Bioethics Final Fall '14

list of authors we need to know

Quill Brock U.S. Bishops Bouvia Longmore Gleason Forman Parens and Asch Vatican Warren Rothman Anderson Nuremburg Helsinki Brandt Wachbroit Harmon Purdy Direct-to-Consumer Shwartz FDA FDA and 23andme

List the moral theories

Utilitarianism Kantian Ethics Virtue Ethics Natural Law Feminist Ethics Ethics of Care

Elizabeth Bouvia case

a 25 year old with CP, quadriplegic, needed 24/7 care and assistance. Wanted to die through starvation, but the independent living facility and then the courts, wouldn't let her die, and force fed her, until she went to the california court of appeals, and decision was reversed and she was allowed to die through starvation, because the doctors didn't have a right to preserve, or make her endure life for 15-20 more years

Gleason

a doc in the NICU who talks about 2 different micro preemies: 1. Patrick: super preemie, mom didn't know she was pregnant, although he shouldn't have lived, he was very active, eyes open etc. gleason allowed him to make his own decision, or that is how he words it, said that making that life and death decision seemed arbitrary, and afraid of the pain and life patrick would have if survived 2. Christopher: 24 wk preemie, give essential info (chance of baby's survival, odd of being "normal". they could help the baby but should they is the question. ask the parents 2 questions to open dialogue and see where the parents are with their knowledge base and value system. use "trial of life" technique which puts the pressure on the baby to "announce" themselves through reactions and movement, essentially giving the baby autonomy they don't have in order to avoid making the choices themselves

Areas of discussion for Parens and Asch

abortion disability rights prenatal testing

What does Sherwin address?

abortion debate

doctrine of double effect

act has to be in line with natural law but act can be permissible even with unforeseen consequences as long as one is aiming for the good

Longmore overall viewpoint on what subject

against voluntary euthanasia "given the lumping together of people with disabilities with those who are terminally ill, the blurring of voluntary assisted suicde and forced "mercy" killings, and the oppressive conditions of social devaluation and isolation, blocked opportunities, economic deprivation, and enforced social powerlessness, talk of their "rational" or "voluntary" suicide is not possible. the advocates of assisted suicide assume a nonexistent autonomy. they offer an illusory self-determination. this would just be another rationalization that leads to the ultimate act of oppression

Ethics of Care

emotions and partiality may be morally relevant along WITH reason males-abstract principles females- care/relationships humans are not purely autonomous, but dependent, which isn't a bad thing what is usually seen as private can be used and questioned in public relm Evaluates: motives, actions, nature and quality of relationships, consequences, character Human Nature: dependency, interconnectedness-has moral relevance- care, type of relationship differs and changes the lens of analysis, relational people different set of questions than other moral theories

Warren

feminist objections to reproductive technologies, specifically IVF and NRTs, looks at micro and macro levels it effects -women receive their power and status from being able to procreate

Schwatz

when considering whether or not to have a test done, it might be better to only do the low-risk tests that are self-pated, as long as they understand the facts and want the information, stopping point when there are higher risk tests and treatments -no evidence that genetic stetting contributes to health or improves healthcare -23andme blurs the lines between personal and medical information and enhances the argument that it is unjust to withhold the test from all people until it is proven useful in medical care -shifts question to how should physicians respond to such a test that might be brought in -professionals need to be provided with guidelines to respond to the screening -regulatory model that ensures informed consent -information and education -addition screening, patient has financial burden

When is it ok to to non-voluntary passive/active euthanasia?

when someone is in a persistive vegetative state-through a surrogate -someone no longer capable of giving consent, but was formally competent - might have formally stated their desires, so it would be honoring their wishes and upholding the principle of autonomy

Parens and Asch Parental Attitude Argument

why prenatal testing is a problem: by prenatal testing allows parents to select or abort certain traits, which goes against the general view of parenthood, which is to accept the child you conceive no matter what, again one trait takes over for the entire person, makes the assumption that disabled people can't have a fulfilling life, and the parents can't have a fulfilling relationship -good parents will accept and raise whatever child they receive, could lead to commodification of children

