1/2 multiple choice / true false.
5 free response. we’ll choose 3.
Equipoise: state of equilibrium.
Paternalism and Patient Autonomy
Key Terms and Cases:
Autonomy: a person’s capacity for self-governance.
Autonomy Principle: Autonomous person’s should be allowed to exercise their capacity for self-governance.
-Strong paternalism: when you override someone’s autonomy who can fully operate themselves.
-Weak paternalism: when you override someone’s autonomy who can’t make decisions themselves.
-Pure: Dworkin: worried that you’re going to make a bad decision, so I restrict you.
-Impure paternalism: Dworkin: worried that you’re going to make a bad decision, so I restrict someone else (like tobacco company).
Futile Treatment: the alleged pointlessness of administering particular treatment
- How have attitudes toward professional/patient relationships changed since 80’s? They’ve gone more toward patient autonomy/choice.
- Dworkin: use justification for acting paternalistically toward children to explain acting paternalistically toward adults? We think that it’s justified to act paternalistically toward children. Because children are more likely to make rational errors, to act myopically, etc. So because we do that, he says it’s okay to act paternalistically towards adults when they make the same errors.
- Ackerman: the psychological impact of illness affect medical professionals obligations towards patients? Essentially, because they have an illness they are not operating in full autonomy, and thus the doctor can and should act more paternalistically with benefiting the patient in mind.
- Schwartz: did the Wangle case fail to address the right moral questions? Schwartz said the question wasn’t whether the father was able act as the caretaker of the vegetative wife. What’s at issue here is that this was not a medical decision. It was a decision about whether a treatment counted as a medical treatment.
- Schwartz: view on how we should determine what treatments count as futile. How does this relate to our discussion regarding difference between amputate limb and sexual orientation surgery? Schwartz says that it should be left to the physicians themselves to determine what counts as futile. I suppose this means that doctors can refuse to do certain procedures.
Truth-Telling and Confidentiality
Confidentiality: some people think that you should withhold some truth from patients, others think only in extreme circumstances. The thought it is may benefit them. Same thing goes for confidentiality.
Carlos R (p. 137). Had HIV, was gay. Came in for gunshot wound. His sister said she would take care of him but he didn’t want her to know he had HIV. But she would be at risk for contracting it if she didn’t know.
-Rachels: why is privacy valuable? How does argument impact value of confidentiality in medical professional/patient relationship? What makes privacy valuable is that privacy is required to maintain valuable social relationships. Suppose I was around when I was with your best friend. Part of having these relationships involves having privacy privacy to keep them separate. The same thing can happen with confidentiality where the doctor leaks certain information, even if it doesn’t harm you or the people who hear the information don’t treat you differently, it could just sort of breach the level of your relationship with that person.
Competence: the ability to render decisions about medical interventions.
Informed Consent: action of an autonomous and informed person to submit to medical treatment or experimentation.
The Nuremberg Code: established after the Nazi’s medical studies. Ensures Clinical trials have a moral standard.
Declaration of Helsinski: essentially reiteration of Nuremberg, but discuses subjects who aren’t capable of giving informed consent.
Belmont Report: principles and guidelines for research on human subjects. Three core principles: respect, beneficence, justice.
Tuskegee Experiment: This is the black town in Alabama. Between 1932-1972. Syphilis. Penicillin was discovered but the subjects weren’t allowed to use it.
Deadly Deception (movie about Tuskegee): movie about the Tuskegee experiment.
AIDS in Africa? This has to do with AZT trials. Where essentially researchers were trying to see if they could reduce the dose of AZT for transmission of HIV to babies from mothers. Had to test using placebo control on African women.
Angell: why according to Angell is it bad to appeal to “local standard of care” in determining whether placebo-controlled study is appropriate? She believes that you can only give placebos when you’re actually not sure if the treatment is better than placebo (so follow world-wide standard of care). She essentially says that appealing to the local standard of care could lead to exploitation.
What is the general justification for using placedbo-controlled studies over other kinds? They can lead to new discoveries that non placebo controlled couldn’t (like lower doses of existing drug) which could lead to the benefaction of way more than those in the study.
Brody: what is distinction between three different objections to studies in Africa: “they were unjust, involved coercion, involved exploitation”. How does he respond to each. How might Angell respond to him? Argues against Angell, saying that the placebos were ethical because nobody was denied a treatment they would otherwise have available. She thinks that the local standard of care is insufficient (she wants global standard). He say that we don’t think that it’s unjust to just not give them the medicine in the first place. So suppose that we don’t already owe them the drugs. If you think that’s just, then why is it unjust to not give them the medicine. Once we fix on what they’re owed, then that’s the standard that we owe them. That’s just the unjust part. Coercion: this is not coercion because if it were coercive you would have to make some sort of threat. Exploitation: exploitation would involve a situation when they’re not given a fair share of the benefits that is made during the study.
