Bioethics
What is cortical death? Why defenders of cortical death think that whole brain death criterion of death should be replaced by cortical death criterion?
1. The regulation of the functioning of consciousness is regulated by the 2 hemispheres 2. Somatic functions are regulated by the brain stem, less sensitive to damage or oxygen deprivation Cortical death or higher brain death is the cessation of function of the cerebral cortex that is regulating the consciousness - Persistent vegetative state - No consciousness, but the brain stem survive → individual that is permanently non-conscious but whose body continue to function indefinitely with no external life support ● Defenders of cortical death is more adequate to humans as conscious being ● If the capacity of consciousness is lost, the person ceases to exist → essential for human existence Arguing against brain death: persistent vegetative state brain stem is damaged without affecting the reticular formation (important for switch on and off consciousness) and closed to a machine responsible for sustention of consciousness Locked in syndrome: spinal cord severely damaged just beneath the brain stem, involving a total paralysation and therefor dysfunction of the body. Person is still completely conscious
Describe the capability to health approach! How this approach differs from alternative approaches?
CH: Right to be healthy, not only right of health care ● 4 factors: biological needs, individual behavior, physical environment, social conditions ● injustice: when people suffer impairments, which are preventable ● difficult to change biological need & behavior ● you can change physical environment & social conditions in order to improve health ● you have to think about which of these factors is maybe changeable? ● Human fulfilment is the ultimate goal→ "capability approach" ● Differences (alternative deontologically "das Erforderliche, das Gesollte") ● Subdivision in factors which maybe help to solve the problem of lacking resources because we can specify the problems
What are the current possibilities of genetic enhancement? Describe some examples!
Can enhance athletes Can stop obesity Supermouse: could run for up to six hours at speed of 20 m/min before needing break Ate 60% more but was fitter and leaner and had ability to give birth up to 3 years old ( equivalent to 80 h.y)
Characterize clinical trials! What are the main ethical issues in clinical trials?
Clinical trials a. use of patients as research subjects and normally employs the classic research method (=randomized clinical trial, RCT) b. Patients are randomly allocated to a control (→ standard treatment/placebo) and an experimental group (→ product to be tested) c. Double blind RCT → neither researcher nor research subject knows which group any patient is assigned to d. placebo → patient may be placed at unacceptable risk by taken off their current medication e. alternative treatment → researchers should be genuinely uncertain of the comparative effectiveness of the medication being trialed (=clinical equipoise) → difficult to be sure that this uncertainty exists
What is communitarism? What are the strong and weak features of this approach? What are the main features of libertarianism?
Communitarism is about whether the actions and decisions of individuals ensure the good of society. The individual will must be subservient to the general will and indeed, a person's own good can be served only when the good of society is also served. The strong features are that it points out that we are not isolated individuals, each living in a world of our own. The weak features are that it can be easily abused and led to totalitarianism and tyranny. Libertarianism is the opposite of communitarianism. It stresses the freedom of the individual from social control, and utts strict limits on the extent to which the state or society can encroach upon the choices and decisions of individuals.
What are the main objections against the use of assisted reproduction?
Conservative: - AR separates sex and reproduction - AR radically alters tradtional relationship Feminist: - AR will reinforce and promote sexism - Adds to men's power over women
How many spheres of justice there are? Please describe them!
Criminal justice: ensures fairness and impartiality in defining and dealing with crimes and in punishing offenders Civil justice: arbitrates in disputes between people or institutions on such matters as finance, property and contracts Social justice: which seeks a balance between the rights of the individual and the welfare of society as a whole Distributive justice: deals with fair distribution of burdens and benefts in society
What are the main shortcomings of utilitarian theory?
It sometimes sanctions injustice and violations of rights. It may be inconsistent with our common moral consciousness. It is also too demanding. Utilitarianism cannot maintain a social distinction between morally obligatory actions ( those required by moral obligations) and supererogatory actions ( those above call of moral obligation and done from personal ideals).
Why the distinction between germline therapy and somatic therapy is not always clear-cut?
It's conceivable that cells introduced into the body in the course of somatic therapy could recombine with other viruses and infect germ cells Further, somatic therapy leads to a greater concentration of mutant gene in gene pool, through allowing patients who would otherwise die to survive and reproduce Thus, while germline therapy is conceived as of changing gene pool directly, somatic therapy could have indirect effect
What are the main characteristics of Kantian theory? How Kantian theory differs from utilitarianism?
Kantian theory aka duty ethics says that an action is right if and only if it is in accordance with a correct moral rule or principle. It differs from utilitarianism because it says that morality is based on duties, not consequences.
What is the difference between killing and letting to die? Is there a moral difference between them?
Killing= euthanasia Letting die = assisted suicide. No moral difference between them.
What are the fundamental values that guide medical practice according to the model of shared decision making?
Two fundamental concepts: promoting patient's well-being and respecting his or her self-determination
What are the main characteristics of utilitarian theory?
Utilitarianism is a consequentialist ethical theory which asserts that actions are right or wrong according to their consequences, rather than because of any intrinsic feature they may have, such as truthfulness or fidelity. In essence, what makes an action morally right or wrong is the toal good or evil it produces. Principle of Utility (PU) is principle that actins are right in proportion to promote happiness and wrong if produce opposite of happiness.
What is moral difference between somatic and germline gene therapy?
Somatic: Only affects that individual who has consented to it Germline: Affects future generations who have not consented
How ethically questionable research has shaped ethical norms in research?
- German and Japanese experimented on human subjects during WWII - The Doctor's Trial: the first of 12 trials for war crimes that US authorities held in their occupation zone in Nuremberg -This led to Nuremberg Code: 10 points defining legitimate medical research - Absolute need for consent - Justification in terms of potential results - Proper design and previous animal experiments - Avoidance of unnecessary physical and mental suffering and injury - Conduct of experiment by scientifically qualified people - Termination of experiment if it becomes clear that harm will result or if subject wishes to bring it to an end - In 1942, Luftwaffe conducted experiments to learn how to treat hypothermia - Unit 781 was covert biological and chemical warfare research and development unit of imperial japanese army - Vivisection of living people - Prisoners had limbs amputated and reattached to other parts of body - Parts of body frozen and thawed to study resulting untreated gangrene - Injected with strains of diseases, disguised as vaccines, to study effects
What is the practical impact of the ethical arguments on animal research?