Feminist Ethics

women's personal rights, body integrity gender has a meaningful and moral significance historical and political oppression

Quill

-Pro-active voluntary euthanasia -physician who has dealt with many terminal patients -patients want to die with as much dignity and control as possible -offers a second option, psychologically, where they can control where and when they pass -fear of lingering death would interfere with her ability to live out the rest of her life to the fullest -potential boundaries he was crossing: spiritual/personal/legal/professional -imminent death and pain led to choice -told the medical examiner that the cause of death was "acute leukemia" to protect the doctor and patient and family -range of help a doc can give if they allow their patients to say what they really want

Rothman

-argues that surrogacy makes babies a commodity -surrogacy=babyselling -reduces the mother to a "container" -the true mother of the child will ALWAYS be the gestational mother, no matter the DNA of the child -medical technology made it possible to see whose "fault" infertility is -come to the same conclusion as Catholic Church on surrogacy but different values -Catholic church values: 1. unnatural because it goes against the nature of women and mothers 2. violates the sanctity of the family -feminist view: relationships are central, specifically the interpersonal relations people establish 1. woman and her experience and her relationships at the heard of understanding all pregnancies 2. women's bodily autonomy as central, and the fetus is part of the women's body, -women can never bear any else's any, regardless of the source of the egg and sperm -buying baby, not compensating for services because the mental health services that might be needed aren't paid for, so it is really baby selling -patient's desire to have a child doesn't mean that it doesn't turn a child into a commodity

Rule Utilitarianism

Apply a particular moral rule that will be universalized, and assess if that rule is consistent and sound, or might cause more harm or cause the rule that it is trying to uphold to become irrelevant, in which one has the duty to change the rule and not live by that rule

Virtue Ethics

Aristotle the development of virtues and moral character to be able to choose right because you want to develop those virtues, cultivates habits, not only good actions, but do because of wanting moral excellence Evaluates: character-who and why Human Nature: self-awareness, rational thought of what is right/wrong, everyone desires good and has capacity to be virtuous

What is Mill's definition of happiness? What theory does this cover?

Happiness= physical/intellectual pleasures sentience (the ability to experience pleasure and pain) Utilitarianism includes animals because they are sentient beings

What is Aristotle's definition of Happiness?

Happiness= the good life, eudaimonia, a life of virtue in accordance with reason

Utilitarianism

"greatest happiness principle"= the maximum benefit for the minimum harm, both current and future, weighing the benefits of a particular action with the potential harms of the action Evaluates: consequences of actions cost-benefit analysis 2 types: act and rule impartiality is key quality of the harms and benefits quantity of those being effected on both sides view of human beings: we are rational beings so it appeals to that, capable of happiness, higher levels and lower ones, and it is the most important goal ends may justify the means

Aristotle's version of natural law

(virtue ethics) the source is from our ability to cultivate virtues and find the mean between two extremes to know what is right and what is wrong, the goal is for human flourishing, or eudaimonia

Ethics in the NICU

-babies born within the abortion timeframe need to be resuscitated no matter what -technology has put docs in a place where they have to make extremely difficult decisions -are mothers and fathers "in their right mind" to make those types of decisions, esp. when they need to be made so quickly -baby can't be autonomous through baby movements (will the baby ever be autonomous?) -quality of life issues: current and future -no one wants to make the decision, psychological toll for docs and patients -baby's potential -authority -research ethics -epistemic barriers (used as ways to get new knowledge) -disability critique (think of Longmore) -many interests at stake -who's knowledge counts: medical team, parents -so sudden, no knowledge of how it works

in vitro fertilization

-conception takes places in a petri-dish outside of the woman's body -embryo emplaned back into the woman or frozen -homologous: egg and sperm from couple -heterologous: egg, sperm, or both are from donor

artificial insemination

-delivering sperm directly into woman's body -homologous: egg and sperm come from couple -heterologous: sperm is from donor -conception happens within the woman's body

