PHL 338 Medical Ethics Final Exam Review PDF

**PHL 338: Medical Ethics** **Study Guide for Final Exam** **Format**: The exam is closed book. It will consist of thirty multiple choice and true/false questions and one essay question. The multiple choice/true-false section will be worth 30 points and will be non-cumulative. It will emphasize kn...

**PHL 338: Medical Ethics** **Study Guide for Final Exam** **Format**: The exam is closed book. It will consist of thirty multiple choice and true/false questions and one essay question. The multiple choice/true-false section will be worth 30 points and will be non-cumulative. It will emphasize knowledge of terms, concepts, and theories and will cover only the second half of the course. The essay question will be worth 20 points. It will require you to understand and analyze arguments made by authors we have read, as well as apply concepts from the readings and lectures. The essay question is the cumulative part of the exam. The essay question will ask you to think about how multiple topics in the course are connected, or how an ethical principle or value applies to multiple topics. You will not be tested in detail on specific authors or theories in the essay section, but you will be expected to make use of at least some ideas from the first half of the course. While there will be only one essay question (instead of a choice between two as on the midterm), the question will be open-ended and provide some built-in choice regarding how to answer it. **Terms and topics covered on the exam (from the second half of the course):** **Weeks 9-10: Human research ethics** **Terms/Concepts** - A commonly-accepted principle is that placebo-controlled trials are acceptable only when there is no current, accepted treatment. - often cause for serious moral concern - An inactive or sham treatment is called a Placebo - The use of control groups has raised ethical concerns, with some critics arguing that controlled trials treat subjects merely as a means to the end of scientific knowledge. - Others reply that physicians do no wrong to their patients who enter a clinical trial if the physicians are in equipoise, rationally balanced between the alternative treatments. - The most widely accepted view is that the use of placebos is unethical when effective treatments are already available. Ethical Requirements for Clinical Trials: - Subjects must give their **informed voluntary consent** to participate. - The study must be designed to **minimize risks to subjects** and offer an acceptable balance of risks and benefits. - Subjects must be **selected fairly** to avoid exploiting or unjustly excluding them. - The **subjects' privacy should be protected**, and the confidentiality of research data must be preserved. - Before the research is conducted, it must be **reviewed and approved by an independent panel.** **Topics** The Declaration of Helsinki (World Medical Association)\* Unlike previous international ethical codes, the Declaration of Helsinki provides guidelines for conducting research on subjects who cannot give their informed consent. 1. **Informed Consent**: - Participants must be fully informed about the research\'s purpose, methods, risks, and potential effects. - Consent should be given **voluntarily**, without coercion, and the participant must have **full capacity** to understand and decide. 2. **Beneficial for Society**: - Research should aim to yield **valuable, socially beneficial** results and should not be arbitrary or unnecessary. 3. **Scientific Justification**: - Research must be based on **sound scientific principles**, with prior animal studies and knowledge of the problem being studied to ensure its validity. 4. **Minimizing Harm**: - The experiment should minimize **physical and mental suffering** and avoid unnecessary injury. 5. **Avoid Fatal Risks**: - Research involving known **life-threatening or disabling risks** is not allowed, except in rare cases where the researcher is also a subject. 6. **Risk Proportional to Benefit**: - Risks should never exceed the **humanitarian importance** of the research. 7. **Adequate Protection**: - There must be **proper safety measures** to protect participants from injury, disability, or death. 8. **Qualified Researchers**: - Only **qualified and skilled researchers** should conduct the experiment. 9. **Right to Withdraw**: - Participants can **withdraw at any time** without consequence. 10. **Right to Terminate**: - Researchers must be prepared to stop the experiment if harm is likely to occur. **Relaxation of Informed Consent:** While the **Nuremberg Code** requires **absolute** informed consent in all cases, the **Declaration of Helsinki** allows for **exceptions** under certain circumstances: 1. **Emergency Situations**: - **Informed consent can be waived** in **emergency medical situations** where patients are unconscious or incapacitated (e.g., during life-threatening conditions). - **Proxy consent** (from a family member or guardian) may be obtained instead. - The **urgency** of the situation justifies proceeding without prior consent if it is in the best interest of the patient. 