Bioethics Test 2

Arithmetic Summing (Bentham)

Correct action - one that produces best consequence (like writing a pros and cons list) potential harm is subtracted from benefits to reach a net figure

McAffee Case

McAffe, a 29 year old male became quadraplegic after a motorcycle accident. McAffee's $1 million insurance policy was "used up" in 16 months and he then had to rely upon medicaid. In Sept. 1989, McAffee received the right to end his own life. Ventilator was to be "rigged" so he could switch it off. Asked for sedation to minimize pain ultimately, ultimately McAffee did not go through with this action. After his Medicare payments ran out in April, 1990, MUCH pressure was put on the state of Georgia to pay for McAffee's care and they did 1995 - after being comatose for MANY months due to toxicity which caused severed strokes, McAffee died

Conceptual Slippery Slope

Once a small change is made in , other changes will logically follow

Spheres of Well-Being

Organic, Psychological, Social, Economic, Religious, Aesthetc, legal, other Current medicine and oath emphasizes trying treat the whole person

Case: Lying to Promote Health

Patient who smokes and does not take care of himself goes to Dr. Gets chest x-ray which shows benign spots. Should Dr. tell him that they are precancerous lesions so he stops smoking?

Proponents to the Right to Die

People should have autonomy in making end of life decisions. People want to die with dignity. Evoke nonmaleficience and Mill's Harm principle.. is a family harmed when they watch a loved one suffer? As of 2023, 7 states uphold legal right to die. Legal in many European countries for physical and mental illness.

Why are pigs often used as experimental model organisms?

Similar to humans: anatomically, genetically, and pig skin is very similar to human skins. pigs are often used in burn experiments to test physiological/immune response to burns.

3 Types of Conflict Resolution

Single Principle Theories: deny there is a conflict (employs duty proper) Ranking/Lexically ordering: used in Rome to cast a vote. Subjectivity in ranking. Balancing: which duties carry more weight than others (subjective)

Edward Taub , Strokes, Learned Helplessness

Taub denervated a limb to mimic a stroke. Developed constraint-induced movement therapy which is proven to be very effective. forcing a patient to use effected limb. after a stroke it is common for a patient to feel defeated bc they cant use a limb so they fail to try again. Taub found that if the limb isnt used 2-3 weeks after damage it will become useless (but it also cant be used within first week of stroke)

Socrates on Living

"Important thing is not to live, but to live well."

Hume on Suicide

"Life of a man is of no greater importance to the universe than the life of an oyster" suicide is not a sin.

The case of the homosexual husband

Doctor knows patient is homosexual (has treated for STDs); patient comes asking for premarital physical (to surprise of doctor). Doctor finds out the man's fiancee is another patient of his...should he tell the woman what he knows??? Prima facie duties... keeping the confidence (to the male patient) but avoiding harm (non-maleficence) to the female patient (STDs; potentially unhappy marriage). What is the Duty Proper?

Federal law does or does not require the number of animals used in research to be recorded.

Does not.... estimate that millions are used each year.

Dr. Browne Birth Control Case

Dr Browne was notified by a clinic that his 16 yo patient was put on the pill. Dr. had 2 concerns: pharmacological well being and moral health. Consulted with his colleagues and decided to tell parents. was charged by general medical council with violation of confidentiality. he argued that his oath was to benefit his patient and the oath permits disclosure if it will benefit the patient.

Betty and George Coumbias

George Coumbias was suffering from a heart disease and requested assisted suicide Betty, his wife, had filed a request alongside her husband although she was in perfect health. her request was ultimately turned down

active euthanasia

death induced deliberately, as by injecting a lethal dose of a drug

Brittany Maynard case

diagnosed with glioblastoma - no treatment would save her life, and the recommended treatments would have destroyed the time she had left moved to Oregon where she had the right to die via passive euthanasia

According to the AMA when can confidentiality be broken?

disclosure is permitted when "a patient threatens to inflict serious bodily harm to another person AND there is reasonable probability the patient might carry out the threat."

Social Utility

does the greatest good for society

Kant on Animals

each animal life has inherent value therefore we should not harm them

Hippocratic utility

individual consequentialist principles using beneficence and nonmaleficence -> ideally objective, but can also be subjective if action increases net good.

