Bioethics Practice Exam

How many genes are currently believed to be contained in human DNA? 1. 30,000 2. 45,000 3. 75,000 4. 100,000

1. 30,000 Human DNA is now thought to contain about 30,000 genes.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. ... The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. ... However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." ... "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." ... "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. .. "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." ... Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. ... Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." ... Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" ... Which statement would Bobbi's mother agree with? 1. A fetus is not yet a person. 2. A fetus lacks full human DNA. 3. A fetus is not yet a full human being. 4. A fetus has full status in the moral community.

1. A fetus is not yet a person. This is typical of someone who believes abortion is permissible. Bobbi's mother thinks that it is.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." ... Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. ... Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." ... Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" ... If John agrees with Bobbi, which line of reasoning might he offer? 1. Abortion is wrong because it deprives the fetus of a future. 2. Abortion is wrong because it deprives parents of genetic offspring. 3. Abortion is acceptable because it can prevent having children with serious impairments. 4. Abortion is acceptable in cases where it is performed to protect the health of the mother.

1. Abortion is wrong because it deprives the fetus of a future. This is a reason often given against abortion and Bobbi is against abortion.

Who originated the concept that all living things have a purpose or goal? 1. Aristotle 2. Immanuel Kant 3. Albert Schweitzer 4. Paul Taylor

1. Aristotle Aristotle's ethics are grounded in his metaphysical view of the purposefulness of all of creation.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. .. The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. .. However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." .. "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." .. "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. .. "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." .. Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. .. Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." .. Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" .. If Bobbi argued that early stage embryos are just one stage in the developmental process leading to human adulthood, which conclusion would she reach? 1. Cloning is wrong. 2. Cloning is acceptable. 3. Only research with very early stage embryos is permissible. 4. Only carefully regulated research with embryos is permissible.

1. Cloning is wrong. Noting that developmental continuum suggests the same moral status for embryos and adults, cloning, which destroys embryos, is wrong.

The Maussimana River, one of the few remaining free-flowing rivers in the eastern US, flows through the Great Greenage National Recreation Area (GGNRA). Despite its status as a scenic and recreational river, a group of industrialists, the Green Clashers, is lobbying public officials to relax governmental protections and fund the construction of a dam. .. The Green Clashers's director, Sam, claims, "The dam is necessary for farmers who need additional water to expand operations and increase profits." Paula, representing members of the public who support the dam project, points out that, "Easy access to stable water supplies will lower water bills." .. Local officials see the project as a potential boon to the economy. "The dam will create jobs," Mayor Smith says, "and raise the standard of living for many minority and poor families who now rely on polluted groundwater. The pollution that the dam will create is acceptable because it will provide cleaner, cheaper water for the poor." .. Because of the dam's exorbitant cost, city planners agreed with the Green Clashers's proposal to cut the local curbside recycling program and to shorten hours that local parks are open in order to pay for the project. .. Environmentalists from the local chapter of Earth Defenders oppose the project because, as the chapter's president, Gus explains, "Building a dam within the recreation area would create a dangerous precedent that would allow destructive human activities in areas where those activities were once restricted. We would be wise to remember that the land is not simply a commodity, but has spiritual and aesthetic value. Our legal system must do more to protect it." .. Beth is concerned about pollution in the reservoir and in the river. "Increased farming," she asserts, "will just mean more chemicals and more chemicals will run into the river and collect in the reservoir sediments." .. Marilyn, another member of Earth Defenders, adds that, "The endangered blue spotted trout would be adversely affected by this project because they would no longer be able to migrate to the ocean and back again to their birth stream to spawn. We have no right to restrict their rights and movements in this way and it would have negative repercussions throughout the local food web." .. Jane continues the argument, "Scientists estimate fish populations will decline by about 50 percent in less than two years." .. Ed points out, "The dam would flood hundreds of acres of ground that is now being used by many animals, including coyotes. If these areas are flooded, animal species would have to migrate into new home ranges. Plant species would be endangered to the point of extinction. This would seriously undermine local ecosystem stability and ultimately affect human survival. We should stop this project before it endangers us and our descendants." .. Whose view contrasts most fundamentally with Joel Feinberg's application of the concept of moral standing to entire species? 1. Ed 2. Paula 3. Sam 4. Mayor Smith

1. Ed Ed offers an anthropocentirc argument that conflicts with Feinberg's theory of animal rights.

How do Carol Gilligan's views on the ethics of care differ from Nel Noddings's views? 1. Gilligan: the ethics of care can be described as feminist; Noddings: the ethics of care can be described as feminine. 2. Gilligan: women are alienated by standard philosophical models; Noddings: women are well served by standard philosophical models. 3. Gilligan: women are central to the development of moral principles; Noddings: women are unable to formulate and rank moral principles. 4. Gilligan: the ethics of care occurs without reciprocity from the cared-for; Noddings: the ethics of care demands reciprocity from the cared-for.

1. Gilligan: the ethics of care can be described as feminist; Noddings: the ethics of care can be described as feminine. Noddings describes her moral theory as 'feminine' because it is rooted in receptivity, relatedness, and responsiveness. Both ethics are considered to be feminist.

When considering the duty not to lie to a patient and the duty to not cause needless suffering to the patient, which method would W.D. Ross use to decide the more stringent duty? 1. Intuition 2. Deductive Logic 3. Inductive Reasoning 4. Scientific Method

1. Intuition Ross is generally regarded as the father of the intuitionist school of ethics.

The children of a patient who is in a persistent vegetative state and dependent on a ventilator want the ventilator removed because the patient's condition is causing them great distress. Which course of action could best be supported by Kantian ethics? 1. It is not permissible to remove the ventilator only to benefit the patient's children. 2. It is not permissible to remove the ventilator for the purpose of respecting patient autonomy. 3. It is permissible to remove the ventilator if it can be used to treat more worthy patients. 4. It is permissible to remove the ventilator if the patient's children will greatly benefit from it.

1. It is not permissible to remove the ventilator only to benefit the patient's children. Removing the ventilator to benefit the children would be unacceptable to a Kantian because it would be using the patient as a means.

In which Philosopher's ethical theory would the deceptive use of placebos always be considered morally wrong? 1. Kant 2. MIll 3. John Rawls 4. W.D. Ross

1. Kant Kant: placebo use involves withholding information from a patient/research subject. It is morally illegitimate because it denies respect and dignity to which a person is entitled.

To maintain the integrity of a clinical study, investigators do not tell participants if the participants are receiving treatment of a placebo, thus creating a conflict with the usual requirements for informed consent. Which moral principle would validate this action? 1. Principle of utility 2. Principle of justice 3. Principle of non maleficence 4. Principle of respect for autonomy.

1. Principle of utility. The purpose of withholding information is to maximize the value of the study for future patients. This is the focus of the principle of utility.

With which claim would Passmore disagree? 1. Some nonhuman animals possess moral standing. 2. People need to develop a more aesthetic attitude toward nature. 3. An environmental ethic can be based on traditional anthropocentrism. 4. The basis of human responsibility to the natural world lies in human interests.

