Ch 8-11 final exam

Higher brain view

"A better notion of death, some argue, is the higher brain view, which says that an indiv.l should B considered dead when the higher brain operations responsible for consciousness permanently shut down" "The thought behind this statement is tht indiv.ls R dead when they R no longer persons, regardless of wht physiological act.y persists, & indiv.ls R no longer persons when consciousness permanently terminates" "By the higher brain criterion, Terri Schiavo died when her higher brain functions permanently stopped, even tho other brain act.y cont.d for yrs."

American Medical Association 1973 policy statement p626

"The intentional termination of the life of one human being by another--mercy killing--is contrary to tht for which the medical profession stands & is contrary to the policy of the AMA.....The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence tht biological death is imminent is the decision of the patient &/ immediate fam.y"

To date no human has been successfully cloned

& for technical & moral reasons none is likely 2B cloned anytime soon.

Primary cloning method for producing live-birth mammals

& the one most likely to be considered for human cloning is known as Somatic cell nuclear transfer (SCNT).

Infertility

(usually defined as the inability to get pregnant after one year of unprotected sex) can befall a couple if there is a problem w/ any1 of these processes. - A couple can become infertile if ovulation doesn't happen, either sperm or egg is of low quality, fallopian tubes blocked, embryo is abnormal, or implantation is unsuccessful.

When self-determination runs amok by Daniel Callahan p658

- 3 impt. turning points in western thought in a pluralist society 1. Legitimate conditions in which one person can kill another 2. meaning & limits of self-determ. 3. medicine should B prepared to accomodate an indiv.s view of a good life I. Self determin. euthanasia is mutual decision be2ween 2, how can a physician determine unbearable suffering? II. Killing & allowing to die: causality & culpability R confused under 3 circumstances. (1) When MD stopping trx of a lethal disease is construed as causing death (2) fail to note moral responsibility/ culpability R human constructs (3) the word killing is a human action (lethal injection), not a nature like disease process by standing aside p601 III. Calculating the consequences: 3 consequences p661 "Three consequences seem almost certain in this or any other country: the inevitability of some abuse of the law ; the difficulty of precisely writing, & then enforcing, the law; & the inherent slipperiness of the moral reasons for legalizing euthanasia in the 1st place" IV: Euthanasia & med.l practice: meaning of life is not the role of medicine, medicine should only relieve the suffering caused by biological phenomena not human condition. "Consenting adult killing like consenting adult slavery or degradation is a strange route to human dignity" "Causality (by which i mean the direct physical causes of death) & culpability (by which I mean our attribution of moral responsibility to human actions) R confused under 3 circumstances"

A person's rights impose duties on others

--either (1) duties not to interfere w/ tht person's obtaining something or (2) duties to help tht person in her efforts to get something. Rights entailing the former obligations R called negative rights; those entailing the latter R called positive rights. -Those who insist tht an indiv.l has a right to health care R referring to a positive right & R claiming tht society has an obligation to provide tht benefit in some way

Four kinds of euthanasia tht have been the focus in bioethics:

-1.active voluntary-directly causing death (mercy killing) w/ the consent of the patient -2. active nonvoluntary-directly causing death (mercy killing) w/o the consent of the patient -3.passive voluntary-w/holding or w/drawing life-sustaining measures w/ the consent of the patient -4.passive nonvoluntary-w/holding or w/drawing life-sustaining measures w/o the consent of the patient ex:Terry case -Active euthanasia (whether voluntary or nonvoluntary) is unlawful, while passive euthanasia (both voluntary & nonvoluntary) is legal provided certain conditions R met.

Voluntary active euthanasia by Dan W Brock p646-657

-2 values tht support euthanasia; self determination/ autonomy & indiv.l well-being (physicians should act according to their own values) - Euthanasia is the deliberate killing of an innocent person, but there R impt. ethical differences. 1. Physician acts w/ pt.'s consent 2. Physician acts w/ good motive 3. physicians role makes him legally authorized - Pot.l good consequences of permitting euthanasia (1) respect self-determination of competent patients (2) euthanasia is tht decreases fear of future suffering. -pot.l bad consequences of permitting euthanasia: (1) physician-assisted suicide is incompatible w/ their proff.l duty (2) euthanasia might get preferred over care/cure (3) being terminally ill hard to justify p653 (5) it might weaken the prohibition of homicide (6) the slippery slope -the slip in2 nonvoluntary active euthanasia -Brock argues tht the same two basic moral principles tht support a patients right to make choices abt life-sustaining treatment also supports the permissibility of voluntary active euthanasia. The first principle is indiv.l self determ.; the second is indivl well being. Indiv.l self-determ. applies to the manner, circumstances & timing of one's death & dying. A concern for indiv.l well-being may justify euthanasia when a suffering patient determines tht life is no longer a benefit.