The Ethics of Respect for Persons

individual duty based principles. Includes fidelity, autonomy, veracity, avoidance of killing

Animal Research Facilities Protection Act 1992

it is a crime to break into research facility of company that breed research animals

Fidelity (Respects for Persons)

loyalty, keeping promises, honoring contracts (Judeo-Christian origin)

Prima Facie Duties

morally binding, exception-less duties. includes telling the truth, protecting others from harm, obeying the law. can come into conflict with one anther.

Cruzan decision

no state may pass a law limiting the right of competent patients to decline medical treatment, even is declining treatment would hasten death.

NIMBY

not in my backyard, opposition to the locating of something considered undesirable in one's neighborhood

Psychobiological experimentation

study how psychological stressors can impact on the brain and behavior. opposition to doing this kind of experimentation on animals as it can be harsh.

Alan Nichols

submitted request to be euthanized in Canada. hearing loss was his reason. he was euthanized. Canadian euthanasia laws have been ethically questioned for devaluing life. this was considered a violation of the UN Universal declaration on human rights

Empirical Slippery Slope

taking the first step unleashes something bad that cannot be stopped. (pandoras box)

LD-50

the amount of a chemical that kills 50% of the animals in a test population. a lot opposition to this and many advocate for LD-10 (diminishes accuracy bc only kills the weak) but increases safety and decreases deaths

Duty Proper

the duty to select the most relevant duty when two prima facie duties come into conflict

passive euthanasia

the withholding of available treatments, such as life-sustaining devices, allowing the person to die

therapeutic privilege

the withholding of relevant information from a patient when the physician believes disclosure would likely do harm (in the hippocratic tradition)

Christianity and Voluntary Death

there is no biblical condemnation of suicide. Augustine (4th c) said: "thou shalt not kill" Aquinas (13th C): life is a gift from God and can only be given/taken by God. suicide deprives the community and goes against nature (the need to preserve life)

Mill on Suicide

we can do to our own lives/bodies whatever we choose... provided others are not harmed...

Social Justice

we owe specific duties to the least well off in society

Dr. Westerman Case

Westerman, a gynecologist, does a pap smear and gets abnormal result. recommends hysterectomy to his patient. reasoning: you cant die if you don't have the tissue. (there is no data that supports this course of action)

AMA and Confidentiality Prior to 1980

a physician did NOT have to keep a confidence if it did not benefit the patient

Draize test

a test done on rabbits eyes to test cosmetics, soaps, etc. for irritation. rabbit eyes are similar to human eyes. lots of opposition to this

Algeria Syndrome

as humans, we are more likely to attack what is far away/abstract than to control what is nearby and concrete ex) attacking animal research but not caring about homeless animals in your community

cogito ergo sum

I think, therefore I am (Descartes)

Natanson v Kline (1960)

Irma Natanson suffered radiation burns after being treated with radiation for breast cancer. She sued her doctor saying she had not consented to the risk of radiation burns. Dr. claimed therapeutic privilege and said he did not want to disturb/confuse her leading to her refusal of a necessary treatment

Animal Rights Movements arguments include...

whether the ends always justify the means, and ad hominem (personal attack)

Opponents to the Right to Die

- Difficult to deem what requests are valid - duty to preserve life - Death is irreversible - Slippery slope of permissibility

Bouvia case

-25 year old patient who was paralyzed from cerebral palsy - did not have a TERMINAL illness, just a low quality of life -tried to starve herself to death but hospital psychiatrist (Fisher) wouldn't let her. She contacted the ACLU. many other physicians also did not let her starve herself. -CA court of appeals ultimately ruled that she should be allowed to die, but she chose to live, is still alive

Cantebury v Spence

19 yo "Cantebury" suffered from back pain. Underwent a laminectomy to repair a ruptured disc. He fell out of bed and this led to paralysis Spence said he did not disclose the risk of paralysis because it was less than 1% for this procedure. Should the doctor have been required to explain to Mr. Cantebury the "risk" of falling out of bed after his procedure?

