Bioethics Final Exam

Briefly (in a couple of sentences) summarize the thought experiment of the visitor to the cemetery. What do Delaney and Hershenov think it shows regarding our usual intuitions about people's refusals to donate their organs?

(Explain thought experiment), Most respond, as we do, that the man's deceased body should be used against his known wish in order to save the life of the man trapped by the fire. But many people are on record as being opposed to taking the organs of people in the hospital when they die if they have expressed their opposition to being donors. How can we maintain both responses? In each case, someone is opposed to her dead body being used to save the lives of others, but in one scenario, it seems that this wish should be respected, in the other it does not. Delaney and Hershenov believe that our attitude to organ conscription that should be abandoned. They think the saliency of the need of the endangered overrides certain distortional factors such as projective grouping and mandatory autopsies. Mandatory autopsies are widely accepted, despite the expressed wishes of the deceased and that of their surviving families. There is no moral difference between organ conscription and autopsies. Live vs. let die-The state does not have a greater duty to prevent people from killing, then it does to prevent diseases from taking the lives of its citizens. --------------------------------------------------------- The thought experiment is about a man who majored in philosophy who died due to an unhealthy lifestyle of poor habit and exercise. Upon his death, he said that he wanted his body and organs to remain untouched (no matter how much good could come from his body being at the disposal of the medical community) and to immediately be put in a coffin and into his mausoleum, and to be left forever undisturbed. On after his burial, a strike of lightening sets the cemetery on fire. A visitor to the cemetery, aware of the deceased's deathbed declaration, can only escape the fire by taking refuge in the mausoleum and using the fresh corpse as a fire shield. The fire badly burns the corpse, but leaves the visitor unscathed. Delaney and Hershenov believe that our attitude to organ conscription that should be abandoned. They think the saliency of the need of the endangered overrides certain distortional factors and put us in touch with not only our core convictions on the matter, but true ones at that. So one of the distortional features may have to do with how we group people in need, what Unger calls 'projective grouping.' The dead and living persons in the cemetery are grouped together; potential organ donors and those in need of transplants are not. We agree with Unger that projective grouping cannot be justified because the psychological factors that cause the projective grouping are usually not morally relevant. There is no good reason to ignore the needs of those far away or in some other way 'distant' from those in need The second argument in favor of organ conscription. Mandatory autopsies are widely accepted, despite the expressed wishes of the deceased and that of their surviving families. If there is, as we suspect, no morally relevant difference between required autopsies and organ conscription, then the latter should no longer be considered beyond the pale. Readers should not contend that only mandatory autopsies are acceptable because they save more lives by facilitating the capture of murderers. It seems safe to say that the number of people saved by organ conscription would be greater than the number saved through the aid autopsies provide law enforcement. organ conscription is justified if mandatory autopsies are. Live vs. let die-The state does not have a greater duty to prevent people from killing, then it does to prevent diseases from taking the lives of its citizens. While it may be worse, everything else being equal, for an agent to kill a person than let an individual die, that moral difference does not give a third party a greater duty to save someone from a killing than saving someone else from a disease

Carefully describe Schneiderman's concept of the 'decent minimum' of medical care to which all persons are entitled. How does he think it improves over other characterizations and approaches to what should be guaranteed?

A Decent minimum is a guaranteed level of care for everyone that enables a person to acquire an education, career, or raise a family. A person of impaired health will be able to attain a reasonable level of function. this proposal is not individualistic and provides for specific outcomes and highlights the obligations of the individual and society. It also respects the right of each individual to make one's own life choices. We would choose and cover treatments directed toward achieving the decent minimum goals for each person and supported by empirical evidence. From childhood to adulthood, a decent minimum would guarantee that the person has access to appropriate screening and immunizations, along with ongoing nutritional and lifestyle counseling to reduce risk factors such as obesity, as well as involvement of social services and legal aid, if necessary, for those who encounter obstacles to access. ------------------------------------------------------------- In brief, I propose that a decent minimum be a level of medical care that enables a person to acquire an education, seek or hold a job, or raise a family. Or, if the person, because of impaired health, is unable to meet any of these goals, to attain a reasonable level of function within the person's limits and respectful of the person's dignity, as well as a reasonable level of comfort, whether it be from pain or other forms of suffering. Unlike proposals that are based solely on benefits to individuals (exemplified by debates that range over whether one should favor the worst-off or achieve the greatest aggregate population benefit-cost ratio), this proposal provides for specific, determinate outcomes and highlights the reciprocal obligations of the individual and society. My ethical rationale is straightforward. Without the support of society, the individual would not prosper; in return, I argue, the individual has a duty to recognize society's needs for productive citizenry. The success of an individual depends on the success of the supporting society. The success of the society depends on the productivity and contributions of its individual members. it respects the right of each individual to make one's own life choices. One's education might be short or long; one might work with a shovel or a computer, with a paintbrush or a frying pan, on a construction site or in a taxicab, as a farmer or a pharmacist. My proposal would do away with attempting to enumerate what "basic package" of services and supplies should be covered, how often and how long and in what age or social group, according to politically determined lists. Rather, we would choose and cover treatments directed toward achieving the decent minimum goals for each person and supported by empirical evidence. Instead of setting up a "health coverage board" that would mandate a one-size-fits-all "standard benefit package" we would recognize the obvious fact that workers who perform heavy physical labor, white-collar workers, and people of varying mental abilities would have different treatment requirements. All treatments would be based as much as possible on evidence-based medicine (Diabetes-) From childhood to adulthood, a decent minimum would guarantee that the person has access to appropriate screening and immunizations, along with ongoing nutritional and lifestyle counseling to reduce risk factors such as obesity, as well as involvement of social services and legal aid, if necessary, for those who encounter obstacles to access. If, despite these preventive measures, the person develops clinical diabetes, he or she would receive guaranteed medical insurance coverage for evidence-based, chronic disease management, including optimal glucose control by diet and medication, along with education and monitoring to prevent infections and organ damage. As long as the person growing into adulthood is either potentially or actively gaining an education, seeking (while unemployed) or holding a job, or raising a family, these would be the goals toward which the decent minimum level of treatments would be directed. Even if severe complications occur during this time, such as heart failure or kidney failure, the decent minimum would include and guarantee any necessary life-sustaining intensive care, renal dialysis, and high priority for organ transplantation to enable the person to pursue those goals. This aggressive life-sustaining version of decent minimum would not be guaranteed if the person were not pursuing or meeting any of those goals. Instead, the person would be guaranteed a version of decent minimum based on the person's functional capacity and comfort

Hardwig

According to Hardwig, we should reject the 'individualistic fallacy' that leads people to believe they are entitled in this way. In fact, Hardwig says, there may be cases where a person has a moral duty to die - or at least cease trying to live on - rather than request additional medical treatments and life-sustaining care. While he does not suggest that such a duty should be legally enforceable, he does argue that it can be morally binding according to standards to which we should hold ourselves individually.

Delaney and Hershenov

Delaney and Hershenov argue that the consent of the deceased or the family of the deceased is not ethically necessary for harvesting organs from the dead. They employ a variety of arguments for their view: for example, they point out that harvesting without asking consent would follow precedents accepted in society (such as autopsy when a death may be a matter of public health) and they explain that the dead person (who no longer exists) cannot have interests or be harmed.

When Callahan considers appeals to legalize euthanasia justified by appeals to autonomy and mercy (an aspect of well-being), he warns that these moral justifications show "inherent slipperiness." Explain why he thinks this of both justifications.