Utilitarian perspective on genetic testing

-A utilitarian perspective is likely to favor genetic testing & gene therapy if they tend to promote general welfare -A utilitarian might say tht tests providing useful info. abt. ppl.s genetic risks R probably beneficial overall, tho. benefits must B weighed against the harm tht can result from misleading test results, genetic discrimination, & breeches of doctor-patient confidentiality -A utilitarian will argue tht prenatal testing & PGD (combined w/ selective abortion & embryo selection) R morally acceptable b/c they can prevent devastating diseases & disabilities in children as well as emotional or economic suffering in families -utilitarian would accept gene therapy (somatic & germ-line cell) , morally permissible if its benefits outweigh its risks -the utilitarian would not hesistate to employ positive eugenics if altering the human genome would on balance, increase human happiness & ease suffering -a utilitarian would sanction the therapeutic use of embryonic stem cells (derived from any source) as long as there was a net benefit to society

Fact file Assisted Reproduction p 410

-Abt. 1.5% of all infants born in the U.S. are conceived using ART. In 2012, the average percentage of fresh, nondonor ART cycle that led to a live birth was 40% in women younger than 35 years; 31% in women 35 to 37 yrs; 12% in women 41 to 42 yrs; 2% in women 44 yrs & older -The avg. cost of a single IVF cycle is $12,400 -In 2013, of the 93,787 fresh nondonor ART cycles started, 33,425 (36%) led to a pregnancy, & only 27,406 (29%) resulted in a live birth. That is, almost 20% of ART pregnancies did not result in a live birth.

2 forms & causes of euthanasia

-Active euthanasia: is said to involve performing an action tht directly causes some1 to die--wht some ppl think of as "mercy killing". Giving a patient a lethal injection to end his suffering, then, is a case of active euthanasia. -Passive euthanasia: is allowing some1 to die by not doing something tht would prolong life. It includes removing a patients feeding tube or ventilator, failing to perform necessary surgery & refraining from giving life-sustaining antibiotics. -Active euthanasia is killing but passive euthanasia is letting die -They point out that whereas letting a patient die is sometimes morally permisisible, deliberately & directly killing a patient is always wrong . The former practice is legal & officially endorsed by the medical profession.

Stem cells p552-554

-Around 3-5 days after a sperm fertilizes an egg, the embryo takes the form of a blastocyst/ ball of cells -The blastocyst contains stem cells -These early cells R undifferentiated, having no specialized function as the other kinds of cells do; but they R also pluripotent, which means they R able to become differentiated, to turn in2 any of the body's specialty cells. -Embryonic stem cells: R the most potent, as their job is to become every type of cell in the body; can reproduce indefinitely, creating replicating cell lines, just a few of them R needed to generate a large supply -Adult stem cells-cells in the developed human--stand ever ready to differentiate themselves to replace worn out or damaged cells, constantly renewing & repairing the body's parts. --> Adult stem cells generate new bone, cartilage, skin, muscle, blood & many other tissues.

Complications on gene therapy

-Complications: GT rarely conclusive, gives probabilities -Environmental factors affect genes -Severity of symptoms unpredictable -GT can identify/ predict but can't do anything abt. it for most.

Genetics dilemma & the child's right to an open future by Dena S. Davis p575-584

-Ethical prob.m: the beneficence for the child's vs the parent's autonomy -4 kinds rights: adult/ children common rights, children's dependency rights, adult rights, rights-intrust: saved for child until adult> child's right to an open future. -reproducing a deaf child violates the child's right to a open future (both in disability & deaf cult.), its harm -sex selection also harmful, since these parents usually have gender-specific expectations

IVF: the risks & benefits

-IVF has the power to help many ppl. overcome infertility -IVF is expensive -**"On avg. a live birth is the outcome in only abt 30% of IVF cycles in which the woman's own eggs R used -Many health insurance plans will not cover the cost -The physical demands of the IVF process--the surgery, the monitoring, the waiting--can B uncomfortable inconvenient, & stressful -Surgery may cause abdominal pain, memory loss, mood swings & headaches, & rarely ovarian hyperstimulation syndrome (swollen & painful ovaries) - Transferring several embryos at once increase chances of high blood pressure, anemia, gestational diabetes, & uterine rupture -May cause birth defects, low birth weight, & cancer -The chances of prenatal & postnatal death R higher than for single pregnancies, & premature birth is much more likely. -Ethical issues arise regarding freezing eggs or cryopreserve; cryopreserved embryos R less likely to result in live births than unfrozen embryos. -IVF has been condemned by some religious groups b/c it breaks the natural connection be2ween procreation & sexual intercourse in marriage.

According to Roman Catholic interpretation of natural law theory, reprductive technologies must B rejected across the board.

-IVF is wrong b/c it defies the natural link be2ween procreation & sexual union. -IVF involves destruction of human embryos , each of which has a right to life. -Surrogacy is immoral b/c it is procreation outside of marriage & an affront to the integrity of the family. -Human cloning repudated b/c it unnaturally separates procreation from sex & is a violation of the rights of the child.

Terry schiavo case: an ethical dilemma p625-626 (moral reasoning & conceptual clarity needed )

-In 1990 when she was 26 her heart stopped suddenly, by the time she was resuscitated, she suffered irreversible brain damage. -she was in a persistent vegetative state--wakeful but w/o conscious or intentional beh. & almost no chance of significant improvement -she was sustained for years by food & water injected in her thru a tube -Her husband wanted to remove feeding tub parents refused, legal war be2ween Michael Schiavo & terri's parents -Many sided w/ husband a judge gave permission to remove Terri's feeding tube, 13 days after removal on March 31,2005 Terri died.