- monitor animal care and use & to inspect facilities - Standards for adequate veterinary care - Control and minimization of pain and suffering - No paralytics are to be used without anaesthetics - Alternatives to painful procedures must be considered
What are the main concerns about identity that are raised by gene therapy?
1) Whether or not the future person has grievances about that change, an identity change is wrong in itself. This is because there is a right not to have an identity-changing intervention and one can see it as killing the "original" person. 2) Another concern is that what's important is a person's perception of their identity rather than the identity. This is expressed by disability rights organizations who fear that eliminating or curing genetic conditions can lead to a society that is intolerant of disability. They also point out that for some, their identity is dependent on their genetic condition. For many in the deaf community, Deaf culture is very important to them and they dislike doctors curing deafness as they see it as trying to eradicate their culture.
What are the main principles of just health care? Are all of them equally defensible?
1) equal share - e.g. don't know if everyone shares fairly. Maybe there are people whose individual choices are not fair to everyone? 2) according to individual choice - e.g old lady decides that she lived enough-discrimination 3) according to what they deserve - e.g who deserve diabetes? 4) according to their social usefulness - e.g. people with intellectual impairment 5) according to their needs - why do rich people need better health care 6) according to potential for future life years 2 principles: one based on utility & other one based on needs and rights ● all individuals should have the hope of well being Utility: but individual should be subordinated the welfare of majority ● groups which do more for general welfare of society, get more ● Problem: state would not pay for people who are e.g. intellectually disabled ● priority for young healthy people on cost of old ill people ➔ brutal, inhumane Alternative deontologically: every human is equal and treated equal → everyone should get what he needs in order to be healthy
Should donors be allowed to donate conditionally?
Suppose, there's a possibility for a donor to indicate special conditions under which his/her organs can be used ( if recipient is Jewish, woman, man, etc) Should donors be allowed to donate conditionally?
Are markets on organs unnecessary unethical?
Are markets in organs necessary and unethical? People have rights to make decisions about their body even if they cause harm to themselves. How can we justify the ban on selling their organs as soon as the decision is freely made?
Is the demand for consent for donation justified?
An organ may save someone's life. Removing an organ from someone after their death does them no harm Saving someone's life should take precedence over whatever interest a person can have over how their body is used after their death Therefore, even if a person doesn't want their organs to be used after their death it could be argued that this should not preclude the use of the organ However, we tend to think about our bodies as our property and we still have some say about how our property should be used after our death. But these rights are not absolute.
What is surrogacy? What are the main ethical issues raised by the use of this technology? What is your opinion on this issue?
A woman carries and delivers a child for another couple or person A fertilized egg is placed in another womans body for further development and birth, and then belongs to the biological parents Can also use their own eggs. Ethical: - Emotional difficult - Using the woman's own egg makes it easier to claim the right of the child - Questions like who is the real mother? Genetic and social aspects? - Legal rights to the child is not well protected, for example in a divorce - The child may have psychological and emotional problems (not feeling normal) - Promotes baby-selling - Psychological effect on the surrogate mother - Promotes the idea that the woman is the baby maker - Poor women will be employed and may accept the contract even though the risks - Promotes pronatalism- you need a child to have true quality of life Concerns regarding the contract: - How does the child really belong to? - If baby is abnormal in any way, is anyone mandatory to take care of it? - Unsuccessful birth, should the surrogate mom be paid? - Poor women accept the contract even if they put themselves in risk My opinion: problematic topic, good option for couples who can't make children themselves, but may cause the surrogate mother some problems. Important with good information about problems and legal issues.
What is AID? What are the main ethical issues raised by the use of this technology?
AID- Artificial Insemination Donor (sperm donation) - Placing sperm obtained from donor in uterus Negativ - Non-traditional way to do have kids, does it effect? May lead to secrecy and lies - Sperm can be donated at home, not checked for diseases like aids - genetic diseases could harm either woman or children - Sperm donation is anonymity, but does the kid has the right to know about its biological parent - Physicians have been caught using their own sperm without consent. - Parents can select children who meet certain criteria, such as freedom from genetic diseases or being a particular sex (not as good as with IVF, but still some possibilities) - Men might feel less attached to their children because they are not biological offspring Positive - For single woman and lesbians - Parents who fail to conceive can get pregnant
What are the main ethical issues raised by pre-birth testing?
Aim is to detect birth defects like downs, fragile x syndrome, or detect the sex Ethical issues: - prevent a disease is to prevent the birth: - Discrimination against people with disease (life with disease or disability is not worth living) - is it as wrong to kill foetus as it is to kill born persons? Moral question about abortion - tests may yield false or inexact results - selection against characteristics promoting designer babies - children have right to an open future, own liberties or conceptions of the good that are not intentionally limited by decisions and preferences of others - may reveal more information than wanted Positive: - quality of life - unnecessary suffering - life is better without diseases so why should we not prevent them
What are the current enhancements already widely used? Describe some examples!
Alcohol: mood enhancer Viagra: improve sexual performance Modafinil: eugeroic drug ( stimulating drug that doesn't cause peripheral effects or addiction/tolerance/abuse of traditional stimulants) Caffeine used to improve productivity Computers/Implants
What are the main objection against acceptance of cortical death?
Although many functions of brain may be lost, some brain activity can remain in patients who meet neurological criteria, e.g. hypothalamic function. Patients diagnosed with brain death can show physical growth, menstruate, and even gestate a fetus over a period of several months It may be ethical to withdraw organ support from patients who meet neurological criteria and it may also be ethical for them to donate their organs; however, this is because of their loss of consciousness and personhood, not because they are dead
It is argued that enhancement is self-defeating. Explain this objection! How one can respond to that claim.
Argument: Enhancement is self-defeating Ex; increase in height Everyone will try to enhance height of children and no one will have benefitted Aka positional goods: goods we value principally because they're markers of success compared with others or give us advantage over others Could have adverse social effects Response: Many enhancements will have significant non-positional qualities Intelligence is not only a positional good; it enables individual to process info more rapidly in life and to develop greater understanding of herself and others There may be adverse social effects but genetic enhancements are no different from other enhancements Additionally, could have important social benefits
How one can justify enhancement by claiming, that enhancement is not different from treating disease? How one can respond to that argument?
