trial 2
22. What are Gert, Culver and Clouser's objections to the claim that the principle of autonomy expresses a negative and a positive obligation? What is the difference between considering this principle as a moral rule and considering it as an ideal? Why are Gert, Culver and Clouser critical of the distinction between autonomous and non-autonomous choices?
Can't find!!
35. What are the main differences between the assessment of paternalistic behavior in cases 1, 2, and 3 (pp. 269-271)? Do you agree with the authors' conclusions about the doctor's behavior? Why or why not? Explain case 4 (p. 274), and evaluate the permissibility of the options available to the physical therapist of (a) chastising the patient versus (b) deceiving the patient. Do you agree with the authors' conclusions? Why or why not? (Note: the point of this study question is not to get you to remember these particular cases, but to get you to practice analyzing various cases).
Case 1 (affair/Mr. K wants to commit suicide so brought to the hospital against his will): Mr. K is clearly acting irrationally, and the severity of his situation is great. Dr. T is acting (justifiably) paternalistically because the intervention at the hospital greatly outweighs the possibility of Mr. K irrationally killing himself. Case 2 (Mrs. R has cancer, wants to know diagnosis but Dr. E lies to her and Mr. R): Mrs. R specifically asked to know "exactly where I stand and what I face", but Dr. E still lied to both her and her husband, with whom she has children with. Especially given the fact that she is a young mother and is not expected to live, Dr. E's action is preventing the Rs from making necessary arrangements that outweigh the comfort of thinking that she will be okay. Therefore, Dr. E's paternalism is unjustified. Case 3a (Mrs. V is in car accident, is about to have a surgery and one of her children has died in the accident, Dr. H believes that Mrs. V shouldn't know about children until after surgery): This is justifiable. Dr. H is not deceiving Mrs. V by withholding this information; he is not obligated to tell her this information, as it is irrelevant to her own current medical situation. In addition, telling her may worsen her condition. Case 3b (Mrs. V is in car accident, is about to have a surgery and one of her children has died in the accident, Dr. H believes that Mrs. V shouldn't know about children until after surgery, Mrs. V asks about them and Dr. H lies): This is still justified, as telling her could increase her chances of dying, and deceiving her would have no long-term effects. Case 4 (Ms. Y is frustrated w/ slowpoke, lazy stroke patient Mr. J who is just a pain in the ass fr and tells him that people who quit permanently have a more disabled arm and leg and then when he keeps going she yells/chastises him bc he's lazy af): Justified. He was caused a little pain/discomfort but like she didn't hurt him or anything and he was prob permanently better. (ALT: if she deceived him into trying to get better): Well if Gert&Co say it's more justified than before and I believe them so
7. What is the relationship between our common moral intuitions and the recommendations of act utilitarianism? What do act utilitarians say in defense of the theory even when it seems counterintuitive?
Common moral intuitions are utilitarian-based, however they believe that we need to listen to all of the consequences and therefore common sense is wrong in some scenarios.
27. What does the criteria of lack of coercion that is part of the doctrine of informed consent say? What kinds of behavior of doctors are coercive? What do Gert, Culver and Clouser say about the possibility of coercion by a family member? Explain their analogy with appendicitis.
Valid consent requires the absence of any coercion by the doctor or the medical staff. Coercion involves a threat of sufficient evil or harm that "it would be reasonable to expect any rational man in that situation not to act on it". On occasion, patients are coerced into/out of a treatment by friends/family. "A victim of appendicitis must contend with her abdominal pain in deciding whether to consent to an appendectomy."
24. What are the criteria that must be satisfied for a patient's consent to treatment to be valid, according to Gert, Culver and Clouser? How do they determine the kind of information that patients must be provided when making medical decisions? What information are doctors morally required to disclose? What additional information could the doctors provide that goes beyond what is morally required?