Public health insurance programs

-Medicare: 65/over, under 65 for the disabled -Medicaid: under 65 low income

The presumptive primacy of procreative liberty by John A. Robertson, A Libertarian lawyer takes a rights perspective on procreative liberty p466-473

-Robertson argues for the fundamental freedom to reproduce or not to reproduce. This "procreative liberty", he says, equates to the right to make a reproductive choice w/o interference from others. The right not to procreate includes the freedom to use various methods to avoid begetting or bearing offspring, including abortion. The right to procreate includes the right to use "noncoital technologies" such as IVF. Robertson contends tht procreative liberty can B overriden--but only by very weighty considerations. "PL the freedom to have children/ to avoid having them; RF (reproduction freedom) free to reproduce/ not in genetic sense rear/not. -PL enjoys presumptive primacy, which means tht the burden of justification rests on ppl who attempt to limit it we need 2B clear abt it in order to prevent govt intrusion in2 this important area. -Women reproduction trad.y includes genetics & gestation, IVF now allows them 2B seperate: women can now reproduce & not gestate, women can gestate/reproductive experience & not reproduce -Reproduction usually rears children, but now not necessarily (Gets messy w/ legal rights, govt gives more right to person who bears child) -2 types of PL: the freedom to have children & the freedom to avoid having children R importantly different. 1. Avoiding reproduction-access to some contraceptives is limited to minors & the poor, which raises issues of justice, diff.t means of avoiding reproduction may implicate the legal & ethical status of "early prenatal stages of human life" 2. The freedom to procreate- In addition to freedom to avoid procreation, procreative liberty also includes the freedom to procreate--the freedom to beget & bear children if one chooses. **"As w/ avoiding reproduction, the right to reproduce is a negative right against public or private interference, not a positive right to the services or the resources needed to reproduce" -"the right to reproduce is widely recognize as a prima facie moral right that cannot B limited except for very good reason" -"To take procreative liberty seriously, then, is to allow it to have presumptive priority in an individual's life" 3. The limits of procreative liberty -"Recognition of procreative liberty, whether in trad.l or in new technological settings, does not guarantee tht. ppl. will achieve their reproductive goals, much less tht. they will B happy w/ what they do achieve" -"Recognition of procreative liberty will protect the right of persons to use technology in pursuing their reproductive goals, but it will not eliminate the ambivalence tht such technologies engender." -"The freedom to act does not mean tht we will act wisely, yet denying tht freedom may B even more unwise, for it denies individuals respect in the most fundamental choices of their lives. -Non-coital reprod.n is more controversial; donors & surrogates R viewed as having some interests & rights, but limited ones. -Tech.l innovations in reprod.n justify 'quality control' technique--like genetic screening/selective abortion/ fetal surgery/genetic engineering--but not futuristic non-therapeutic enhancement, cloning/ prod.n of fetuses/ embryos for non-reprod.n uses like materials for research/ transplant p470 4. There may B ethical issues tht. R not associated w/ reproductive lib.y thru reprotech may reduce the # of already existent children who R adopted/ fostered; there's a risk of coercive deals being offered to poor women; commodification of children & reproductive collaborators; objectification of women & underming of the nuclear fam.y p471 -J.R.'s conclusion is tht reproductive freedom/liberty is so important tht. it should have a wide latitude of permissibility. He thinks its important to distinguish be2ween harms to indiv.s vs. harms to personal choices & the right to reproduce.

Natural law view on euthanasia & assisted physician suicide

-Roman catholocism condems active & passive euthanasia tho the condemnation comes w/ qualifications -directly intending to bring abt a person's death to end suffering is prohibited but the doctrine of double effect permits actions tht have unintended but fatal results -the doctrine would not allow doctors to give high-dose analgesics to put patients out of their misery, but it would sanction their doing the same thing w/ the intention of easing pain thru death is foreseen. -under catholic principles there is no obligation to use every means possible to prolong a person's life in every case. The vatican declares.."When inevitable death is imminent in spite of the means used"

IVF: The simple case by Peter Singer

-Singer addresses seven moral objections tht. have been lodged against in vitro fertilization (IVF), focusing on its use in the "simple case" ("a married, infertile couple use an egg taken from the wife & sperm taken from the husband, & all embryos created are inserted in2 the womb of the wife"). The objections include the charges that IVF is unnatural, that it is risky for the offspring, & tht. it separates the procreative & conjugal aspects of marriage & so damages the marital relationship. He concludes tht all the objections are weak & tht "[t]hey should not count against going ahead w/ IVF when it is the best way of overcoming infertility" & when the infertile couple decides against adoption. -"The so-called simple case of IVF is tht. in which a married, infertile couple use an egg taken from the wife & sperm taken from the husband, & all embryos created R inserted in2 the womb of the wife." -Objections to the simple case: 1. IVF is unnatural (think Aquinas) 2. IVF is risky for the offspring 3. IVF separates the procreative & the conjugal aspects of marriage & so damages the marital relationship. (Aquinas) 4. IVF is illicit b/c it involves masturbation (religion) 5. Adoption is a better sol.n to the problem of childlessness 6. IVF is an expensive luxury & the resources would B better spent elsewhere. 7. IVF allows increased male control over reproduction & hence threatens the status of women in the community. -"In an ideal world we would find loving families for unwanted children be4 we created additional children; & in an ideal world we would clear up all the preventable ill-health & malnutrition releated diseases be4 we went on to tackle the problem of infertility." -"I think women will B helped, rather than harmed , by the development of tech.y which makes it possible for them to have children w/o being pregnant."