1. Some nonhuman animals possess moral standing. Passmore denies this, based on anthropocentrism.

Which descriptor best characterizes quantitative futility? 1. The likelihood of benefit is very small. 2. The number of patients treated is too small. 3. The quantity of needed resources is too great. 4. Treatment must continue over a very long time.

1. The likelihood of benefit is very small Futility means that the treatment is expected to bring very little benefit.

Tom Anderson, the new administrator of City Hospital, is about to conduct his first meeting with the hospital's Board of Ethics. The other members of the 4-member board are physician Brown, nurse Carter, and professional ethicist Dillon. Today's order of buisiness is to determine the end-of-life treatment for four patients. Each board member has one vote and three of four votes are necessary to justify euthanasia, so, before the meeting, Anderson decides to vote to discontinue all life-suppport measures for all four patients. The first case discussed concerns an older female patient, Easterly, for whom medical intervention, both quantitative and qualitative, appears futile. Three of the four Board members vote to disconnect Easterly's respirator. Only Brown votes no, arguing for transferring her to a hospice. The outcome of the next vote is also three to one in favor of discontinuing life-support measures for the second patient, a young female. Fisher, who has been unconscious since an automobile accident six months ago. Because he is not being mechanically sustained, the committee decides to withhold food and water. When Brown objects on the grounds that this might cause a slow and painful death, Anderson suggests administering an overdose of painkillers. But he withdraws this suggestion when ethicist Dillion and nurse Carter cast hum disapproving looks. The third patient, a middle-aged woman, Graham, is conscious but in excrutiating pain from incurable metastatic cancer. She urgently requests to be euthanized because she is expected to live another six months, with her pain only increasing. The committee votes three to one to honor Graham's request and decides to have her feeding tube removed. This will lead to death within a few days. "Since the patient is conscious and in great pain," suggests Anderson, "why not allow her to speed up her death by leaving her a bottle of sleeping pills on her bedside table?" Again, he withdraws this suggestion when Dillion and Carter stare at him in disbelief. Anderson considers the fourth patient, a man named Harper, to be an ideal candidate for discontinuing life support. Harper appears to be in pain, even though he does not display any of the higher brain functions. Anderson suggests removing his ventilator. Dillion and Carter join Brown in voting against euthanasia for Harper. "It's simple," explains Dillion, "He has no advanced directive on file with this hospital." Anderson considers this a setback, but is still pleased with the outcome of the meeting. He feels that three out of four is a good start. Which argument against Brown's recommendation for Easterly is based on the principles of utilitarianism? 1. The move to a hospice would cause more pain. 2. Hospices would become overcrowded if every dying patient were admitted. 3. Hospices may encourage patients to regard death as a positive development. 4. Only patients who have remaining treatment options should be moved to hospices.

1. The move to a hospice would cause more pain. This uses a utilitarian principle to minimize the pain that results from our actions.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. How would Marcia Angell view the role of scarce resources in deciding Camden's health care? 1. There is no problem of scarce resource funding in the US. 2. The problem of funding scarce resources is central to the case. 3. Money is fairly important, but is less so than Camden's well being. 4. Money is fairly important, but less so than Jackson's medical judgment.

1. There is no problem of scarce resource funding in the US. Angell: America's healthcare system has ample money, but uses it very inefficiently.

Which focus of moral theories is most often considered to be speciesist? 1. anthropocentric focus 2. biocentric focus 3. ecocentric focus 4. utilitarian focus

1. anthropocentric focus Most Western ethical theories are anthropocentric, with no justification given for that focus. Many defenders of animal rights claim this lack of justification shows a preference for humans and is prejudicial.

What is meant by ELT? 1. exotic life-saving therapy 2. effective long-term treatment 3. extraordinary legitimate therapies 4. entitlement to lifesaving technology

1. exotic life-saving therapy ELT means exotic life-saving therapy.

Which factor in the allocation of organs for transplant is unrelated to moral concerns? 1. if the patient is able to pay 2. if the patient is otherwise healthy 3. if the patient is too old for a transplant 4. if the patient is first on the list for transplant

1. if the patient is able to pay Affordability is an economic issue, not a moral issue, in life-threatening situations.

The structure of randomized clinical trials prevents researchers from always acting in the best interests of their research subjects. What does Kant's moral theory imply about the permissibility of such studies? Randomized clinical trials are 1. impermissible under any circumstances. 2. permissible if they produce valuable results. 3. permissible if clinical equipoise is maintained. 4. permissible if subjects who are harmed leave the study.

1. impermissible under any circumstances. Because subjects are used merely as a means to attain the researcher's goals, such trials are impermissible.

How did the dissenting opinion in the case of Tarasoff v. Regents of the University of California argue against the majority opinion? The dissenting opinion argued that, under the majority ruling, 1. patients would fear disclosing information to the therapist. 2. too many people seeking care would over-burden the system. 3. therapists would be placed in personal danger from their patients. 4. therapists would be allied with the state rather than with their patients.

1. patients would fear disclosing information to the therapist The majority ruling would create distrust between therapist and patient, and discourage disclosure by the patient.

Which justification for breaching confidentiality does Ronald Munson believe is questionable? 1. reporting the intent to harm others 2. reporting the intent to commit suicide 3. reporting the possibility of child abuse 4. reporting the presence of communicable diseases

1. reporting the intent to harm others Many argue that Tarasoff went too far. Because it is difficult to predict if a patient will harm someone, it is difficult to justify such breaches.

What is the goal of negative eugenics? 1. to decrease the number of undesirable genes in the human population 2. to discourage in vitro fertilization of embryos of unproven superiority 3. to promote reproductive patterns that ensure exceptionally intelligent offspring 4. to increase the number of human genes responsible for cognitive brain functions

1. to decrease the number of undesirable genes in the human population Negative eugenics aims to decrease the number of undesirable genes

Which moral theory provides the strongest basis for a researcher's obligation to be beneficent? 1. utilitarianism 2. natural law 3. intuitionism 4. rationalist deontology

1. utilitarianism Utilitarianism requires maximizing good outcomes while minimizing bad outcomes. This implies that researchers act permissibly only when generating the best balance of good outcomes over bad outcomes.

Which indicator is the best predictor of HIV infection developing into full-blown AIDS? 1. viral load 2. chest X rays 3. T cell count 4. extreme weight loss

1. viral load Viral load is the best indicator.