Moderate argument of abortion

-draws a clear line on the continuum to determine personhood: after that point no more abortion -gradual approach, not clear cut, as develop moves from minimal to full rights -5 cell organism vs. viable fetus- morally significant difference

Longmore argument

-euthanasia isn't just used on the terminally ill, but the socially devalued, disadvantaged, disabled, and elderly -WHY? medical costs, social prejudice, historical views and conceptions of what it means to live with a disability -historical background that shows social prejudice of the non handicapped towards the handicapped, and fears lead to the farce of paternalism -disabled looked at as a drain on social resources, burden, euthanasia turns into eugenics -medical "findings" of a correlation between disability and evil, so the solution is segregation and sterilization, lead to the handicap holocaust -disability as socially constructed -when the disability movement occurred, it helped, but it was too much money to assure equality and society didn't see that it would produce productive members of society from it, medical also too expensive -Elizabeth Bouvia-parents socially ashamed of their daughter so they institutionalize her, when she tries to get a higher education, they deny her and say that if they knew about her condition they never would have accepted her in the first place, so she became depressed, and disheartened, which led to her request for suicide, but the entire trials said that her depression and desire to end her life was due to her disability and that alone made her feel unworthy, not citing the social influences that actually caused this, work disincentive, marriage disincentive, she couldn't assert self-determination because she was socially stonewalled and discriminated against, dehumanizing her -RIGHT to die, turns into DUTY to die -rationalization allows prejudices to continue, and those who defend assisted suicide lump together the terminally ill with those that are disabled, or elderly -disabled people are then seen as terminally ill -fear of lines blurring between voluntary and non voluntary euthanasia -way to deal with overpopulation and resource scarcity -social Darwinism added to this viewpoint of discrimination against people who are disabled -"suicide is societal and specifies self-cleansing -suicide helps to alleviate suffering -false assumption that sidled people have nothing to contribute to society WHY WE WANT DISABLED IN COMMUNITY: 1. allows for humans to practice virtuous behaviors 2. good for experimentation 3. viewed as charity cases 3 OPTIONS LEFT FOR THE DISABLED COMMUNITY: 1. live as objects of pity and moral elevation 2. be experimented on 3. commit suicide

Catholic Position on Abortion

-from conception the unborn is considered a full human person with full rights and sanctity of life -all babies are gifts from God that should be cherished -sanctity of life-God is the provider and taker of life, who are we as humans to make this choice, it is killing to abort -hasn't always been considered this way, Aquinas said males become full humans at 40 days, and women at 90 days

Issues with reproductive technologies

-humans into commodities -social inequality -selective precess "type" of child you want -donor anonymity (broken/repsonsiblity/change of heart/impact on child, medical history, right to know or not) -"what is a family" -pre-implantation screening-selective IVF

U.S. Bishop's view of medically assisted nutrition and hydration

-intent matters, if you are withdrawing treatment because it is not working and may be causing more pain that is ok, but if someone is withdrawing treatment to cause death, that is not ok -use palliative care -decision of treatment should be made with the family, patient, and doctor's advice in mind -money should not be a consideration and society should aid in making sure that isn't a consideration -disability does not reduce the quality or inherent dignity of a person's life -quality of life is important but the sanctity of life overrides quality -people in a persistent vegetative state pose a difficult situation that the Church has not been able to fully agree on

Wachbroit

-no right to genetic testing -paternalistic vs. non paternalistic reasons for limiting genetic testing 1. time and resources -limited resources, doesn't make sense to test all possibilities due to lack of responsible need autonomy vs. expert 2. social and psychological harms -anxiety false +/- -employment and insurance affected-genetic discrimination Paternalistic argument: the subject won't understand, doc deciding what would and wouldn't be good for the patient, **instead: have doc tell the patient about the test about the other conditions that the test can find, and then the patient can decide for him/herself whether or not that is a good idea or not moral responsibility to know: limited but clear: if an individual might have a condition that would interfere with his or her job performance to endanger other people than that person has an obligation to know, whether they want to or not -very individualized -need to know that these decisions will not only effect us, but other as well