Kantian perspective can oppose or defend reproductive tech.

-Some could argue, for ex, tht. IVF surrogacy, & cloning R impermissible b/c they treat children merely as a means, instead of an end in themselves. -Children R "manufactured" & sold as commodities to serve the ends of others. -A Kantian could refuse to take this view, arguing tht, couples create children b/c they wish to respect & love their offspring as persons. What matters is how children are treated not how they were brought into the world.

Eugenics

-The deliberate attempt to improve the genetic makeup of humans by manipulating reproduction. study of factors that influence the hereditary qualities of the human race and ways to improve those qualities, u can replace genes to have them anyway u want

Genetic determinism p418

-The underlying fallacy is that genes make the person, that genetics ordains all of an individuals characteristics. -This view is known as genetic determinism & it is a myth -National Academy of sciences makes the point this way: "even if clones R genetically identical w/ one another, they will not B identical in physical or behavioral characteristics, b/c DNA is not the only determinant of these characteristics"

"Instruction on respect for human life in its origin and on the Dignity of Procreation by Congregation for the doctrine of the faith

-This document articulates the official position of the Roman Catholic Church, declaring that many kinds of reproductive technology or practices R morally impermissible. Among other affirmations, it asserts (1) nontherapeutic experimentation on embryos is illicit, (2) "it is immoral to produce embryos destined 2B exploited as disposable "biological material" (3) nontherapeutic genetic manipulations R contrary to human dignity, (4) artificial fertilization involving sperm & egg from unmarried individuals is illicit & (5) IVF is not morally legitimate. "The fundamental values connected w/ the techniques of artificial human procreation are two: the life of the human being called in2 existence & the special nature of the transmission of human life in marriage" "In the Declaration on Procured Abortion: From the time that the ovum is fertilized, a new life is begun which is neither tht of the father nor of the mother; it is rather the life of a new human being w/ his own growth." "Heterologous-using gametes coming from @least one donor other than the spouses who R married to each other" "Homologous-using gametes of two spouses joined in marriage" -Conservative: pro heterosexual, pro-marriage, procreation by conjugal act 1. Respect except for thosefor embryos, an innocent human being a person (right to human dignity/respect); medical research must B therapeutic. 2. Interventions upon Human Procreation a. Heterologous artificial fertilizationi: not moral, surrogacy forbidden -"Heterologous artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation proper to parents, & to the child's right to the vocation proper to parents, & to the child right 2B conceived & brought in2 the world in marriage & from marriage" b. Homolous artifical fertilizationo: must B conjugal act= unitive + procreative meaning can't B approved; artificial insemination can't substitute the conjugal act but can assist. 3. Wht should medical intervention/ medicine do? 4. Suffering caused by infertility p465 "Medicine which seeks 2B ordered to the integral good of the person must respect the specifically human values of sexuality. The doctor is @the service of persons & of human procreation. He does not have the authority to dispose of them/ to decide their fate" "Homologous artificial insemination w/in marriage can't B admitted except for those cases in which the technical means is not a substitute for the conjugal act but serves to facilitate & to help so tht the act attains its nat.l purpose....if the tech.l means facilitates the conjugal act or helps it to reach its nat.l objectives, it can B morally acceptable. If on the other hand, the procedure were to replace the conjugal act, it is morally illicit." "The suffering of spouses who can't have children/ who R afraid of brining a handicapped child in2 the world is a suffering tht every1 must understand & properly evaluate" "Nevertheless, marriage doesn't confer upon the spouses the right to have a child, but only the right to perform those nat.l acts which R per se ordered to procreation" "A true & proper right to a child would B contrary to the child's dignity"

Health care in trouble

-US health care system: high expenditures & low grades of care, spends more on healthcare than any other country -life expectancy lower -infant mortality rate higher -higher death rates, fewer physicians, half of patients receive less than adequate health care -managed care (HMO/PPO) at odds w/ pt welfare? P772 -Barack Obama's Affordable health care

New concept of Death

-breathing -heart rate -brain death** -**"According to this whole brain view of death, an indiv.l should B judged dead when all brain functions permanently cease. Brain death means genuine death"

Utilitarians on euthanasia & physician-assisted suicide

-classic utilitarianism defines the good as happiness & would therefore judge the issues by how much happiness various actions might produce for every1 involved -from this perspective, euthanasia or assisted suicide for some1 suffering horrible, inescapable pain might B permissible b/c ending life would bring abt the most net happiness -the calculations would have to include other factors such as the psychological, social & financial impact on the pt.'s fam., friends, & caregivers -Those in utilitarianisms camp who take this view R known as preferance utilitarians, holding tht right actions R those tht satisy more of a person's preferences overall. To them killing is bad when it prevents some1 from satisfying his own preferances; it can B good (as in euthanasia) when more of the person's future preferences will B frustrated than satisfied. -Rule utilitarian approaches can lead to positions both favoring & opposing euthanasia & assisted suicide -Most slippery-slope arguments R essentially rule-utilitarian, asserting tht a general policy of authorized killing will step by step take society down a path to awful consequences. -some argue on rule-utilitarian grounds for a general policy citing relief of suffering as the most obvious benefit

Theories of justice p723-725

-distribute justice -what is right?

