Health ethics midterm

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Tulane University *

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4950

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Philosophy

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Apr 3, 2024

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.MIDTERM REVIEW This exam [100 points total] consists of five multiple choice Or true /false questions (2 points each); four short answer questions (15 points each); and one long essay (30 points). When answering a short answer question, expect that you will need at least a paragraph to thoroughly explain the concept or argument under discussion.Your long essay answer should be about one and a half to two handwritten pages.Do not forget to bring an official blue book Intro to Ethical Theory ● By what criteria might we assess competing ethical theories? ○ 1. Is the theory internally consistent? ○ 2. Are the implications of the theory largely reconcilable with our moral life? ○ 3.Does the theory provide effective guidance in practice? ● What is meant by the claim that act-utilitarianism can be rightly understood as a form of “situation ethics”? Fully explain the act-utilitarian attitude toward moral rules. ○ Meant that when using act utilitarianism, one must make moral judgements based on the entirety of a situation. More focused on the circumstances that surround the issue. In regards to moral rules, act utilitarians believe ● How is rule-utilitarianism different from act-utilitarianism? Which prominent criticism of act-utilitarianism does it attempt to remedy? ○ To really understand act and rule utilitarianism, first we need to establish the meaning of the word utilitarianism, which is to always act to maximize utility. Though both are rooted in utilitarianism, act and rule have very different meanings. For example, rule utilitarianism involves first assessing with moral rules that are generally likely to maximize net utility, then acting in accordance with said rules. Degrazia, Mappes, and Brand-Ballard wrote how rule utilitarianism emphasizes how, “ a person ought to act in accordance with the rule that, if generally followed, would produce the greatest balance of good over evil, everyone considered” ( pg 13). This is different from act utilitarianism because with this type, “ a person ought to act as to produce the greatest balance of good over evil, everyone considered” ( pg 13). In other words, act utilitarianism is a version of “situation ethics” and has the intent to calculate net utility for all choices. This is the prominent criticism of this type of utilitarianism because it's impractical. It's impossible to calculate all choices. Rule utilitarianism allows for an indirect appeal to the principle of utility. Rule utilitarians, “ develop a moral code on the basis of utilitarian considerations and then assess individual actions,
not on the basis of utilitarian considerations but on the basis of the moral rules that have been established” ( pg 14). ● What is the key principle of Kantian deontology? And why do so many find Kantian deontology to be “intuitive”? ○ The key principle of Kantian deontology is respect for persons. Many people find this to be intuitive because it 1) tries to root out subjectivity of fairness to make it more universal 2) tries to acknowledge that others are rational beings like yourself 3) tries to act as if everyone were already treated a an end to themselves ● How does Kant distinguish between “perfect” and “imperfect” duties? ○ “perfect”= absolute duties; can’t be altered or changed in any way ○ “imperfect” = duties that must enable others to act as autonomous beings ● Why do virtue ethicists emphasize the importance of character? What are the benefits of this approach to ethics? What are the potential limitations or weaknesses? Do you think that virtue ethics should have a role to play in a biomedical context? ○ limitations/weaknesses: not all virtuous examples are gonna be examples that produce moral action in every context ○ Benefits: more integrated into our own lives. More human, easily taught. Serves as a pillar of the community. ● Define autonomy then state and explain the four conditions on an autonomous act. Finally, how does paternalism relate to autonomy? Why is it sometimes difficult to tell the difference between a doctor respecting a patient’s autonomy and a doctor acting paternalistically? Do you think physician paternalism is ever justified? Why or why not? ○ Autonomy: the state or condition of self governance. Living one's life in accordance with one's own values and desires. ○ 4 conditions: Intentionality, understanding, freedom from external constraints, freedom from internal constraints ● Is it ever justifiable to interfere with or limit the autonomy of another person? If so,when? State and explain at least Two possible liberty-limiting principles. ○ Paternalistic actions can sometimes be justified for example when a patient is not in a condition where they can be trusted to make a rational decision. Not all paternalistic actions can be justified. The Professional- Patient Relationship ● Explain Pellegrino’s three- tiered system of obligations for physicians? Why does he rank these different obligations hierarchically? What does it mean to say that the hierarchy proceeds in “ascending order of ethical sensitivity”? ○ Pellegrino’s three-tiered system of obligation for physicians is 1) legal obligation 2) observance? Fulfillment of moral rights and duties 3) the practice of virtue
● What is the key danger of virtue-based ethics, according to Pellegrino? By contrast, what is its potential benefit? When or in what context would the application of virtue- based professional ethics be most beneficial? ○ Virtue ethics are not sufficient to explain why people should act rightly, that virtue ethics is not necessary to account for the intrinsic value of the “admirable type” when, intuitively, our ethics should be motivated by the opportunity to improve the lives of others. The potential benefit however is that virtue ethics strongly emphasizes that individuals can be trained in the virtues so that they develop excellent habits of mind. Virtue ethics recognizes that resolution of difficult problems depends, above all, on the character of the people who make decisions. The ethics are based on a positive view of human nature. It would be most beneficial for surgeons or people who are in high ranking medical positions who have control over a life or several lives. ● State and explain each of the five models or metaphors of the doctor patient relationship discussed by Childress and Siegler. (NOTE: You will be responsible for memorizing these) ○ The five models of the doctor patient relationship are 1) parent or paternal 2) partnership 3) rational contractors 4) friendship 5) technician ○ Paternal: the locus in decision making is the healthcare professional who has the “ moral authority” within the relationship ○ Partnership : a model that stresses that healthcare professionals are and their patients are partners in the pursuit of a shared value of health ○ Rational contractors: healthcare professionals and their patients are related or should be related by a series of specific contracts. Both parties agree to exchange goods