Estimated Breakdown of animal use in different types of research

40% basic/applied research 26% drug development 20% safety testing 14% science/medical et al science programs

Rule of Rescue

A perceived duty to save endangered life where possible

Negative/Liberty Rights

A person has the right to be free to do some action or to do no action. They are to be free from the interference of another person or group of persons. Usually, negative rights views focus on rights of a citizen to noninterference on the part of their government. (the right to be left alone)

Dax Cowart Case

Cowart suffered severe burns that left him disfigured and in pain. Physicians treated him against his will for 14 months. After getting out of hospital, Cowart debated whether or not to kill himself but ultimately did not. In retrospect, Cowart says he is happy to be alive but believes physicians mistreated him by keeping him alive/making him live through 14 months of awful pain.

Harrison Narcotic Act of 1914

Created to regulate opiates. Prior to the act, Americans could purchase heroin and opiates to lessen the pain of terminal cancer so they could die at home. Today, physicians control these dugs, death has been medicalized, and most people die in hospitals.

CASE 8, The Promised Internship

Deals with duty of fidelity/loyalty. Senior medical student matched into residency but program contacted her later saying that they found a better fit who will be better for their patients...

WD Ross (19th century)

English philosopher who came up with the prima facie duties includes.... Fidelity (We should strive to keep promises and be honest and truthful) , Reparation (we should make amends when we have wronged someone else) , Gratitude, non-maleficence, Beneficence, Self-improvement, Justice.

Why is the use of anesthesia not great for research?

Introduces another variable and invalidates data. Comes into question with experiment on animals

Hippocratic Tradition and Autonomy/Informed Consent

Physician is not required to disclose anything that will not benefit the patient.

Three Standards for Disclosure

Professional Standard (refers to informational obligations as understood by the professional community and as required by internationally-agreed rules) Reasonable Person Standard (what info must be disclosed to a reasonable person?) Subjective Standard (what information is relevant to particular individuals? )

ALF vs UPenn

Thomas Gennarelli (neurologist) interested in creating a reproducible model for human brain injury. Used primates as model organisms. Research was supposed to address the effectiveness of mannitol in reducing brain swelling after trauma, which was found to be effective and is now regularly administered. Also provided first evidence of neural regneration. Criticized for how poorly animals were mistreated. ALF broke into his lab at UPenn

Kant on Suicide

acts are only right if they can be universalized. suicide cannot be universalized bc it is motivated by self-interest, and for Kant self-interest can never justify a moral decision. also argued that if a person cannot respect his own life, he will not respect anything else. man cannot use his own free will to destroy himself.

Sentience vs Self - Consciousness

advocated for by CS Lewis who believed animals are sentient (aware) but not self-conscious (aware of their position in the world) like humans.

Cartesian view on animals

animals are soulless (also supported by Christian doctrine) performed vivisections on animals (live dissections) as a learning tool bc human dissection was outlawed until about the 15th C

Institutional Animal Care and Use Committee (IACUC)

any research institute that does animal research must have an IUCAC that includes a veterinarian to vet experiments

Embracing of idea of autonomy...

early christians first to embrace. solidified with the protestant reformation which affirmed the authority of the individual. Kant provided a secular affirmation. Many philosophies/religions do not embrace autonomy.

Foundation for Biomedical Researc

established in the 1980s, lobbies on behalf of research universities (oppose PETA lobbyists)

New generation of doctors is moving away from ...... and turning towards.....

hippocratic paternalism, duty based principles

WMA (world medical association) emphasizes which sphere of well being

only organic sphere... b/c it impossible to address all of the other spheres in various communities around the world (cultural differences + economic disparities)

Organic Sphere of Care includes

preserve life, promote health, relieve suffering, cure disease

Animals used in research that are protected by the USDA

rabbits, guinea pigs, pigs, cats, cows, dogs. not protected: rats/mice

Hume Self Identity/Humanness

requires a permanent self or mental substance which unites all of a persons thoughts as his or hers. argued humans have bigger brains so must be more intelligent than animals. (also used by men to justify their superiority to women)

Veracity

respecting the patient by being truthful with them. Evolved in the 1960's bc society's perspective on the truth changed and intro of informed consent

Positive (Entitlement) rights

rights that provide something that people need to secure their well being, such as a right to an education, the right to food, the right to medical care, the right to housing, or the right to a job

Autonomy is associated with...

rights.. the most visible aspect of medical ethics in the past generation.