Bioethics Exam #3
Does Resnik believe that the therapy-enhancement distinction is morally significant? Why or why not?
the therapy-enhancement distinction does not mark a firm boundary between moral and immoral genetic interventions,
How does Admiraal respond to the "slippery slope" argument against allowing active euthanasia?
"I do not accept that there is a slippery slope. A clear moral and legal boundary can be drawn around the notion of consent....No patient-no matter how ill-will have his or her life cut short, unless there is an explicit request." (397)
How does Admiraal argue that active euthanasia is not only compatible with the duties of a doctor, but sometimes required by them?
"I regard it as morally right, as not only compatible with the properly understood duties and responsibilities of a doctor, but as an act sometimes required by them. To fail to practice voluntary euthanasia under some circumstances is to fail the patient." "As doctors we have two primary duties: to ensure the well-being of our patients, and to respect their autonomy. The first duty entails that we should seek to restore patients to health, and, if we can't, that we should try to reduce their suffering. The second duty entail that we listen closely to, and respect, the wishes of our patients."
What is intelligence?
"Intelligence is a very general mental capability that, among other things, involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience...it reflects a broader and deeper capability for comprehending our surroundings."
Should euthanasia be restricted to those who are terminally ill, according to Admiraal? Why or why not?
"The notion of 'terminal illness' is slippery....This means that the notion of terminal illness cannot be employed, in a straightforward way, to justify medical end-of-life decisions." "The doctor might think that life with a certain condition is, or ought to be, bearable; but to the extent that the properly counselled and supported patient takes a different view, it is the patient's view, which must ultimately be the determinative one." (395)
What does Callahan mean by the difference between causality and culpability?
'Causality vs. culpability◦Direct physical cause vs. attributing moral responsibility to human actions◦Causality: direct physical cause of death ◦Culpability: Our attribution of moral responsibility to human actions Stopping treatment is not the cause of death◦The cause of death is always the underlying disease Example: Turning off the life-support machine does not kill a healthy person Although not a cause, we might find stopping treatment culpable (blameworthy)◦Stopping treatment out of malice or mistake So omissions do not ever CAUSE death, but we might hold a doctor culpable for omitting treatment Now that we have some control over death (only its timing and circumstances), we have decided what actions are culpable regarding life and death Calling cases of letting die (i.e., cases of passive euthanasia) 'killing' is to make a mistake Killing' should be reserved for lethal injections and stopping life support for patients who would otherwise recover Two disturbing consequences of conflating killing and letting die: 1) Doctors will feel morally and physically responsible for the deaths of their patients 2) Doctors will be encouraged to kill on grounds of "humanness and economics" (even if patient not so keen ?)
What are the 4 categories of euthanasia arguments?
1) Self-determination 2) Killing and allowing to die 3) Calculating the consequences 4) Euthanasia and medical practice
What are some of the ethical concerns regarding euthanasia in the Netherlands?
1) The line between euthanasia and palliative sedation can be blurred, and oftentimes crossed, in clinical practice The goal of palliative sedation is to relieve a patient's intractable symptoms to the point of unconsciousness if necessary All physicians, even the ones that oppose euthanasia should support palliative sedation BUT: physicians who say they are providing palliative sedation sometimes cross the line to euthanasia due to a confusion regarding the intention (Doctrine of Double Effect?) 2) Decisions about palliative sedation should be discussed with patients or families Ethically, palliative sedation involves a trade off between awareness and comfort Patients vary in how they want to set this balance, so communication is paramount 3) Failure of doctors to report cases of euthanasia (up to 20% of cases) raises concerns 4) Cases of euthanasia without the explicit request of the patient are contrary to Dutch law and ethically problematic
What are some objections to genetic enhancement and how do the authors answer those objections?
1) it is against nature BUT: all medical interventions are 'against nature' 2) it is akin to 'playing God' BUT: all serious intervention (that involve life and death or conception) are akin to 'playing God' 3) the treatment/enhancement distinction BUT: there are many contexts where that line is already blurry MORE INFO: Should We Undertake Genetic Research on Intelligence.pptx
What are the three methods of changing the genetic composition of future generations mentioned by Glover?
3 methods of changing the genetic composition of future generations 1) Environmental changes 2) Use of eugenic policies aimed at altering breeding patterns (ex. Genetic counseling or even various kinds of compulsion 3) Genetic engineering using enzymes to add to or subtract from DNA
What is Hill's medical condition? What is the note about? Why does Hill decide life is no longer worth living for him?
