Bioethics Exam Study Guide

• The exam will consist of a multiple-choice section and a short answer section.
• Multiple-choice questions will be similar to or identical to quiz questions, and will test terminology and understanding of concepts.
• Short answer questions will require demonstrating understanding of course concepts and defending arguments/opinions with course concepts.

Terminology

• Bioethical terminology includes: Autonomy, Nonmaleficence, Beneficence, Utility, and Justice.
• Knowledge of terminology from ethical theories and previous units is required.
• New terminology from the Birth Control Unit and the Pediatric Care Unit is also required.

Ethical Theories

Utilitarianism

• The Principle of Utility states an act is morally required if and only if it is optimific.
• "Morally required" and "optimific" must be understood.
• Utilitarian methodology must be understood for decision-making.

Deontology

• The Universal Law Formulation (ULF) requires acting only according to maxims that you can simultaneously will as a universal law.
• "Maxim" and "universalizability" must be understood.
• The ULF must be understood to determine if an action is morally permissible.
• The Formula of Humanity (FoH) requires treating all human beings (yourself included) as an end and never as a mere means.
• "End" and "mere means" must be understood.
• The FoH must be understood to determine if an action is morally permissible.

Course Readings: Autonomy and Paternalism

The Refutation of Medical Paternalism (Goldman)

• Weak paternalism and strong paternalism must be differentiated; strong paternalism is controversial.
• Goldman believes the argument for strong paternalism fails.
• Goldman's argument against strong paternalism must be understood.
• Arguments against strong paternalism should employ the principle of autonomy, utilitarianism, deontology, or Goldman's argument.

Why Doctors Should Intervene (Ackerman)

• Ackerman argues in favor of strong paternalism.
• Arguments in favor of strong paternalism should employ the principle of autonomy, utilitarianism, deontology, or Ackerman's argument.

Course Readings: The Definition of Death & Medical Futility

Changing the Conversation about Brain Death (Miller and Truog)

• Brain death, biological death, and legal death must be defined and distinguished.
• Distinguishing between legal death and biological death can solve current miscommunication in medicine.
• "Legal death" as a concept is beneficial.

Defining Medical Futility and Improving Medical Care (Schneiderman)

• Medical futility must be defined.
• Quantitative futility and qualitative futility must be defined and distinguished.
• Medical cases must be identified as examples of quantitative futility, qualitative futility, both, or neither.
• "Medical futility" as a concept is important.

Autonomy, Futility, and the Limits of Medicine (Schwartz)

• The relationship between autonomy and medical futility must be understood.
• The limits of medicine must be understood; Patients may not require:
  • Treatment by non-medical means.
  • Medically futile treatment.
  • Treatment that is inconsistent with the ends of medicine,
• Reasons why a doctor may refuse a case must be determined with the numbers listed above.
• The goals of medicine must be understood.

Course Readings: Euthanasia and Physician Assisted Suicide

Chapter 10 (Vaughn)

• Active euthanasia, passive euthanasia, and physician-assisted suicide must be defined.
• Decisions must be defined as voluntary, involuntary, or nonvoluntary.
• Cases of: voluntary active euthanasia, involuntary active euthanasia, nonvoluntary active euthanasia, voluntary passive euthanasia, involuntary passive euthanasia, and nonvoluntary passive euthanasia must be identified.

Active and Passive Euthanasia (Rachels)

• The distinction between "killing" and "letting die" might not be morally useful when considering active euthanasia.
• The bathtub example and what it demonstrates should be known.
• Denying a moral difference between "killing" and "letting die" makes an argument in favor of active euthanasia.

Death and Dignity: A Case of Shared Decision-Making (Quill)

• The case of Diane (the leukemia patient) should be known.
• Diane's case must be known as an example.
• The death with dignity argument in favor of active euthanasia must be understood.

A Planned Death in the Family (Miller)

• The case of Debbie (the patient with paralysis) should be known.
• Debbie's case must be known as an example.
• How Debbie's case is meaningfully similar to (or different from) the case of Diane must be explained.
• Conclusions can be drawn from the similarities and differences between the Diane case and the Debbie case.

When Self-Determination Runs Amok (Callahan)

• Three arguments presented against active euthanasia must be explained:
  • The argument of self-determination and moral rights
  • The killing and letting die distinction
  • The role of medicine argument
• The distinction between "killing" and "letting die" might be morally useful when considering active euthanasia.

Externalist Argument Against Medical Assistance in Dying for Psychiatric Illness (Muang)

• Internalists and externalists beliefs about the nature of mental disorder must be discussed.
• The externalist account of mental disorder should be explained using examples (the smoke detector, the white moth, Zootopia, or the anxiety mechanism).
• If externalism is true, treating persons with mental disorders may not be medically futile.
• If externalism is true, an approach to treating mental disorders must be discussed.
• Externalists may believe that active euthanasia is immoral.