-3 criteria for valid patient consent: Patient must be given adequate info Patient must be competent Coercion must not be used to obtain decision -4 types of info: Volume-outcome studies Number needed to treat measures Geographic variation data Practice guidelines
33. What is the difference between paternalistic behavior and a paternalistic attitudes? How do Gert, Culver and Clouser analyze cases in which one person refuses to do what a second person wishes, for the second person's own good? What do they think about a husband who hides his own pills because he is worried that his wife might take them? What do they say about a doctor who urges a patient to be hospitalized or to pursue a particularly beneficial treatment?
-Active vs. passive paternalism: taking action vs. refusing to carry out an action/request -Husband→ not paternalistic -Doctor→ not paternalistic because the patient is asking him for advice
31. What can be done, according to Hardwig to make sure the interests of the family are included in medical decisions about treatment? What are the main problems with Hardwig's views?
-Because it is not realistic for physicians to mediate discussions and it would be against the Hippocratic Oath for if they do not work towards the patient's best interests, families should have family conferences so that the outcome can be in everyone's best interests -There won't necessarily be agreement from the family conferences--can be left unresolved -Physicians/higher courts/ethics committees are too impractical/time-consuming, esp for cases that are time-sensitive
26. Explain the "ability to make rational decisions" definition of competence proposed by Gert, Culver and Clouser. What are the drawbacks of incorporating the notion of rationality as part of the definition of competence? What are the advantages of this definition? Does this definition imply that all patients who make irrational decisions are incompetent? Why or why not?
-Competence is task-specific, and making a rational decision is always competent -Drawbacks: distorts the accepted meanings of "understand" or "appreciate" -Advantages: Determining incompetence and justifying paternalistic interventions are distinct but related→ incompetence is not determined by the seriousness of a patient's situation, but paternalism is Consistent with legal tradition--everyone who makes seriously incompetent decisions are incompetent Competence is the ability to make a rational decision, but incompetence of a person isn't just determined by the irrationality of a decision -Irrational decisions does not determine competency
29. What arguments does Hardwig give in favor of including family interests in decisions about medical treatment? Why does he say that his approach is not utilitarian? In what ways would Hardwig's proposal lead to changes in the way the physician's role is understood?
-Families are interconnected with the patients and are impacted emotionally and financially by these decisions -Not utilitarian because interests of the patient are still favored -Physician would offer treatments with the families' interests in mind (impartial to the patients), build medical ethics theory on the presumption of equality b/t patients' and families' interests
19. What does the principle of respect for autonomy say? Why does Childress claim that this principle expresses both a negative and a positive obligation? What are the conditions for autonomous choice, in his view? How does Childress argue in support of the view that autonomous choice is consistent with following the direction of a medical or religious authority?
-It is important for the moral life that people be competent, be informed, and act voluntarily→ can yield first-order decisions -Neg obligation: autonomous actions should not be subjected to controlling constraints by others -Pos obligation: requires respect in disclosing info, probing for and ensuring understanding and voluntariness, and fostering autonomous decision-making -People exercise second-order autonomy when selecting a figure of authority because they elect to be subservient to this professional or institution
32. How do Gert, Culver and Clouser describe paternalistic behavior in medicine? What are the main elements of their definition of paternalism? Briefly explain each element of the definition. Does future consent turn an action that otherwise would be paternalistic into one that is non-paternalistic? Can a doctor act in a paternalistic way toward incompetent patients?
-Paternalistic behavior in medicine is currently a pervasive moral problem -Main elements: A believes that his action benefits S A recognizes that his action towards S is a kind of action that needs moral justification A does not believe that his action has S's past, present, or immediately forthcoming consent A regards S as believing he can make his own decisions on this matter -If the patient would have given consent in the future, the action is non-paternalistic -If S believes that he is able to make his own decision but he is incompetent, the action is paternalistic
28. What is Hardwig's argument in support of the claim that the ethics of patient autonomy is limited? What place do family interests typically have in bioethical discussions about informed consent? What is the most common assumption about the physician's role, shared by the models of beneficence and respect for autonomy?