If we really believe in self-determination, then any competent person should have a right to be killed by a doctor for any reason that suits him. If we believe in the relief of suffering, then it seems cruel and capricious to deny it to the incompetent.

Brock offers two pairs of cases that are very similar, the first focused on a terminally ill, respirator-dependent patient with ALS, and the second focused on a terminally ill patient arriving in the ER in respiratory distress. What does each pair of cases illustrate?

In the first case-the terminally ill, respirator-dependent patient with ALS, the patient is competent, does not like her current condition, and she begs constantly to be extubated and taken off the respirator. However, the patient's greedy, malicious son sneaks into her room one day when she is sedated, and takes her off the respirator, solely because he wanted his inheritance, and he noticed that his inheritance was slowly dwindling away in order to pay for his mother's expensive hospital bills. After the hospital staff realized what the son does, they question him about it, only for the greedy son to say that he didn't kill his mother, he simply allowed her to die, it was her underlying condition, the ALS that killed her. Not him. Subsequently, Brock asks, "the son performed just the same physical actions, did just the same thing, that they physician would have done. If that is so, then doesn't the physician also kill the patient when he extubates her? "(Brock, 1992). To answer this question, Brock insists that No, what the greedy son and what the physician would have done is not the same, and that there are ethical differences. The first is that the physician would have acted on the patient's consent, whereas the greed son does not. The 2nd ethical difference has to do with motive. The son's motive is greedy and selfish, he does it simply to protect his inheritance, where the physician would have acted in order "to respect the patient's wishes and self-determination" (Brock, 1992). Lastly, the physician's actions are legal and acted within a certain social context where he is legally authorized to do so, where the son does not have legal authorization. Thus, what the greedy son did is not morally justified, whereas if the physician did it, it would have been morally justified. Brock also states that it was the son who killed, where as the physician allowed to die. Brock states, "One can either kill or allow to die with or without consent, with a good or bad motive, within or outside of a social role that authorizes one to do so"(Brock, 1992). The next case Brock discusses is a case about a terminally ill patient arriving in the ER in respiratory distress. The patient's family members and physician arrive at the ER to tell the ICU staff that when the patient was competent, the patient decided he didn't want to be intubated due to his terminal illness and "state of debilitation"(Brock, 1992). Thus, the ICU staff did not intubate the patient, which ultimately resulted in respiratory failure. Brock then gives another scenario about this case. Suppose, Brock says, that the patient's family and physician were stuck in traffic, and the ICU staff intubated him. The staff then extubates him, which causes him to die of respiratory failure. Brock states that in the first scenario he is allowed to die, whereas the 2nd scenario, he is killed, however, there are no moral differences between scenario 1 and scenario 2, which ultimately makes one not worse than the other. Brock states that other factors have to exist in order to make most killings worse than allowing one to die, and he believes that euthanasia cannot be wrong "simply because it is killing instead of allowing to die" (Brock, 1992). In both cases of the ALS patient and the terminally ill patient arriving in the ER, Brock shows that passive euthanasia is not worse or better than active euthanasia and that it is morally justified if the motives are good, if the patient gave consent, and/or if it is within a social role that authorizes one to do so. Brock states that killing someone cannot be wrong simply because it is killing and not allowing to die, and I believe that he successfully shows this in both of his cases.

Brock

Justifying his view both in terms of patient autonomy and patient well-being, Brock argues that physician assistance in dying is morally permissible. And he follows up with a two-part response to Callahan's worries over bad consequences: first, he points out, it is unfair to discuss only the potential bad consequences when many good consequences would foreseeably result. Second, he argues that the bad consequences Callahan thinks are certain to accompany the practice are not inevitable, after all; they could be avoided with appropriate regulation and enforcement.

Matas

Matas provides several arguments for establishing a carefully regulated system for people to sell a kidney, rather than only being permitted to gift a kidney. He defends his proposal from numerous objections turning on key concepts in medicine and ethics, including what may be counted as benefit in medical decisions, what counts as coercion, and questions of justice.

Schneiderman

Schneiderman tackles the perennially unpopular idea that medical care should be rationed in a systematic way. He sets out a proposal for guaranteeing minimums of different degrees and types of medical care depending upon what kinds of activities the patient is engaged in. He argues that he is not grounding his view on assigning a 'social worth' to each person, in the sense of seeing a person solely in terms of how useful she is to society. But he does want to tie the amount of care every person is guaranteed to whether it's needed for the kind of thing she is doing. He thinks that this approach has several advantages. For one, it leaves patients the freedom to 'buy up' to more health care than their guaranteed minimum if they have the means and the resource is available. For another, he thinks it will be a great improvement for the situation of elderly people, because it also provides substantially more comfort care and maintenance care for them, rather than attempting to cure the elderly of all conditions regardless of their age.

One might think that the importance of autonomy as a justification for voluntary active euthanasia diminishes in certain circumstances (like advanced age or terminal illness). Carefully explain why one might think this and Brock's response.

it cannot justifiably be administered, for example, in cases of serious dementia or treatable clinical depression. The fourth potential bad consequence of permitting euthanasia has been developed by David Velleman and turns on the subtle point that making a new option or choice available to people can sometimes make them worse off, even if once they have the choice they go on to choose what is best for them. (n18) Ordinarily, people's continued existence is viewed by them as given, a fixed condition with which they must cope. Making euthanasia available to people as an option denies them the alternative of staying alive by default. If people are offered the option of euthanasia, their continued existence is now a choice for which they can be held responsible and which they can be asked by others to justify. We care, and are right to care, about being able to justify ourselves to others. To the extent that our society is unsympathetic to justifying a severely dependent or impaired existence, a heavy psychological burden of proof may be placed on patients who think their terminal illness or chronic infirmity is not a sufficient reason for dying. Even if they otherwise view their life as worth living, the opinion of others around them that it is not can threaten their reason for living and make euthanasia a rational choice. Thus the existence of the option becomes a subtle pressure to request it. This argument correctly identifies the reason why offering some patients the option of euthanasia would not benefit them. Velleman takes it not as a reason for opposing all euthanasia, but for restricting it to circumstances where there are "unmistakable and overpowering reasons for persons to want the option of euthanasia, " and for denying the option in all other cases. But there are at least three reasons why such restriction may not be warranted. First, polls and other evidence support that most Americans believe euthanasia should be permitted (though the recent defeat of the referendum to permit it in the state of Washington raises some doubt about this support). Thus, many more people seem to want the choice than would be made worse off by getting it. Second, if giving people the option of ending their life really makes them worse off, then we should not only prohibit euthanasia, but also take back from people the right they now have to decide about-life-sustaining treatment. The feared harmful effect should already have occurred from securing people's right to refuse life-sustaining treatment, yet there is no evidence of any such widespread harm or any broad public desire to rescind that right. Third, since there is a wide range of conditions in which reasonable people can and do disagree about whether they would want continued life, it is not possible to restrict the permissibility of euthanasia as narrowly as Velleman suggests without thereby denying it to most persons who would want it; to permit it only in cases in which virtually everyone would want it would be to deny it to most who would want it.