Ms. Williams, a 44-year-old single woman with no children, has been drinking alcohol heavily for the last 25 years. As a result, she now has cirrhosis of the liver. She also has an inflamed pancreas and experiences occasional seizures, resulting from her alcohol use. These factors lower the likelihood that a liver transplant would be a long-term success. However, a liver transplant is her only hope for long-term survival and she has been on the transplant waiting list for nearly 200 days. During this period, a few organs have become available but they have gone to healthier patients. The longer she must wait for a liver, the worse her condition becomes, and the less likely she will be chosen to receive an organ that becomes available. ... Mr. Alvarez, a 30-year-old married man with two young children, is a patient in the same hospital. He, too, has cirrhosis of the liver, caused by accidental poisoning in his workplace. The other effects of the poisoning have been treated successfully, but his liver has been hopelessly damaged. He has been on the transplant waiting list for 33 days. ... A liver has become available and the transplant committee holds a meeting to decide which of these two patients will receive it. Ms. Williams's doctor claims that since both patients are reasonable candidates for the transplant, the decision should be made on a first come, first served basis. Ms. Williams should receive this organ because she has been waiting longer. Ms. Williams's social worker adds that Ms. Williams is finally making a serious effort to get her drinking and related problems under control. Therefore, the social worker argues, Ms. Williams should receive the liver while it can still be of benefit to her. ... Mr. Alvarez's doctor disagrees, saying that his patient should be given the liver. After all, the doctor points out, Mr. Alvarez is not to blame for his medical problems and is an asset to the community; Ms. Williams has caused her own problems and is a burden to the community. Dr. Smith, the chair of the transplant committee, points out that the entire Alvarez family depends on Mr. Alvarez while no one depends upon Ms. Williams and so Mr. Alvarez should receive the liver. ... Suppose Williams develops new medical complications that lower her chances of benefiting from a transplant. How would Kant's moral theory apply to the decision about who should receive the transplant? 1. Alvarez should have priority because he has a greater chance of benefiting. 2. Alvarez and Williams should have equal priority to receive the transplant. 3. Williams should have priority because a transplant is her only chance for survival. 4. Williams should have priority because she has been waiting longer for a transplant.

2. Alvarez and Williams should have equal priority to receive the transplant. Kant: because both patients are rational beings, they have valuable lives, and there is no basis for preferring one over the other.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. Why might John Locke believe that Duplexa's proposal for specimen collection violates the private property rights of the Brazilian peasants? 1. Contemporary Brazilian peasants hold the property deeds to the land on which they live. 2. Ancestors of contemporary Brazilians have lived on and mixed their labor with the land for generations. 3. International free trade agreements do not supersede owners' private property rights obtained through legal land purchases. 4. Brazil's government-created extractive reserves give peasants private property rights to collect resources from public lands.

2. Ancestors of contemporary Brazilians have lived on and mixed their labor with the land for generations. Locke's theory of private property says that land, in its natural state, is unowned. It becomes owned once someone's labor, which is owned, is mixed with the land. At that point, a person's exclusive rights over their labor are transferred to the land and the person comes to own the land. Along with ownership come private property rights that secure the owner's uses and exclude uses by non-owners. The scenario says the peasants' ancestors have used the land for generations.

How can treatment for AIDS be best improved for the African American community? 1. Improve the availability of medications 2. Establish greater credibility of the medical establishment 3. Improve AIDS testing for the community 4. Expand clinical trials for AIDS in the community

2. Establish greater credibility of the medical establishment This is the best way to encourage African Americans to be tested, take the appropriate medications, and participate in clinical trials. This may happen through education and producing more African American physicians.

Dr. Hernandez is a cancer specialist at County Hospital. She prepares for her first appointment with Mr. Patel, a patient referred to her by his primary care physician, Dr. Singh. The patient's medical records show that Dr. Singh suspected cancer and ordered an MRI on Mr. Patel three months ago in response to the patient's complaint of back pain and fatigue. Dr. Hernandez notes that this MRI showed a small tumor attached to Mr. Patel's right lung and an adjoining part of his spine. An MRI done that morning in preparation for the appointment shows that the tumor has grown quite rapidly. Without treatment, Mr. Patel will probably die within a few months. Surgery to remove the tumor offers the best chance for entirely eliminating the cancer but, because of its location, this surgery carries a high risk of death or of paralysis. Treatment with chemotherapy and radiation has a good chance of slowing the growth of the tumor, but would result in several months of severe discomfort with only a small chance of eliminating the cancer entirely. However, chemotherapy and radiation are unlikely to cause death. Dr. Hernandez is one of the three local surgeons qualified to perform this surgery and has treated many patients with similar tumors. She is familiar with the latest relevant research. Although she knows that both surgery and chemotherapy combined with radiation are accepted treatments for tumors like Mr. Patel's, she dislikes performing operations that carry a high risk of death. In the examining room, Dr. Hernandez and Mr. Patel discuss his situation: Dr. Hernandez: I am sorry to tell you that your tumor is growing very quickly. If left untreated, it is likely to prove fatal within a few months. Mr. Patel: I was afraid of that. This is so upsetting, I can't think straight. Please just tell me what to do. Dr. Hernandez: You need to make your own decision about this. However, chemotherapy with radiation is the only treatment option for patients in your condition. This treatment can be difficult to tolerate, but it offers a chance for a long life and might even eliminate your cancer altogether. Mr. Patel: I'll think about it. Please don't tell anyone that I have cancer; at least until I decide whether I want treatment. After the examination, Dr. Hernandez phoned Dr. Singh. They discuss whether Mr. Patel has any history of mental illness that might affect his response to the bad news. What is the most paternalistic action in this situation? 1. Singh referring Patel to Hernandez 2. Hernandez talking to Singh about Patel 3. Patel asking Hernandez to tell him what to do 4. Hernandez recommending a particular treatment for Patel

2. Hernandez talking to Singh about Patel Health care providers show paternalism when they act for the patient's benefit without the patient's permission

Ms. Williams, a 44-year-old single woman with no children, has been drinking alcohol heavily for the last 25 years. As a result, she now has cirrhosis of the liver. She also has an inflamed pancreas and experiences occasional seizures, resulting from her alcohol use. These factors lower the likelihood that a liver transplant would be a long-term success. However, a liver transplant is her only hope for long-term survival and she has been on the transplant waiting list for nearly 200 days. During this period, a few organs have become available but they have gone to healthier patients. The longer she must wait for a liver, the worse her condition becomes, and the less likely she will be chosen to receive an organ that becomes available. ... Mr. Alvarez, a 30-year-old married man with two young children, is a patient in the same hospital. He, too, has cirrhosis of the liver, caused by accidental poisoning in his workplace. The other effects of the poisoning have been treated successfully, but his liver has been hopelessly damaged. He has been on the transplant waiting list for 33 days. ... A liver has become available and the transplant committee holds a meeting to decide which of these two patients will receive it. Ms. Williams's doctor claims that since both patients are reasonable candidates for the transplant, the decision should be made on a first come, first served basis. Ms. Williams should receive this organ because she has been waiting longer. Ms. Williams's social worker adds that Ms. Williams is finally making a serious effort to get her drinking and related problems under control. Therefore, the social worker argues, Ms. Williams should receive the liver while it can still be of benefit to her. ... Mr. Alvarez's doctor disagrees, saying that his patient should be given the liver. After all, the doctor points out, Mr. Alvarez is not to blame for his medical problems and is an asset to the community; Ms. Williams has caused her own problems and is a burden to the community. Dr. Smith, the chair of the transplant committee, points out that the entire Alvarez family depends on Mr. Alvarez while no one depends upon Ms. Williams and so Mr. Alvarez should receive the liver. ... Suppose that Williams and Alvarez were in exactly the same medical circumstances, but differed only in the degree of support from family and friends. Which moral theory would be most likely to determine that Alvarez should receive the transplant? 1. Ross's intuitionism 2. Mill's utilitarianism 3. Rawls's theory of justice 4. Kant's rationalist deontology

2. Mill's utilitarianism Mill's theory implies that if giving Mr. Alvarez the transplant yields more happiness for more people, then he should receive it.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. .. How are Jennifer's beliefs about other species of animals and plants similar to Paul Taylor's? 1. She believes in the positive duty of nonmaleficence. 2. She sees all individuals as teleological centers of life. 3. She believes in the supremacy of anthropogenic valuation. 4. She recognizes the metaphysical reality of ecological wholes.