and and services ○ Friendship: the patient expresses trust and confidence in the physician while the doctor uses that trust to give effective technical help ○ Technician: the physician provides technical service to patients who are “consumers”. Doctor only presents facts. ● How, according to Ackerman, is the imperative of respect for patient autonomy typically understood? What does autonomy mean to most practitioners? And what has been the main consequence of this interpretation? ○ The imperative of respect for patient autonomy is typically understood as allowing patients to make their own choices, which is generally understood as non-interference to most practitioners. The main consequence of this interpretation is that it reduces the role of the physician from one with some choice to that of a technician who has to blindly follow the customer’s desires. Additionally Ackerman acknowledges that the state of being sick is extremely transformative and is a state of wounded humanity, meaning that you don’t necessarily have the mental capacity to make rational decisions. ● Which liberty limiting principle is Ackerman suggesting doctors should appeal to more often when making decisions about patient care? Ultimately, what does he think is
necessary in order to “return control” to the patient? Do you agree with him? Why or why not? ● According to Newton, what are the “peculiar virtues” of the traditional nurse? Why does she reject the idea that nurses should serve as patient advocates? Do you agree with her?Why or why not? ○ Believes that the role of the nurse being an “autonomous professional” undermines efficiency. Quality care in a hospital setting ( roles is to provide emotional, motherly support) ○ Peculiar virtues are: ■ 1) hospital bureaucracies require clear roles and lines of authority ■ 2) only physicians are properly trained to handle medical emergencies ■ 3) nurses main role should be to humanize care and provide emotional support ● What considerations are most important in establishing a duty to warn? Also, do you agree with the following statement: “The risk that unnecessary warning may be given is a reasonable price to pay for the lives of possible victims that may be saved.” Which ethical theory is implicitly appealed to here? ○ When thinking about one’s duty to warn, there are 2 considerations that come to mind. Those conditions would be 1) if the threat is foreseeable and 2) if the threat is severe 3). In regards to a foreseeable threat, Tobriner argues that,” a defendant owes a duty of care to all persons who are foreseeably endangered by his conduct, with respect to all risks which make the conduct unreasonably dangerous” (pg 111). This means that if someone has reason to believe that another’s life could be put in harm's way very soon, then they have a responsibility to tell said person. As for the severity of a threat, it's most important to consider the public interest and safety from violent assault and this principle must be thought of when considering warning someone of a possible threat. Tobriner goes into greater detail on page 109 when he says, “ when a therapist determines that their patient presents a serious danger of violence to another, they incur an obligation to use reasonable care to protect the intended victim against such danger.” The statement listed above is one that I have to agree with. One should not gamble with another person’s life, especially when there is reasonable doubt. If I put myself in this situation, I’d want someone to tell me if they heard some troubling news about a possible attack on my life. This is not a question of morality, it’s now a question of obligation. I believe you are obligated to tell someone when their life is at risk, even if it may be hard or cause other issues in your personal life. At the end of the day, uncomfortableness is a simple cost to pay when the price could be someone’s life. The ethical theory that’s applied here would be Pellegrino’s “ The virtuous Physician”. This theory says that we should combine a duty- based and a virtue-based approach to medical ethics. He thinks this because he believes that physicians who merely abide by the law and respect patient rights are doing the moral minimum. This model promotes selfless acts in the care of others, which could be applied to others who are in need of help even if they don’t know it. One question I have for the other would be if they think there are other cons
● State and explain the key concern at the heart of Justice William P. Clark’s dissent from the majority opinion in the Tarasoff case. ○ The very practice of psychiatry depends on the reputation in the community that the psychiatrist will not tell. If it's violated then care will be less effective, there will be an increase in violent crime, and it will make less people want to go/believe in therapy. ● Do you think that the duty to warn is sufficient cause to breach doctor-patient confidentiality in the scenario at issue within “Please don’t tell: A case about HIV and confidentiality”? Why or why not? ○ Contested Therapies and Biomedical Enhancement ● Do you think that the use of cochlear implants constitutes ordinary or extraordinary care?What does Tucker think of this? How does she defend the claim that pre-lingual deaf children should have the opportunity to hear and learn English, in addition to ASL? ○ Personally, I think the use of cochlear implants constitutes ordinary care. When someone first finds out their child is deaf, it’s a normal reaction to do everything possible in order for them one day to have the ability to hear. Wanting your child to have some sense of hearing, even if it may be small, is what most parents would do. In reality, many people don’t know ASL or have any familiarity in the deaf community world. Not everyone has the funds or resources to support a fully deaf child. For most, people go with what’s familiar to them, and that would be communicating with others verbally. Cochlear implants are not extraordinary care because the idea would be the first instinct for many people when faced with this decision. In addition to that, Tucker would classify implants as a way to, “expand the range of opportunities available to deaf children whereas hostility to mainstream hearing culture narrows those opportunities” (pg 162). She defends the claim that pre-linguistically deaf children should have the opportunity to hear and learn English as well ASL because, “ the inability to hear is genuinely disadvantageous and learning both gives the child a better chance to overcome those disadvantages” (pg 162). It wouldn’t be beneficial to isolate deaf and hearing people because at the end of the day, they could learn something from one another. One question I’d have is if you think hearing people learning ASL would also do just as good as deaf people hearing and learning English? ● Whose argument (Crouch or Tucker)do you think could more reasonably be characterized as paternalistic? Explain and justify your view? ○ Crouch’s argument seems more paternalistic since she doesn’t want the patient’s autonomy to be violated. She says that the CI robs them of enjoying the values of ways of life of the deaf community. A parent would want their child to enjoy life
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