2. **Non-Therapeutic Research**: - **Simplified consent procedures** may be used for **minimal-risk studies**, where participants are fully informed, but the study poses little or no harm. - In some cases, **minimal risk research** may be approved with **simplified informed consent** processes, particularly when there is no direct benefit to participants. 3. **Vulnerable Populations**: - For **vulnerable individuals** (e.g., minors, cognitively impaired persons, prisoners), **proxy consent** can be obtained from a legal guardian or authorized representative, rather than the participant themselves. - This is to protect individuals who cannot provide valid consent on their own. 4. **Compassionate Use**: - **Compassionate use** of experimental treatments is allowed for patients with **terminal or severe illnesses** where no other treatment options are available. - In these cases, **informed consent** remains required, but the process can be expedited or simplified due to the **urgent nature** of the situation. - **Autonomy---Respect for persons as autonomous agents** - **Respect for Persons: Involves treating individuals as autonomous agents capable of making their own decisions, and protecting those who lack full autonomy (e.g., children, prisoners).** - **Beneficence**---Doing good for, and avoiding harm to, persons - **Beneficence**: Researchers must strive to do no harm, maximize benefits, and minimize risks to participants. This principle underscores the responsibility of researchers to ensure that the benefits of research outweigh the harms. - **Justice**---Treating equals equally - **Justice**: Research should be conducted fairly, ensuring that the benefits and burdens are distributed equitably. Vulnerable populations should not be exploited, and research should serve the broader public interest, particularly in ensuring that findings and treatments are accessible to all. - (Prof. Kendrick adds...) **Utility--**Maximizing beneficial consequences - **Utility**: Research should aim to maximize the **overall social good**, ensuring that the long-term benefits of research justify the risks. This involves balancing the ethical costs of exposing participants to risk with the potential societal value of the outcomes. - Patients may consent to research out of desperation, fear, or wishful thinking. - Paying research subjects may undermine informed consent. - Potential subjects may not be able to understand the research well enough to give informed consent. 1. There must be consent by the subject's representative and possibly also the subject 2. Research should only be done on such persons if the reason the prevents obtaining the consent is a necessary characteristic of the research population 3. The research must be intended to benefit the population involved (e.g. children, the mentally impaired) Hellman & Hellman\'s argument that randomized trials are unethical (especially on Kantian grounds) - [According to the Hellmans, randomized trials often put the good of patients against the good of society] - [The Hellmans point out that the purpose of the randomized clinical trial is to avoid the problems of observer bias and patient selection] - [According to the Hellmans, idea that a patient\'s interests should be sacrificed for the general good is essentially a utilitarian idea.] - [The Hellmans argue that the obligations of a physician to the patient are best understood in terms of Kantian ethics] - **Scientist role:** - obligation is to the research and society - Utilitarian - **Physician role:** - obligation is to the patient - this "special obligation" takes priority over the obligation to society - Kantian approach is more appropriate - In Kantian ethics we are never to use someone as merely a means to an end. - Randomized trials use patients as a means to an end (sacrificing their interests for the good of society). - Some (see Freedman) have argued that this is acceptable because physicians are in equipoise. - But this is rarely going to happen. Usually, they have at least some belief about how promising the new treatment is. - Informed consent: - A patient *can't* morally sign away their right to receive the best treatment from their physician. - Even if they could, the physician *shouldn't* ask them to do so. - Patients are under pressures to sign up such as wanting to please the physician or being desperate. - The benefit to society can\'t be used as a justification for doing unethical research. - We need to develop other techniques for research that do not rely on randomized trials. In sum, Hellman and Hellman argue that **randomized trials** can be ethically problematic, particularly from a **Kantian perspective**, because they: - Potentially violate the **autonomy** of participants by failing to respect their right to choose the treatment they believe is best for them. - Treat patients as mere **means to an end** (advancing scientific knowledge) rather than as ends in themselves, which undermines their intrinsic dignity. - Expose participants to **unnecessary risks** and fail to ensure that the **risks are outweighed by the potential benefits** for individual participants. - May involve a failure to meet the **duty of beneficence** by randomizing participants to potentially harmful or inferior treatments. Freedman\'s argument that randomized trials are **not** unethical (versus Hellman/Hellman) - [Clinical trials are not about balancing patient