2. She sees all individuals as teleological centers of life. Jennifer believes species have a right to live their own lives according to their own interests. This is very close to seeing species as teleological centers of life.

Which claim would Murray Bookchin reject? 1. Social domination is correlated with ecological destruction. 2. Social ecology is indistinguishable from traditional Marxism. 3. Social hierarchy is compatible with a benign relationship to nature. 4. Social structures of domination are likely to lead to domination of nature.

2. Social ecology is indistinguishable from traditional Marxism. Bookchin would say that, contrary to Marxism, a deterministic connection exists between social domination and the domination of nature.

Which action occurs after parents and doctors agree that further treatment of an infant is futile? 1. The infant is given terminal sedation. 2. The infant is disconnected from the respirator. 3. The hospital review board is asked to approve termination of treatment. 4. The hospital ethics committee is consulted about discontinuing treatment.

2. The infant is disconnected from the respirator. If the treatment (respirator) is judged futile, it will be withdrawn.

Which incident led to moral complications in the Baby M surrogate mother case? 1. The contracting couple refused to accept the child. 2. The surrogate mother refused to surrender the child. 3. The surrogate mother attempted to have an abortion. 4. The child was born with some serious congenital anomalies.

2. The surrogate mother refused to surrender the child. Whitehead talked the Sterns into allowing her to keep Baby M for one week. She then fled from New York to Florida.

Dr. Hernandez is a cancer specialist at County Hospital. She prepares for her first appointment with Mr. Patel, a patient referred to her by his primary care physician, Dr. Singh. The patient's medical records show that Dr. Singh suspected cancer and ordered an MRI on Mr. Patel three months ago in response to the patient's complaint of back pain and fatigue. Dr. Hernandez notes that this MRI showed a small tumor attached to Mr. Patel's right lung and an adjoining part of his spine. An MRI done that morning in preparation for the appointment shows that the tumor has grown quite rapidly. Without treatment, Mr. Patel will probably die within a few months. Surgery to remove the tumor offers the best chance for entirely eliminating the cancer but, because of its location, this surgery carries a high risk of death or of paralysis. Treatment with chemotherapy and radiation has a good chance of slowing the growth of the tumor, but would result in several months of severe discomfort with only a small chance of eliminating the cancer entirely. However, chemotherapy and radiation are unlikely to cause death. Dr. Hernandez is one of the three local surgeons qualified to perform this surgery and has treated many patients with similar tumors. She is familiar with the latest relevant research. Although she knows that both surgery and chemotherapy combined with radiation are accepted treatments for tumors like Mr. Patel's, she dislikes performing operations that carry a high risk of death. In the examining room, Dr. Hernandez and Mr. Patel discuss his situation: Dr. Hernandez: I am sorry to tell you that your tumor is growing very quickly. If left untreated, it is likely to prove fatal within a few months. Mr. Patel: I was afraid of that. This is so upsetting, I can't think straight. Please just tell me what to do. Dr. Hernandez: You need to make your own decision about this. However, chemotherapy with radiation is the only treatment option for patients in your condition. This treatment can be difficult to tolerate, but it offers a chance for a long life and might even eliminate your cancer altogether. Mr. Patel: I'll think about it. Please don't tell anyone that I have cancer; at least until I decide whether I want treatment. After the examination, Dr. Hernandez phoned Dr. Singh. They discuss whether Mr. Patel has any history of mental illness that might affect his response to the bad news. What is most likely to support Patel's autonomy? 1. adoption of a dog or cat 2. articles on the risks and benefits of chemotherapy with radiation 3. a brochure on common types of his condition 4. preparation at a hospice for his impending death

2. articles on the risks and benefits of chemotherapy with radiation Because Patel's prognoses with and without treatment involve different likelihoods of death and recovery, understanding the benefits and risks of the proposed treatment could support his ability to make a rational, informed decision.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. .. The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. .. However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." .. "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." .. "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. .. "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." .. Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. .. Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." .. Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" .. If Jim disagreed with the principle behind the campus newspaper advertisements, how could he defend his opinion? .. The principle 1. is prejudicial against men. 2. commodifies women and children. 3. might turn into another Baby M case. 4. is paternalistic and insulting to women.

2. commodifies women and children. Offering money is bad because it treats women and children as objects to be bought and sold (commodities).

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. Pharmaceutical exploration 1. exacerbates the inherent inequalities between humans and nature. 2. is a way for patriarchal science to attempt to dominate and control nature. 3. uses people of color living below the poverty line to make company profits without providing fair remuneration. 4. increases the difficulty of women's work by removing species essential for feeding families.

2. is a way for patriarchal science to attempt to dominate and control nature. This is an ecofeminist criticism of the Duplexa plan. Albert cites domination, aligning himself with ecological feminist philosophies.

The American Medical Association urges the use of palliative care as an alternative to which practice? 1. life support withdrawal 2. physician-assisted suicide 3. overuse of pain medication that may be addictive 4. experimental drug therapy for terminally ill patients

2. physician-assisted suicide The AMA believes people will not want physician-assisted suicide if end-of-life pain is better controlled.

What best describes palliative care? 1. medical care at the end of life 2. treatment that only controls pain 3. treatment by a multidisciplinary team 4. special care for neonates with breathing impairments

2. treatment that only controls pain Palliative care aims at comfort, not cure.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. How would act utilitarianism and rule utilitarianism compare in the moral evaluation of discharging Camden today rather than tomorrow? 1.Act utilitarianism and rule utilitarianism would both say it is permissible. 1.Act utilitarianism and rule utilitarianism would both say it is impermissible. 3. Act utilitarianism would say it is impermissible; rule utilitarianism would say it is permissible. 4. Act utilitarianism would say it is permissible; rule utilitarianism would say it is impermissible.

3. Act utilitarianism would say it is impermissible; rule utilitarianism would say it is permissible. Other actions would yield better results, so act utilitarianism would say the decision is impermissible. The policy of covering the costs of only basic necessary care would result in greater access to health care and thus better results. Therefore, rule utilitarianism would say it is permissible.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. ... The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. ... However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." ... "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." ... ... "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. ... "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." ... Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. ... Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." ..... Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" ... Which is the best argument Bobbi might give to counter Marty's statement? 1. Fertility treatment requires freezing embryos and is wasteful of human life. 2. Sperm donation encourages people to try for perfect babies and this will improve society. 3. Fertility drugs are bad because they increase multiple pregnancies and lead to selective reduction. 4. People have a right to be parents and society should bear the cost of in vitro fertilization when needed.