Argument: If we accept treatment and prevention of disease, should accept enhancement Moral obligation to benefit people that provides grounds for treating disease that also provides grounds to enhance people insofar as this increases chance of having better life Can increase people's opportunities for well-being " All purpose goods" : traits that are valuable regardless of what kind of life person chooses to live Response: Treatment and prevention of disease have more significant impact on well-eing than other enhancements and should have priority Health is different from other enhancements because it is a bounded good Once healthy, one cannot be more and more healthy ( compared to intelligence) We all suffer from various genetic predispositions to disease and we are all aging
How one can argue against enhancement by appealing to the precautionary principle? How one can respond to that argument?
Argument: Unwise to assume that we have sufficient knowledge to meddle biologically with human nature Could have unknown side effects Response: If confidence is justifiably high and benefits outweigh risks, we should enhance Risks will always be present
It is argued that enhancement is playing God and unnatural. How one might respond to that argument?
Argument: We shouldn't play God We shouldn't interfere with human nature Response: We do a lot of things routinely Screen embryos and fetuses for diseases Vaccinate Pain meds for women in labour Treat cancer/ give antibodies This interferes with nature since they were the one to give us those dangerous diseases When humans make decisions that improve lives by biological or other means, we show rationality and show that humans choose to be better
How one can argue for enhancement appealing to consistency? How one can respond to this argument?
Argument: We use education, diet and training to make our children better people and increase opportunities later in life Early experience can modify molecular interactions that regulate gene expression Genetic manipulations may be irreversible but so are environmental ( cannot unlearn how to play piano or ride bike) Response: Environmental enhancement is different from biological enhancement Altering someone's political beliefs through argument compared with drug First option, respects person and autonomy and beliefs remain her own Second method, brainwashing and fails to respect autonomy
It is argued that enhancement might lead to genetic discrimination. How one can respond to that objection?
Argument: Would benefit rich more than power Would take pay gap that divides our society and world and write it into biology Would result in two-class society of enhanced and unenhanced Response: Already is great genetic inequality Gifted children Allowing choice to change biology could be more egalitarian and allow ungifted to approach gifted It's possible to use enhancement to increase inequality but it's not a necessary outcome We have free will and sense of responsibility
How research community justifies the use of animals as experimental subjects? What are the main arguments deployed by defenders of animal research? How strong and persuasive are their arguments?
Arguments because of benefits: - Many significant results (new understanding of diseases, drugs, cures, vaccines, operative procedures) - Without animal use, it would been unobtainable Arguments against: - Link between premises and conclusion - Even if significant benefits have been gained and couldn't been achieved in other ways, doesn't mean its justified - Where's the difference to unwilling humans and we would have gained big benefits? - Big amount of researches who havnt gained any benefits, what about them? ● To be able to defeat the argument is to find morally relevant differences between humans and animals ● Once can also argue that the same results and benefits may have been achieved in other ways (extremely hard to prove it) Carl Cohen - Only beings who have rights, can be said to have sufficient moral status and be protected from invasive use in research - animals cant respond to moral claims → cant be right-bearers & protected from this type of use - Humans are rational and right arises only among rational beings Problems with his thoughts: - even if the concept of a right arises among rational beings (humans), doenst have to mean that it is limited only to humans couldn't be extended to other morally relevant features - He also means that marginal humans belong to a kind that is rational, while animals don't - Then we could argue that in fact, both humans and animals belong to the same kind, animals! Neo-Cartesian - Argue that scientific ideology is correct and animals are incapable of pain, suffering and other morally relevant mental states, for questions that claim that what we do to animals matters to them ● Lot of proof exists for those who think animals are "machines" ● →Humans: evolutionary miracles with able to feel pain and have other modes of awareness ● neurophysiological, neurochemical and behaviour evidence that animals feel pain ● Lots of scientific research would be vitiated (spoil or impair of quality) if animals were just machines without awareness and able to feel pain. Carruthers "Morality is a set of rules derived from what rational beings (humans) would rationally choose to govern their interactions with one another in a sicail environment, if giver a chance to do so." - animals aren't rational, they are excluded from moral status necessary to question the moral legitimacy of experimentation on them - Only reason to worry about animals wellbeing is because some people ephatise with animals Peter Singer - Utilitarian - Might be justified if it's the case that these results benefit a large number of humans and that outcome could be attained in no other way Frey - Utilitarian approach - Animals are equivalent to humans (experiments on humans morally wrong - same with animals) - Animals might have even richer and more complex lived than many marginal humans do
What is distributive justice? How it is relevant in health care? Explain the paradox of health care!
Distributive justice: fairness in the distribution of rights and benefits possibility to extend life pretty long → high expectations in medicine older people more chronic diseases → high costs older people more cognitive illnesses eg. Alzheimer's disease, costs increase "diseases of affluence" diabetes, obesity, heart disease Paradox of health care: ● modern medicine has been a victim of its own success ● very good health care supply in some countries but very expensive ● could make many people healthier instead → Effective health care makes people less satisfied and less healthy
What is the doctrine of double effect? How the doctrine is relevant in the discussions about treating pain of terminal patients?
Doctrine of double effect: first action can be morally permissible whereas the latter is morally prohibited. Ex: giving dying patients massive amounts of pain relief that will end their life faster is okay considering the amount of pain they're in
What is epidemiological research? What are the main ethical issues in epidemiological research?
Epidemiological research a. Trusted third parties → who code the data and provide it in this form of those who are studying the associations with other data
What the terms "ethics" and "morality" mean? What is moral philosophy?
Ethics is a word derived from Greek and means custom or habit. Morality is a word derived from Latin and has the same meaning as Greek ' ethos'. Moral philosophy refers to the philosophical reflection on morality's nature and function. The purpose of such theory is to introduce clarity, substance and precision of argument into the domain of morality.
How assisted suicide differs from euthanasia? Is there any ethical difference between them?