Roman Catholic Church Position on reproductive tech

-not all medical intervention is wrong or morally impermissible -don't want to use embryos as research tools -IVF vs. AI -AI ok because conception takes place within the woman natural argument applied, as long as it is homologous -heterologous use is wrong because it disrupts the unity of marriage -IVF not ok because it still disrupts the sanctity o marriage and the natural order of procreation, -children are a gift from God within marriage, marriage is still meaningful and the desire for children is understandable, but not a RIGHT for a couple to have a child

Warren macro level effects

-the use of IVF and NRTs opens the door to designer babies -segregation/discrimination of those who can pay and those who cannot

Brock's responses to bad consequences of permitting euthanasia

1. always ethically wrong to commit euthanasia RESPONSE: yes, it is wrong to kill, but different because A. the physician get the consent of the patient B. the physician is acting with a good motive, respecting the self-determination and wishes of the patient C. physician is in a social role, as a medical professional, to be able to carry out the patient wishes 2. goes against physician's role, patients will lose trust in doc, incompatible with their prof. and undermines moral center of medicine RESPONSE A. patients ask voluntarily B. patients would fear but their would be more trust because the patient's autonomy is being respected 3. Weakens society's commitment to provide optimal care for dying RESPONSE A. same could be said about withdrawing/withholding treatment through surrogates-no evidence that changed public perception B. only few will request it, consequence doesn't hold up with current evidence 4. Some individual cases it's ok, but do not make it a legal policy because slippery slope. RESPONSE A. because values are individual and not universally shared, public policy shouldn't be grounded in religious beliefs B. Lack of data about the consequences of legalization C. moral disagreements about importance of effects D. need moral safeguards in place

Problem with euthanasia and surrogates

1. disagreements between surrogates 2. high level of pressure on the surrogate 3. time-frame/condition of person/prognosis/financial burden/ medical team's assessment futile treatment

Parens and Asch: Counter arguments to the expressionist argument

1. it is impossible to say that one action, that being prenatal testing, represents an entire message about something, because actions are founded upon more than one motivation or meaning 2. calls into question the morality of all abortions because the specific trait doesn't have to be a disability, but another type of trait that is inherent in the child's birth i.e. being the 4th child in a family 3. presumers that prenatal testing is morally problematic where other sources of precautions are not, such as taking vitamins, like folic acid, to reduce the chance of spin bifida, how is that different

Liberal argument for abortion and evidence and counter arguments

1. killing a person is wrong 2. the unborn is not a person because just because you have human genes doesn't make you a person, personhood is moral defined 3. all persons have the right to life 4. abortion is killing the unborn 5.therefore, abortion is not wrong

Conservative argument against abortion and evidence and counter arguments

1. killing of innocent person is wrong 2. the unborn is an innocent person from the moment of conception 3. abortion is the killing of an unborn child 4. therefore, it is wrong to kill, aka abort, the unborn evidence to support: -genetic argument: unique, new DNA and human DNA ^ could be considered specisism, just because cells have humans DNA doesn't mean that every cell is a person -JPII: potential for DNA to develop into full human being and features that define a person means that that unborn is a person -sanctity of life, gift from Gof ^not rational or sentient, which is many of the qualifications for being considered a person

Anderson's citing of the defense of surrogacy

1. like adoption, it is a way to help qualified parents to raise a family, especially when adoption options are so short 2. the right to procreate and the freedom to contract 3. surrogate mother is offering her services out of altruistic means 4. no different from AI, adoption, wet-nursing and day care

Nuremberg code say about research subjects

1. must be voluntary choice to participate 2. freedom of choice, including to change their mind and leave the experiment 3. given the material information about the experiment 4.respect for persons- non-maleficence/autonomy/justice