-Patients can essentially make unlimited demands from the healthcare system when they are given complete autonomy, which will bankrupt the healthcare system -"Prevalent ethic of patient autonomy ignores family interests" -Most common assumption about physician's role is that they are to serve the interests of the patient
20. What are the difficulties in establishing when the preferences of a patient are autonomous? Does authenticity of judgment matter when determining the autonomy of preferences? Why or why not? How does Childress propose that we can decide which patients are autonomous and which are not?
-Preferences can be expressed through many different actions: written, verbal, non-verbal actions are temporal and often contradictory -Authenticity of judgement can at most be a caution flag about whether or not an action is autonomous, as basic values may change
21. What does Childress mean when he says that the principle of autonomy has limited weight? When is this principle "overextended" in medical ethics, in his view? Give a couple of examples.
-Principle of autonomy is prima facie binding when competing with these other prima facie conditions are satisfied: proportionality, effectiveness, last resort, least infringement -Can be overextended→ if someone cannot express autonomy, better to act in the best interest than judgement -Examples: --referring to cadaver as "donor", when the donor is the one who autonomously decided to donate (such as a family member or the individual prior to death) --appeal to substituted judgement where it does not apply: patient no longer has autonomy
23. What was the purpose of the study conducted by Blackhall and colleagues? What methodology did they use? What were the main results of the study? Explain the main disagreements the respondents had, regarding the importance of (i) personal autonomy and control over personal decisions, and (ii) receiving precise information about their condition and prognosis? What different views did respondents have about the role of the doctor and the family regarding treatment decisions of elderly patients? What issues are raised by this study regarding the practice of informed consent?
-Purpose: examine/compare experiences/attitudes of elderly people from different ethnic groups with respect to topics such as truth-telling, patient autonomy, advance care directives, and forgoing life support -Methodology: recruited 200 senior citizens (65+ years old) from 4 different ethnic groups (African Americans, European Americans, Korean Americans, Mexican Americans) from senior citizen homes, interviewed by someone of the same ethnicity in preferred language, asked if doctor should tell patient that they have/are dying of cancer (2 separate questions). Then 10% of original group interviewed again to illuminate/enrich findings of the survey -Results: --People who thought doctors should tell patients that they have cancer: 89% Europ., 87% Afr., 65% Mex., 47% Kor. --People who thought doctors should tell patients that they are dying of cancer: 69% Europ., 63% Afr., 48% Mex., 33% Kor. -EAs and AAs believed that patients should have total autonomy and should know their diagnoses, where MAs and KAs believed that doctors and families should withhold this information from the patient and give him/her hope -Almost everyone shared opinions from both sides -In America, doctors are required to disclose diagnoses to the patients. However, many subjects interviewed (not exclusive to MAs and KAs) believed that this would make quality of life worse, but on the other side, others believed that patients would be unable to come to terms with the end of their lives.
34. Do Gert, Culver and Clouser think that paternalism is always acceptable, never acceptable or sometimes acceptable? What procedure do they propose to establish the permissibility of paternalistic behavior?
-Sometimes acceptable, using common morality (rather than act consequentialism and strict deontology) --Use 10 moral rules listed in chapter 2
25. What role does competence play in informed consent? What does the U+A definition of competence say? What are the advantages and disadvantages of the U+A definition? Give one example of a case that raises issues for the U+A definition. What changes can be introduced to deal with such cases?
-To be competent, one must understand the minimal amount of information -U+A: understand and appreciate -Advantages: allows competent patients to make any decision they want, easy to determine -Disadvantages: can be counterintuitive -Depressed elderly woman who understands/appreciates that her most promising treatment is ECT, but has an irrational fear -Modifications of U+A: Competence can be claimed as determinate A physician is morally justified to overrule a competent person's irrational decision Change the definition of competence based on context Competence is the ability to make a rational decision
30. Explain the two different ways of understanding autonomy that Hardwig points out. What are the consequences of taking seriously the idea that autonomous choices carry with them moral responsibility, when evaluating medical choices?
