Medical Ethics Test 3

Kant says you are not permitted to lie even to save a life

• Kant was presented with the Axe Murderer case: • Your friend runs into your house. • Shortly thereafter, a guy covered in blood and carrying an axe knocks on your door and asks where your friend is. • You know (somehow) that you can lie to him, not come to harm yourself, and save your friend. - Are you permitted to lie in this case? • What is Kant's response?

-Collins' clear point is that it the patient in this case was no worse off for having the information withheld (the outcome would be the same no matter what). • But not knowing the full extent of the condition actually benefitted the patient.

• The patient was told this, but it was withheld just how bad things would be after the year (though he was told he should get his affairs in order). • In the last few weeks of the year it was revealed how bad the ailment was. • The patient had avoided depression, etc. and was able to put his affairs in order -What are Collins' thoughts?

intentions

-The moral issue concerns one's ________________ • One may not be able to convey everything to a patient, but one must do so the best of one's ability. • If a doctor fails to do so, is overly technical, leaves important details out with the intent to deceive, then the doctor acts immorally.

Kant

-he thought that when a type of action is immoral, the reasons why it is immoral entail that it will always be immoral, no matter the circumstance. -ex: if murder is immoral, there is no circumstance, no amount of good results, that would make a particular murder morally permissible.

biological

Death is a _____________ category, and when a human organism continues to breath, have a heartbeat, and even metabolize food, then it is alive according to this definition.

Collins

He thinks that a patient should be told the truth ONLY to the degree that it does not negatively affect their health

1. the trust argument 2. the autonomy argument

Higgs makes two key arguments in favor of always telling one's patients truth, what are they?

Peter Singer

His argument is that brain death isn't actual death; defining people with no cerebral function as "dead" avoids difficult legal problems regarding organ transplants (which is what the committee was after)

B

Identify the missing premise: The Autonomy Argument (1) A patient's autonomy must be respected by their health care providers at all times. (2) [Blank] (3) Lying or concealing information about a patient's condition denies the patient knowledge. (4) Therefore, health care providers must refrain from lying or concealing information about a patient's condition. a. a patient can't be autonomous if they are dead, so their life must be protected at all costs b. in order to exercise their autonomy a patient must have knowledge of their options c. a doctor is also an autonomous agent and so must be responsible for his or her actions

B and C

Identify which of the following reasons Singer gives to support his claim that brain death is not actual death (choose 2): a. no religious text supports brain-death as being actual death b. people are inclined to accept statements like "brain-dead woman gives birth and then dies" c. some brain dead patients still have some brain functions, often in their brain stem

well-being

In Singer's view, the British court made an important decision to judge Bland's case not solely on the patient's wishes (because no one knew what those were) but rather on the patient's ______________

Hiding bad outcomes is highly paternalistic and, again, undermines the autonomy and freedom of the patient.

In what way does Higgs think a doctor or nurse withholding the truth is entirely self-serving?

white lies

Kant thought there is no such thing as _________ ___________

permissibly

Present Higgs' two arguments against the claim that doctors and nurses can (permissibly/ impermissibly) lie to their patients.

no reflexes

Pupils remain dilated and do not respond to light sources. Other reflex actions like swallowing, yawning, etc. are absent.

consciousness

Singer contends that Instead of looking for total brain death, we should be looking at the permanent cessation of functions that are responsible for...

1. Normal folks are set in their ways of thinking and aren't giving into proper scientific ways of thinking (at least not entirely). 2. Common sense is right: Brain death is not death. (singer thinks this one is correct)

Singer thinks that there are two possible explanations of these sorts of inconsistencies in our thinking about these cases:

biological death

Singer wants to maintain the basic medical practices that are supported by incorrect descriptions of brain death as...

true

T/F: With respirators, intravenous nutrients, and/or artificial stimulation to the heart, a human body can be kept functioning indefinitely under these conditions

person;human

The (person/human) has ended but the (person/human) remains and for that reason the classification of these cases as "dead" is destined to be unstable.

1. Patients who honestly want it so that they can make as ready as possible. 2. People who do not (really) want to know, and if they did would be injured by it. 3. Those who are wholly incapable of hearing it. Who won't believe it, perhaps; or who might be destroyed by it. 4. Those who are perfectly healthy (hypochondriacs).

What are the four types of patients that demand the truth?