Warren's solution

1. need for equal participation from women in all areas of medicine 2. equal participation and views from men and women of different racial/ethic groups, SES in determining the RTthat are used and developed 3. gov't needs to regulate NRTs and create an ethics committee for ant research 4. contraception and abortion needs to be available to all but not used as a coercive measure, and need to made safer and more education provided for options available 5. need respect for women as persons, not as vehicles for next generation

U.S. Bishops limits to duty to preserve life

1. one is not obliged to use extraordinary means to preserve life 2. can refuse forms of treatment that would only prolong death that is already imminent, so that person can stop burdensome or precarious care

Brock's good consequences of permitting Euthanasia

1. respect the self-determination of the competent patient who want it, but can't get it because of its illegality 2. the majority of Americans already want to have the CHOICE to decide to ask for PAS or not 3. release them from prolonged suffering and pain- phyiscal and psychological 4. once death is accepted it is better to end life quickly and peacefully, if that is what the patient wants

Parens and Asch 2 reasons why selective abortion is morally problematic according to disability critique

1. selective abortion shows a negative or discriminatory view about the disabling trait and those who carry it 2. shows an intolerance to diversity and harms societal and parental attitudes towards children

Nuremberg code say about the research itself

1. should be looking for results that will be beneficial for society 2. only way to find the results 3. necessary and planned in nature 4. based on results of prior experimentation on animals and the knowledge of the problem being studied 5. avoids all unnecessary physical or psychological suffering and injury 6. no knowledge that death will occur 7. risk of the experiment doesn't exceed the the importance of the problem to be solved 8. proper facilities

Parens and Asch view of perfect way to conduct prenatal testing, and the problem with ideal way

1. talk with potential parents about their views of family life and children 2. how testing is performed, what is can detect and how that information may affect the child 3. do the testing 4. economic and social resources 5. how other families have dealt with the decision, on both sides Problem because the ideal way means a lot of time and many visits, which increases health care costs, which is the opposite go what is trying to be done

U.S. Bishops moral principles

1. the Christian belief that life is a gift from God 2. respect the life of each human being because each is made in the likeness and image of God 3. we are redeemed by Christ and called to eternal life with him 4. plea for death is actually a plea for help and love 5. suffering is a part of being human and has a redemptive quality to it- 6. death is unavoidable and a person should accept and prepare for that 7. dignity/value/worth of ever human being needs to be upheld 8. it isn't our place to say where or when life should end and under what circumstances

Nuremberg code say about the researcher

1. the researchers who initiate the experiment have the duty to inform the research subjects about their voluntary participation, the freedom of choice, and provide the material information about the experiment 2. should be qualified physicians highest degree of skill and care 3. researchers will stop the experiment if at any time there is a likely result of injury, disability, or death due to the continuation of the experiment

Natural Law

2 versions, Aristotle and Aquinas direct actions must coincide with out nature/goal (teleological good) understood through reason moral reason and law follows the doctrine of double effect Evaluates: Intent and the Act itself Human Nature: rational, within us to act morally and aim at good, teleological view, ultimate purpose, human flourishing

commercial surrogate

Anyone who is paid money to bear a child for other people and terminate her parental rights, so that the others may raise the child as exclusively as their own.

JP II

Discusses abortion -"unspeakable crime" - the fundamental moral right to life is at stake because of societal views on subjects such as abortion -linguistics of what you call it change the magnitude it deserves -fetus is the most innocent thing that can be imagined, entrusted to the care of the woman carrying -Mother's reasoning for aborting: protect the baby from the life he/she would be born into family pressure/ doc pressure because it is legal it is ok supporting organizations make it seem ok -from the time of conception, that unborn is considered a human, with all of the dignity and worth that any other being would have, and as such, deserves the dignity and respect, aborting is just another linguistic term for killing -Church has stood on this ground, and is now backed up by science -moral obligation to stop the killing of innocent lives

how does one define personhood?