-Two different ways of understanding autonomy: A patient's freedom/right to choose a treatment that he/she feels is best for him/herself A patient's responsible use of autonomy, which does take into account the interests around him/her -Patient autonomy also gives them the responsibility of making difficult moral decisions which may not always be in his/her best interest
16. What do the general moral rules say? How can violations of these moral rules be justified? Explain the justificatory procedure proposed by Gert, Culver and Clouser.
1. Do not kill. 2. Do not cause pain. 3. Do not disable. 4. Do not deprive of freedom. 5. Do not deprive of pleasure. 6. Do not deceive. 7. Keep your promises. 8. Do not cheat. 9. Obey the law. 10. Do your duty. Justified violations must be upfront about breaking rules and all justifications must have the following qualities: impartiality, be rational to favor everyone violating, everyone must know. (long step by step instructions on pages 39-40)
14. What actions count as irrational, according to Gert, Culver and Clouser? What actions count as rational? What is the relationship between irrationality and harm? What explains people's disagreements regarding the rationality of actions that involve harm to the agent? What are the reasons that justify suffering harms? Why can't the instrumental account of rationality ultimately explain what individuals ought to do?
Actions count as irrational if they are harming yourself without any purpose, they are rationally required if they are essential and they are rationally allowed if they are option (dictated by personal beliefs). These personal beliefs or different rankings of importance explain disagreements regarding rationality, additionally we sometimes do irrational things because of emotions. Check on on page 31 to see if there is more to elaborate on the last part of the question
12. What conclusions do Gert, Culver, and Clouser draw from the amount of agreement and disagreement on moral matters? What is the purpose of morality, in their view? What kind of behavior is subject to moral assessment?
Agreement shows the rules and disagreement shows the scope of the moral community. The purpose of mortality is to make actions (specifically medical decisions) uncontroversial. Only behavior towards others is subject to moral assessment.
2. What does utilitarianism recommend regarding cases like Matthew Donnelly's? What does it recommend regarding the treatment of animals? How do utilitarians justify the claim that animals should be treated as equals and what exactly do they mean by that claim?
In the case of Matthew Donnelly utilitarians say that killing him was morally okay because it decreased suffering. In the case of animal treatment they say that animals should be treated as equally as different races, however, it must be considered that they don't need to be treated exactly like humans because they don't have the same complex thoughts and therefore something like the appreciation for literature would be irrelevant to them. Additionally this means that everyone should be vegetarian.
6. What is rule utilitarianism? What are the advantages and disadvantages of rule utilitarianism as a moral theory?
Instead of evaluating each circumstance, it makes rules based on utilitarian that people should follow. The benefits are that it's less extreme but many say that a disadvantage is that it is non-commital inbetween of act utilitarianism and common sense.
4. What are some objections to the claim that only the consequences of actions matter for their moral evaluation? Present a couple of counterexamples to this claim, explaining why act-utilitarians seem to recommend actions that clash with our intuitions about (a) the importance of justice and personal rights, and (b) the importance of considerations about the past.
Justice (example of the black guy being hung), rights (woman who had her privacy violated), and backwards-looking reasoning. Defense against these are that the consequences aren't good if they result in these bad things, common sense is wrong, all values have utilitarian basis, our gut reactions can't be trusted when cases are exceptional, and we should focus on all the consequences (its not actually too demanding, its the right thing).
13. What do Gert, Culver and Clouser mean when they say that morality is a public system? What kind of beliefs are presupposed by morality? What kind of beliefs are not presupposed by morality but may be relevant when making moral decisions?
Morality is a public system means that as a moral agent there are rules that everyone is assumed to know and understand. Only facts that are known by everyone may be presupposed by morality, beliefs that are not presupposed by morality but may be relevant are facts that are not known to everyone, like religion.
15. How do Gert, Culver and Clouser describe the notion of impartiality? What kind of impartiality is required by morality, in their view? Are we required to be impartial when following moral ideals? Why or why not?