A natural law theorists view on genetic testing

-genetic tesing (newborn screening & predictive testing) morally permissible b/c u gain knowledge abt health risks & to guide treatment -a theorist in Roman Catholic tradition would in most instances object to pre-natal testing & PGD b/c they usually lead directly to selective abortion & embryo selection--clear violations of the unborns right to life -natural law theory would countenance somatic cell gene therapy b/c the aims R therapeutic, like conventional med.l treatment -germ-line therapy as a tool of positive eugenics would B contrary to nature -research using stem cells derived from embryos would B considered immoral b/c it i nvolves destroying innocent human life

U.S. health care system:

-high expenditures & low grades of care, spends more on healthcare than any other country -life expectancy lower -Infant mortality rate higher -Higher death rates; fewer pysicians, half of pts receive less than adequate healthcare -managed

Active euthanasia

-illegal, except in certain states, immoral by most physicians & AMA -legal brief p628 -1st was Oregon, Washington, Vermont, Cali. -world most liberal euthanasia law: Belgium -the physician performs the final act -some say they R morally equivalent -**AMA denounces as unethical & inconsistent w/ physician duty to promote healing/preserve life

Positive eugenics

-improve not repair normal functions, enhancement. -morally unacceptable; bad start w/ Nazi Hitler, designer babies -worry? can lead to becoming a competitive good for those who can afford it, strongest objection is the possession of social injustice.

Is there a right to HC and if so, what does it encompass? By Norman Daniels p736-42

-is there a right to healthcare? Legal positivists > contractarianism. HC right is a positive right Libertarians vs utilitarians vs Rawls contractarian theory of justice > right to HC =right to equality of opportunity but are limited in 2 ways p739 What does a right to HC include? -system -relative entitlements (utility) -strongest claim to HC right-care that promotes normal functioning -distributive fairness: to tier or not conflict between equality/Liberty p742 "A positive right requires others to refrain from doing something, usually harmful or restrictive, to right-bearers"

Passive euthanasia

-moral by most physicians & AMA leaves it to autonomy of pt./ fam., legal. -is there a difference? some forms of passive euthanasia can B seen as active euthanasia

Stem cells: ethical problems p553

-moral controversy pver the scarce if embryonic stem cells -stem cell removal destroys embryos some IVF is used to create embryos to extract cells only -can derive stem cells from aborted fetuses -research trying to produce embryos to obtain stem cells by research/ therapeutic cloning

Arguments for active voluntary euthanasia

-p630-631 -strongest: principle of autonomy, self-determination, right-to-die, beneficence (mercy); pt. not see death as a harm

A right to healthcare p725-727

-ppl have a moral right to healthcare -person's rights impose duties on others 1. Duties not to interfere with that person obtaining something; negative rights 2. Duties to help that person obtain something; positive rights > healthcare -why? John Rawls "fair equality of opportunity"; ppl have a pos right to HC

Negative eugenics

-prevention or treatment of disease thru. genetic testing, embryo selection, selective abortion, germ-line therapy. -Morally permissible; such as prenatal screening, may become morally obligatory

Human rights approach to public policy by Tarantola & gruskin p793-802

-respect for human rights -human rights as governmental obligations -The right to health-not the right 2B healthy but 2B able to achieve optimal health -HIV linked to neglect & human rights violations- laws created to promote sex.l/reproductive health -Human rights & health policy in the new millennium: key concepts-progressive realization, human rights limitations for public health interests, discrimination neglects human rights -public health policy & nondiscrimination -public health policy: value of health & human rights-3 ways tht HR & PH policy intersect p800-2

Kantian view on genetic testing

-right to genetic testing as long as there are rules of privacy & confidentiality -if an embryo is a person than destroying it after genetic testing is impermissible -destroying embryo after testing only permissible if it would prevent suffering -positive eugenics is seen as improving human life while leaving personhood untouched.

Critics of cloning

-say it violates the rights to a unique identity -violates a "right to ignorance" or a "right to an open future" -say its unnatural, a deviant way of brining a child into the world -Cloning replaces natural procreation w/ the artificial manufacture of children as products--a demeaning process tht erodes our respect for human beings

Kantian view on euthanasia & physician asssisted suicide

-suicide prohibited b/c it treats persons as mere things & obliterates personhood -Kant asserts tht "the rule of morality does not admit of (suicide) under any condition b/c it degrades human nature below the lvl of animal nature & so destroys it" -it is apparent tht competent persons must not B killed or permitted to die -its not clear what kantians would think of individuals no longer regarded as persons b/c they have lapsed in2 a persistent vegetative state

The ethics of rationing

-utilitarian approach p728: yes, measure the benefits -egalitarian: no, justice & moral equality of persons -kantian: no all persons have equal worth

Genetics and Reproductive Risk: Can Having Children be Immoral? by Laura M. Purdy p564-569

-yes it is wrong -Huntington's disease genetically hereditary up to 50% chance of passing it, duty to avoid passing gene> right to reproduce -prenatal testing w/ an option for selective abortion/ don't get pregnancy/ adopt/ ART -Based on our decisions to procreate/ not -Prenatal screening is helpful in providing info. abt. developing fetus -Abortion issues & how it relates & a possibility of aborting genetically compromised children. >>Huntington's disease<< -is a progressive degenerative disease of nerve cells in the brain caused by a single defective gene located on a non-sex chromosome. -affects speech, movt personality -Nancy Wexler (Eugenic company 1980) could tell ppl. in high degree of probability if they had gene for disease/not -March 1993 the defective gene itself was discovered -Optimist vs pessimist ex: Rick Donhue >>Possible children & pot.l parents<< p567-568 -our duty to provide every child w/ a minimally satisfying life--> utilitarian & contractarianism