Euthanasia "mercy killing", done for the sake of the killed persons good It intentionally ending a life in order to relive pain and suffering It involves someone doing something to bring about another's death with intention of death - Lethal injections - Give medicine/don't give medicine - Switch of machines Assisted suicide: someone helping another person commit suicide Main difference: action of suicide is committed entirely by the person who is killing him or herself Ethical differences: ● Can claim that euthanasia devalues (reduced value) human life, because a person is killing actively or passively another person ● In some states euthanasia is second degree murder, and AS is second degree manslaughter (less than murder) ● AS - more self-autonomy than euthanasia → a bit more dignity to the person ● physicians and other medical care people should not be involved in directly and actively causing death of a patient (job: saving lives and not ending it) ● BUT: patient has the right of self-autonomy and die in dignity ● Sometimes it just makes a technical difference (injection by person itself or doctor) →main difference might be for relatives& people who conduct it (they technically killed someone)
How hypothetical imperatives differ from the categorical imperative? What is the role of the categorical imperative in Kantian theory?
Hypothetical imperative lays down the requirements for achieving some desired end. Categorical imperative requires unconditional obedience and overrides our preferences and desires. According to Kant, it doesn't depend on your having certain desires at all but solely on knowing your duty and following it, no matter the consequences.
Why it would be wrong to choose not to enhance? How one might respond to this argument for the enhancement?
Example: Neglectful Parents give birth to a child with special genetic condition, Intellectual Sensitivity. Child has stunning intellect but is sensitive to the environment. Needs a simple, readily-available, cheap dietary supplement to sustain intellect. Parents neglect the diet of their child and result in the child becoming normal. This is wrongful neglect. Conservative parents have child with normal intellect. Drug becomes available that targets the genome of a child which results in Intellectual Sensitivity. If they were to give this drug and introduce the same dietary supplement, child's intellect would rise to stunning level. Parents object to genetic modification. CP are as bad as NP because of same consequence: normal child. Response: Moral difference between failing to maintain state of affairs and failing to bring about a better state of affairs Difference between interventions such as diet, and genetic interventions
Why the concept of "extraordinary treatment" is rejected in the decisions about lifesupport?
Extraordinary treatment is treatment that is excessively burdensome or without benefit for patient. It doesn't produce sufficient benefits to outweigh its burdens.
How the concept of futile treatment is defined? What is physiological, quantitative and evaluative futility? What are the main issues in defining the concept of futile treatment?
Futile treatment is treatment that patient's physicians would be futile but that patient or families of patients insist on. Physiological futility: covers treatment that is known with highest medical certainty not to produce physiological effect in patient for which patient or family wants it Quantitative futility: when there is only a very low probability, no more than 1%, of a treatment having hoped-for effect Evaluative futility: treatment that it is agreed is likely to have a particular physiological effect in patient but there is disagreement over whether effect is a benefit for, or would be wanted by, the patient Main issues in defining: How to restrict physician's right to provide futile treatment to relatively uncontroversial cases, like physiological futility, and prevent their denial of patient's or families' right to make treatment according to their own values.
What is genetic research? What are the main ethical issues in genetic research?
Genetic research a. relates not just to the person whose genes are studied, but also to the family b. Genetic exceptionalism: i. Family members informed? ii. Fed back to research participants? iii. Clinical significance? Pass information? iv. Safeguarding of information? v. False generalizations?
Should nuclear replacement be characterized as somatic of germline therapy?
Germline therapy since it targets the reproductive cells
What conception of death is defended by J. McMahan. How he justifies his position?
He defends cardio-pulmonary criterion of death since we cannot know at what point consciousness is lost. Additionally since corpses can show physical growth, menstruate and gestate a fetus, brain death isn't death.
Please characterize the differences between hedonistic, pluralistic and preference utilitarianism.
Hedonistic = Utility is understood in terms of pleasure. Pluralistic = there are many goods that have to be involved in utilitarian calculus and not just pleasure but friendship, knowledge, health, courage, beauty, etc Preference = utility needs to be analyzed in terms of an individual's actual preferences, rather than in terms of intrinsically valuable experiences. All are utilitarianistic theories but differ in the way about how utility should be understood in formulation of PU.
What is IVF? What are the main ethical issues raised by the use of this technology?
IVF: in vitro fertilization - fertility treatment in which sperm and eggs are combined in a laboratory outside the body, in vitro. fertilised egg + a few cell multiplications → inserted back into the woman's uterus - way how to detour around blocked or damaged fallopian tubes (uterus tubes) - major treatment for infertility when other methods of assisted reproductive technology have failed. Ethical: - costs a lot, some countries cover it by insurance system - risky for woman to extract egg - if an embryo has defect, its discarded (murder?) - risk for ectopic pregnancy (foetus develop outside the uterus) - can be both physically and mentally hard on woman, since many that try to give birth by IVF do not achieve this goal - overpopulation?
Describe the main accounts of moral status of embryo (identity as a human organism, the potential to be a person, identity as a person, conferred status). What are the most important shortcomings of each account?
Identity as a human organism: there are no good reasons to accord different moral status to human being at different stages in its development. At throughout cycle of life, it is the same being or entity, the moral status of being stays the same. Therefore, if it is wrong to kill the child, it is wrong to kill the fetus. Moment embryo attains full moral status as conception. An individual cannot be said to exist until the potential of twinning is lost. The potential to be a person: killing an embryo is killing a potential child. ' future of value' argument: killing aperson is wrong because it's cutting short a valuable future. Identity as person: moral status of embryo depends on its actual properties. It's wrong to kill a person but a embryo is not a person. What determines stage during development when human organism becomes a person? Being a person must involve some degree of consciousness - ability to feel pain, etc (24 weeks). Being a person must involve self-consciousness - a creature's ability to reflect on its own mental states, to be aware of itself as a being with past, present and future, etc. Killing a self-conscious being is wrong because it involves frustation of desires that the being has for its own future. Conferred Status: moral states need not be based only on intrinsic properties of entity but can be conferred by others. At birth, infant takes on important social role and that justifies conferring moral status. Therefore, a strong prohibition on killing infants is justified and because the fetus has not yet been accepted as member of society, nor granted social standing, it would be acceptable to terminate pregnancy Shortcomings: Identity of human organism: implies that killing one cell or few cells is as bad as killing a 10 year old child and that post-coital conception is wrong Potential to be a person: contraception and sexual abstinence is wrong Identity as person: infants are not self-conscious. Does that mean that infanticide doesn't differ from abortion? There is no consensus about what features characterizes a person. Conferred Status: justifies our intuitions about wrongness of killing infants, but for seemingly wrong reasons.