Morality requires complete impartiality. Meaning, what is okay for one person has to be publicly okay for another other person. This is because they believe morality should be an objective process?
1. What is the point of morality, according to utilitarianism? What is the purpose of the law? What does the Principle of Utility say? What role does this principle play in the utilitarian theory?
Mortality is about making the world as happy as possible. The Principle of Utility requires one to choose the choice where the best consequences happen for everyone concerned.
18. If someone suffers as a consequence of something we did, does this mean that we acted immorally? What guidelines do Gert, Culver and Clouser offer to interpret the moral rules in order to determine whether an act counts as a violation or not? (note: the primary example discussion is about the rule against causing pain, and it uses the idea of personal decisions).
No, when deciding what is right you must look at which choice causes the least amount of harm. Stuff may offend or hurt someone unintentionally but that does not mean that they were actually suffering as a result of the action. For example, playing a game, there always has to be a loser and they may be hurt that they lost but the winner didn't hurt them or violate a moral rule. They say that an act is not a violation in the following circumstances: decisions that are personally weighed, the act is controversial and the act is extremely trivial.
8. What is the structure of the theory of prima facie duties? What is distinctive about this theory's understanding of morality?
Prima facie duties are moral reasons to act that we can weigh to see which is important in a given situation. This is different than other theories because it takes into account exceptions and allows the right choice to be chosen contextually.
10. What are prima facie duties? Give some examples. What role do these duties play in moral decision making? What should be done when moral principles are in conflict? What does Ross mean by "duty proper"?
Prima facie duties are things that matter morally, like not letting people down or not lying. Their role in decision making is that you look at the prima facie duties and use them to decide in a given situation what the morally right thing to do is. Conflict between them is okay, even necessary, they are cultivated overtime whenever you are confronted with a moral conflict because just the existence of the conflict shows you that they matter morally. Duty proper is the right choice, what you should do, and you never know what this actually is.
17. How do Gert, Culver and Clouser explain the variety of moral norms that exist in different societies, as well as the variety of codes for professional conduct? How are particular moral rules like "do not drink and drive", "obtain informed consent", or "respect confidentiality" derived?
Subcommunities use the basic moral rules and specifically design them for the community. For example, 'do not drink and drive' was derived from 'do not kill' because in our society that is a way that people can be killed.
9. What is Ross' criticism of utilitarian and other consequentialist theories? Explain the purpose of the example of the promise to a neighbor.
There isn't room for backwards look theories. For example, promises. It fails to capture the whole story. With the situation of the promise to the neighbor, you see that even though it may produce more happiness given the current situation to do one thing, there are other things, like having already promised to meet a neighbor, that mean that would be letting someone down even though it doesn't appear to directly affect them if you don't take into account the context.
3. How do classical utilitarians evaluate actions? What is the relationship between the good and the right in their theory? What is hedonism? What are the problems with the hedonist account of the good?
They evaluate in each situation the consequences, the amount of happiness involved, and always consider all happiness as equal. Start by defining what is good, these are the things that are valuable and good. For hedonism they say good is pleasure and no pain. Doesn't have to be an action. The RIGHT actions maximize the good. Hedonism is that pleasure is the ultimate good, however this doesn't take into account that other stuff has value.
5. Why do critics of utilitarianism claim that it is too demanding and that it disrupts personal relationships?
Treating everyone as equal means abandoning special relationships. Additionally, it is too demanding because it requires that you give everything you have until you have the amount that the least well-off individual has. This means that you are not allowed to enjoy things because, "children are starving", etc.
11. How do we acquire moral knowledge, according to Ross? What kind of knowledge do we have of our prima facie duties? What about knowledge of our duty proper? What are moral principles, according to Ross, and what role do they play in his theory?
You acquire moral knowledge through moral experience, from which we figure out (explained above) what really matters. We know our prima facie duties but we do not know our duty proper. When you're in a situation you generalize the moral reasons at play to make a principle.