IVF & Women's interests: An analysis of feminist concerns by Mary Anne Warren

1. Feminist criticisms: the Microlvl. -Microlvl: the lvl. of indiv.l beh., indiv.l rights & wrongs -Macrolvl.: the lvl. of historical context & social implications -@the microlvl. the primary issue is whether IVF is sufficiently beneficial to IVF patients to justify the commercial marketing of the procedure, or even continued research & development -"An abnormally high percentage of IVF pregnancies end in spontaneous abortion or still-birth. -women who undergo IVF face physical risks & bear personal & pschological burdens. 2. IVF & informed consent -"Those who regard motherhood as the greatest pleasure or achievement of which (some) women are capable will B prepared to tolerate greater risks & uncertainties than those who see motherhood-- or rather, the way it is institutionalized--as a significant burden." -"Informed consent requires, among other things, an understanding of the medical & psychological risks, & the probability of success." -**"They argue tht. women's reproductive "choices" R conditioned by the patriarchal power structure & the pronatalist ideology w/ which it is associated. Having children is commonly regarded as a duty or prereq. for adult status, especially for women. This pronatalist ideology makes it difficult for women to make genuinely free choices abt. reproduction in general, or IVF in particular Gena Corea says.."The propaganda..tht women R nothing unless they bear children, tht if they R infertile, they lose their most basic identity as women..has a coercive power. It conditions a woman's choices as well as her motivations to choose. Her most heartfelt desire, the pregnancy for which she so desperatly yearns, has been--to varying degrees--conditioned." -Radicals oppose IVF b/c process makes woman go thru. so much suffering just to please her man & b/c society says she's not a woman b/c she doesn't have a bby. -**"Pronatalist ideology may put undue pressure upon infertile women to submit to IVF, but so long as pot.l IVF patients R adequately informed abt. the costs, risks, & odds of success, such covert social pressure need not make valid consent impossible" 3.The macrolvl. critique: -"Patriarchal marriage, the sex.l double standars, the confinement & legal disenfranchisement of women, the massace of women healers & wise women during the witch-craze era, & the subsequent ascendancy of male-dominated obstetrics & gynecology, R all seen as pt. of this male project of control". 4. The shape of the future: -"The new reproductive technologies should not B primarily in the hands of male physicians & researchers, but neither should any other form of medical treatment." -"Some feminists argue tht the very existence of IVF as a treatment for female infertility increases the pressures on infertile women to keep on trying until they have exhausted every possible treatment for their infertility" "The prevailing pronatalist ideology may thereby B strengthened & the social stigma & suffering of all infertile women increased". 5. The final sol.n?: -"If there has been a central patriarchal project, it has been to service of male needs--not to eliminate women, which would B self-defeating. 6. The Mystique of Motherhood: -Corea deplores the way that, "woman, once deified as the life-creating Goddess, is now lying on a table w/ her mouth taped shut, having the eggs sucked out of her body" -"What feminists want, or should want, for women is not the largely smbolic power tht comes from the awe of female procreativty, but respect for women as persons." -"Persons R due respect, not primarily b/c of the mystical powers tht may act in or thru them, but b/c of their capacity to think, feel, & act." 7. The social causes of female infertility: -"But feminist critics have argued tht the primary focus of the medical profession & the society as a whole has been too much on the treatment of infertility & too little on its prevention, & tht the publicity given to IVF is symptomatic of this imbalance." -"One group of social causes comprises a large range of sexual & contraceptive practices" -"As noted above, much female infertility is caused by infective damage to the fallopian tubes. Such infections R, in the majority of cases, sexually transmitted; & sexual practices & modes of contraception can affect the likelihood of contracting such sexually transmitted diseases (STDs). 8. Conclusion: -"The use of new reproductive technologies might in time become legally or socially mandatory even for (some) fertile women, e.g., as a way of implementing eugenic goals. But this danger can better be counteracted by protecting indiv.l civil rights than by seeking to eliminate the new reproductive technologies." -"Yet IVF may remain the best (medical) approach to the treatment of some forms of infertility"

3 types of theories of justice

1. Libertarian theories of justice -no one has a right to healthcare 2. Utilitarian theories of justice-may endorse universal healthcare 3. Egalitarian theories of justice-society access to healthcare distributed equally -human rights approach

Rationing

1. Micro allocation - who should receive the resources? Ex: organ transplant 2. Macro allocation-what portion of society's resources should go to healthcare -social value is considered when rationing resources ex vaccine for COVID going to health care workers first

Process of IVF & embryo transfer p410-411

1. Ovarian stimulation (superovulation) 2. Egg retrieval 3. Insemination/ fertilization 4. Embryo cult. 5. Embryo transfer

Two types of Gene therapy

1. Somatic cell- potential to cure many diseases, but vectors can lead to disease. 2. Germ-line cell- egg & sperm cells, zygotes; potential to eradicate disease be4 birth, but can lead to designer babies/ horrible genetic errors. p547

Human genome

3 billion base pairs of DNA code, all grouped in2 20,000-25,000 genes.