rights against the interests of society because there is no patient right being violated by them. Freedman does not think they violate any of a patient\'s rights] - A patient's right to treatment is "restricted to\... those treatments that are understood by the medical community to be appropriate for his condition." - A study begins in a state of equipoise, meaning there is no medical consensus for or against the treatments. - [Freedman argues that true equipoise ( a state of doubt about a treatment\'s effectiveness) should be understood to mean uncertainty in the medical community] - He argues that true equipoise does not depend on uncertainty in the physician but on genuine disagreement in the medical community about a treatment's value because of a lack of good evidence gleaned from randomized clinical trials. When this kind of doubt exists, randomized clinical studies are permissible. - Kant actually says we cannot treat someone as *merely* a means to an end. We may treat someone as a means if at the same time they are also treated as an end in themselves. - [According to Freedman, randomized clinical trials do not violate Kantian ethical principles.] - If informed consent is obtained for the study, we are allowing people the choice of whether to participate, so we are not treating them as merely a means. - Freedman suggests that RCTs can be ethically acceptable **if there is genuine uncertainty** about the relative effectiveness of the treatments being tested. If there is insufficient evidence to determine which treatment is best, then randomizing participants is a way to resolve that uncertainty while treating all participants equally. - Freedman defends randomized trials as ethically acceptable in the face of uncertainty about treatment effectiveness, arguing that they are necessary for advancing medical knowledge and improving patient outcomes over time. He believes that when proper informed consent is obtained and safety measures are in place, randomization is ethically justified. - Hellman and Hellman, however, are more skeptical of randomization, particularly when the risks of harm are high or when there is a clear standard of care that should not be deviated from. They argue that the potential harms to individual participants must be weighed more heavily, and that the risks of randomization might outweigh its scientific benefits in certain situations. Brody\'s argument that placebo-controlled trials are ethical *in some circumstances* even if a standard treatment exists (e.g. the case involving HIV vertical transmission drugs) a. [Brody argues that placebo- controlled trials in developing countries are ethical if no subjects are denied treatments that would otherwise be available to them in light of the practical realities of health care resources in the country of question] b. [Brody says third world clinical trials do not exploit developing countries if after the studies the subjects are given access to any treatment proven effective after the trial.] Three concerns about these studies were raised: 1. An injustice was done to the control group since they received a placebo despite a proven effective therapy being available. 2. Participants were coerced into participating because antiretroviral therapy was otherwise unavailable to them. 3. The countries in question were exploited as the regimens would not be available to the citizens of those countries after the trials. Brody Responds 1. Placebo control group - None of the participants in this trial would have received any antiretroviral therapy at all as those therapies were not available in their countries. - Suggested wording for revising the Declaration of Helsinki: "all participants in the study should not be denied any treatment that should otherwise be available to him or her in light of the practical realties of health care resources available in the country in question." 2. Coercion - Coercion involves a threat to put someone below their baseline unless they cooperate, but at worst, participants were at the same baseline they would have been (no treatment). 3. Exploitation - It is the specific participants in the trial who need to be protected from exploitation. If the participants are receiving a fair share of the benefits from the trial, they are not exploited. - Patients in the control group can be compensated by offering treatment for future pregnancies or for themselves. - He argues that the use of placebo control groups was ethical because no subjects were denied "any treatment that should otherwise be available to him or her in light of the practical realities of health care resources available in the country in question." - According to a reasonable understanding of coercion, he says, no subjects were coerced into participating in the trials. - Finally, some have claimed that the trials exploit developing countries "because the interventions in question, even if proven successful, will not be available in these countries." But such trials will not be exploitative, Brody says, if after the studies the subjects themselves are given access to any treatment proven effective. \*Obviously I don\'t expect you to know the entire code in either case. But I would expect you to know some of the most important features of them, and particularly