Matas provides six distinct arguments for the institution of kidney sales. Describe THREE that are endorsed primarily or exclusively on grounds of the good consequences he expects

1. Decrease number of patients with ESRD on waiting list who die 2.) Establishing a regulated market will eliminate or minimize unregulated markets: thus, patients will be better cared for. would increase the number of transplants, protect and respect the donor, and reduce the likelihood of rampant, unregulated commerce"3.) Respect Individual Autonomy A..)The major pro argument is that kidney sales would help decrease the number of patients with ESRD (end-stage renal disease) who die on the waiting list. Sales would likely increase the number of available kidneys, shorten waiting time and improve patient survival rates. B.) Finally, we cannot ignore this reality: although most countries in the world have laws against the sale of organs, a growing unregulated market for sales already exists— a market in which donors are often poorly evaluated and cared for, a market in which most of the payment goes to a broker (22,24,25). Eliminating the legislative ban on sales and establishing a regulated system may well eliminate or minimize the ongoing unregulated markets (30,39), thereby leaving those people who actually do sell a kidney in a better position: better paid and better cared for. C.) Another argument in favor of sales relates to current Western philosophical principles, that is, the emphasis on autonomy. The ban on sales is paternalistic and ignores the need to respect individual autonomy. In general, with "few constraints, people make personal decisions on what they wish to buy and sell based on their own values" (38), and should be allowed to do so

Hardwig describes several factors that could make a particular person more or less likely to have a duty to die. Briefly summarize three of them. Why does Hardwig say he cannot predict a duty to die in advance with perfect accuracy for every case (even his own!)?

1.) First, Hardwig suggests that a duty to die is more likely when the burden of care by family and loved ones, whether these burdens be physical, financial, or emotional, exceeds the benefit of continuing to live. 2.)Second, Hardwig proposes that there is a greater duty to die when an individual has already lived a fulfilling and meaningful life. 3.)A third factor suggested by Hardwig is that there is a significant duty to die when one's individuality and mental capacity is severely impacted. One reason for the inability to predict with accuracy for each case is that each individual case provides a different context. While two individuals may be suffering from the same illness that places a significant burden on their loved ones, each may have different resources or the ability to handle such burdens more efficiently. In addition, it is difficult to truly know how a family can withstand the burdens of caring for a loved one. ------------------------------------------------------------- The duty to die is considered by some to be the responsible thing to do when one reaches a certain point in their life in which the burden of their care outweighs the benefits of the continuation of life. John Hardwig supports such claims and suggests there are many reasons that can cause a particular person more or less likely to have a duty to die. This discussion addresses three of these factors suggested by Hardwig as well as why he states a person's duty to die cannot be predicted with accuracy. Hardwig posits several factors that could make a person more or less likely to have a duty to die. First, Hardwig suggests that a duty to die is more likely when the burden of care by family and loved ones, whether these burdens be physical, financial, or emotional, exceeds the benefit of continuing to live. For example, if one is terminally ill, while certain treatments may prolong life for a short period of time, the quality of life from such treatments coupled with the financial hardships and the necessity for around the clock care may be more than the family can handle. Especially when the inevitable death is only prolonged for a short period of time and at a great cost. Second, Hardwig proposes that there is a greater duty to die when an individual has already lived a fulfilling and meaningful life. As one grows older and has had the opportunity to experience a pleasurable and meaningful life, that is more reason to have a duty to die instead of prolonging the inevitable and causing significant burden on loved ones. A third factor suggested by Hardwig is that there is a significant duty to die when one's individuality and mental capacity is severely impacted. Meaning the ability to be the person that has been loved by family is compromised including the inability to give love to the family that is sacrificing their lives to care for the individual. As dementia advances, an individual's ability to remember loved ones diminishes, personalities can change drastically, and the ability to complete even the simplest activities of daily living are compromised. Hardwig suggests in these situations, one has the responsibility to die prior to becoming so incapacitated that they are not mentally competent to make such a decision. Hardwig presents several more factors that support the duty to die. However, he warns that despite such a duty to death, it cannot be predicted with perfect accuracy for every case. One reason for the inability to predict with accuracy for each case is that each individual case provides a different context. While two individuals may be suffering from the same illness that places a significant burden on their loved ones, each may have different resources or the ability to handle such burdens more efficiently. In addition, it is difficult to truly know how a family can withstand the burdens of caring for a loved one.

Why does Callahan think that it would be difficult to write a sufficiently precise law to permit euthanasia? Why does he think that no matter how carefully law is written, abuses would happen and enforcement would be difficult?

1.) Not everyone will follow it, and will bend or break it if they can get away with it 2.) The law will most likely have a low enforcement policy. ------------------------------------------------------- Abuse is inevitable because almost all laws on delicate and controversial matters are abused to a certain extent. This happens because not everyone will agree with the law as written and will bend it or ignore it if they can get away with it. For example, Callahan is convinced in the Netherlands that there are substantial numbers of cases of nonvoluntary euthanasia. The other reason abuse is inevitable is that the law will most likely have a low enforcement priority in the criminal justice system, and violations might ordinarily be tolerated. Callahan says that in Holland, there was an indifferent attitude toward abuse. It would be hard to write and enforce the law because a requirement of "unbearable suffering" and "terminal" are terms that are indefinable, and there will be difficulties of knowing when an illness is actually terminal, and there is no way to actually measure someone's suffering.

Matas provides six distinct arguments for the institution of kidney sales. Describe THREE that are grounded in principles and precedents (that is, in applying the same logic used to support commitments we already hold in society).

1.) The "Good Donor Claim"- "If donating a kidney ought to be legal, and if the only difference between donating a kidney and selling one is the motive of monetary self-interest, and if the motive of monetary self-interest does not on its own warrant legal prohibition. 2.) The Tissue Claim- it is already legal (and ought to be legal) for living persons to sell parts of their bodies (blood, sperm, eggs). Thus, since it is already legal to sell these body parts, we should sell kidneys too. 3.) Autonomy- The ban on sales is paternalistic and ignores the need to respect individual autonomy. In general, with "few constraints, people make personal decisions on what they wish to buy and sell based on their own values" (38), and should be allowed to do so.

Briefly summarize the good consequences that Brock sees arising from a social policy permitting euthanasia

1.) patient's autonomy. 2.) if euthanasia were to become legalized, it could benefit a large group of individuals. 3.) concerning individuals who are dying with a very painful or severe disease. Euthanasia could relieve them of this pain. 4.) the fact that it is potentially more humane for individuals to end their life quicker and as peaceful as possible, if that is the patient's goal.

What are the three kinds of circumstances involving patient death where we tend to confuse causality and culpability, according to Callahan?

1.) they are confused when the action of a physician in stopping treatment of a patient with an underlying lethal disease is construed as causing death. The doctor is only responsible if omitting a certain treatment or procedure that would have prevented death. Causality and culpability are confused, 2.)when we fail to note that judgments of moral responsibility and culpability are human constructs. We cannot confuse nature vs. human action. It is a misuse of the word killing to use it when a doctor stops a treatment he believes will no longer benefit the patient--when, that is, he steps aside to allow an eventually imevitable death to occur now rather than later. The only deaths that human beings invented are those that come from direct killing--when, with a lethal injection, we both cause death and are morally responsible for it. In the case of omissions, we do not cause death even if we may be judged morally responsible for it. A doctor cannot help that death will be the final result. Another is self-determination, the choice of death ultimately falls back on the patients themselves. There is no way in determining the actual level of suffering a patient is going through, so if a patient were having a weak moment in time where their life seemed unbearable for the moment, a doctor could potentially contribute in the ending of their life. Suffering cannot be measured. 3.)The last situation would be a doctor omitting a certain treatment or procedure that would have prevented death.

Why does Hardwig argue that the public debate about physician-assisted suicide and euthanasia must encompass more than conditions of unrelieved pain and terminal illness?