3. Fertility drugs are bad because they increase multiple pregnancies and lead to selective reduction. Selective reduction is achieved through abortion, so Bobbi would be against it.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. How would a follower of Leopold justify rejection of Duplexa's proposal? 1. It is unethical to sacrifice individuals of a species for the collective pharmacological good of human beings. 2. All species are integral to the land/energy pyramid and none should be removed, even for pharmaceutical exploration. 3. It is unethical to violate the integrity and beauty of the natural world and pharmaceutical exploration that does so should be prohibited. 4. The disruption of the ecosystem is unethical because it would interfere with ecological succession and prevent reaching the climax stage.

3. It is unethical to violate the integrity and beauty of the natural world and pharmaceutical exploration that does so should be prohibited. Leopold would say that a thing is right when it tends to preserve the integrity, beauty, and stability of the natural world, and wrong when it tends otherwise. Since pharmacological exploration would disrupt/destroy the integrity, beauty, or stability of the natural environment, land ethicists would oppose it based on this principle.

After Margaret Welby, a 71-year-old teacher, detects a lump in her right breast, her primary care physician refers her to an oncologist. The oncologist, Dr. Hertz, immediately orders a biopsy which shows a stage 3A malignancy. Hertz scolds Margaret for waiting so long to have the lump checked and tells her that she must have an immediate radical mastectomy. He also encourages her to participate in trials of a new experimental for of chemotherapy from a company in which he is a consultant and minor stockholder. He tells her that her participation may also help others but avoids mentioning the very unpleasant side effects, or that 80% of the participants have, so far, experienced no improvement. In addition, not all risks of the chemotherapy have been identified. Hertz's nurse is aware of this but reluctantly decides not to interfere. The doctor does tell Margaret that her chances for 5-year survival are about 30%, perhaps even more with the experimental treatment. He gives her no other details or options because he believes she would not understand them and is afraid she might refuse the therapy. Margaret's husband recently died of Alzheimer's disease and she cared for him during the course of his illness. Now, she plans to use his life insurance money to take a long cruise. She decides that, at this point in her life, she does not want surgery and would rather avoid the pain and disability of chemotherapy so she can enjoy what life she has left. Hertz strongly disagrees wit Margaret's decision and, without her permission, tells her daughter and son that their mother has refused treatment for breast cancer. He points out that the experimental therapy could significantly extend her life and urges them to talk to her into undergoing treatment. The children try, but Margaret is adamant, telling them, "It's my life and my business. I'll ask only for palliative care when it becomes necessary." "Margaret is still a relatively young woman," Hertz tells her children. "Although she has some heart problems, she is healthy in other respects and should tolerate the treatment well." He advised the children to have her declared incompetent because the grief and stress over their father's illness and death have caused her to make an irrational decision. The son wants his mother to live and wants everything to keep her alive. The daughter, however defends her mother's competency and convinces her brother to respect their mother's decision. Hertz, insisting that Margaret have the time rather than give up, refuses to continue to care for her and suggests she finds another doctor. How would the experimental treatment for Margaret pose a conflict for Hertz? 1. Hertz known that Margaret may not benefit from participation. 2. Margaret may not understand any effects or possible experimental outcomes. 3. Margaret may receive a placebo which may do nothing for her or could harm her. 4. Hertz could explain that the experiment may not help Margaret but could help others.

3. Margaret may receive a placebo which may do nothing for her or could harm her. The doctor's main concern is the patient's welfare. If the medication or therapy is beneficial, and the patient receives the placebo, the patient may not receive adequate treatment.

After Margaret Welby, a 71-year-old teacher, detects a lump in her right breast, her primary care physician refers her to an oncologist. The oncologist, Dr. Hertz, immediately orders a biopsy which shows a stage 3A malignancy. Hertz scolds Margaret for waiting so long to have the lump checked and tells her that she must have an immediate radical mastectomy. He also encourages her to participate in trials of a new experimental for of chemotherapy from a company in which he is a consultant and minor stockholder. He tells her that her participation may also help others but avoids mentioning the very unpleasant side effects, or that 80% of the participants have, so far, experienced no improvement. In addition, not all risks of the chemotherapy have been identified. Hertz's nurse is aware of this but reluctantly decides not to interfere. The doctor does tell Margaret that her chances for 5-year survival are about 30%, perhaps even more with the experimental treatment. He gives her no other details or options because he believes she would not understand them and is afraid she might refuse the therapy. Margaret's husband recently died of Alzheimer's disease and she cared for him during the course of his illness. Now, she plans to use his life insurance money to take a long cruise. She decides that, at this point in her life, she does not want surgery and would rather avoid the pain and disability of chemotherapy so she can enjoy what life she has left. Hertz strongly disagrees wit Margaret's decision and, without her permission, tells her daughter and son that their mother has refused treatment for breast cancer. He points out that the experimental therapy could significantly extend her life and urges them to talk to her into undergoing treatment. The children try, but Margaret is adamant, telling them, "It's my life and my business. I'll ask only for palliative care when it becomes necessary." "Margaret is still a relatively young woman," Hertz tells her children. "Although she has some heart problems, she is healthy in other respects and should tolerate the treatment well." He advised the children to have her declared incompetent because the grief and stress over their father's illness and death have caused her to make an irrational decision. The son wants his mother to live and wants everything to keep her alive. The daughter, however defends her mother's competency and convinces her brother to respect their mother's decision. Hertz, insisting that Margaret have the time rather than give up, refuses to continue to care for her and suggests she finds another doctor. Which principle did Hertz exhibit regarding Margaret's autonomy? 1. Contribution 2. Equality 3. Paternalism 4. Utility

3. Paternalism The principle of Paternalism would allow someone else to make decisions for her if she is unable to do so.

After Margaret Welby, a 71-year-old teacher, detects a lump in her right breast, her primary care physician refers her to an oncologist. The oncologist, Dr. Hertz, immediately orders a biopsy which shows a stage 3A malignancy. Hertz scolds Margaret for waiting so long to have the lump checked and tells her that she must have an immediate radical mastectomy. He also encourages her to participate in trials of a new experimental for of chemotherapy from a company in which he is a consultant and minor stockholder. He tells her that her participation may also help others but avoids mentioning the very unpleasant side effects, or that 80% of the participants have, so far, experienced no improvement. In addition, not all risks of the chemotherapy have been identified. Hertz's nurse is aware of this but reluctantly decides not to interfere. The doctor does tell Margaret that her chances for 5-year survival are about 30%, perhaps even more with the experimental treatment. He gives her no other details or options because he believes she would not understand them and is afraid she might refuse the therapy. Margaret's husband recently died of Alzheimer's disease and she cared for him during the course of his illness. Now, she plans to use his life insurance money to take a long cruise. She decides that, at this point in her life, she does not want surgery and would rather avoid the pain and disability of chemotherapy so she can enjoy what life she has left. Hertz strongly disagrees wit Margaret's decision and, without her permission, tells her daughter and son that their mother has refused treatment for breast cancer. He points out that the experimental therapy could significantly extend her life and urges them to talk to her into undergoing treatment. The children try, but Margaret is adamant, telling them, "It's my life and my business. I'll ask only for palliative care when it becomes necessary." "Margaret is still a relatively young woman," Hertz tells her children. "Although she has some heart problems, she is healthy in other respects and should tolerate the treatment well." He advised the children to have her declared incompetent because the grief and stress over their father's illness and death have caused her to make an irrational decision. The son wants his mother to live and wants everything to keep her alive. The daughter, however defends her mother's competency and convinces her brother to respect their mother's decision. Hertz, insisting that Margaret have the time rather than give up, refuses to continue to care for her and suggests she finds another doctor. How would Rawls's view of participation in experimental therapy pose a problem for Maragaret? 1. Hertz could offer her a reward for participation in experimental therapy. 2. She must give voluntary consent for participation in experimental therapies. 3. She can become an experimental subject if Hertz feels it would benefit others 4. She must have given prior approval for her family to give surrogate consent if she were unable to do so.