AIDS Decision to end life due to immense suffering Horrible low quality of life... Hill is now "a talking head mounted on a bloody wheelchair." He urinates through a 30-cm-long Si tube and "sticks a finger up [his] arse every second day to dig out the shit." Ugly sores, UTI's, hemorrhoids, the potential visit to the hospital constantly looming.
What is the authors' stance regarding the issue of enhancement (of intelligence)?
Authors claim that there is no intrinsic difference between different means of increasing intelligence therefore, genetic enhancement does not require higher ethical standard than that which is currently used for the distribution of medical treatments or goods within a just society Assumption: 1) enhancement procedure not more risky than minor medical procedures; 2) motivation of parents is to improve quality of life of children
What is the authors' conclusion regarding genetic research on intelligence?
Authors conclude that despite objections, research into intelligence is ethically permissible In fact, such research may be morally required since it will allow the creation of significant interventions to optimize the potential of all children!
How does Lachs answer Callahan?
Callahan has missed the personal side of this problem by focusing on abstract theories ◦ "Moral reasoning is more objectionable when it is abstract than when it is merely wrong" [386] Callahan's mischaracterization of people with terrible diseases "looking for the meaning of existence and find it, absurdly, in a lethal injection" [386] They are not looking for meaning, they want relief from their suffering! "They must bear the pain of existence without the ability to perform the activities that give life meaning" [387] And "few have a taste for blowing out their brains or jumping from high places" [387] "That leaves drugs" but... the medical profession has "monopoly power over drugs" [387] (which is why we turn to them) And laws deter or prevent medical professionals from assisting these people22John
How could the allocation of resources be used as an argument against conducting genetic research on intelligence? And how do the authors answer this argument?
Contends that public research funding should not be allocated to genetic research on intelligence, since the info gleaned has a limited potential for beneficence and a high risk of individual and group harm Authors offer two counter claims 1) the amount spent on this research has to be compared with the costs that learning disabilities generate for taxpayers (in excess of $5 billion/year) 2) even if there are not any tangible benefits from initial research, it is better to obtain actual info than rely on pseudo-biology or speculation for info
How does Rachels argue that active euthanasia is sometimes preferable to passive euthanasia?
Case 1.1: Patient is dying of incurable cancer, in terrible unalleviated pain, subject to irrefutable imminent death. 1) Because of the last clause, the patient and his immediate family has decided to end the patient's life 2) If the doctor withholds treatment (via the AMA doctrine) he would justify the action by noting that the patient would die anyway, and it is wrong to prolong suffering needlessly. 3) But, if one simply withholds treatment, the patient may take longer to die, and would thus suffer more, relative to the case of active euthanasia, i.e., lethal injection. 4) Thus: once the decision to not prolong agony is made, active euthanasia is preferable to passive . (Otherwise, the patient would suffer more, which is contrary to the "humanitarian impulse" that prompts the decision to end the suffering in the first place!) Case 1.2: An infant with Down Syndrome suffers a malady (ex: intestinal blockage) that requires a simple operation in order to live. Suppose his parents and the doctor decide not to operate and to instead let the baby die. The baby would suffer dehydration and infection before dying It would be cruel if the baby were not given a lethal injection (since its terminal fate is death anyway)
What are potential social harms of the genetic research on intelligence? How do the authors answer those claims?
Claim that genetic testing will cause 'geneticism,' the judging of people exclusively as products of their genes Authors classify these harms into 4 overlapping classes 1) family harm 2) harm to individuals in social context 3) Group harm 4) eugenic harm
How could research on intelligence lead to eugenic harm?
Claims that availability of genetic information could justify the creation of a new 'eugenics' where people are not allowed to be born on the basis of predictive genetic tests on intelligence (or are subject to compulsory treatment) 4)
How could individuals be harmed by genetic research on intelligence?
Claims that genetic info about intelligence can cause psychological harm because people might use "genetic label" as an indication of their capabilities Objection fails because genetic tests would actually be less efficient than current IQ tests (only difference would be that genetic tests could be used predictively)
What example does Rachels give to illustrate that the doctrine against active euthanasia lead to decisions concerning life and death on irrelevant grounds?