What is the difference between micro-, meso- and macro-allocation? Please, characterize each level of allocation!
In regard to health economics: Micro ● on a much smaller scale, who gets the treatment and who doesn't, when not possible for everyone ● e.g.: an expensive antibody treatment for multiple sclerosis could halt disease progression in one patient, but for the same price, 5 patients with hydrocephalus could be treated. Meso ● The distribution of resources among different health providers ● Concerned with how the total resources available for health are distributed among different services and pacient group ● E.g.: hospitals, long care facilities, rehabilitation and so on. Macro ● The amount of resources (or money) that the health sector of a country will get, compared to defense, transportation and so on.
What is informed consent? What are the main elements or conditions of informed consent?
Informed consent: permission granted in full knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits Main elements: Competent Must understand information disclosed to them and appreciate its significance Must give consent freely
What are the main shortcomings of Kantian moral theory?
It seems to promise too much by way or moral certainty. Is our duty really always as clear as suggested? Also, duties conflict at times and not all of them can be met in some examples. He also expects us to only use reason and not to let our feelings lead us astray. Requiring this logical reasoning is asking too much and too little of us.
What are the main means to promote procreative liberty?
This can be achieved by: Contraception, sterilization or termination of pregnancy ( abortion) Assisted reproduction ( IVF, etc) Genomic or other testing of embryo or fetus for disease or non-disease states
Describe J. Rawls' approach to distributive justice! How N. Daniels applies Rawlsian approach to health care?
Liberty Principle: "each person has an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all" Difference Principle: "social and economic inequalities are to be arranged so that they are both- to the greatest benefit of the least advantaged and attached to offices and positions open to all under conditions of fair equality of opportunity" ● For him justice doesn't requires equal share of resources ● But people have an equal opportunity to improve their situation ● He does concede that attention should be paid to improving the lot of those most disadvantaged by the social and economical differences ● Differences in income are inevitable ● Justice only requires equal opportunity, not equal share → maximin principle ➔ So not exploring the poorest in order to make the rich richer ● Doesn't take health status in consideration Pro: attention paid to most disadvantaged people by social economic differences Con: how should this work in practice when we don't have enough resources for everyone? N. Daniels applies: "people have right to those healthcare care interventions that that help them pursue the 'normal opportunity range'(according to age/degree of persons disability)
Describe the main types of solid organ donation!
Living donation: living patient consents to donate a single non-critical organ ( or part of organ). - Living related: donation to family member - Living unrelated: donation to non-family member Deceased organ donation: donation after death ( often multiple organs) - Donation after brain death: death diagnosed on basis of neurological criteria - Donation after circulatory death: death diagnosed on basis of circulatory criteria, most commonly after withdrawal of mechanical ventilation
What are the claims of transhumanist movement? How this movement has been criticized?
Looks toward a "posthuman" future, when humans will have perfected their physical and mental abilities with the aid of nanotechnology and artificial intelligence ● creating a perfectly engineered world of human contentment Critic: - Current evidence for effective enhancement of human capacities is very sparse (dürftig) - Questions about whether making people more content, or less aggressive, or more altruistic, by means of drugs is in any sense a moral gain, since these states of mind, rather than being authentic commitments of the person, are simply a form of chemical coercion (Zwang) - Enhancement → in what sense of "better" are these changes to human capacities
Describe the main elements of disclosure that are necessary for informed consent!
Nature of Procedure: Diagnostic or therapeutic If invasive: what part of body will be entered and how What effect on body part Anesthetic, blood transfusion or X-ray needed? How long procedure will take Where it will be carried out Is procedure experimental? Risks of Procedure: Kind of Risk they face How likely those risks are What effects will be When effects will occur Alternatives to Procedure What alternatives are there? Ex: women have not always been advised of alternative, less disfiguring approaches to breast cancer than radical mastectomy Benefits of Procedure: Spell out benefits so they can weigh pros and cons Especially if experimental
What social values promote assisted reproduction?
Need to have one's own bio children Women unfulfilled unless they have kids
Describe the main principles of resource allocation!
No value-free medical criteria for allocation 1. insufficient (ignore morally relevant considerations) could form part of an acceptable multiprinciple system 2.Flawed feilaktig (recognize morally irrelevant considerations) Categories: 1. treating people equally: by lottery - been used in military conscription, education - prevent small differences from drastically affecting outcome - each person's desire to stay alive should be regarded as of the same importance - is quick and requires little knowledge about recipients - resists corruption Lotteries are blind to many seemingly relevant factors Treating people equally often fails to treat them as equals first come, first saved Sometimes used in distribution of beds in intensive care units or organs for transplant - ignores relevant differences between people - in practice fails to treat people equally - queues are vulnerable to corruption - allows morally irrelevant qualities to decide who receives scarce interventions (wealth, power, connections) 2. favouring the worst-off sickest first - allocation on how sick someone is at the current time, a morally arbitrary factor in genuine scarcity - even if the sickest person will probably day and someone else could be safed - ignores post-treatment prognosis. youngest first - not favouritism - ignores prognosis - categorically excludes older people - insufficient principle 3. maximizing benefits save the most lives - avoids comparing individual lived - some lives are shorter than others, some lives can be extended longer than others - principle is insufficient Prognosis or life-years - aims to save the most life-years - living more years is valuable - limitations: unable to consider distribution and quantity - the principle is relevant but insufficient alone 4. social usefulness instrumental value - prioritizes specific individuals to enable or encourage future usefulness - responsibility allocation (to people who agree to improve their health& thus use fewer resources) - necessarily insufficies, derives its appeal form promoting other values (such as saving more lives) - people disagree about usefulness reciprocity (gjensidighet) - backward looking- rewards past usefulness or sacrifice - justice as reciprocity calls for providing something in return for contributions people have made - might potentially require time-consuming, intrusive and demeaning inquires - does not have future-directed appeal of promoting important health values
Describe the difference between normative and non-normative approaches in moral philosophy!