Surrogate

A surrogate is a woman who gestates a fetus for others, usually for a couple or another woman. -She contracts w/ them to carry bby to term , to relinquish the bby @birth & to let them legally adopt it.

Libertarian theories of justice

According to libertarian theories of justice the benfits & burdens of society should B distributed thru the fair workings of a free market & the existence of liberty rights of noninterference

Genetic testing

As a result of the tracing of the human genome sequence by the Human Genome Project, it's possible to check for genetic disorders by looking for changes in a person's DNA; genetic testing which includes over two thousand tests designed to detect disease. -Testing done: Newborn screening-the first mandatory genetic testing was for phenylketonuria (PKU), a disorder resulting in profound mental retardation when not treated early w/ a special diet. Carrier testing- to determine whether some1 is a carrier of a type of genetic disease known as an autosomal recessive disorder. ex: cystic fibrosis, sickle cell disease Predictive testing-to find out b4 any symptoms appear if some1 is likely to develop a genetic disease later in life. ex: be4 sx, disease tht. can develop like Huntingtons Diagnostic testing-to confirm or rule out a genetic disorder in some1 w/ symptoms. ex: confirm/ rule out disorders sx (symptoms). Prenatal testing-to determine if a fetus has genetic abnormalities likely to cause physical or mental impairments. ex: down syndrome, Tay Sachs Preimplantation genetic diagnosis-PGD to test embryos produced thru. IVF for genetic abnormalities. ex: test IVF embryos

Broch vs Callahan

Brock was for voluntary euthanasia & Callahan was against euthanasia b/c of slippery slope

Reproductive cloning p553

Creation of a genetic duplicate of an adult animal or human -aims @the live birth of a bby

Euthanasia

For the sake of clarity (& neutrality), euthanasia can B characteized as directly or indirectly bringing abt. the death of another person for tht person's sake. -the term derives from the Greek words meaning "good death" & evokes the idea tht causing or contributing to some1's end may bestow on tht person a good.

A rule utilitarian will oppose

If the widespread use of reproductive technologies would harm society-- for ex.: surrogacy or cloning would result in a general disregard for human life& welfare, as some critics argue.

Managed care

In the U.S. most health care is allocated thru. managed care, a system for providing care to a particular group of patients (memb.s of the system) using regulatory restraints to control costs & increase efficiency. -managed care plans try to control costs by influencing the kind & amount of care tht providers offer & by restricting the choices tht members have -ppl who enroll in a managed care plan--such as health maintenance org. (HMO) or a preferred provider org. (PPO)--get health care @discounted prices from the plan's network of providers (physicians, hospitals, etc)

Chromosomes

In the cell's nucleus, the genes R neatly organized--bundled in2 46 stringlike molecules known as chromosomes. -These bundles R arranged in2 23 pairs, w/ 22 of the pairs appearing the same for both males & females & the 23 pair--the sex chromosomes--differing for males & females.

Genetic mutations

Occasionally extra genes or chromosomes R added, or essential ones R left out -Genetic mutations may happen in ppl randomly or b/c of exposure to noxious agents such as radiation, chem.ls or cigarette smoke, may be hereditary, genetic diseases may arise from many mutations in one or more genes, coupled w/ a persons lifestyle habits & environmental influences

Some utilitarians may reason that cloning & IVF

R impermissible b/c the considerable money spent on them could yield far more happiness if spent on, (EX) food for the hungry ppl. of the world.

Twinning

Scientists have managed to duplicate this process in a form of cloning known as twinning. -Thru IVF they produce an embryp (zygote), & when it consists of two to four identical cells, they seperate them & let them grow in2 discrete but genetically identical organisms.

Ethical arguments against surrogacy

Surrogacy arrangements amount to baby-selling, a blatant affront to human dignity. (The charge is usually made against commercial surrogacy, in which money changes hands, not against altruistic surrogacy, in which women volunteer their surrogate services). -Defenders of surrogacy deny tht it constitutes bby selling, claiming instead tht a surrogate is simply relinquishing her right as a parent to have a relationship w/ the child. She is not selling an existing close relationship w/ some1; she is selling,/forfeiting the right to enjoy a future parent-child relationship--& it is not obvious tht doing so is wrong.

The human rights approach

The idea is tht we can best achieve just distributions of health & health care by ensuring tht human rights in general R respected -respecting human rights (which encompass fair treatment, freedom from coercion, nondiscrimination, protection from abuse, equalit, & other entitlements) contributes to well-being & health (including access to health care) & these positive contributions to health depend on the respect for human rights

Is it morally permissible to employ ART, surrogacy, even cloning?

The utilitarian will say yes if the benefits of the tech.y outweigh its harms, no if they don't. -utilitarians see a net gain in the use of IVF & surrogacy arrangements, & would endorse cloning if its risks to children could B decreased to an acceptable lvl. -IVF's real but low risk of birth defects & maternal complications is outweighed by the happiness brought to infertile couples, & the loss of embryos in the process would not B a major factor.

Genetic discrimination

Their wariness is prompted by the possibility of genetic discrimination, the use of genetic info. by employers insurance companies, & others to discriminate against or stigmatize ppl.

Two forms of surrogacy: Traditional Vs. Gestational

Traditional surrogacy- sperm from either the couple's male partner or a donor is used to artifically inseminate the surrogate (the "surrogate mother") Gestational surrogacy- the surrogate receives a transferred embryo created thru. IVF using the sperm & egg of others (the contracting couple or donors). -the gestational surrogate (gestational carrier) does not contribute her own egg, she has no genetic connection to the bby.