Course Readings: Procreation Ethics

IVF: The Simple Case (Springer)

• In vitro fertilization (IVF) must be defined.
• Objections to IVF must be explained.
• Responses to each of the objections by a defender of IVF must be considered.
• When IVF is morally permissible must be explained.

Genetics and Reproductive Risk: Can Having Children Be Immoral? (Purdy)

• Whether it is morally permissible to have children when the potential parents risk passing harmful diseases to their offspring should be known.
• Huntington's Disease as an example should be known to establish the thesis that it is morally impermissible to procreate when there is a risk of passing on harmful diseases.
• Arguments against the claim that it is morally permissible to have children when the potential parents risk passing harmful diseases to their offspring must be discussed.
• Responses to those objections are important.

Course Readings: Abortion Ethics

The Stand-Off (Powerpoint Presentation & Marquis)

• The abortion stand-off must be defined.
• The main arguments in the abortion stand-off must be listed.
• Why the stand-off is unlikely to make any forward progress should be known.

A Defense of Abortion (Thomson)

• The acorn and oak tree example and what it represents must be known.
• The violinist example and what it represents must be known.
• Arguments that abortion is permissible in rape cases should be known.
• Whether a fetus has a right to life should be discussed.
• When pregnancy is going to result in the death of the mother or the fetus, how to proceed must be known.
• The people-seed example and what it represents must be memorized.
• Arguments that abortion is permissible in some cases of consensual sex must be discussed.
• The distinction between the Minimally Decent Samaritan and the Good Samaritan must be known.
• What the distinction between the Minimally Decent Samaritan and the Good Samaritan tells about abortion should be discussed.

Why Abortion is Immoral (Marquis)

• The future like ours account of the wrongness of killing must be defined.
• How the "Future Like Ours" argument establishes that abortion is morally impermissible must be known.
• The desire account of the wrongness of killing must be explained.
• Why this account does not establish that abortion is morally impermissible must also be discussed.
• The discontinuation account of the wrongness of killing should be known and why it does not establish that abortion is morally impermissible.
• Why Marquis believes that the future like ours account is superior to the desire account and the discontinuation account must be stated.

Course Readings: Malpractice & Negligence

Medical Error, Malpractice, and Complications: A Moral Geography (Zientek)

• Medical error must be defined, and examples must be identified.
• Malpractice must be defined, and examples must be identified.
• Complications must be defined, and examples must be identified.

Systemic Negligence: Why it is Morally Important for Developing World Bioethics (Chakraborti)

• Systemic negligence must be defined, and examples must be identified.

Course Readings: Birth Control

When Doctors Deny Drugs: Sexism and Contraception Access in the Medical Field (Delston)

• The primary reasons that doctors require pap smears prior to allowing patients access to birth control must be known.
• Why limiting access to birth control might be considered paternalistic must be argued.
• Why limiting access to birth control might be considered sexist must be argued.
• How limiting access to birth control could be damaging to patient informed consent must be argued.
• Whether putting up barriers to accessing medication (like birth control) is ever ethical must be argued.

The Pill Hasn't Been Improved in Years. No Wonder Women are Giving Up on It (Gill)

• Factors contributing to women moving away from using birth control must be argued.
• Why contraceptives aren't improving must be discussed.

Additional Discussion on Birth Control/Medication (from class lecture on 4/11)

• Reasons that medications are not improved must be listed.
• Why pharmacies focus on developing new medications rather than improving old medications must be discussed.
• The focus on creating new medications (rather than improving old medications) means for patients must be discussed.

Course Readings: Pediatric Care

Ethical Considerations in Pediatric Research (Podany)

• The three ethical principles that serve as a framework for human subjects in research: beneficence, justice, and respect for persons must be discussed..
• How these principles apply to research generally must be discussed.
• How these principles apply to pediatric research must be discussed.
• Legal informed consent must be defined.
• Assent must be defined.
• The relationship between legal informed consent and assent must be discussed.
• The relationship between research risk and informed consent must be discussed.
• Main challenges in conducting pediatric research: guardianship, role of compensation, commercial sponsorship, and research competencies must be known.
• How these challenges impact pediatric research must be argued.

The Ethics of Informed Consent and Shared Decision-Making in Pediatric Surgery (Loeff & Shakhsheer)

• Standard informed consent vs legal informed consent must be discussed.
• Assent must be defined.
• Implied consent must be defined.
• What should be done in cases related to pediatric decision-making should be argued.

Informed Consent (from class lecture on 4/16 and activity on 4/18)

• The standard account of informed consent must be defined.
• Legal informed consent must be defined.
• Types of situations that count as:
  • Standard informed consent without legal consent must be defined.
  • Legal consent without standard informed consent must be defined.
  • Situations that count as both standard informed consent and legal consent must be defined.
  • Situations that count as neither standard informed consent nor legal informed consent are important.
• Barriers to children achieving standard informed consent must be discussed.
• Most children are unable to achieve legal informed consent and the two exceptions to this should be known.
• It is possible for children to have standard informed consent and when should be argued.
• What should be done in cases related to pediatric decision-making must be discussed.