Don't need all of these -reason -ability to communicate -self-motivated (will) -conciousness -sentience -ability to interact with others -self-awareness

Kantian Ethics

Duty based ethics (deontology) Rationally using reason to discern moral law Applies universally Evaluates: the human act itself Humans are seen as-rational, autonomous, fundamentally having human dignity and worth, good will (our capacity to choose and judge) never use a person to justify an end, only if each party does it willingly and knowingly we are self-regulating and have a duty to keep our selfishness in check Rationality, Impartiality, Universality Categorical Imperative: comes from reason and so we can discern its truth, 2 parts

Rothman

Feminist view on surrogacy

Decision Making Framework for NICU babies

Mandatory: parents who ask to withhold even through prognosis is good, doctors can do that because of duty to baby=patient, against interests of survival Optional: rights high, benefits low or minimal, legiminate for parents to decide Unreasonable: when parents make demands that are futile for the child Investigational: dialogue between many fields including parents, resuscitation in babes, best knowledge is that it is investigative research, it this ethical within itself?

Parens and Asch disability critique of prenatal diagnosis and selective abortion

Misinformed viewpoint 1. discrimination against disabilities is prominent and fuels the heightened choice and push for selective abortion 2. view that disability will disrupt their ideal vision of their family and the type of child they want, picking and choosing 3. a baby with a disability is viewed as not being able to have a good quality of life, and thus the parents think they are sparing the child, which isn't necessarily true

Categorical Imperative

Part of Kantian Ethics 1. Can the rule justifying the action be applied universally? If not, the concept itself will break down 2. Respect for Persons- can't treat persons as a means to an end because it violated human's autonomous nature

Life timeline of a fetus

conception---zygote---blastocyst---embryo (5days)---fetus (8 wks)---quickening (16-20wks)---viability (22-24wks)---birth

Abortion

all parties agree that: 1. murder/killing is wrong 2. all persons have a right to life 3. personal liberal (autonomy) is of utmost value DISAGREEMENT: How we define "person"/moral status of unborn -what features are there, which are ethically relevant -actual vs. potential capacity of life -fetus=independent being OR need to look at the relationship to mother -at what point on the timeline of the unborn does the unborn become a person?

Any-particular distinction

an argument made by parens and asch that distinguishes abortion from selective abortion in that abortion terminates the fetus at that specific time, but selective abortion terminates a fetus because of a specific trait or disability

What constitutes a premature birth?

any birth before 39 weeks

Purdy

argues that conception can sometimes be morally wrong on grounds of genetic risk, although this judgement will not apply to those who accept the moral legitimacy of abortion and are willing to employ prenatal screening and selective abortion -RT offers solutions to still have children -morally compelling obligation and reason to prevent birth of a child with a genetic disorder -pre-conception decision: genetic counselor and testing, moral obligation to refrain from reproducing -burden of proof on those who disagree -moral proposal for further debate=to make people think -DOES NOT mean that there should be laws or restrictions to prevent pregnancies "mindlessly reproduce" ignoring possibility of passing on disorder standard of judgement: "minimally satisfying life" -"minimally satisfying life"- health is the focus, not other factors, changes depending on the social and cultural environment, "normal health for children" -the greater the danger of serious problems, the stronger the duty to avoid them -ignorance is not an excuse -"quality of life" could be considered a slippery slope

if the person who is no longer competent, who determines, what principles?

beneficence, nonmaleficende, justice, fairness (financial and personal desires)