how the Declaration relaxes the informed consent requirement. **Weeks 11-12: Genetic Choices** **Terms/Concepts** - Serious safety concerns surrounding the therapy. - In its current form, it's generally thought to be morally unacceptable. - Scientists don't yet understand the likely ramifications of changing the genetic machinery of germ-line cells. - Gene therapy in germ-line cells is currently not feasible Positive eugenics- **involves attempts to improve on "normal" functions (enhancement)** - Allow someone to reach an adequate baseline - Are either present or not (not continuous) Competitive good (Glannon\'s concept) - Give someone a competitive advantage - Are continuous (can always be better and better) **Topics** Ethical concerns about PGD and disabilities [A common charge against genetic testing to prevent children from being born with genetic disorders is that it amounts to disrespect or discrimination against people with disabilities] - **Genetic discrimination,** the use of genetic information by employers, insurance companies, and others to discriminate against or stigmatize people. The main ethical concern here is justice, whether people are being treated fairly. - **Reproductive decisions:** prenatal testing combined with the possibility of abortion, and the use of PGD to select embryos in IVF, mean that parents can choose not to have a child with a disability Purdy\'s argument that it can be immoral to have children - [According to Purdy, it is morally wrong to reproduce when we know there is a high risk of transmitting a serious disease or defect.] - A "high risk" is an *unusual* risk, and our standard for unacceptably high should be relative to how bad the outcome is. - [Purdy thinks the duty to avoid bringing children into the world who will suffer from serious diseases takes precedence over the right to reproduce.] - [We have a duty to to provide a \"minimally satisfying life\" for our child.] - What is a minimally satisfying life? - According to Purdy, it involves "something like normal health." - How should we weigh that right against the duty to avoid having children who won\'t have minimally satisfying lives? - Most good reasons for having a child can be satisfied without having a genetically related child, through adoption. - If you have a reason to think you might carry a serious genetic disorder, do you have the right not to be tested for it? - Yes, if you're planning not to have children. - But if you\'re intending to reproduce, then you must get tested. Harris\'s argument that genetic enhancement is ethical (especially as it relates to the principle of beneficence and his view of disability) - [According to John Harris, it is **not** morally wrong for a parent to hope that their child is not born disabled.] - [According to Harris, it is rational for someone to prefer not to be disabled.] - [According to Harris - There are two different definitions of \"eugenics\"; gene therapy is eugenics according to one definition of the word, but not according to the other.] Harris's argument is based on the Principle of Beneficence. - Disability is undesirable. - What is "disability?" - [A physical or mental condition we have a strong, rational preference not to be in; a "harmed condition."] - A condition involving shorter lifespan, greater susceptibility to disease, etc., is disabling; one is harmed by it. - If we can lengthen life, provide immunity to disease, etc., we *ought* to, based on the Principle of Beneficence. - Principle of Beneficence: one ought to act to benefit others and prevent harm to them. Harris considers possible counterarguments: - Counterargument: gene therapy is OK only to "restore normal functioning," not lengthen life, etc. - Response: what constitutes a normal healthy life is partly determined by technology, medicine, etc. - Counterargument: gene therapy devalues people with disabilities. - Response: disabled people have full moral rights. Curing disability is not an attack on people with disabilities. - Counterargument: gene therapy is eugenics. - Response: the wrong of eugenics is that it assumes those who are "genetically weak" should be prevented from reproducing or are morally less important. But: - Gene therapy can make it so that those who are genetically weak can reproduce without risking harming their offspring - People who are "genetically weak," like people with disabilities, have full moral rights Harris\'s argument that therapy and enhancement cannot be distinguished - Repair and enhancement: *is* there a difference? - Some argue not... "There is in short no moral difference between attempts to cure dysfunction and attempts to enhance function where the enhancement protects life and health." (John Harris) Glannon\'s argument that genetic enhancement is unethical - [Glannon thinks that the moral objection to genetic enhancement could be overcome by providing universal access to the technology.] - [Glannon argues that inequalities resulting from enhancements above physical and mental functioning could threaten to undermine the conviction in the fundamental importance of equality] - [Walter Glannon argues that genetic enhancement is morally illegitimate.] - [Glannon thinks we should use genetic engineering to provide basic goods.] - [Glannon claims that