Person: Conscious, reasoning, self-motivated action, capacity to communicate, self awareness.
Potential Person: something that could become a person
Viability: the ability for a fetus to survive independent of mother
Fetus: baby inside womb
“Future Like Ours”: Argument put forth by Marquis. Essentially, examine the reasons why it’s wrong to kill a human being. It’s wrong because you deprive them of future experiences. You can carry this wrongness over to killing a fetus because it would have identical future experiences. This is a good argument because it doesn’t depend on a classification of a fetus as a human or not.
The Space Explorer: Warren’s case. Talks about potential persons. Suppose there’s a space explorer, say the aliens say that we can turn your cells into people, but ultimately the space explorer should have the right to do as they please, even though he could be allowing them to make people from his cells.
The Violinist Case: you have a really famous violinist and he’s dying from kidney failure so society of music lovers kidnaps you and forces you to help him. Is it okay for you to disconnect?
The Expanding Baby Case: imagine you had an expanding baby and it was going to crush you unless you popped it. Is it okay for you to pop it? Is it okay for someone else to pop it?
The People Seeds Case: imagine people seeds flew around and grew in cushions, you could either live in house with no cushions or buy special people seed protectors. If a people seed flew into your house even though you had the protector, is it okay to kill the baby?
The chocolates case: unjust if violates someone’s rights. Suppose grandmother gives you box of chocolates and tells to share with brother, eating them all would be unjust. If she didn’t say share, eating would be cruel but not unjust.
The Coat Ownership Case: Thompson: when you look at the dialog that’s going on about the abortion case. A lot of it is about what a third party can do. She talks about difference between third-party person acting and person in danger acting. But, now imagine you have smith and jones and there’s danger of dying from cold. One picks up a coat but it’s the other’s coat. Then it’s at least permissible for you to give the person who owns it.
Marquis: what is wrong with abortion debate as it is now? Essentially it’s all about the classification of human beings. The pro-choicer wants to narrow the definition, and pro-abortionist wants to widen. But they can never solve anything this way.
Marquis: why think that “future like ours” view of the wrongness of killing is better than either of alternatives? Essentially, by looking at what makes killing wrong and then applying it to fetuses, we prevent having to look at classifications of humans.
Marquis: why does he say his argument not extend to argument against contraception? Essentially because there are millions of combinations of potential people, and so by preventing a combination you’re not violating an individual’s right to a “future like ours”.
Warren: five features central to concept personhood? The five mentioned above. Conscious, reasoning, self-motivated action, capacity to communicate, and self-awareness.
Warren: Why does permissibility of abortion not imply permissibility of infanticide? Because new babies are so very close to being persons, so killing them is wrong just like other near humans such as dolphins, whales, chimpanzees, etc.
Warren: why abortion permissible even if potential person have rights? Because the rights of a full person (mother) will always outweigh that of potential persons.
Thompson: what is relevance of thought experiments she presents? You should be able to look at each of the thought experiments and how they apply to abortion things.
Thompson: why does fetus right to life not guarantee right to mother body? Because the woman has the right not to allow the baby to use her body without her permission (such as rape cases).
Thompson: why is moral status of abortion more complex than “right” or “wrong”? She avoids stating whether it’s right or wrong because she thinks that the mother should be held to “a good samaritan”, which she doesn’t define because you’d have to take that case by case.
Thompson: why important to distinguish between mother may do and what third parties may do? Because it’s doctors who end up committing the abortion, not the mother. This is the expanding baby in the house. Essentially the mother owns the house, and so it’s reasonable to have a third party abort the baby.
Thompson: why might some abortions be wrong but not unjust? Unjust just means that you violate a right. Something can be wrong (like the chocolate case) but not unjust. Something that would be wrong would be the woman getting an abortion because she wants to go on vacation.
Dworkin: pure vs unpure. children based paternalism.
Ackerman: should increase paternalism for mentally impaired patients.
Schwartz: vegetative state case/futile treatments.
Rachels: honesty separates relationships.
Nuremberg: Nazis. Clinical studies.
Helsinski: Reiteration of Nazis. Can’t give informed consent.
Belmont: Research on human subjects. Respect, beneficence, justice.
Angell: Bad to appeal to local standard of care.
Brody: OK to appeal to local standard so long as not unjust, involved coercion, exploitative.
Person: Conscious, reasoning, self motivated, capacity to communicate, self aware.
Marquis: Future like ours. Problem with abortion debate.
Warren: Five features of person. Weak pro-abortion argument.
Thompson: Thought experiments. Coat ownership.