Conventional doctrine: active euthanasia is always forbidden. Example: AMA Doctrine: Mercy killing ("the intentional termination of life of one human being by another") is wrong. The patient and immediate family decide on withholding treatment if and only if there is "irrefutable evidence" of imminent death RACHELS Arguments: 1. Active euthanasia is often more humane than passive. 2. The conventional doctrine leads to decisions concerning life and death on irrelevant grounds. (The "excuse" to let babies with Down Syndrome die) 3. The conventional doctrine rests on a distinction between killing and letting die that itself has no moral importance. 4. The most common argument in favor of the conventional doctrine is invalid Rachels
What does the current data regarding euthanasia suggest? Does euthanasia seem to be abused in the Netherlands?
Euthanasia accounts for about 2.8% of deaths in the Netherlands Abuse has not been widespread, and there is no apparent disproportionate use in vulnerable populations Physicians do not substitute hastening death for the provision of palliative care Physicians grant fewer than half of euthanasia requests from patients
involuntary euthanasia
Euthanasia: The person cannot make a decision or cannot make their wishes known. This includes cases where the person is in a coma, the person is too young (e.g. a very young baby), the person is senile, the person is mentally retarded to a very severe extent, the person is severely brain damaged, the person is mentally disturbed in such a way that they should be protected from themselves. Indirect
What is the "nasty uncle" scenario that Rachels gives and how does it illustrate his argument that killing is no worse than letting die?
Example: "The Nasty Uncles": In both cases, the perpetrator stands to gain, perhaps through a large inheritance, if his 6-year old cousin were to die. ◦ Case 3.1: The perpetrator Smith purposefully drowns his cousin. ◦ Case 3.2: The perpetrator Jones plans to drown his cousin, but his cousin dies in an accident (which he did not cause), which Jones witnesses in full sight. Jones has the power to save his cousin, but he merely stands by and does nothing! Jones argues, "I didn't kill him; I only let him die." If letting die is intrinsically less bad than killing, this "defense" is actually somewhat valid -- however, such a "defense" can only be regarded as a grotesque perversion of moral reasoning. Thus, it is no defense at all. Therefore: the bare difference between killing and letting die does not, in itself, make a moral difference
What example does Kuhse give to show a case where killing is better than letting die?
Example: A truck driver is trapped in a blazing truck and will burn to death. He asks his co-driver to kill him, to put him out of his misery.
How could research on intelligence lead to group harm?
Genetic information could be used to assert 'supremacy' of one group over another
What is their stance on martyrs, i.e., is giving one's life (for someone else or for some higher purpose) intentional killing?
Grisez and Boyle claim that martyrs don't intend their own deaths. They intend some other action, recognizing that their death is likely to follow as a side- effect. Example:the soldier who jumps on the grenade to save his fellows realizes that his actions will result in his own death. But he doesn't intend to kill himself. He intends to smother the grenade, recognizing that his death will be a side-effect of the only way to do this, given the circumstances
Is intentional killing ever morally permissible according to them?
Grisez and Boyle think every intentional killing is immoral because it is at odds with the respect we owe to the life of such persons
Is death always the greatest evil that can befall a person?
If patients can be benefitted by being let die, because death is good for them in their particular situation, they can be benefitted by being killed. There are patients for which death would be a good
How could research on intelligence lead to harm to individuals in social context?
Individuals could suffer discrimination This could occur in educational settings (in regards to children) and the workplace (in the case of adults)
Why are Smith-like persons more dangerous than Jones-like persons, according to Nesbitt?
It is clearly preferable to have (modified) Jones- like people around than Smith-like people: we are threatened by the latter, but not by the former. • This is why killing is, indeed, morally worse than letting die.
Doctrine of double effect
It is sometimes permissible to cause a harm as a foreseen side-effect of one's intentional action, even though it would be impermissible to intentionally cause the same harm. Ex: Terror bomber vs strategic bomber: Terror bomber intends to destroy the school and the munitions factory. Strategic bomber intends to destroy the munitions factory, seeing that destroying the school is a side- effect of hitting the factory. Both inflict the same harm. But DDE at least allows that the latter may be permissible even if the former isn't. DDE is a focus of the G&B distinction between killing in the strict sense (which they take to always be impermissible) and certain cases of letting die (which are sometimes permissible).
How does Kuhse argue that killing may be worse than letting die in some cases, and better than letting die in others?
Kuhse: "Killing may be worse than letting die in those cases, and better than letting die in others." ◦ Kuhse argues that we should not be comforted by the presence of the difference thesis believer who would not have killed even in an act of mercy.