3. She can become an experimental subject if Hertz feels it would benefit others Rawls would say that is is never right to force or deceive anyone to be part of research, His principles of justice apply only when liberty can be established and maintained. Otherwise, justice becomes a general conception restricting liberties if done for the benefit of all. Margaret does not want to participate but could be forced to under these conditions, which creates a contradiction.

During a routine examination, a pediatrician discovers that a 10-year-old child has HIV infection. According to Kant's moral theory, to whom does the physician have a moral obligation to reveal the child's HIV status? 1. The medical staff 2. The child's school 3. The child's parents 4. The 10-year-old child

3. The child's parents Kantian ethics applies only to rational adults. The parents stand for the child, have an obligation to care for the child, and are at risk of being infected themselves.

A fictional television program depicts a hospital's Board of Ethics committee making decisions about end-of-life care. The following plot is scheduled as the pilot episode. Tom Anderson, the new administrator of City Hospital, is about to conduct his first meeting with the hospital's Board of Ethics. The other members of the 4-member Board are physician Brown, nurse Carter, and professional ethicist Dillon. Today's order of business is to determine the end-of-life treatment for four patients. Each board member has one vote and three of four votes are necessary to justify euthanasia. Anderson's supervisor, the Chief Executive Officer, has ordered him to make cost saving his priority. The CEO has also told him that Brown is a conservative Catholic who always opposes euthanasia, so, before the meeting, Anderson decides to vote to discontinue all life-support measures for all four patients. The first case discussed concerns an older female patient, Easterly, for whom medical intervention, both quantitative and qualitative, appears futile. Three of the four Board members vote to disconnect Easterly's respirator. Only Brown votes no, arguing for transferring her to a hospice. The outcome of the next vote is also three to one in favor of discontinuing life-support measures for the second patient, a young male, Fisher, who has been unconscious since an automobile accident six months ago. Because he is not being mechanically sustained, the committee decides to withhold food and water. When Brown objects on the grounds that this might cause a slow and painful death, Anderson suggests administering an overdose of painkillers. But he withdraws this suggestion when ethicist Dillon and nurse Carter cast him disapproving looks. The third patient, a middle-aged woman, Graham, is conscious but in excruciating pain from incurable metastatic cancer. She urgently requests to be euthanized because she is expected to live another six months, with her pain only increasing. The committee votes three to one to honor Graham's request and decides to have her feeding tube removed. This will lead to death within a few days. "Since the patient is conscious and in great pain," suggests Anderson, "why not allow her to speed up her death by leaving her a bottle of sleeping pills on her bedside table?" Again, he withdraws this suggestion when Dillon and Carter stare at him in disbelief. Anderson considers the fourth patient, a man named Harper, to be an ideal candidate for discontinuing life support. Harper appears to be in pain, even though he does not display any of the higher brain functions. Anderson suggests removing his ventilator. Dillon and Carter join Brown in voting against euthanasia for Harper. "It's simple," explains Dillon, "He has no advance directive on file with this hospital." Anderson considers this a setback, but is still pleased with the outcome of the meeting. He feels that three out of four is a good start. How does Brown follow the Ethical Directives for Catholic Hospitals (EDCH) when voting on Graham's care? 1. The patient has urgently requested to die. 2. The patient is experiencing intractable pain. 3. The patient is kept alive by ordinary means. 4. The patient's prognosis is death within months.

3. The patient is kept alive by ordinary means. EDCH says that failure to provide ordinary means to preserve life is equivalent to euthanasia. Thus extraordinary means that offer no hope and cause hardship to the patient are not morally required.

According to the Nuremberg Code, under which condition may a human subject withdraw from a research project? 1. Whenever the subject so wishes 2. Whenever the subject's life circumstances change 3. When the subject feels continuation is impossible 4. When the subject believes that the subject has suffered harm

3. When the subject feels continuation is impossible This is Article 9 of the Principles of the Nuremberg Code

Ms. Williams, a 44-year-old single woman with no children, has been drinking alcohol heavily for the last 25 years. As a result, she now has cirrhosis of the liver. She also has an inflamed pancreas and experiences occasional seizures, resulting from her alcohol use. These factors lower the likelihood that a liver transplant would be a long-term success. However, a liver transplant is her only hope for long-term survival and she has been on the transplant waiting list for nearly 200 days. During this period, a few organs have become available but they have gone to healthier patients. The longer she must wait for a liver, the worse her condition becomes, and the less likely she will be chosen to receive an organ that becomes available. .. Mr. Alvarez, a 30-year-old married man with two young children, is a patient in the same hospital. He, too, has cirrhosis of the liver, caused by accidental poisoning in his workplace. The other effects of the poisoning have been treated successfully, but his liver has been hopelessly damaged. He has been on the transplant waiting list for 33 days. .. A liver has become available and the transplant committee holds a meeting to decide which of these two patients will receive it. Ms. Williams's doctor claims that since both patients are reasonable candidates for the transplant, the decision should be made on a first come, first served basis. Ms. Williams should receive this organ because she has been waiting longer. Ms. Williams's social worker adds that Ms. Williams is finally making a serious effort to get her drinking and related problems under control. Therefore, the social worker argues, Ms. Williams should receive the liver while it can still be of benefit to her. .. Mr. Alvarez's doctor disagrees, saying that his patient should be given the liver. After all, the doctor points out, Mr. Alvarez is not to blame for his medical problems and is an asset to the community; Ms. Williams has caused her own problems and is a burden to the community. Dr. Smith, the chair of the transplant committee, points out that the entire Alvarez family depends on Mr. Alvarez while no one depends upon Ms. Williams and so Mr. Alvarez should receive the liver. .. If Williams had significant cognitive disability, how would Rawls's theory of justice impact the total amount of resources expended on her care? 1. Alvarez's cognitive abilities confer preference because these abilities are morally significant. 2. Alvarez should receive preference because he can better appreciate the benefit of the procedure. 3. Williams should receive preference because her disability entitles her to a greater share of resources. 4. Williams's cognitive disability is irrelevant because the differences between people have no moral importance.

3. Williams should receive preference because her disability entitles her to a greater share of resources. Rawls' theory: inequities are acceptable when they improve the lot of those who are worse off.

