled child. 
		-McMahan: why okay view to say “bad to become deaf but not bad to be deaf”? Transitional costs: born deaf is okay, but then becoming deaf you have to get used to and lose goals make new ones. That’s what’s bad. 
		-Glannon: how to draw the line between treatment and enhancement, how might concerns about “normal” affect line? treatment is to fix people operating below normal. enhancement is to increase above normal. The problem is the definition 
			      of normal. What do you say is normal? For instance, what IQ is normal? You could say “let’s just allow a little above and below”, but how much above and below? 
		Glannon: how would some modifications undermine autonomy? Essentially, you could make everyone generous and careful etc, but that would undermine autonomy even if it is a net social good. People should have full autonomy, not limited 			     to what their parents desired their genes to be. 

Euthanasia/Physician-Assisted Suicide
Key Terms and Cases: 
	Physician-Assisted Suicide (PAS): patients taking their own life with the help of a doctor. The patient pulls the plug. 
	Passive vs active euthanasia: passive is when a doctor/someone lets die (including removing feeding tube), so essentially stopping/not doing something. Active is actually killing when they could live, like injection. 
	Voluntary/non-voluntary/involuntary euthanasia: voluntary is patient approved of dying, non-voluntary is the patient didn’t say either way (could be in coma), and involuntary is the killing patient without consent and they’re competent to decide.
	Death with dignity act (Oregon): allowing Physician assisted suicide. Lots of steps. 
	Dutch Euthanasia: the dutch allow active voluntary euthanasia. Can be used to counter slippery slope argument. Have not shown that this legalization resulted in more nonvoluntary cases. 
	Belgian brothers: two identical twins that were deaf who found out they would soon go blind. They decided to die by euthanasia because they couldn’t bear not to see either. 
	Down Syndrome Babies: essentially, babies born with down syndrome and intestinal blockage can be let die, but with down syndrome without intestinal blockage can’t let die so have to let live. 
	Smith and Jones: smith gets money if cousin dies, he goes to bathtub and drowns cousin and makes look like accident. jones same case, goes upstairs about to kill, but notices that the child hit head and is drowning, waits for drown. Done. 
	Important Questions:
		-Arras: why would legalization of PAS lead to other, bad things: May be just that he thinks that there is little a line between PAS and active euthanasia, and then that starts a slippery slope. Allowing PAS is to say that 			autonomy is supreme so the argument is “it’s arbitrary to draw the line here, why not even further?” etc. 
		-Arras: why significant concerns about abuse come with legalizing PAS? claim: doctors can’t adequately diagnose depression —> unnecessary deaths; all options not exhausted, especially with poor/minorities; things won’t be reported well because doctors are scared. 
		-Arras: why no theoretical difference between kill/let die, import diff between legalization of passive euthanasia and PAS? It seems like he’s just afraid as hell that doctors will take matters into their own hands, ignore the extra bureaucracy and commit more than PAS. 
			He thinks that doctors aren’t going to follow the regulations which means people are going to die needlessly, because they could have pursued life longer. 
		-Arras: favored approach to social policy on PAS? No matter what choice we make (tragic choice), there are going to be victims. He says that what we should do is instead launch a campaign to educate doctors about how to treat dying patients, that way PAS is not necessary in 			most cases. The cases where it is necessary, he says the doctors can still help them kill themselves in private but that it’s important for PAS to still be criminalized because it helps saves poor people months/years of their lives. 
		-Rachels: How does case of certain down syndrome babies show active euthanasia > passive and passive euthanasia allows death on irrelevant grounds? Down syndrome with intestinal block: letting baby die is painful and takes days while active would be immediate. It is 			      irrelevant grounds because the babies are dying only because they have Down’s Syndrome, why should it matter that they happen to have intestinal problems? 
		-Rachels: How does case of Smith and Jones show no moral difference let die and kill? If there were a moral difference, the two could both have intentions to kill and one would feel worse about the one who killed, but one doesn’t which shows there is no moral difference. 

Dividing up Healthcare resources
Key Terms and Cases: 
	Theories of justice: 
		Libertarian: benefits and burdens should be left to free market, rights of noninterference (so government just makes sure people don’t kill each other). 
 		Utilitarian: benefits and burdens should be distributed in a way that maximizes net good for society. 
		Egalitarian: benefits and burdens should be distributed equally. So there is a small gap, essentially. 

	QALYS (quality adjusted life year): So 1 QALY unit is one person living in good health for 1 year. <1 is not living in good health (scalar dependent on how bad). 

	Important Questions: 
		-What would each theory of justice say about distribution of healthcare and right to healthcare? Libertarian would say nobody has a right to healthcare. Distribution based on wealth. Utilitarian says that healthcare distributed in a way that makes people best off, 
		still no right to healthcare. Egalitarian you would just want to have everyone on the same field, still no real right to healthcare but you could have a moral right with this. 
		-Deber: lessons US learn about Canada healthcare? Single-payer is government paying for healthcare (what they have). Divide more up (Canada handles at state level, we should too). It can cost less to cover everyone. Last lesson: don’t make it a mix between national and state, 			  because that has sort of messed things up in Canada. 
		-Daniels: what four unsolved problems make it hard to say how to divide up resources? Fair chances/best outcomes: who to give transplant to if one would live 2 years and the other 12 years? Priorities problem: one group worse off and one group better off, should help worse off group a little or better off group a lot? 
			    Aggregation problem: how many people should lose their legs vs one person’s life being saved? You can’t really do these comparisons. Democracy problem: essentially weighting the badness of certain diseases by what’s commonly accepted socially? People without disability may overestimate and without it may 			    underestimate. 
		-Rescher: what three factors taken into consideration screening for exotic life saving therapies? What five taken into consideration for final selection stage? Constituency (person has to be a constituent of the healthcare provider), Progress-of-science (inclusion in studies could further research), Prospect-of-success (only idea 			      candidates get treated). Final: relative likelihood of success, life expectancy, family role factor, potential contributions, and previous contributions.


Main things to remember and person identification: 

Anderson: anti-surrogacy. Commodities. Etc. 
Arras: guy who is wrong. Says that legalizing PAS may result in more non voluntary passive euthanasia and possibly active. 
Brock: cloning guy. Didn’t really come one way or another. 
Daniels: How to divide up resources. 
Gannon:  PGD difference between enhancement and treatment, how autonomy can get undermined. 
McMahan: screening for disability is cool via sexual enhancement. Transitional costs. 
Robertson: dude showing that PGD is cool via Perfect Pitch. 
Rachels: shows that passive can be worse than active, and that no diff between killing and let die. 
Rescher: How to figure out who to give experimental shit to. 

Anderson: anti-surrogacy 
Brock: cloning
Robertson: perfect pitch. 
Mcmahan: sex pill 
Glannon: “normal” 
Arras: anti-PAS
Daniels: dividing up
Rescher: screening

	Cheaper for covering everyone. 
	Don’t split between federal and state. 

	Fair/chances best outcomes. 

Life saving: 
	Ideal candidate. 
	Better for science. 

	Life expectancy. 
	Past contributions. 
	Future contributions. 
	Family relation. 
	Likelihood of success.