How does Nesbitt modify Jones to show that killing is indeed morally worse than letting die?
Modified Jones Case : Jones manages to slip and fall and knock himself unconscious before he can drown the child, which he is attempting to do. • By the time he regains consciousness, the child (unaware of Jones' intentions) manages to call his parents, and Jones' opportunity is gone. • Here, Jones neither kills his nephew nor lets him die, but "it would be agreed that given his preparedness to kill the child for personal gain, he is as reprehensible as Smith."
What does Glover mean by the "genetic supermarket"?
One solution to the problem of having one group of people impose their views on the world is to have parents choose their children's characteristics BUT: the genetic supermarket might still lead to problems, such as imbalance of the sexes, so some central regulation might be necessary
How do Grisez and Boyle define intentional killing?
One intends to bring about a person's death, thereby undertaking a commitment to bring this result about
What is their conclusion regarding the enhancement of intelligence?
Overall, the optimization of intelligence is ethically acceptable, and indeed morally demanded in Western society, as long as the processes to achieve this do not impose social harms
What are some objections to the development of genetic testing on intelligence?
Overriding claim is that genetic information will be used to divide, disadvantage and disempower people Two groups of objections: 1) claims to individual harm 2) harm to groups of people
passive euthanasia
Passive euthanasia is an alternative name for withdrawal of treatment - the doctor withholds life- sustaining treatment. Passive euthanasia occurs when the patient dies because the medical professionals either don't do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive. The doctor may switch off life-support machines, disconnect a feeding tube, not carry out a life-extending operation, or don't give life- extending drugs "letting nature take its course"
Why does Nesbitt say that the behavior of Smith and Jones (the "nasty uncles") is equally reprehensible?
Rachels assumes that we will agree that Smith, who kills his nephew, is no worse, morally speaking, than Jones, who merely lets his nephew die. • Rachels argues that if letting die were in itself less bad than killing, Jones' defense that "I didn't kill him; I only let him die" would carry some weight. • So we conclude that Jones is just as reprehensible as Smith.
Are euthanasia and medical practice compatible according to Callahan?
Some think: "euthanasia and assisted suicide are perfectly compatible with the aims of medicine" [385] Do doctors have the relevant expertise? Lots of people commit suicide because they find no meaning in life, so it becomes a question of values Does anyone have the expertise to know if lives are worth living? "The great temptation of modern medicine, not always resisted, is to move beyond the promotion and preservation of health into the boundless realm of general human happiness" [385] "It would be terrible for physicians to [...] think that in a swift, lethal injection, medicine has found its own answer to the riddle of life." [385] Doctors should only provide therapy for biological concerns related to illness and aging
physician assisted suicide
Somewhat of a hybrid between passive and active euthanasia is physician-assisted suicide (PAS), also known as voluntary passive euthanasia. In this situation, a physician supplies information and/or the means of committing suicide (e.g., a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas) to a person, so that that individual can successfully terminate his or her own life.
What does Resnik mean by positive and negative eugenics? What does he mean by state-sponsored and parental eugenics? Are all forms of eugenics immoral according to Resnik?
State-sponsored eugenics: the government attempts to control the human gene pool Parental eugenics: parents exert control over the gene pool through their reproductive choices doesn't seem as troubling; in fact, parents practice this kind of eugenics every time they select a mate, or a sperm or egg donor Distinction
How could research on intelligence lead to family harm?
States that genetic information will harm supportive family environment by detrimentally influencing parental expectations and allow for "genetic blame" of children
What is their stance on suicide, i.e., is suicide a case of intentional killing?
Suicide is one such intentional killing—the suicidal person intends to bring about his or her own death. So suicide is always wrong in virtue of its incompatibility with respect for the good of life. And assisting suicide will be assisting someone's perpetration of a wrongful killing. So voluntary euthanasia is wrong as well, as it's the assistance of a killing
How is the difference between active and passive euthanasia usually framed? Does Rachels agree that killing is always worse than letting die?
The distinction between active vs. passive euthanasia is essentially "to kill or to let die." (Example: the direct action to kill a terminally ill patient as a form of 'mercy killing' or to merely withhold treatment) If letting die is intrinsically less bad than killing???
What is the raison d'etre of morality?