genetic enhancement that gives some people an advantage over others in possessing competitive goods would be unfair] Why enhancement is morally objectionable - Would give some an unfair advantage over others in competitive goods unless there were universal access - Universal access would mostly neutralize competitive goods while likely causing some harm - Enhancements could erode the belief in the fundamental equality of people - Enhancements of noncompetitive goods like moral virtues would undermine autonomy and moral agency **Weeks 13-14: Euthanasia and Physician-assisted Suicide** **Terms/Concepts** - [Dan W. Brock argues that the possible good consequences of establishing a public policy of permitting voluntary active euthanasia can outweigh the bad.] - [The American Medical Association has denounced physician-assisted suicide as unethical and inconsistent with physicians' duty to promote healing and preserve life.] - Many people (including some physicians) support its use. - To date, it is legal in Washington D.C. and California, Colorado, Hawaii, Oregon, Vermont, Washington, and Montana. Theories of death: the traditional view, the whole-brain standard, and the higher-brain standard - **Traditional view**---Death is the cessation of breathing and heartbeat. - **Standard in law and medicine**---[Whole brain view]: An individual should be judged dead when all brain functions permanently stop. [become the current legal standard] - **Alternative notion**---[Higher brain standard]: Individuals are dead when the higher brain functions responsible for consciousness permanently close down. **Topics** Moral principles that are relevant to euthanasia/assisted suicide - [According to Vaughn, the strongest argument offered to support active voluntary euthanasia is derived from the principle of autonomy] **Arguments for Active Voluntary Euthanasia:** - **[Autonomy-]- Respecting people's inherent right of self-determination means respecting their autonomous choices about ending their lives.** - **[Beneficence]\-- If we are in a position to relieve the severe suffering of another without excessive cost to ourselves, we have an obligation to do so.** **Arguments against Active Voluntary Euthanasia:** - **[Moral difference between killing and letting die:] Killing is worse than letting die, so active euthanasia is wrong, but passive euthanasia is sometimes permissible.** - **[Moral difference between intending someone's death and not intending but foreseeing it:] The former is wrong; the latter is permissible.** - **[Non-maleficence:] a physician's greatest obligation is to "do no harm." Active euthanasia involves actively ending a patient's life.** - **[The teleology of medicine:] the proper end (*telos*) of medicine is life and health.** - **[Appeal to bad consequences:] allowing active euthanasia or physician assisted suicide will result in a slippery slope** The debate over the teleology of medicine and its relevance to euthanasia - **[the proper end (*telos*) of medicine is life and health.]** - **The debate:** - **Critics of euthanasia** (especially those who hold to a **traditional view of the teleology of medicine**) argue that **medicine's primary purpose** should be to preserve life, and **euthanasia contradicts this goal**. They maintain that any act of intentionally ending a human life is fundamentally incompatible with the role of the physician as a **healer**. Instead, physicians should focus on providing **comfort** and **care** at the end of life, not actively ending it. - For these critics, euthanasia undermines **trust** in the doctor-patient relationship. If physicians can intentionally end lives, it risks turning the medical profession into one that may harm, rather than heal. - - **Supporters of euthanasia**, however, argue that the primary goal of medicine is to **promote well-being** and **alleviate suffering**, not just to prolong life at all costs. They suggest that in some cases, when life is reduced to a state of unbearable suffering with no hope for improvement, **euthanasia is ethically permissible**. - The decision to die may be seen as a **rational choice** when the quality of life has deteriorated beyond the point of meaningful existence. Supporters claim that **patient autonomy** is a central part of medical ethics, and patients should have the right to decide when their suffering is unbearable. - Additionally, they argue that **palliative care** does not always provide sufficient relief, and in these cases, euthanasia might be the **most compassionate choice**. The killing/letting die distinction [Those who oppose euthanasia often draw a sharp distinction between killing and letting die] - Callahan: No distinction between killing/letting die - Confuses causality and culpability - Makes physicians seem to "cause" all deaths! - **Moral difference between killing and letting die**: Killing is worse than letting die, so active euthanasia is wrong, but passive euthanasia is sometimes permissible. - **Moral difference between intending someone's death and not intending but foreseeing it**: The former is wrong; the latter is permissible. - **active euthanasia is *killing*, but passive euthanasia is *letting die*.