Derivative right

Utilitarians can admit a right to healthcare, tho it would B what some have called a derivative right, a rule ultimately justified by assessments of utility

distributive justice

When we ask wht justice demands in societys allocation of health care, we R dealing w/ matters of distributive justice--justice regarding the fair distribution of society's advantages & disadvantages, or benefits & burdens, including income, property, employment, rights, taxes, & public service.

Utilitarian theories of justice

a just distribution of benefits & burdens is one tht maximizes the net good (utility) for society -a utilitarian may grant some principles of allocation the status of rights--rules tht can B enforced by society & tht can override considerations of utility in specific situations -the ultimate justification of the rules is utilitarian (actually, rule-trilitarian): consistently following the rules may maximize utility generally, altho. rule adherence in some instances may not produce a net good -a utilitarian might endorse a system of universal health care insurance, or a qualified right to health care, or a two-tiered plan (like the U.S. arrangement) in which govt-supported health insurance is combined w/ the option of privately purchased health coverage for those who can afford it.

Physician-assisted suicide

a patient takes his own life with the aid of a physician -a patient asks the physician for help in commiting suicide, the physician assists the patient by prescribing lethal doses of drugs or explaining a method of suicide, & the patient--not the physician--performs the final act tht causes death. -in active euthanasia the physician performs the final act -pt takes own life w/ aid of physician -pt performs the act w/ the fatal drug -pt bears ultimate moral responsibility

Egalitarian theories of justice

affirm that important benefits and burdens of society should be distributed equally -to achieve greater equality, a egalitarian (unlike the libertarian) would not B adverse to mandating changes to the distribution of society's goods or to interfering in the workings of a free market -the egalitarian (unlike utilitarian) would not allow utility to B the ultimate overriding consideration in a system of distrib. -from egalitarian premises, theorists have derived several schemes for allocating health care, including systems tht give equal access to all legitimate forms of health care, tht offer a guaranteed minimal lvl of health care for every1, or tht provide care only to those most in need

Gene therapy

also referred to as genetic engineering, the manipulation of some1's genetic material to prevent or treat disease. -It is an attempt to alter the workings of cells by, among other things, (1) replacing a missing or defective gene w/ a normal one, (2) repairing a faulty gene so it will function properly or (3) activating or deactivating a gene (switching it on or off).

Genome

an organism's complete set of DNA; In a typical human cell, the DNA strands total abt 6 ft., coiled & crammed efficiently in2 an incredibly small space.

Therapeutic, / research, cloning

ch 9

Some men have no sperm; some women, no eggs; cloning could solve this

for couples tht value genetic connection & who want to avoid passing on a genetic disease or health risk to their child , cloning is a good option

The discovery of the double helix structure of DNA by

in 1953 by Francis Crick & James Watson

clones

in the sense used by biologists, R genetically identical entities, whether cells, DNA molecules, plants, animals, or humans.

Involuntary euthanasia

is bringing abt. some1's death against her own will or w/o asking for her consent while she is competent to decide. -usually brought up in slipper-slope arguments

Nonvoluntary euthanasia

is performed when patients R not competent to choose death for themselves & have not previously disclosed their preferances. (Incompetent patients include not onl incapacitated adults but infants & small children as well). In these circumstances, the paitient's fam.y, physician, or other officially designated persons decide for the patient.

Cloning

is the asexual prod.n of a genetically identical entity from an existing one.

In Vitro Fertilization (IVF)

is the uniting of sperm & egg in a laboratory dish, instead of inside a woman's body. -In vitro means "in glass" -The idea is to create embroys that can B transferred to the woman's uterus, w/o sexual intercourse in hopes of achieving fertilization in the woman's body.

Research (or Therapeutic) cloning

it is possible--but not yet feasible --to derive embryonic stem cells from blastocysts produced thru what is called resarch cloning

Against active voluntary euthanasia

p631-634 1. Killing (murder) is wrong; letting die (nature) is permissible (passive>active) >no difference thesis 2. Doctrine of double effect: intending death is diff.t from foreseeing it (use it to intend release from suffering b/c u don't intend death, so morally permissible 3. Terminal sedation p632 4. Slippery slope p632 "to produce a result".."it is permissible to do something intended" (U cant push the drug b/c u kill her but u can intend to relieve her of her suffering, u foresee her death)..."if active euthanasia becomes legal, we'll just kill ourselves"

Money paid to surrogates

range of $10,000 to 30,000--is supposed to B regarded as compensation for such things as her time & effort or her diminished job opportunities

Voluntary euthanasia

refers to situations in which competent patients voluntarily request or agree to euthanasia, communicating their wishes either while competent or thru instructions 2B followed if they become incompetent (if they fall in2 a persistent vegetative state for ex)

Eugenics

the deliberate attempt to improve the genetic makeup of humans by manipulating reproduction ex: Nazi's racial purity thru mandatory sterilization

ch 10 Euthanasia & physician assisted suicide; The bioethical heart of the matter:

the moral rightness of killing/ letting die for the goof of the person p625

Genes p540

words of genetic code R genes, the fundamental units of biological inheritance. Each gene has a duplicate w/ one copy inherited from the male parent & one from the female parent.