Non-normative approaches don't recommend any particular set of values or principles. It is merely philosophical analysis of some problems that are related to ethics. Normative approaches are a philosophical attempt to formulate and defend basic moral principles and standards of virtue.
What is nuclear replacement? What is the purpose of this treatment?
Nuclear replacement: where nucleus is removed from woman's egg and transferred to a donor egg from which nucleus has been removed This is to get rid of any disease in the mitochondrial DNA that is passed from the mother to her children
Describe the opt-out and opt-in systems. What are the main reasons for or against acceptance of each system?
Opt-in system: patients become organ donors through active decision during life ( or by family after death) Opt-out system: patients become organ donors if they are eligible to do so unless they have made active decision that they don't wish to donate organs ( presumed consent) For opt-out? Data suggests that countries with opt-in system, many people who would have wanted to donate do not end up donating Countries with opt-out systems have higher donation rates on average Approaching families to agree to organ donation places extra burden on them to make a decision at extremely stressful time There are different forms of opt-out system - for example, in a soft opt-out system, families are still asked about organ donation Against opt-out? Some patients don't wish to donate their organs. However, they may not get around to opt-out during life There's no clear evidence that an opt-out system itself inc donation rates Countries with opt-ut systems often have pursued other measures to increase donation so it's not clear which factor causes higher donation. Some countries with opt-out system have low donation rates Change to an opt-out system might lead to backlash, with paradoxical reduced rates of consent to donation If families are asked about donation anyway, there may not be any advantage of an opt-out process Relaxed Consent: Even in opt-in systems, consent for organ donation is typically less stringent than consent for surgery during life Can become an OD by signing up on website or ticking form on a DL application Is there a good justification for this difference? Unlike procedures performed during life, donation of organs after death doesn't have any side-efffects and cannot harm the donor More stringent consent rules would likely reduce the number of donors and harm those in need of organs In majority of cases, patients have to make a decision about organ donation a long time in advance, while actual chance of donation is very small
How passive euthanasia differs from active euthanasia? How voluntary euthanasia differs from non-voluntary euthanasia?
Passive: someone allowing( by acting or omitting an action) someone to die Active: someone inducing someone's death ( by injecting death-causing drug) Voluntary: willed by party who is either killed/let die Involuntary: killing or letting die takes place when person who is killed or let die has not willed it but also has not ruled it out
Should registered organ donors receive priority?
Patients can be eligible to receive organs, even if, in different circumstances, they would not be prepared to donate organs. This seems hypocritical Should people who have been on the organ donor register get higher priority for organs?
What are the main problems in public health ethics (preventive medicine and health promotion)?
Preventive medicine: screening, vaccination and immunization, pandemic control ● Problem of screening: false positives, false negatives, inaccurate predictions (most screening should be optional) ● Problem of vaccination: does not guarantee immunity ● Ethical issue: mandatory or voluntary? May cause discomfort, serious side effects, conflict between individual choice and community benefit. → herd immunity ● Problem of pandemic control: people's freedom may be restricted. ● Dilemma: to know how high the likelihood of harm should be in order to trigger such restrictions and what degree of restriction on freedom is justified by it. Health promotion: effort to achieve healthier behavior in individuals and population ● One child policy in china: extreme form of coercion to achieve social goals, resulted in an imbalance between males and females, increased infanticide and abortions. ● Advertising techniques: seek to change behavior. People are not given a chance to make a considered decision. ● Dilemma: we may need to use the force of advertising or of the law to ensure a maximization of the public good.
What are the main arguments pro and contra legalization of euthanasia or assisted suicide?
Pro: - person can end his suffering and is not a prisoner of his life - person decides by himself if he/she wants to die (no pressure for relatives) - provides a way to relieve extreme pain, or low life quality Contra: - can become a business (easier to end somebody's life (coma) → health system saves money) - we don't know how people in come feel, don't give them the opportunity to fight till the end - religious component: are we doing God's work? - physicians and other medical care people should not be involved in directly causing death
Describe the main account of procreative choice (procreative autonomy, procreative beneficence, the interests of the future child, the interests of the state, preserving life).
Procreative autonomy: emphasis on the value or rights of adults to make their own reproductive choices. The state or professional interference should be kept to a minimum and exercised only in extreme situations. Procreative beneficence: couples have moral obligation to make reproductive choices that will maximize welfare of children they conceive. Parents should select the best child of the possible children they could have Interests of the future child: if not conceived, the child would not be born. Therefore, it's in the interests of that child to be born Interests of the State: reproductive choices affect composition of future population. The state therefore has an interest in our reproductive choices. Some choices may be very costly for society. Preserving life: reproductive choice should not be enabled through killing an already existing fetus or embryo
What standards of disclosure have been (or are) used to obtain informed consent from patients? Please describe their strong and weak points!
Professional practice standard: what any health care practitioner would do under similar circumstances Strong points To do any less is tantamount to negligence Weak points Professional standards of disclosure were set too low to satisfy patient demand for information No agreed standards for new procedures Patients were put at significant disadvantage in having to rely on expert witnesses in disputes about standards of care Reasonable person standard: what any reasonable patient would consider it material to know Strong points Health care had to explain to patient more about risks/gains and make a greater greater to get patients to participate in decision-making about their own health care Weak Points Practitioners have had to disclose whatever the patient might consider material
Describe the difference between quantitative and qualitative hedonism!
Quantitative hedonism= the right action is one that maximizes pleasure and minimizes pain, Qualitative hedonism = there are different levels of pleasure, meaning some will be better than others.
What are the main issues about resource allocation raised by gene therapy?
Reinforcement of differences between wealthy and poor by enabling wealthy to acquire better genes
Describe the main resource allocation systems!