** - Some argue that **there is no morally significant difference** between mercifully killing a patient and mercifully letting the patient die. Rachels\' arguments against the killing/letting die distinction (especially the Smith/Jones example and the babies with Down syndrome example) - [Rachels claims that there is no meaningful distinction between killing and letting die. It is harmful] - [Regarding the traditional distinction between active and passive euthanasia, Rachels urges doctors not to write it into official statements of medical ethics.] - [To argue against the traditional distinction between active and passive euthanasia, Rachels offers a famous thought experiment involving Smith and Jones] There is no meaningful moral distinction between killing and letting die. - [In the first case, Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom, drowns the child, and arranges things so that it will look like an accident.] - [In the second, Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith, Jones sneaks in, planning to drown the child in his bath. However, as he enters the bathroom Jones sees the child slip, hit his head and fall face down in the water. Jones is delighted; he stands by, ready to push the child's head back under if it is necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, "accidentally," as Jones watches and does nothing.] - [Now Smith killed the child, while Jones merely let the child die. That is the only difference between them. Did either man behave better, from a moral point of view?5] - [Rachels concludes that any dissimilarity between killing and letting die does not make a moral difference.] - [The distinction leads to decisions made on irrelevant grounds (e.g. babies with Down syndrome)] - [Consider again the case of the infants with Down's syndrome who need operations for congenital defects unrelated to the syndrome to live. Sometimes, there is no operation, and the baby dies, but when there is no such defect, the baby lives on. Now, an operation such as that to remove an intestinal obstruction is not prohibitively difficult. The reason why such operations are not performed in these cases is, clearly, that the child has Down's syndrome and the parents and doctor judge that because of that fact it is better for the child to die.] - [But notice that this situation is absurd, no matter what view one takes of the lives and potentials of such babies. If the life of such an infant is worth preserving, what does it matter if it needs a simple operation? Or, if one thinks it better that such a baby should not live on, what difference does it make that it happens to have an unobstructed intestinal tract? In either case, the matter of life and death is being decided on irrelevant grounds. It is the Down's syndrome, and not the intestines, that is the issue. The matter should be decided, if at all, on that basis, and not be allowed to depend on the essentially irrelevant question of whether the intestinal tract is blocked.] - "Letting die" is an action, like killing - Allowing someone to die may be more painful than killing them Callahan\'s arguments against voluntary active euthanasia, especially why the autonomy argument does not work - [Callahan maintains that there is an important moral difference between killing and letting die.] - [Callahan thinks that abuse of a law permitting euthanasia is inevitable.] **Four (failed) arguments for voluntary active euthanasia (VAE):** - **Self-determination (autonomy)** - **Right to life cannot be transferred or disposed of as we wish** - **No way for the doctor to judge whether someone\'s life is worth living** - **No distinction between killing/letting die** - **Confuses causality and culpability** - **Makes physicians seem to "cause" all deaths!** - **Social consequences will not be harmful/are exaggerated.** - **Abuse and a slippery slope are a real concern.** - **Euthanasia is compatible with the aims of medicine.** - **The aim of medicine is that of maintaining health and life, not serving all private interests.** **Week 15: Abortion** **Terms/concepts** **In *Roe v. Wade*, the Court saw a guaranteed right of personal privacy in the Fourteenth Amendment** Good Samaritan- Someone who goes beyond what morality requires in aiding others - **Usually, carrying an unwanted child to term would make someone a Good Samaritan.** - **However in some cases, having an abortion may be "morally indecent."** **Topics** The liberal, moderate, and conservative position on abortion 1. **The conservative position:** Abortion is never morally acceptable (except possibly to preserve the mother's life) because the unborn is a human being in the full sense. 2. **The liberal position:** Abortion is acceptable whenever the woman wants it because the unborn is not a human being in the full sense. 