1.)The lives of our loved ones can be seriously compromised by caring for us, and we can become a burden to others. 2.) Life-preserving technology may eventually render us incapacitated, and our quality of life will diminish. 3.)Monetary reasons-sometimes the cost of end-of-life healthcare is too much on society and on the family. 1.) continuing to live will impose burdens 2.)A duty to die becomes greater as you grow older. A 3.) If you've lived a meaningful and fulfilling life 4.) If your loved one's lives have been impoverished 5.)loved ones have already made great contributions--perhaps even sacrifices--to make your life a good one. 6.)If you can't make a good adjustment to your illness 7.) If you can't make anymore contibutions. 8.) When the part of you that is loved will soon be gone 9.)There is a greater duty to die to the extent that you have lived a relatively lavish lifestyle instead of saving for old age. -------------------------------------------------------- According to Hardwig, people who are not able to take care of themselves and then become a burden to the family should have a duty to die. To fulfill this duty, they could have access to physician-assisted suicide or euthanasia. Hardwig states that these practices should encompass more than conditions of unrelieved pain and terminal illness for several reasons. First, a patient may have a duty to die without having unrelieved pain or terminal illness. There are many situations where a patient may become a burden to the family due to other diseases as for example dementia. Hardwig argues that there are situations besides terminal illness that make a person a burden to the family. If a person due to dementia is not able to take care of herself and she needs a caregiver, she may have a duty to die. Second, it could be other situations where an old family member has not dementia, but she has a physical disability that prevents her from being able to perform basic tasks by herself needing the constant care of a family member. In this case, the patient would also have a duty to die. Hardwig explains, that a person would have the duty to die when she reaches a state where she depends on her family and becomes a burden for them. It can be a burden due to the family needing to physically take care of her and also a burden due to the economic expenditure in medical care treatments. To conclude, Hardwig argues that physician-assisted suicide and euthanasia should include more than cases of unrelieved pain and terminal illness because there are other conditions that make people not to be able to take care of themselves, so they would have a duty to die and not become a burden for their families and loved ones.

Which potential bad consequence does Brock think is most worrisome? What does he think is the best way to manage the situation to avoid such outcomes?

A legal policy permiting euthanasia would inevitably lead to active euthanasia being performed in many other cases in which it would be morally wrong. To prevent those other wrongful cases of euthanasia we should not permit even morally justified performance of it. Now it cannot be denied that it is possible that permitting euthanasia could have these fateful consequences, but that cannot be enough to warrant prohibiting it if it is otherwise justified. It is at least clear, however, that both the character and likelihood of abuses of a legal policy permitting euthanasia depend in significant part on the procedures and safeguards put in place to protect against them The patient should be provided with all relevant information about his or her medical condition, current prognosis, available alternative treatments, and the prognosis of each. Procedures should ensure that the patient's request for euthanasia is stable or enduring and fully voluntary All reasonable alternatives must have been explored for improving the patient's quality of life and relieving any pain or suffering. A psychiatric evaluation should ensure that the patient's request is not the result of a treatable psychological impairment such as depression These examples of procedural safeguards are all designed to ensure that the patient's choice is fully informed, voluntary, and competent, and so a true exercise of self-determination

Why is it such a plausible concern if euthanasia becomes legal, society might become less committed to providing optimal care to those who are suffering and dying? What is Brock's response to the worry? How does the history of a right to refuse treatment fit in to his reply?

A second bad consequence that some foresee is that permitting euthanasia would weaken society's commitment to provide optimal care for dying patients. We live at a time in which the control of health care costs has become, and is likely to continue to be, the dominant focus of health care policy. If euthanasia is seen as a cheaper alternative to adequate care and treatment, then we might become less scrupulous about providing sometimes costly support and other services to dying patients. Particularly if our society comes to embrace deeper and more explicit rationing of health care, frail, elderly, and dying patients will need to be strong and effective advocates for their own health care and other needs, although they are hardly in a position to do this. We should do nothing to weaken their ability to obtain adequate care and services. This second worry is difficult to assess because there is little firm evidence about the likelihood of the feared erosion in the care of dying patients. There are at least two reasons, however, for skepticism about this argument. The first is that the same worry could have been directed at recognizing patients' or surrogates' rights to forgo life-sustaining treatment, yet there is no persuasive evidence that recognizing the right to refuse treatment has caused a serious erosion in the quality of care of dying patients. The second reason for skepticism about this worry is that only a very small proportion of deaths would occur from euthanasia if it were permitted. In the Netherlands, where euthanasia under specified circumstances is permitted by the courts, though not authorized by statute, the best estimate of the proportion of overall deaths that result from it is about 2 percent.(n16) Thus, the vast majority of critically ill and dying patients will not request it, and so will still have to be cared for by physicians, 2 families, and others. Permitting euthanasia should not diminish people's commitment and concern to maintain and improve the care of these patients.

Why does Rachels think that the AMA is in error to assert that cessation of treatment is not intended to terminate a patient's life? What diagnosis does this lead Rachels to make about the way we usually think about acts of killing and allowing death?

According to Rachels, there is absolutely no moral difference between active and passive euthanasia. He states that doctors need to reconsider the AMA's views on cessation of treatment. Cessation of treatment is usually decided on the basis of preventing further pain and suffering; however, it would take the patient longer to die, causing more pain and suffering, when the patient could have just received a quick and painless lethal injection instead. The diagnosis Rachels makes about the way we think about acts of killing and allowing death is that passive and active euthanasia are considered 'bad' because death in itself is considered a great evil. However, Rachels states that if a given case has come to the conclusion that active or passive euthanasia is necessary, then in this instance, the patient's continued existence is actually as or more evil than death, thus, "the usual reason for not wanting to be the cause of someone's death simply does not apply" Also, Drs. treat their patients according to the law to avoid legal consequences. He doesn't believe that the law should be forcing a moral doctrine upon doctors that has a considerable effect on their practices. It should be up to the Drs. discretion, not the law. -------------------------------------------------------- Rachels states that doctors need to reconsider the American Medical Association's views on cessation of treatment. He states that cessation of treatment is usually decided on the basis of preventing further pain and suffering. However, according to Rachels, cessation of treatment would actually take the patient longer to die, causing more pain and suffering; when the patient could have received a lethal injection instead, thus avoiding the unnecessary pain and suffering. Rachels believes that here, active euthanasia is better than passive euthanasia, and he states that if one endorses the AMA's idea, then they are allowing the patient to die a slow, painful death, whereas with active euthanasia, it is quick and painless. He states that killing in itself is not any worse than just simply allowing a patient to die. Even though the AMA might think that cessation of treatment is not intended to terminate a patient's life, it does just that-it ultimately ends a person's life. Thus, according to Rachels, letting someone die is no better than actually doing the killing. Thus, there are cases where active euthanasia would be appropriate. Rachels also points out that the doctor's motives are humanitarian, vs. motives of personal gain, which makes the euthanasia more acceptable. Thus, according to Rachels, there is absolutely no moral difference between active and passive euthanasia. The diagnosis that Rachels makes about the way we usually think about acts of killing and allowing death (besides that there is no moral difference between active or passive euthanasia) is that active and passive euthanasia are considered to be bad because being the cause of someone's death is considered evil, and death in itself is regarded as a great evil. However, Rachels states that if a given case has come to the conclusion that active or passive euthanasia is necessary, then in this instance, the patient's continued existence is actually as or more evil than death, thus, "the usual reason for not wanting to be the cause of someone's death simply does not apply" (Rachels, 1975). Last but not least, Rachels states that most doctors are concerned with the law when it comes to these matters, and thus will treat their patients according to the law, even if they feel otherwise, in order to avoid legal consequences. He doesn't believe that the law should be forcing a moral doctrine upon doctors "that may well be indefensible, and has a considerable effect on their practices" (Rachels, 1975). It should be up to the doctor's discretion, not the law.