Resource allocation system (RAS) ● any set of rules that allows fair allocations to be made to people who need extra support ● works by connecting a particular level of need with a particular level of money ● idea that rules can be used to make fair allocations resources in not new ● Combining principles into systems is inevitable if allocations are to incorporate the complexity of our moral values (though it will increase complexity and controversy) For example: Quality adjusted life-years - calculation of the number of years of life to be gained by the intervention multiplied by the fraction of quality of those years: Two basic elements: 1) Outcome measure that considers the quality of life-years (QALY) young man has better outcome to live a long and productive life, instead of an old woman. 2) Maximizing assumption The system incorporates five principles: 1) youngest first 2) prognosis 3) save the most lives 4) lottery 5) instrumental value → prioritizes younger people who havn't yet lived a complete life& will be unlikely to do so without aid
What are the basic requirements described in the most ethics codes of research ethics? Please describe them!
Respect for the autonomy, privacy and dignity of individuals and communities ● Psychologists value the dignity and worth of all persons equally ● sensitivity to the dynamics of perceived authority or influence over others ● with particular regard to people's rights including those of privacy and self-determination Scientific integrity ● Research should be designed, reviewed and conducted in a way that ensures its quality, integrity and contribution to the development of knowledge and understanding Social responsibility ● Discipline of psychology (science and profession) exists within the context of human society ● → shared collective duty for the welfare of human and non-human beings, (within the societies in which psychology researchers live and work & beyond them) must be acknowledged by those conduction the research Maximizing benefit and minimizing harm In accordance with Ethics Principle 3: Responsibility of the Code of Ethics and Conduct → psychologists should consider all research from the standpoint of the research participants (aim of avoiding potential risks to psychological well-being, mental health, personal values, ...)
What are "savior siblings"? What are ethical problems raised by creating "savior sibilings"?
Savior Siblings Tissue typing is combined with preimplantation diagnosis to select embryo with a view to a future transplant to help an existing child Ethical issues: Reproductive autonomy has limits which are set by considerations relating to interests of future children If we can select against genetic disorder, can others select for it?
What is "scientific ideology"? How scientific ideology has buttressed the denial of ethics in science.
Scientists until the middle of 1980 said: "animals use is not a moral issue, it's a scientific necessity" - primary reason for researchers that takes such a position - set of assumptions that's to nascent scientists as facts rather than datable assumptions - many researchers were convinced that etichs is simply emotions - almost became a universal adherence among scientist that science was "value-free" and could not and did not deal with ethical issues in science - statement "one should allow into science only what is intersubjectively observable"
What are the main technologies of sex selection? What are the main arguments against sex selection?
Sex selection: attempt to control the sex of the offspring to achieve a desired sex. Technologies: Infanticide - simplest, most effective, most morally problematic form of sex selection - Killing of undesired sex after birth Prenatal diagnosis and abortion - determining of sex of the child and then abort the foetus if its not desired sex - Prevalent in India, China where male as first child has high value Preimplantation genetic diagnosis and embryo selection - examination of the in-vitro fertilised embryo before implantation in the uterus - Can test for genetic abnormalities and determining of the sex Sperm sorting - before fertilisation, by whether they are X chromosome bearing or Y chromosome bearing - If this is done successfully, then the sperm can be used in artificial insemination or in vitro fertilization to help ensure that any resulting child will be of the desired sex. Main arguments agains sex selection: Sex-ration imbalance- often valued to have males as first child Sexist motivation- preference for males over females is a manifestation of sexism.
Characterize the four principles approach! Compare this approach to utilitarianism and deontological ethics!
The first principle is respect for autonomy. People are free to act according to their personal values and beliefs, provided this does not cause harm to others. The second and third principle are non-maleficience and beneficience. Non-maleficience means do no harm. Beneficience stresses that not only should we not do any harm, we should actively prevent harm to them, to remove that which is harmful, to counterbalance any harm with benefit, and actively to promote their well-being. The final principle is justice. We need to treat all people equally as well as distribute the benefits and costs fairly.
What are the main problems that utilitarianism must face? How these problems can be solved?
The main problems that utiliarianism faces is: " What is the right thing to do? What makes an action morally right? Whether one should focus on outcome only? Or to the fact that the action is of a particular type( helping a friend, stealing, killing, etc)?" It solves these problems by saying that an action is right if and only if it promotes the best consequences. The best consequences are those in which happiness are maximized.
What are the main issues in using animals in research? Describe the welfarist approach on the use of animals in scientific research!
The use of animals a. No moral right to treat animals only as means to our own ends (=speciesism) → see animals as worthy of respect and compassion as any other living creatures? b. Utilitarian calculus of happiness can see the suffering of animal as relevant to the need to maximize happiness and minimize pain in this world c. Welfarist approach: seeks to minimize both the suffering inflicted on animals in medical research and the number of animals used i. 4 R's: respect, reduction, refinement, replacement
How therapy differs from enhancement? How they differ morally?
Therapy: treatment of disease Enhancement: employment of therapeutic techniques for purposes that go beyond therapy and introduce improvement In engaging in enhancement we might be losing something that is essentially human Designer babies: enhancing children to suit their whims and high expectations
How virtue ethics is relevant for bioethics? What are the main limitations of virtue ethics?
There are several ways in which VE can be related to bioethics. Most frequent way is the virtous practitioner which is a health professional whom patients can trust and who provides a good role model for students and trainees. It also emphasizes on the whole moral life and not just incidents of moral choice and dilemma. The main limitations are that it can be elitist and utopian. Additionally, its account of virtues and vices can seem very culturally relative.
What are the main features if virtue ethics? How virtue ethics differs from utilitarianism and deontological ethics?
Virtue ethics attempts to blend reason and emotions. It attempts to base ethics on the essential elements of human nature. All of the virtues are characterized by the golden mean, a proper balance between deficiency and excess. Example, courage is a moral virtue and its corresponding vices are cowardice ( deficiency) and rashness ( excess). To answer question of how I should live, VE explains self-fulfillment that our lives have been worthwhile and have brought some goodness into lives of others. Virtue ethics is a mix of utilitarianism and DE.
When there is no requirement to obtain informed consent? How these exceptions are justified?
Waiver When patient wishes to waive disclosure of information While there are some issues with this as a doctor could manipulate the patient into using one of these, these are very valuable for those patients who are anxious, depressed or even confused when they have to make decisions about their health care. Therapeutic Privilege when a doctor may withhold information that would otherwise have to be disclosed if it's judged that disclosure could lead to harm to a patient. This is justified since some patients can become so ill or emotionally distraught on discovering that information that they cannot make a rational decision. Emergency patients will sometimes not be competent to consent to any procedure; in others, there isn't enough time for the patient to gain the understanding and significance in order to gain informed consent. It is also pointed out that reasonable patients would want to be provided with treatment in emergencies and especially if they are dying or seriously injured.