Dr. Hernandez is a cancer specialist at County Hospital. She prepares for her first appointment with Mr. Patel, a patient referred to her by his primary care physician, Dr. Singh. The patient's medical records show that Dr. Singh suspected cancer and ordered an MRI on Mr. Patel three months ago in response to the patient's complaint of back pain and fatigue. Dr. Hernandez notes that this MRI showed a small tumor attached to Mr. Patel's right lung and an adjoining part of his spine. An MRI done that morning in preparation for the appointment shows that the tumor has grown quite rapidly. Without treatment, Mr. Patel will probably die within a few months. Surgery to remove the tumor offers the best chance for entirely eliminating the cancer but, because of its location, this surgery carries a high risk of death or of paralysis. Treatment with chemotherapy and radiation has a good chance of slowing the growth of the tumor, but would result in several months of severe discomfort with only a small chance of eliminating the cancer entirely. However, chemotherapy and radiation are unlikely to cause death. Dr. Hernandez is one of the three local surgeons qualified to perform this surgery and has treated many patients with similar tumors. She is familiar with the latest relevant research. Although she knows that both surgery and chemotherapy combined with radiation are accepted treatments for tumors like Mr. Patel's, she dislikes performing operations that carry a high risk of death. In the examining room, Dr. Hernandez and Mr. Patel discuss his situation: Dr. Hernandez: I am sorry to tell you that your tumor is growing very quickly. If left untreated, it is likely to prove fatal within a few months. Mr. Patel: I was afraid of that. This is so upsetting, I can't think straight. Please just tell me what to do. Dr. Hernandez: You need to make your own decision about this. However, chemotherapy with radiation is the only treatment option for patients in your condition. This treatment can be difficult to tolerate, but it offers a chance for a long life and might even eliminate your cancer altogether. Mr. Patel: I'll think about it. Please don't tell anyone that I have cancer; at least until I decide whether I want treatment. After the examination, Dr. Hernandez phoned Dr. Singh. They discuss whether Mr. Patel has any history of mental illness that might affect his response to the bad news. How did Hernandez fail to satisfy her duty of telling the truth? 1. the basis of her diagnosis 2. where to find information on his condition 3. about an acceptable option for a possible recovery 4. that she avoids procedures she does not like to perform

3. about an acceptable option for a possible recovery This information could affect Patel's decision.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. ... Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. ... How would Marcia Angell describe the rationing system used to make decisions about Camden's care? 1. an open system guided by her medical needs 2. a closed system guided by her medical needs 3. an open system guided by the goal of saving the company's money 4. a closed system guided by the goal of saving the company's money

3. an open system guided by the goal of saving the company's money Managed care systems are open because resources withheld from one patient may not be used to care for other patients. They are also guided by the goal of saving the company's money.

According to the reverence for life principle, which type of value do all living things share? 1. consequential value 2. instrumental value 3. intrinsic value 4. sentient value

3. intrinsic value The value of living things is primitive, basic, and based on their internal essence.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. Which position is illustrated by Jackson's response to the suggestion that Camden has a moral right to health care? 1. medical virtue 2. medical deontology 3. medical individualism 4. medical consequentialism

3. medical individualism Medical individualism: acknowledging a patient's claim of a right to health care violates the rights of medical professionals by obligating them to provide that care and depriving them of their autonomy.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. Which kind of right does Beckley cite when claiming that Camden has a right to medical care? 1. economic 2. legal 3. moral 4. political

3. moral If Mrs. Camden has a right to medical care, it is a moral right derived from the principles of a moral theory.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. Jackson's response to Beckley's suggestion about Camden's moral right illustrates the conflict between which two moral obligations? 1. respect for Camden's rights and respect for her autonomy 2. respect for Camden's rights and concern for her well-being 3. respect for Camden's rights and respect for Jackson's autonomy 4. concern for Jackson's autonomy and concern for the efficient use of resources

3. respect for Camden's rights and respect for Jackson's autonomy The patient's rights to health care conflict with physician's autonomous choice about which patients to treat.

Which public policy is analogous to compelling adults to undergo genetic screening? 1. bans on foods imported from countries having viral outbreaks 2. mandatory testing to identify the father of an unsupported child 3. testing to detect and prevent the spread of communicable diseases 4. rules requiring athletes to be tested for the use of steroids and other drugs

3. testing to detect and prevent the spread of communicable diseases This is the strongest analogy. Genetic diseases are vertically communicable between generations, so this is correct because both measures are meant to prevent the spread of communicable disease. Though not everyone accepts this model, it is the most reasonable.

According to Peter Singer, what is the criterion for moral standing? 1. being alive 2. being human 3. the capacity for suffering 4. the capacity for abstract thought

3. the capacity for suffering Singer would say that sentience, which is the capacity to suffer, is the criterion to moral standing.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. ... The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. ... However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." ... "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." ... "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. ... "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." ... Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. ... Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." ... Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" ... Which statement would Marty be most likely to support? 1. Artificial insemination violates the rights of infertile couples. 2. Artificial insemination is wrong because it violates the rights of the child. 3. A disadvantage of artificial insemination is that the donor is "playing God." 4. An advantage of artificial insemination by donor is that lesbians can become mothers.

4. An advantage of artificial insemination by donor is that lesbians can become mothers. Marty is in favor of assisted reproductive technology and this is a reason in favor of it.

In Canada, which problem resulted from the decision to have most health services covered for the entire population? 1. The system quickly became bankrupt 2. Services became severely overburdened 3. Disease prevention received less emphasis 4. Availability of higher cost services became limited

4. Availability of higher cost services became limited. Large scale availability of expensive technology and services because limited since funds became limited and basic care became emphasized.

A physician discreetly moves his mother to the top of the list to receive a vaccine that is in short supply. How is this action best described? 1. Displaying the virtue of honesty 2. Fulfilling his moral duty of fairness 3. Showing compassion for his patient 4. Experiencing a conflict among virtues

4. Experiencing a conflict among virtues. The physician is in a conflict between caring for his mother and for his other patients who also require a vaccine.