The raison d'etre of morality is the connection between actions and their possible outcomes, which embodies the concept of risk. If the raison d'etre of morality is to allow people to live together in relative peace and security, we would like doctors to be motivated to primarily seek our good, to "let die" or "make die," when either action serves us best.
Why does Callahan argue that self-determination in cases of euthanasia is different from other cases of self-determination (in other words, what makes euthanasia more problematic than, say, physician-assisted suicide)?
The value of self-determination◦It's good to be able to build our lives as we see fit, but what should the limits be? Suicide is more personal than euthanasia◦'Euthanasia is ... no longer a matter only of self-determination, but a mutual, social decision between two people, the one to be killed and the one to do the killing.' How to get from our right of self-determination to waiving our right to life and giving a doctor the right to kill us?◦"I have yet to hear a plausible argument why it should be permissible for us to put this kind of power in the hands of another" To be responsible moral agents, doctors' would also need "independent moral grounds" to kill [382] No objective grounds to decide whether:◦Suffering is unbearable or ◦A life is worth living or◦How much value a life can provide These decisions don't rest on objective physiological facts◦Pain is felt differently◦Physical disabilities cause varying psychological problems To decide if a life is worth living (etc.), doctors will have to treat patients' values but how can they make this judgment? Doctors say that there is no objective measure of whether a life is worth living
what is the difference thesis
There is a moral difference between killing and letting die: it is morally worse to kill someone than to let them die.
active euthanasia
Those instances of euthanasia in which a clearly competent person makes a voluntary and enduring request to be helped to die causing the death of a person through a direct action, in response to a request from that person More HUMANE than passive!!!
What are the three almost certain consequences of permitting euthanasia according to Callahan?
Three consequences that seem almost certain A) the inevitability of some abuse of the law B) the difficulty of precisely writing and ten enforcing the law C) the inherent slipperiness of the moral reasons for legalizing euthanasia in the first place
Why do many people believe that gene therapy is permissible while genetic enhancement is not?
Usually, therapeutic genetic engineering (not overriding autonomy) is regarded as morally unproblematic whereas enhancement is regarded as problematic
what is the value-laden approach to the definition of health versus the value-neutral approach? Are the goals of medicine clearly defined?
Value-neutral (descriptive) approach: claims that health and disease are descriptive concepts that have an empirical, factual basis in human biology. Example: a diseased organism lacks the functional abilities of a normal (typical) member of its species Value-laden (prescriptive) approach: argues that our concepts of health and disease are based on social, moral, and cultural norms. A healthy person is someone who falls within those norms. Example: although schizophrenia has biological basis, some cultures view schizophrenics as "gifted" or "sacred" Another argument claims that genetic therapy is on solid moral ground because it promotes the goals of medicine, while genetic enhancement promotes other, morally questionable goals BUT: what exactly are the goals of medicine?
positive eugenics
attempts to increase the number of favorable or desirable genes in human gene pool
negative eugenics
attempts to reduce the number or harmful or undesirable genes
germ line therapy
directed at the reproductive cells, and so passed on to future generations
positive gene therapy
enhancement; adding desirable traits, improvements
Does Resnik believe that genetic enhancement is inherently immoral?
genetic enhancement is NOT inherently immoral
somatic gene therapy
intended to affect the somatic or body cells of individuals BUT can indirectly affect germ cells as well permissible via the law of double effect!
Geneticism
is a school of thought that holds that genetics determines all human characteristics, particularly psychological characteristics. This concept is primarily associated with the works of Francis Galton.
What is the main argument of the article?
our resistance to genetic improvement of the human race is based on a complex of different values and reasons, none of which is sufficient to rule out in principle the positive use of genetic engineering
Palliative Sedation
palliative practice of relieving distress in a terminally ill person in the last hours or days of a dying patient's life
triage
process of determining the priority of patients' treatments based on the severity of their condition.
euthanasia
the act of painlessly killing a suffering person or animal; mercy killing;literally, from Greek meaning "good death"
voluntary euthanasia
the person can make a decision or can make their wishes known in regards to euthanasia.
eugenics
the study of or belief in the possibility of improving the qualities of the human species or a human population, especially by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits (negative eugenics) or encouraging reproduction by persons presumed to have inheritable desirable traits (positive eugenics).
negative gene therapy
therapy; getting rid of genetic diseases, elimination of defects
Principle of Caution
we should alter genes only where we have strong reasons for thinking the risk of disaster is very small, and where the benefit is great enough to justify the risk