Explain the process of decision-making endorsed by such entities as the United Network of Organ Sharing. How does Schneiderman respond to that approach

Already a rationing process has been established by the United Network of Organ Sharing (UNOS) to allocate this limited treatment based on waiting time on the list, blood-type antigen matching, and urgency. Astonishingly, given that organ transplantation involves allocation of a limited life-sustaining resource, and hence requires consideration of just distribution—taking into account that a life is lost for every life saved—weighing and comparing outcomes to potential recipients, such as likelihood of returning to work, pursuing an education, and caring for others dependent on the potential recipient, these matters are not formally considered. The argument presented is that doing so would introduce a "value choice" into decision making. As a result, physiologic numbers, which determine urgency, and calendar numbers, which measure length on the waiting list, rule over broader patient considerations. Ironically, this approach does not avoid making a value choice; clearly it is a value choice. Hence, according to UNOS guidelines, a retired 70-year-old hypertensive diabetic with no family responsibilities who has been waiting 5 years on dialysis should get a kidney ahead of an otherwise healthy 45-yearold school teacher and parent who develops an aggressive glomerulonephritis and has been waiting only a year. By my rationing proposal the latter patient, who is in the lifesustaining category of decent minimum, would be higher on the recipient list with guaranteed access to the transplant if a suitable one becomes available, competing only with other potential recipients in the same life-sustaining category.

It is a standard view of advocates that the permissibility of voluntary active euthanasia is grounded in two medical values, autonomy (or self-determination) and patient well-being. But a skeptic could worry that relying upon both of these values at the same time to reach that conclusion involves a contradiction. Explain this potential conflict. How does Brock resolve the worry?

Brock defines autonomy (or self-determination, as he refers to it), as "people's interest in making important decisions about their lives for themselves according to their own values or conceptions of a good life, and in being left free to act on those decisions" (Brock, 3). Typically, one associates a good life with a healthy life, as people generally do not picture health concerns in their idea of a successful, fulfilled life. This seems to contradict one seeking euthanasia as a means to achieve well-being, but the term well-being is being defined by the patient, not by an outsider. If a patient, who is competent and of sound mind, decided they want to die, then it is likely because they no longer see life as good, and they know they can never achieve the 'good life' again; instead, they may feel as a burden. Furthermore, Brock states that "In exercising self-determination people take responsibility for their lives and for the kinds of persons they become. A central aspect of human dignity lies in people's capacity to direct their lives in this way" (Brock, 3). Basically, by allowing people to choose euthanasia, you are allowing them to continue to have self-determination by not forcing them through treatment they do not want, even if it would prolong their life, or improve their well-being, for a time. By allowing them to die the way they want, the patient will not have to experience the burdensome life and drawn out ordeal of death, but instead benefit from that death that is dignified, and values what they want out of what was left of their life.

How does Hardwig answer the religious view that we are permitted to extend life using medical technology as long we as can, but are not permitted to end life? (question for different reading)

But what convinces us that we always have such a religious duty in the first place? And what guarantees that it always supersedes our obligations to try to protect our loved ones? surely we ought to agree that I may legitimately end my life for other-regarding reasons, not just for self-regarding reasons We do not even ask about meaning in death, so busy are we with trying to postpone it. But we will not conquer death by one day developing a technology so magnificent that no one will have to die. Nor can we conquer death by postponing it ever longer. We can conquer death only by finding meaning in it. We find meaning in death by our connection to others. If we only care about our own lives and our self, then what we care about and our meaning will die with us. But, if we care about others, our death will have meaning through our connection with others. ----------------------------------------------------------- Hardwig explains through religious views; there is an obligation to live due to duty to God. Despite the pain and suffering that can be endured in one's life, God is the giver of life, and we are ultimately responsible for preserving the gift of life. We are given one life to live, and therefore, we should value this life. One of the Ten Commandments is "thou shall not kill," so it seems we are not permitted to end life. The use of medical technology to prolong the lives of terminally ill patients cannot truly be compared or connected to the duty to God. Medicine has played an important role and has allowed people to maintain healthy lives, survive chronic illnesses longer than intended to, and live longer. Whatever God's plan may have been, we cannot completely assume that medicine and technology were God's doing or his ultimate plan for us. The use of medical technology may prolong someone's life from what God had in store. It could be that prolonging life is preserving the gift of life longer than intended. Ending one's own life contradicts human dignity and goes against recognizing the value of a person. However, if we consider what God has planned, it would seem that just as it is wrong to end someone's life sooner, it is also wrong to prolong someone's life longer than what was planned.

Callahan

Callahan argues that any attempt to ground the permissibility of euthanasia on the autonomy of the patient as well as her well-being will be open to several serious criticisms. And he flatly rejects the idea that a patient's death could be part of her well-being. Callahan considers both the theoretical and the practical issue of euthanasia; another way to put this point is that he examines not only the moral but the legal status. He does the by first considering whether euthanasia could ever, in principle, be morally permissible. But in the later part of the article, he argues that even if euthanasia could be morally permissible in principle or in theory, we should never make it legal: this is because too many bad consequences are foreseeable and unavoidable in trying to frame public policy on the issue and then enforce that public policy. -Callahan doesn't believe the claim that there's a moral difference between killing and allowing to die.

Why does Callahan think it is impossible for euthanasia to be justified as permissible entirely on grounds of self-determination (autonomy), even though that is one of the cornerstones of medical ethics? What must the advocate of the permissibility of euthanasia show, and why is it her burden of proof (rather than Callahan's)?

Euthanasia is thus no longer a matter only of self-determination, but of a mutual, social decision between two people, the one to be killed and the other to do the killing. Callahan believes that it is not permissible to put this kind of power (the "right" to kill) in the hands of another, whether a doctor or anyone else. There is no objective way of measuring or judging the claims of patients that their suffering is unbearable. Euthanasia is not a private matter of self-determination. It is an act that requires two people to make it possible, and a complicit society to make it acceptable. Those who advocate for its permissibility must be able to provide a viable argument against Callahan's claims. It is the responsibility of such advocate as Callahan has already provided sound arguments against the most common arguments for the permissibility of euthanasia.

Delaney and Hershenov imagine their readers giving up on all prior intuitions and doubling down on the view that "organ conscription is impermissible because it harms the deceased by thwarting [the deceased's] interests." [5] Explain how the authors employ the view of Epicurus to show that this stance is wrong.

Epicurus- Since the dead do not exist, they are without interests. Where there is no one to have an interest, no interest can be frustrated. Deprivations, misfortunes, and harms are properties or states of entities. If the entities in question are absent, it makes little sense to say their properties are present. ----------------------------------------------------------- Our response is that they cannot argue organ conscription is impermissible because it harms the deceased by thwarting their interests. The dead cannot be harmed by taking the remains of their bodies for reasons that Epicurus gave centuries ago. Where there is no one to have an interest, no interest can be frustrated. Since the dead do not exist, they are without interests, experiential or non-experiential, that can be thwarted. The standard response to Epicurus about the evil of death operates with a counterfactual theory of harm. Death is a harm because if it had not occurred, the deceased would have lived on and had a valuable existence we should not allow the anti-Epicurean to make an exception for the dead and allow their misfortune or harm to exist when they do not. Deprivations, misfortunes, and harms are properties or states of entities. If the entities in question are absent, it makes little sense to say their properties are present. This wrongness lies not in harming the deceased, but in preventing him from enjoying more life. Preventing someone from more life can be a terrible act and deserves to be severely punished. Therefore, much of common sense morality and its accompanying attitudes have little to fear from Epicurus' view of death

Schneiderman argues that in spite of involving rationing, his proposal will also respect personal autonomy. In what ways does it do so?