Higg's Autonomy Argument

What argument is this? (1) A patient's autonomy must be respected by their health care providers at all times. (2) In order to exercise their autonomy, a patient must have knowledge of their options. (3) Lying or concealing information about a patient's condition robs the patient of that knowledge. (4) Therefore, health care providers must refrain from lying or concealing information about a patient's condition.

Collins' Argument for the Permissibility of Lying in Medical Practice

What argument is this? 1. The purpose of medicine and those who practice it is to produce and/or preserve the health of their patients. 2. Telling the full truth to patients can result in worse medical outcomes. 3. Lying to patients can result in better outcomes. 4. Therefore, in cases in which lying or withholding the truth will result in a better outcome, a medical professional is permitted to lie.

Higg's Trust Argument

What argument is this? 1. The relationship between a patient and doctor requires trust. 2. In order for the patient to trust the doctor, they must be certain that the doctor will not lie to them or withhold information and that the doctor has their best interests at heart. 3. If doctors habitually lied to their patients or withheld information, patients would not trust their doctors. 4. Therefore, if a doctor is to do their job, they must not lie to or withhold information from their patients.

A

What cognitive function does Singer identify as the indicator of genuine death? a. the permanent cessation of conscious experience b. the permanent cessation of muscle reflex c. permanently stable blood pressure

• Singer thinks that redefining brain death in these terms is a good start but is destined to fail. • We could keep refining this definition as medical tests, and our understanding of the brain continue to improve.

What does Singer think the problem to the solution is?

1. unreceptivity and unresponsiveness 2. no movements or breathing 3. no reflexes 4. flat EEG MUST BE REPEATED AFTER 24 HOURS TO CONFIRM

What is the diagnostic criteria for if a patient is brain dead?

they involve using another person for your (or other people's) ends ignoring their own goals.

What was Kant's reason for why actions are immoral?

-the basic problem was that medical technology had advanced to the point that in some cases a human body could be kept function when there is no brain activity or possible resumption and the person was never expected to wake up

What was the point of the report by Harvard?

1. increased medical technology leads to extraordinary measures to save lives 2. an organ donor who is in an irreversible and permanent coma could have organs that could be used to save lives

What were the two reasons that Harvard Medical School decided to report on the issue of brain death?

Immanuel Kant

Who is famous for arguing that lying is ALWAYS morally wrong?

Kant

Who thought this? - An accurate representation of the world is necessary for a person to plan and pursue their goals. • By depriving them of the truth or deceiving them, you prevent them from freely and effectively doing the things they want to do.

Singer's Core Position

Who's thoughts are these? 1) It is permissible to take measures to end a patient's life when they are rendered permanently and irrevocably unconscious. 2) This is so not because they are dead but rather: 3) The human continues to exist even though the person has ceased to exist, AND 4) There is no benefit or value for the person in their body continuing to be kept alive.

B

Why does Collins think it's sometimes morally permissible to lie to a patient? a. sometimes, lying actually makes the situation and medical condition worse b. sometimes the trust will hamper recovery or make the medical conditions worse, which is the antithesis of good medical practice c. He doesn't, he thinks doctors should always tell the truth

C?

Why is Singer's proposal to identify death by his specified cognitive function still run into problems? a. it wouldn't have settled the issue in Terry Schiavo b. religious individuals and organizations likely won't accept his definition c. "death" is a biological concept, but a permanently unconscious body can still breathe and metabolize

C

Why might someone think that telling patients the whole truth is impossible? a. doctor's time is too precious to waste on making sure patients understand what is going on b. there is no such thing as truth; everyone is relative/subject c. medical conditions and diagnoses can be incredibly technical and involve concepts that patients simply don't posssess

because understanding everything will involve a level of expertise and knowledge that the patient does not permit.

Why would telling the full truth to the patient will, in many cases, be impossible??