What are the consequences for vital organ donation if we abandon the neurological criteria of death determination?
We lose a lot of organ donors Lots of people in vegetative states and more hospital beds used
How gene therapy is defined by the Human Genome Organization Ethics Committee?
experimental technique that uses genes to treat or prevent diseases Prevention of disases through the addition and expression of genetic material promising treatment option for a number of disases Methods: normal gene is inserted into nonspecific location within the genome to replace a non-functional gene Abnormal gene is swapped for normal one through homologous recombination (DNA crossover) Irregular gene is repaired by selective reverse mutation, which resotres normal functionality Mechanism that turns the affected gene on and off is regulated to get the desired results
Please, describe, what are the main problems at the micro level?
health care rationing ● who gets the treatment when there is not enough for everyone? ● "good, cheap, quick repairs" ● any two of these are possible, but not all three ● normally everyone should get a treatment which is quick, cheap and good ● not able to do this, so we only get "good and cheap", and waiting list ● 3 problems: queue jumping, deciding of length of wait, risk that someone dies before get treatment
What is brain death? Why it is considered to be a good definition of death? Why brain death has replaced the irreversible cessation of cardiopulmonary functioning as the accepted criterion of death?
irreversible cessation (the fact or process of ending or being brought to an end) of functioning in the brain as a whole. ● The definition nowadays is accepted by the vast majority that brain death includes 2 concepts of death: 1.The cessation of existence as a conscious being, the person 2.Biological death This underlies the assumption that as soon as the body ceases its function, the person cease to exists, too. Is seems that both dimensions of death are captured ● Brain death is equivalent to them, good criterion, because the brain is the center of consciousness and therefore once its dead, the person can be called gone too ● Biological death when brain as whole is dead ● → no longer any internally integrated functioning of the organism. ● Good definition ● practical advantages ● captures both dimensions of death: the ceasing to exist of the person and the biological death of the human organism ● locked in syndrome - there is no regulation possible, but the person is still considered to be alive because she can breath indepetant(sometimes people are considered to be dead because life-saving-machines keeping them alive) ● Definition of cardiac arrest is outdated: A person could not be reanimated according to this definition
Please, describe the main problems at the meso level! What is the inverse care law?
most countries use most of their money on acute incidents ➔ Not preventive ● easier to prevent something in earlier stages, even if this seems to cost more money & resources →beneficially in long term ● Healt care & commercial industries have differents interests (smoking, cheap food and alcohol) ● Industries: making money and don't care about health of consumers/ humanity ● Inverse care law: The availability of good medical care tends to vary inversely with the neeed of the population served. Developed by Tudor Hart. ● American zip code: richer regions are popular for good medical practitioners to settle down and also work ➔ better health care for people living in these areas ➔ people in poor regions are the once in most need for good heath care, receves not good health care offer ➔ When they don't get good help, people who are sick avoid seeking medical help for their condition → evil circle From Bia: → Sector of medical care absorb a massive proportion of the overall budget → Unfair distribution of resources → Commercial interests behind the promotion of heath-hazardous products
Why is ethics important in research?
product human conduct minimize harms and risks promote aim for research like knowledge, truth, avoidance of error prohibits fabricating, falsifying, misinterpreting research data
What the 10/90 gap? Why this is a problem? What suggestions of filling the gap are discussed in the text on Research ethics?
● 10/90 gap → signifying that less than 10 per cent of the billions of dollars spent on health research is devoted to the health problems which account for 90 per cent of the global disease burden Problem: - most of disease burden is borne by poor nations not likely to benefit from most international research - Pharmaceutical industry → maximize the return to shareholders, rather than to produce an effective range of drugs of relevance to the health needs of the world as a whole o Focus on "me too" drugs o Outsourcing of research to low- or middle-income countries → are unlikely to benefit from the results o Conduct of research is being increasingly streamlined, through the use of Contract Research Organizations (CROs) → hard to monitor and regulate o Increased regulation of human-subject research in wealthy countries - Gap filling: o prize fund which would be used to give a major financial reward to individuals, groups or companies who find effective and inexpensive solutions to neglected global health problems o health impact fund → do away with patents & reward companies on the basis of the health impact of their new products Change in attitudes towards the sharing of publicly funded scientific discoveries
How germline therapy differs from somatic therapy?
● Germ line: gene therapy that targets reproductive cells, thereby having impact on individuals children and on the gene pool of the species ● Somatic therapy: directed at somatic cells which is the cells that constitutes all multicellular organisms Ethic: ● Somatic therapy does not affect anyone else than the person being treated ● Risks are increased and the people affected have not consented to the therapy (mutations)
What is the role of research integrity? What are the main forms if research misconduct?
● Scientific research depends crucially on the honesty of scientists in both carrying out the research and reporting the results ● C.P. Snow: The only ethical principle which has made science possible is that the truth shall be told all the time ● ● Research misconduct: - Fabrication of data (researches has invented data to "prove" their hypothesis) - Falsification of data (e.g. make the numbers better for a more convincing result) - Plagiarism (copying another person's work without acknowledgment - False claims to authorship (requiring/allowing one's name name to appear as an author when in fact the work was entirely done by others) - Media hype (ethical problems associated with communicating scientific findings to the public media)
What are the main reasons why society has been satisfied with a very minimalistic ethics for animal treatment?
● long traditions with animals as important producers of food and other products ● human took care of the animal and it gave back products, labour or lives ● Harming animals meant diminishing (forsvinne) of the animal product ● →If you hurt your animal you hurt yourself ('symbiotic agriculture') ● with time become high-technology intensive agriculture ● "factory farming" destroyed symbiotic husbandry based agriculture ● antibiotics and vaccines allowed us to put animals into environment witch harmed the animals while still promoting efficiency and productivity ● →more complicated ethics were need ● new research of diseases, new drugs and new operative procedures have given significant benefits for humans and animals