Freedom of choice (to choose whether to go to school, or choose a trade to work in,) and if one is not fully satisfied with the decent minimum, they can choose to purchase additional healthcare. ---------------------------------------------------------- I remind you that individual choice is not limited, hence personal autonomy is respected. the resilience of its democratic values again and again. The strength lies in our culture, which, as Thomas Friedman reminds us, has defied totalitarianism because of its ultimate commitment to "individual freedom, free markets, rule of law, great research universities and a culture that celebrates immigrants and innovators" (Friedman 2010). And consider the alternative, what is happening right now: state-mandated funding cuts of Medicaid-covered medical services, including mental health and organ transplantation (Cruz and Powers 2011). Paradoxically, these cuts deprive those who most benefit from the kinds of medical treatments that enable them to be productive in society. It is the poor, not the rich, who most depend on society's help in order to keep their jobs or gain an education or raise a family. -Buchanan says: We must frankly acknowledge that the character and scope of the list of services included in the decent minimum is a matter of collective choice. All that is necessary is that there be some fair procedure for reaching a social decision on which set of services to provide"t

What two responses does Rachels offer to the objection that in the case of cessation of treatment, the patient's condition causes his death, rather than the physician, and this makes a moral difference?

He states that it is not correct to say that in passive euthanasia the doctor does nothing, for he does do one thing that is very important: he lets the patient die. Letting someone die is a kind of action that one may perform by way of not performing certain other actions-for example, one may let a patient die by way of not giving medication. It is a type of action nonetheless. The decision to let a patient die is subject to moral appraisal in the same way that a decision to kill him would be subject to moral appraisal If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons. If his decision was wrong—if, for example, the patient's illness was in fact curable—the decision would be equally regrettable no matter which method was used to carry it out. And if the doctor's decision was the right one, the method used is not in itself important. -------------------------------------------------------- A number of points need to be made here. The first is that it is not exactly correct to say that in passive euthanasia the doctor does nothing, for he does do one thing that is very important: he lets the patient die. "Letting someone die" is certainly different, in some respects, from other types of action—mainly in that it is a kind of action that one may perform by way of not performing certain other actions. For example, one may let a patient die by way of not giving medication. But for any purpose of moral assessment, it is a type of action nonetheless. The decision to let a patient die is subject to moral appraisal in the same way that a decision to kill him would be subject to moral appraisal: it may be assessed as wise or unwise, compassionate or sadistic, right or wrong. If a doctor deliberately let a patient die who was suffering from a routinely curable illness, the doctor would certainly be to blame for what he had done, just as he would be to blame if he had needlessly killed the patient. Charges against him would then be appropriate. If so, it would be no defense at all for him to insist that he didn't "do anything." He would have done something very serious indeed, for he let his patient die. (bring up Jones and Smith thought experiment) -sometimes "letting someone die" is worse than active euthanasia because then the patient will suffer a slower, longer, painful death as opposed to being given a lethal injection and dying immediately. Thus, "letting someone die" could be crueler in this situation. - Last but not least, Rachels states that most doctors are concerned with the law when it comes to these matters, and thus will treat their patients according to the law, even if they feel otherwise, in order to avoid legal consequences. He doesn't believe that the law should be forcing a moral doctrine upon doctors "that may well be indefensible, and has a considerable effect on their practices" (Rachels, 1975). It should be up to the doctor's discretion, not the law.

What two disturbing implications that arise from confusing killing with allowing death, on Callahan's view?

If we fail to maintain the distinction between killing and allowing to die, moreover, there are some disturbing possibilities. The first would be to confirm many physicians in their already too-powerful belief that, when patients die or when physicians stop treatment because of the futility of continuing it, they are somehow both morally and physically responsible for the deaths that follow. That notion needs to be abolished, not strengthened. It needlessly and wrongly burdens the physician, to whom should not be attributed the powers of the gods. The second possibility would be that, in every case where a doctor judges medical treatment no longer effective in prolonging life, a quick and direct killing of the patient would be seen as the next, most reasonable step, on grounds of both humaneness and economics. I do not see how that logic could easily be rejected.

Briefly describe why neither unassisted suicide nor family-assisted suicide are satisfying options for Hardwig in planning to meet an eventual duty to die. (question for different reading)

John Hardwig in his article, is there a duty to die? presents a compelling argument especially leaning towards the opponent side. As Hardwig (1997) notes, in the introduction of the article, there is no duty to die. No one is obligated to give their life; however, he points out that there are some complex circumstances where the situation requires rationality and that there are no clear-cut answers as to whether one has a duty to die or not. Nonetheless, he is convinced that neither unassisted suicide nor family-assisted suicide is satisfying options in planning to meet one's eventual 'duty to die'. According to Hardwig (1997), there is no adequate rationality in individualistic thinking that an illness or any life-threatening situation only affects the person affected. It is not right for one to believe that they are totally alone, and for that reason, they are obligated to keep living, not only for their sake but also for that of the people around them who love them such as family and friends. Therefore, the fact that people's lives are interwoven, prevents any individual from making self-regarding decisions such as unassisted suicide. In terms of family-assisted suicide, Hardwig (1997) argues that the situation may seem a little dilemmatic but the bottom line is that it is irrational to subject your family to the burden of loss especially one that can be directly faulted on one of the family members. This is a crueler fate than one just spending their remaining time with their families until such a time when nature takes its course. Hardwig (1997) indicates that sometimes even the family members do benefit from the suffering of a loved one since the caring fosters growth despite the hardships faced. It encourages unity and caring for each other in the family. As such, if caring for an ailing family member benefits the family, it rules out the duty to die on the basis that the ailing member of the family is a burden.

Rachels

In this famous essay, Rachels argues that the traditional distinction between killing and letting die is untenable, that "killing is not in itself any worse than letting die." If so, then active euthanasia is no worse than passive euthanasia. Thus doctors may have to distinguish between active and passive euthanasia for legal reasons, but "they should not give the distinction any added authority and weight by writing it into official statements of medical ethics." Rachels argues that the principle of beneficence - the principle that the patient should not suffer needlessly - is what justifies the practice of allowing death at the patient's request. He then applies that reasoning to euthanasia and argues that the same principle - avoiding unnecessary suffering - justifies helping a patient by ending her life at her request. Further, he argues that in spite of common perception, there is no moral distinction that attaches to the causal distinction between allowing death and killing.

What are the boundaries of the medical profession on Callahan's view? How can the physician serve the patient past that point?

It is not medicine's place to lift us from the burden of suffering. It is not medicine's place to determine when lives are not worth living, or when the burden of life is too great to be borne. Doctors have no conceivable way of evaluating such claims on the part of patients, thus they have no right to act in response to them. Medicine should try to relieve human suffering, but only that suffering which is brought by illness and dying as a biological phenomena, not that suffering which comes from anguish or despair at the human condition. The answer to suffering is not to be killed by another, it rarely helps and adds to one evil still another.