Collins

____________ thinks (like everyone) that in most circumstances a doctor should tell the patient the truth; however, he does think that it is permissible to lie to patients in some cases; he thinks lying in some cases produces results

irreversible coma (what we refer to today as brain death)

a complete lack of central nervous system activity; this proposal was that if the brain has ceased to function entirely, then the patient may be treated as dead even if their heart continues to beat

Anthony Bland

• In 1989 at a soccer match in England the crowd grew unruly, and a crush ensued. • 95 people died. • ____________ ___________ (17 years old) was suffocated, and his brain was deprived of oxygen for a long period of time. • Though his heart was still beating, brain scans showed that only his brain stem still functioned. • A controversy ensued as to whether it was morally/legally permissible to remove Bland's feeding tube and allow his body to die. • The case worked its way all the way up to the British House of Lords. • The "unanimous medial opinion" (327) in this case was that Bland was not aware of anything and there was no possibility of recovery. • The court, therefore, ruled that Bland's feeding tube could be removed.

Terri Schiavo

• In 1990 __________ ___________ (age 26) suffered a cardiac arrest. • She was able to be resuscitated, but only after massive damage was done to her brain due to lack of oxygen. • After two months with no detectable brain activity she was diagnosed as being in a persistent vegetative states. • From 1990-1994 she underwent various treatments and attempted rehab procedures. • In 1998 her husband asked that her feeding tube be removed and she be allowed to die. • He claimed that her stated wishes (there was no living will) were that she would not want to be kept alive under these conditions. • Her parents fought him in court claiming that she was a devout Roman Catholic who would not want to o against Church directives. -In 2005 her tube was removed for the last time and she died -autopsy scans showed that most of her brain responsible for cognitive function and awareness were destroyed

Singer

• In Bland's case: • He was not conscious, aware, feeling or sensing anything • He would never be conscious again (his brain "was fluid" (326)) • Therefore, __________ argues, Bland could not value or benefit in any way from his continued biological life. • Like Tooley, __________ thinks the individual must be able to experience and appreciate that life/future.

Collins; Higgs

(Collins/Higgs) argues that patients just won't understand medical content so you can bend the truth while (Collins/Higgs) thinks it is part of the job of medical professionals to explain what they do know, and to express what they don't, in order to discuss likely outcomes and to explain the possibility of unlikely outcomes.

Collins; Higgs

(Collins/Higgs) suggested that many patients don't actually want the truth or can't handle it if it is given; (Collins/Higgs) finds this utterly unpersuasive. In no profession is it okay to suppress bad news just to avoid suffering.

false

(T/F): According to Collins, there are four types of patients who would genuinely benefit from the full disclosure of bad diagnoses.

true

(T/F): As an added precaution, the Harvard Committee suggests repeating diagnostic measures a second time 24 hours (or more) after the initial failed screening

false

(T/F): Contrary to common sense, Singer thinks that brain death is death

false

(T/F): Higgs agrees with Collins that patients generally don't actually want to know what's happening to them.

True

(T/F): Higgs argues that, because trust is a crucial aspect of the doctor-patient relationship, doctors must never lie to their patients.

false

(T/F): Terry Schiavo's parents argued that she should be kept alive because her living will made clear it was her stated preference.

true

(T/F): The Harvard Committee problematically claimed that being kept alive was a "burden" to the brain-dead patient (who by definition can't be burdened)

D

According to the Harvard Committee brain death (or a permanent coma): a. is defined as a complete lack of central nervous system activity b. can be confirmed by a flat EEG scan carried out multiple times c. Results from the brain reaching a state where it is permanently non-functioning d. All of the above

medical

Collins' most powerful arguments had to do with lying in order to avoid ___________ harms to the patient; his idea was that telling the truth can often have a negative impact on a patients health

unreceptivity and unresponsiveness

No vocal or physical response to any outside stimuli regardless of duration or intensity.

• Higgs thinks that cases like this call for greater care for the patient. • This requires special training for doctors and nurses on how to deliver news, emotional and psychological support, monitoring, etc. But while giving bad news can have bad short term effects, the long term damage of lying is far worse.

One of Collins most powerful arguments that lying to patients can be permissible pointed out that sometimes the truth can be harmful to patients (i.e., it can reduce their chances of recovery). Which of the following claims does Higgs make in response to this argument?

Harvard committee

The __________ ______________ itself stated that being kept on a respirator was a "burden" to the patient. • But if they are dead, then nothing is a burden to them!

no movements or breathing

The patient does not breath or otherwise move unaided by respirators or other devices. If the respirator is turned off for three minutes and there is no autonomous breathing, they fail this test.

flat EEG

There is no brain activity measured by direct means (probably the more important measure today). The first three are symptomatic, this is directly confirmatory.