3. **The moderate position(s):** We must reject both views and take a stance somewhere between them. All sides tend to accept that murder is wrong, that persons have a right to life, and that personal freedom should not be curtailed except for very important reasons. [Both liberals and conservatives on the abortion issue agree that murder is wrong and that persons have a right to life.] [A key premise in many arguments against abortion is that The unborn is an innocent person from the moment of conception and Killing an innocent person is wrong] [According to Vaughn, Mary Anne Warren identifies five traits that are "most central" to personhood and declares that a fetus has none of these traits] The conservative personhood argument Does the conservative argument *equivocate* on the meaning of "human being?" - **Equivocation** is a logical fallacy that happens when the meaning of a word shifts between the premises of an argument. - A criticism of the conservative argument is that it's wrong to kill a human being *in the moral sense* (a **person**)*,* but a fetus is only a human being *in the biological sense*. 1. Killing an innocent human being is wrong. 2. The unborn is an innocent human being. 3. Therefore, abortion (killing an unborn human) is wrong. 1. Killing an innocent person is wrong. 2. The unborn is an innocent person. 3. Therefore, abortion (killing an unborn person) is wrong. When does someone start being a person? a. The conservative position is that personhood begins at conception. b. Critics believe this is implausible as the unborn at that stage lacks the psychological qualities associated with personhood. The debate over what a \"person\" is - Critics of the conservative argument think it is *speciesist* to equate **human being** with **person.** - Since there could be persons who are not human beings, being a person must be defined by other characteristics than species. - When does someone start being a person? - The conservative position is that personhood begins at conception. - Critics believe this is implausible as the unborn at that stage lacks the psychological qualities associated with personhood. The arbitrariness argument - Conservatives defend conception as the correct place to draw the line for personhood on the grounds that it is the only point with a clear, non-arbitrary difference between "before" and "after." - Critics of the conservative position argue that: - At the zygote stage, the egg can still divide to form twins, or fuse with another egg to form a chimera. - The fact that we can't point to the exact moment when one thing becomes another doesn't mean there isn't a real difference between the start and end state (e.g. the tadpole/frog example). Potentiality arguments - Some conservatives argue that the unborn is not a person, but is a *potential* person, and that it is wrong to kill a potential person. - This is based on the idea that the unborn has a "future like ours" and we are depriving it of this future. Judith Jarvis Thomson\'s argument in defense of abortion - Avoiding the personhood question - For the sake of argument, Thomson grants that the fetus is a person - She argues that *even if* it is a person, abortion is still permissible - The "Henry Fonda" example: the right to life does not give you the right to demand something from someone else to preserve your life. - The burglar/"peopleseeds" example: having sex does not necessarily mean that you "invited" the fetus to use your body. Consequentialism- - **Consequentialist theory**---Asserts that the rightness of actions depends solely on their consequences (result oriented reasoning, doesn't care about reasoning, only what happened as result of action) - Good or bad intentions don't matter only the effect or outcome of action - Outcome-oriented - Examples: utilitarianism, ethical egoism Deontology - **Deontological theory**---Asserts that the rightness of actions is determined partly or entirely by their intrinsic value - Care about your intentions not result oriented (action self is wrong and principle can be analyzed independent of the outcome - Principle oriented - Example: Kant's ethics- avoid lying important bc moral principle not bc has beneficial result Teleology View of world by Aristotle, world built in goal and purpose -- look for goals and purpose Utilitarianism- - Right actions are those that result in the most beneficial balance of good over bad consequences for everyone involved Principlism (which includes five commonly used principles in bioethics: autonomy, nonmaleficence, beneficence, utility, and justice) - **The theory that right actions are not necessarily those sanctioned by single-rule theories such as utilitarianism, but rather by reference to multiple moral principles that must be weighed and balanced against each other.** Kantian ethics - A traditional moral theory that rests on principles for determining whether an action is right or wrong - Principles are absolute - The Good Will- - The only thing unconditionally good is *the good will* (the agent's moral intentions). - Every consequence is only *conditionally* good (e.g. happiness). - Paternalism: weak and strong paternalism - **Paternalism**---The overriding of a person's actions or decision-making for their own good - **Weak paternalism**---Paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished - **Strong paternalism**---The overriding of a person's actions or choices although they are substantially autonomous Informed consent - **The action of an autonomous, informed person agreeing to submit to medical treatment or experimentation.** - ♣ **Informed consent is thought to be an ethical ideal in which physicians are obligated to tell patients about possible medical interventions and to respect their choices regarding them.\ **♣ **Informed consent is also a legal requirement.**