Sherwin

feminist view on abortion: -women are the only ones who have to deal with this decision, so women should be the ones deciding whether it is right or not, not men, or the whole of society, which is controlled by men -looks at the status of the fetus as well as that of the mother and the broader morally relevant issues -women's personal rights-bodily integrity -relationship to fetus is with the woman- "parasitic" doesn't always choose it, women should have full control over the baby and the decision -societal and familial pressures -women were always reproductively impotent, their autonomy was taken, it was expected, not chosen, -women defined by their ability to reproduce -giving human dignity by allowing women to choose -moral significance of embodiment -women need to have access to services -freedom to choose abortion leads to freedom to choose sexuality -pregnancy forces women to become dependent on men -women are socially taught to be compliant and accommodating, but this is a way that they can protect themselves **women's potential struggles that lead to abortion 1. ill 2. responsibilities at work 3. limited means to support child 4. living with chronic disease 5. homeless/addicted 6. victims of rape 7. disability/AIDS 8. child exposed to abuse 9. incompatible with life plans -most of the time the focus is on the fetus and the responsibility to the fetus, but what about the woman? they become passive hosts, carriers, demeaned and diminished to being holders of another being, without a say -even doctors look at the fetus more than the needs and desires of the woman -look at the fetus in relation to the woman and see that interconnection -fetus's existence is relational to the woman -fetus' are not persons because they haven't developed the social relationship to be persons in any morally significant sense

Anderson

feminist view on surrogacy *the fundamental problem with commercial surrogate is that commercial norms are inherently manipulative when they are applied to the sphere of parental love distort parental desires -potential harms to the child -control over surrogate-surrogate looses autonomy -exploit poor women -legal complications -too many risks -fail to value the baby in the appropriate way -modes of valuation: respect and use, the way we treat something shows the value we place on it -3 parties: intended father, the broker, and the surrogate mother -women are degraded because they are asked to repress their parental love for the child and manipulate and deny the legitimacy to the mother's pregnancy and exploit her -changes parental love -pregnancy is a social practice so it is psychological and socially degrading to be a surrogate -

Genetic Determination

genes dictate who you are/what you will be

Helsinki

goes into detail about the needs that need to be met in order for an experiment to be ethical

What constitute extreme prematurity?

gray zone- 24-26 weeks, lungs not fully developed and need machines and technology to stay alive

What does Brandt mean when he said that the tuskeegee study showed more about the pathology of racism?

it means that the pretenses that the study was conducted under were due to racist pretences, such as the belief that african americans were less than human, animalistic, a dawinistic example of how lower species self-destruct, that african americans had more sexual urges than others, that they wouldn't ask for help or try to receive treatment for syphilis, when in fact that was the only reason they stayed

Parens and Asch thesis

lens of the disability critique of prenatal diagnosis and abortion and then responds to the potential critiques and responds -looks specifically at 2 broad claims: 1. the prenatal genetic testing followed by selective abortion is morally problematic 2. prenatal testing followed by selective abortion it is driven by misinformation -distinguishes between acceptable and unacceptable testing and how to help professionals navigate through the genetic testing results

What do the U.S. Bishops discuss?

life-sustaining treatment, when it is morally acceptable or not to continue or stop treatment

Act Utilitarianism

look at only a specific situation and see if that specific act will result, or have the consequence, of the greatest benefit for the most people, with minimal harm for the least amount of people

Euthanasia vs. Palliative Care

makes you comfortable but does not help someone intentionally die or remove life-sustaining treatment, just allowing a person to be comfortable while nature takes it's course

Euthanasia

means "good death" 4 types: 1. Active voluntary- directly causing the death of another with the informed consent of the patient 2. Active non-voluntary- directly causing the death of another without the informed consent of the patient 3. Passive Voluntary-withholding or withdrawing life-sustaining support with the consent of the patient or a surrogate 4. Passive Non-voluntary-withholding or withdrawing life-sustaining support without the consent of the patient of a surrogate

23 and me

medical and social purposes-can be confusing to cliental $99 vs. genetic counselor visit +time commitment + going through info -gives carrier status, drug response -genetically verified info and inconclusive info value: good research method to share genetic info to researchers by signing the "23andme" questionnaires of health info -way info is presented poses it as a good thing, helps you prepare your life or take preventative measures, Implications: impact on consumer, dr-patient relationship, scientific knowledge, genetic identity and privacy -shut down the medical part because it fell under the medical device part of the FDA and 23andme weren't cooperating with the demands made by the FDA, who were worried about false +/- as well as patients getting this direct care and then trying to self manage and understand without the help of prof., also didn't show that their kit worked or was properly screened for accuracy, which is an issue, weren't communicating with the FDA, so the FDA shut that part down because they weren't able to prove the safety and effectiveness of the kit