Matas does not suggest simple legalization (or decriminalization of kidney sales). Instead, what specific features does he recommend for a system of kidney sales, and why does he do this?

Matas suggests regulated selling of kidneys, orchestrated by government or government approved vendors, could be a possible solution. Transplant officials would be involved in every step of the process, from evaluation, to surgery, and finally post-surgery care. He further argues that currently everyone except the donor benefits financially from kidney donation, and that systems are already in place for sale of other body parts, such as eggs, plasma, and sperm, and surrogacy. Additionally, the donation of kidneys is already legal, so why can't one be compensated for it? The main argument was about the relative danger between kidney donation, and say, blood donation, but if kidney donations are currently legal, then the case for being compensated should not immediately be shut down without investigating the legality of donations as a whole. In conclusion, Matas argues that compensating donors for the safe donation of their kidneys through approved and monitored means could end the organ shortage, saving countless lives that would otherwise be lost on the waiting list.

. Rachels argues that the conventional AMA doctrine that euthanizing a patient is always wrong misdirects our moral concern and "leads to decisions concerning life and death on irrelevant grounds." Carefully explain this argument for rejecting the conventional doctrine. [You may use his example of the ill baby or, if you prefer, an example of your own.]

Rachels gives an example about an infant with Down's syndrome who needs operations for congenital defects unrelated to the syndrome to live. Sometimes, the parents choose not to operate, and the baby dies, but when there is no such defect, the baby lives on. Now, an operation such as that to remove an intestinal obstruction is not difficult. The reason why such operations are not performed in these cases is, clearly, that the child has Down's syndrome and the parents and doctor judge that because of that fact it is better for the child to die. But notice that this situation is absurd, no matter what view one takes of the lives and potentials of such babies. If the life of such an infant is worth preserving, what does it matter if it needs a simple operation? Or, if one thinks it better that such a baby should not live on, what difference does it make that it happens to have an unobstructed intestinal tract? In either case, the matter of life and death is being decided on irrelevant grounds. It is the Down's syndrome, and not the intestines, that is the issue. The matter should be decided, if at all, on that basis, and not be allowed to depend on the essentially irrelevant question of whether the intestinal tract is blocked. What makes this situation possible, of course, is the idea that when there is an intestinal blockage, one can "let the baby die," but when there is no such defect there is nothing that can be done, for one must not "kill" it. The fact that this idea leads to such results as deciding life or death on irrelevant grounds is another good reason why the doctrine should be rejected.

Brock grants that euthanasia is the deliberate killing of an innocent person and yet claims that euthanasia is not necessarily wrong given that description. How does he justify this view?

That suicide or attempted suicide is no longer a criminal offense in virtually all states indicates an acceptance of individual self-determination in the taking of one's own life analogous to that required for voluntary active euthanasia. He claims that it is self-determination alone, and that safeguards should be put in place in order to make sure that the person is truly acting on self-determination alone. -Brock says that the claim that euthanasia is the deliberate killing of a person is only with minor qualifications correct. First, the physician acts with the patient's consent whereas the son does not. Second, the physician acts with a good motive--to respect the patient's wishes and self-determination--whereas the son acts with a bad motive--to protect his own inheritance. Third, the physician acts in a social role through which he is legally authorized to carry out the patient's wishes regarding treatment whereas the son has no such authorization. These and perhaps other ethically important differences show that what the physician did was morally justified.

What is the 'individualistic fantasy', according to Hardwig? Carefully explain why it is mistaken.

The "individualistic fantasy" leads people to imagine that lives are separate and unconnected, that actions and decisions will not affect others and therefore, other individuals' decisions will not affect them. This gives individuals the freedom to do whatever they want without considering the benefits or harm that it could bring to others. Most of us are affiliated with particular others and most deeply, with family and loved ones. Families and loved ones are bound together by ties of care and affection and more. Within a health care context, the individualistic fantasy leads us to assume that the patient is the only one affected by decisions about her medical treatment.. This will put the patient in a position where he or she has total control of their treatment and their choices. However, the authors argue that the individualistic fantasy is indeed a fantasy since decisions made daily can affect other individuals in different magnitudes. But life without connection is meaningless. The individualistic fantasy, though occasionally liberating, is deeply destructive. When life is good and vitality seems unending, life itself and life lived for yourself may seem quite sufficient. But if not life, certainly death without connection is meaningless. If you are only for yourself, all you have to care about as your life draws to a close is yourself and your life. Everything you care about will then perish in your death. And that--the end of everything you care about- -is precisely the total collapse of meaning. We can, then, find meaning in death only through a sense of connection with something that will survive our death. --------------------------------------------------------------- Hardwing starts the article by mentioning that people were livid when Richard Lamm stated that people have the duty to die. This reaction occurred because many individuals believe in an individualistic way of life, in which they prefer to live and not care that they are a burden to their families and that health care resources could've been used for other purposes. The "individualistic fantasy" leads people to imagine that their actions and decisions will not affect others and therefore, other individuals' decisions will not affect them. This gives individuals the freedom to do whatever they want without considering the benefits or harm that it could bring to others. Hardwing explains that the duty to die possibility could be very real if the bioethics community would not still believe in the individualistic fantasy. In a health care context, the individualistic fantasy makes us believe that the patients' decisions will solely affect them. This will put the patient in a position where he or she has total control of their treatment and their choices. However, the authors argue that the individualistic fantasy is indeed a fantasy since decisions made daily can affect other individuals in different magnitudes. Therefore, the patients' decision to be euthanized or not does affect other people that surround them. An example given by the author is our family and loved ones. The decision made by the patient to be euthanized will affect their loved ones, as they will no longer be a burden to them but it would also make them miserable. Another way the author uses to explain that "individualistic fantasy" is destructive is that we humans cannot live without connections and that "the connections that sustain us are to other people"

Explain the argument against a system of kidney sales that is concerned with coercion or exploitation. In what ways does Matas respond to this anticipated objection?

The core of the exploitation argument is that the poor are more likely to become vendors than the rich. However, if a vendor makes an autonomous decision, and, in return, receives a substantial payment that may significantly improve his or her quality of life, we must ask, is this truly exploitation? Also, society already allows less-wealthy to take jobs that the wealthy won't apply for, (military, firefighters) and we allow both rich and poor to engage in risky recreational activities (smoking.) Many authors argue that a payment is coercive in that it might "manipulate the victim's preferences, even if it would be rational to accept" However, if the vendor makes an autonomous decision and, in return, receives a substantial payment that may significantly improve his or her quality of life, we must ask, is this truly exploitation? The fact of payment does not necessarily mean that the vendor's choice was not free and voluntary. Also, I do not think we are willing to say that being poor removes the ability to make rational decisions.

How does Brock respond to the argument [made by Callahan, although Brock doesn't mention him by name] that even if euthanasia could be justified in principle, it still could not be accepted as public policy in practice because of the numerous bad consequences that would arise throughout society?