Forman

mother of twin preemies made the immediate decision that she didn't want any life-sustaining treatment, but against the state law to not resuscitate, she said again, no heroic measures, no joy to this birth like she had with her last, living vs. existing vs. surviving: all parties had a different views of what they wanted from and for the babies, DNR never instated, both babies ended up passing, the girl first and the boy a couple years later

Parens and Asch: expressionist argument

part of the disability critique against prenatal testing and selective abortion -by looking at and deciding the life or nullification of the life of a fetus based on one disability trait, the parents are expressing a view that that one feature is a representation of the whole person, which can then reflect on those with that disabling trait, it is discriminatory -makes the assumption that a disability leads to an automatic conclusion that the life of a disabled person is not one worth living, or even giving the chance to live -abortion protects the disability from developing by killing the fetus

Key Ethical /'s for Euthanasia and PAS

patient's autonomy active v. passive- moral difference? potential abuse law protecting patient vs. physician vs. family

Parens and Asch Prenatal testing based on misinformation argument and proposed solution

prenatal testing is laid in the misinformation that a life with a disability is not fulfilling or valuable or meaningful or worth it for the family or child, which isn't true info from: clinicians, genetic counselors, societal views/context SOLUTION: 1. expose parents to those with children that have a disability or people who are dealing with a disability 2. have open communication about knowing what the parents want and needs and limitations 3. educations 4. adoption: if the biological family can't deal with the disability, another family might

Brock arguments

pro-voluntary active euthanasia -values: self-determination and individual well-being -self-determination: people's intent in making important decisions about their lives according to their own values/conception of a good life and being able to act on that -individual well-being: how a person views their life worth living -taking responsibility for their lives and the kinds of people they want to be -there is no 1 definition of when life is worth living or not, a self-determined choice -competent choice -doctors cannot be compelled to do it -rejects the active/passive distinction, motive matters -if rights can be waived by a competent person, then why can't a person decide that they want to waive their right to live? -ANTI-nonvoluntary euthanasia

Harmon

tested positive for huntington's disease, parents didn't want to know but now they do because the daughter knows, -her priorities changed once she found out she was going to get Huntington's disease, 12 years until she shows symptoms -never regretted being tested

Brock- killing vs. allowing to die

the distinction isn't really important, but the word killing should be used because A. seems to be taken as an unjustified cause of death, when the person actually requested it, consented to it B. the word kill in itself is psychologically unsettling to physicians C. takes the responsibility away from the patient and puts it on the doctor even though the patent makes the decision D. killing implies that the victim is being denied their right to life, but instead, their rights and values are actually being upheld

Warren micro effects

the individual level of behavior that is right or wrong, ?=whether IVF is sufficiently beneficial to IVF patients to justify the commercial marketing of the procedure, or even the continued research and development -physical risks -psychological risks -financial burden -informed consent can never be fully given, but that is true in every case of freedom, we make decisions based on the knowledge we have, and the current situation and circumstances we are in

Aquinas' version of natural law

the source of where we find good and bad is in God, we, as humans, are expected to access this information through reason

what is a surrogate and what do they do?

the substitute decision maker that honors the wishes of the previously competent patient -reasonable person standard- who would a reasonable person want to do

Direct-to-Consumer Genetic Tests and the Right to Know

there can be misunderstandings and contradictions which can be explained by: 1. companies look at different genetic markers 2. actual illnesses and family medical histories -probability NOT certainty that is being found at this point -constantly changing -DNA effected by historical and environmental and social determinants -comsumers have a right to their own medical records and information, but intermediary might be helpful, although not always needed, could turn into paternalism -fear of "too much information" but still have right to the information "we" want

Parens and Asch view of disability traits and diagnosis

there is a duality or split between what constitutes a "serious condition" which could then lead to what constitutes an acceptable selective abortion and what doesn't. policies need to take these complexities into account