There are worries about abuse, but Brock says that there are safeguards and regulations. The misuse of authority will be stopped before it gets to that point. There are numerous bad consequences that would arise throughout society in the topic of accepting euthanasia. First, Brock mentions it will raise distrust between the patient and the doctor. If the doctor has the ability to "harm", or "kill", they will be looked at different than before. It would be undermining the moral center of medicine if the physicians were allowed to kill (Brock pg. 9). Patient's should not fear that this is something their providers are allowed to do, there is will safeguards and regulations to this. The second consequence that he mentions is providing optimal care for the dying patients. These elderlies, frail, patients will need advocates to stand up for them when they can't. Brock mentions that it is hard to assess the second consequence due to the amount of firm evidence that supports this full erosion of care in dying patients (Brock pg. 10). A third possible consequence is threatening the progress in the security of the patient's rights about deciding and refusing life-sustaining treatment. There is worry about abusing the system with euthanasia. That the authority will takes different actions to ending life that are wrongly misused. Many people would rather refuse treatment strongly then oppose to euthanasia. Brock mentions that there is will safeguards in place for this worry, that the misuse of authority will be stopped before it gets to that point (Brock, pg. 11). The fourth consequence is making euthanasia an option will not let them stay alive by the default option. People will have to choose between more options and explain their choice to people who don't agree. They will have to justify their actions. These are some consequences that are being mentioned in the argument of euthanasia.

Carefully explain how Rachels argues that no moral distinction rests on the causal distinction between killing and allowing death. [You may use his thought experiment if you like, or not, but if you do be certain you explain what the parts of it mean.]

There is no moral difference/distinction between killing and letting die. If a doctor lets a patient die for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons. If the doctor's decision was wrong (Ex- if the patient's illness was in fact curable) the decision would be equally regrettable no matter which method was used to carry it out. And if the decision was the right one, the method is not in itself important. Explain Smith and Jones thought experiment. Although killing is shown in a worse light than of letting die, there is no difference between killing and letting die. Rather, the other factors—the murderer's motive of personal gain, for example, contrasted with the doctor's humanitarian motivation—account for different reactions to the different cases. ----------------------------------------------------------- Rachels states that the bare difference between killing and letting die does not, in itself, make a moral difference. If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons. If his decision was wrong-if, for example, the patient's illness was in fact curable, the decision would be equally regrettable no matter which method was used to carry it out. And if the doctor's decision was the right one, the method is not in itself important. The AMA says the crucial issue is the intentional termination of life of one human by another, and that cessation of treatment is not the intentional termination of life. But cessation of treatment is the intentional termination of life...if it were not, there would be no point of it. Although killing is shown in a worse light than of letting die, there is no difference between killing and letting die. Rather, the other factors—the murderer's motive of personal gain, for example, contrasted with the doctor's humanitarian motivation—account for different reactions to the different cases. If a doctor deliberately let a patient die who was suffering from a routinely curable illness, the doctor would certainly be to blame for what he had done, just as he would be to blame if he had needlessly killed the patient. Charges against him would then be appropriate. If so, it would be no defense at all for him to insist that he didn't "do anything." He would have done something very serious indeed, for he let his patient die. (Talk about smith and jones)

For a physician to act in the patient's best interests and for her well-being, what must she be able to do, according to Callahan? Why does he think this is impossible regard to a request for euthanasia?

They must have their own independent moral grounds to kill those who request such services. According to Callahan a physician must believe in their moral standards to fulfill the request of those who want to end their lives due to a chronic illness. The doctor will in effect be treating the patient's values. To be responsible, the doctor would have to share those values. The doctor would have to decide, on her own, whether the patient's life was "no longer worth living," and would have to share the same beliefs and values of the patient that their life is not worth living. In addition, he argues that a physician could not make such a judgment concerning an individual's life. Moreover, he also states there is no way to objectively to measure an individual's pain and suffering. Callahan feels this is impossible regard to request euthanasia because it is unethical to assist another in killing themselves. Callahan fells this is impossible regard to request euthanasia because it is unethical to assist another in killing themselves. He views it much differently than suicide and that an individual can be allowed to choose their own fate solely. He feels that too many individuals think that there is no moral distinction.

Suppose that a reader still resists Delaney and Hershenov's reasoning and believes that conscripting her organs after her death would be wrong because her body is her property. What responses do the authors provide?

To own property, one must exist. If there is no owner, there's no ownership. That is why property must change hands at death — or, at least the item comes to belong to no one. Recognizing that the dead body cannot be owned, courts have referred to the corpse as "quasi-property" ----------------------------------------------------------- Some readers might still claim that the remains are their property to be disposed of as they wish...We want to question whether the dead can be said to possess property and, if they can, that their remains qualify as their possessions. If the matter of the corpse can be used for lifesaving medicinal purposes, we doubt that you should be entitled to block such use. d. We recognize how important remains are to the relatives that survive their loved one's death. However, it is important to bear in mind that our advocated organ conscription is not leaving families without any bodily remains to physically tie them to and facilitate their reflections upon the deceased (or to give their families a "final resting place." To own property, one must exist. If there is no owner, there's no ownership. That is why property must change hands at death — or, at least the item comes to belong to no one. Recognizing that the dead body cannot be owned, courts have referred to the corpse as "quasi-property" (Silver 1988). So one cannot claim that the deceased has a property right to his corpse comparable to the right the living person has to exercise control over their current body parts. Living bodies and their parts cannot be sold or inherited. Or if they can, assuming an extreme libertarian position, our earlier metaphysical reflections established that the remains are not the same entity that was once alive. So there is no bodily property that persists across the death event that can become the same property of the relatives or designated heir. This distinguishes bodies and corpses from houses and jewelry

. Schneiderman endorses the 'proceduralist' view developed by Buchanan on how to make hard decisions about rationing medical care. Briefly describe this view and how it would look in practice. What two answers does Schneiderman make to the worry that an established procedure will be inherently open to abuse?

that healthcare organizations and caregivers should practically be tested through a procedural justice to determine whether their actions are just or not. Implementation of the approach was a costly intervention, and the country was incapable of managing its budget. This implied that there would have been insufficient capital to support the medical rationing program, and this will incorporate ineffectiveness in its operation, resulting in various injustices. His 2nd response is that rationing should be simple and fair to the public. ------------------------------------------------------------- James Buchanan developed the proceduralist approach of rationing activities and actions of healthcare organizations and caregivers. Buchanan stated that the approach implied that healthcare organizations and caregivers should practically be tested through a procedural justice to determine whether their actions are just or not. The approach was developed to facilitate the rationing process, which was complicated since it was based on no standards but individual or a team's decision. In practice, this meant that the judicial service system, in collaboration with the health sector, needed to develop performance standards and a code of ethics that the various healthcare organizations and providers had to completely meet for their actions to be considered just (Buchanan, 2009). The proceduralist approach experienced several criticisms, with most basing their argument on whether an established procedure will be inherently open to abuse. Schneiderman made two responses to the criticism. His first response was that the idea of medical rationing to reduce costs does not fit the American political structure, which was chaotic (Schneiderman, 2011). Implementation of the approach was a costly intervention, and the country was incapable of managing its budget. This implied that there would have been insufficient capital to support the medical rationing program, and this will incorporate ineffectiveness in its operation, resulting in various injustices. Schneiderman's second response was that the rationing plan should be simple and fair to the public, which means incorporating the people's basic health needs before implementing the plan. He proceeds to propose for development of a decent minimum to be incorporated in the rationing procedures. Schneiderman describes a decent minimum to be a level of medical care that allows an individual to meet other basic needs.

What role is played in Schneiderman's view by the interconnection and interdependence of individual and society? What justification does he give for its importance?

this proposal provides for specific, determinate outcomes and highlights the reciprocal obligations of the individual and society. My ethical rationale is straightforward. Without the support of society, the individual would not prosper; in return, I argue, the individual has a duty to recognize society's needs for productive citizenry. The success of an individual depends on the success of the supporting society. The success of the society depends on the productivity and contributions of its individual members