The Maussimana River, one of the few remaining free-flowing rivers in the eastern US, flows through the Great Greenage National Recreation Area (GGNRA). Despite its status as a scenic and recreational river, a group of industrialists, the Green Clashers, is lobbying public officials to relax governmental protections and fund the construction of a dam. .. The Green Clashers's director, Sam, claims, "The dam is necessary for farmers who need additional water to expand operations and increase profits." Paula, representing members of the public who support the dam project, points out that, "Easy access to stable water supplies will lower water bills." .. Local officials see the project as a potential boon to the economy. "The dam will create jobs," Mayor Smith says, "and raise the standard of living for many minority and poor families who now rely on polluted groundwater. The pollution that the dam will create is acceptable because it will provide cleaner, cheaper water for the poor." .. Because of the dam's exorbitant cost, city planners agreed with the Green Clashers's proposal to cut the local curbside recycling program and to shorten hours that local parks are open in order to pay for the project. .. Environmentalists from the local chapter of Earth Defenders oppose the project because, as the chapter's president, Gus explains, "Building a dam within the recreation area would create a dangerous precedent that would allow destructive human activities in areas where those activities were once restricted. We would be wise to remember that the land is not simply a commodity, but has spiritual and aesthetic value. Our legal system must do more to protect it." .. Beth is concerned about pollution in the reservoir and in the river. "Increased farming," she asserts, "will just mean more chemicals and more chemicals will run into the river and collect in the reservoir sediments." .. Marilyn, another member of Earth Defenders, adds that, "The endangered blue spotted trout would be adversely affected by this project because they would no longer be able to migrate to the ocean and back again to their birth stream to spawn. We have no right to restrict their rights and movements in this way and it would have negative repercussions throughout the local food web." .. Jane continues the argument, "Scientists estimate fish populations will decline by about 50 percent in less than two years." .. Ed points out, "The dam would flood hundreds of acres of ground that is now being used by many animals, including coyotes. If these areas are flooded, animal species would have to migrate into new home ranges. Plant species would be endangered to the point of extinction. This would seriously undermine local ecosystem stability and ultimately affect human survival. We should stop this project before it endangers us and our descendants." .. When applying Singer's ideas to the case of the blue-spotted trout, the ethicist would find which critical challenge the most cogent? 1. Considering the interests of the trout as equal to the interests of humans is too complex. 2. Only mentally normal mammals aged one year or more can really be considered in his conceptual approach. 3. The distinction between basic and peripheral interests clouds the necessity of the dam and the negative effects on the trout. 4. His theoretical orientation fails to recognize that neither interests nor suffering are directly commensurable between the trout and humans.

4. His theoretical orientation fails to recognize that neither interests nor suffering are directly commensurable between the trout and humans. The interests of trout must be weighed against those of humans. Because the interests and suffering between species are not commensurable this is the most cogent critical challenge application of Singer's ideas.

Dr. Hernandez is a cancer specialist at County Hospital. She prepares for her first appointment with Mr. Patel, a patient referred to her by his primary care physician, Dr. Singh. The patient's medical records show that Dr. Singh suspected cancer and ordered an MRI on Mr. Patel three months ago in response to the patient's complaint of back pain and fatigue. Dr. Hernandez notes that this MRI showed a small tumor attached to Mr. Patel's right lung and an adjoining part of his spine. An MRI done that morning in preparation for the appointment shows that the tumor has grown quite rapidly. Without treatment, Mr. Patel will probably die within a few months. Surgery to remove the tumor offers the best chance for entirely eliminating the cancer but, because of its location, this surgery carries a high risk of death or of paralysis. Treatment with chemotherapy and radiation has a good chance of slowing the growth of the tumor, but would result in several months of severe discomfort with only a small chance of eliminating the cancer entirely. However, chemotherapy and radiation are unlikely to cause death. Dr. Hernandez is one of the three local surgeons qualified to perform this surgery and has treated many patients with similar tumors. She is familiar with the latest relevant research. Although she knows that both surgery and chemotherapy combined with radiation are accepted treatments for tumors like Mr. Patel's, she dislikes performing operations that carry a high risk of death. In the examining room, Dr. Hernandez and Mr. Patel discuss his situation: Dr. Hernandez: I am sorry to tell you that your tumor is growing very quickly. If left untreated, it is likely to prove fatal within a few months. Mr. Patel: I was afraid of that. This is so upsetting, I can't think straight. Please just tell me what to do. Dr. Hernandez: You need to make your own decision about this. However, chemotherapy with radiation is the only treatment option for patients in your condition. This treatment can be difficult to tolerate, but it offers a chance for a long life and might even eliminate your cancer altogether. Mr. Patel: I'll think about it. Please don't tell anyone that I have cancer; at least until I decide whether I want treatment. After the examination, Dr. Hernandez phoned Dr. Singh. They discuss whether Mr. Patel has any history of mental illness that might affect his response to the bad news. Which consideration suggests that Hernandez needs more information about the patient before she can determine which treatment best satisfies a duty of beneficence? 1. Patel may die in a few months without treatment. 2. Patel has not yet made a decision about treatment. 3. The medical community does not know the cause of this condition. 4. Individuals disagree about preferring the risk of death over months of discomfort.

4. Individuals disagree about preferring the risk of death over months of discomfort. Because different patients have different ideas about what constitutes a benefit, learning about patient preferences can be important in determining how to satisfy a duty of beneficence.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. Whose view least reflects the ideals of ecological feminism? 1. Albert 2. Benito 3. Brenda 4. Jens

4. Jens Jens is the pharmaceutical company representative, and supports anthropocentric concerns at the expense of the interests of other organisms. This is clearly in opposition to ecofeminist ideals.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. Whose statement is consistent with Leopold's "land ethic"? 1. Albert 2. Benito 3. Jens 4. Mallitta

4. Mallitta Mallitta's reference to beauty and integrity of the land reflects Leopold's land ethic.

Some philosophers believe that all animals above a certain neurological threshold are sentient and therefore deserve direct moral consideration. What is the most probable consequence of such a view? 1. Consumers' choices would remain constant. 2. Suffering of animals would barely be avoided. 3. Animals would act in accordance with their internal moral structures. 4. Radical changes would need to be made in animal experimentation practices.

4. Radical changes would need to be made in animal experimentation practices. This is a very probable consequence of such a view.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. ... The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. ... However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." ... "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." ... "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. ... "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." ... Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. ... Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." ... Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" How does Marty view in vitro fertilization? 1. Sperm is donated to a couple. 2. An embryo is created outside of marriage. 3. An embryo is carried by an unrelated woman. 4. Sperm is united with an egg outside of the body.

4. Sperm is united with an egg outside of the body. This is also called test tube babies.

John and Bobbi Smith were very excited when Dr. Brown confirmed their home pregnancy test. "I know you want to have a healthy baby, so I'm sure you'll follow all the instructions about diet and exercise," he said. ... The couple couldn't wait to tell their family and friends the good news, so that weekend they invited both sets of parents to dinner. Their announcement was met with great joy. ... However, Bobbi's mother, always the practical one in the family, spoke up. "I hope you're planning to get your fetus tested," she said. "You and John aren't so young anymore and things can go wrong." ... "But what good will testing do?" Bobbi asked. "It's too late now. I'm already pregnant." ... "Well, if this fetus has Down syndrome, for example, you know..." and her mother's voice trailed off. ... "Oh no, Mother. No way! I wouldn't even consider abortion. It's wrong and anyway, I already love this baby, whatever problems it may have." ... Bobbi tried to put her mother's worries out of her mind and went out for the evening with their best friends. Within ten minutes, when Bobbi repeatedly refused her usual glass of wine before dinner, her friend Marty guessed. She congratulated the couple for getting pregnant the natural way. "So many of our friends have gone through in vitro fertilization. Well, I suppose that way you can choose the healthiest embryos and maybe even choose the sex of your child. I think that would be great. We've come a long way since Louise Brown," she said. ... Marty's husband, Jim, a biologist at Prospect University, joined the conversation. "I am fascinated by all that science can do, now, to help infertile couples. The campus newspaper regularly runs ads offering big money for young women who will donate eggs or serve as surrogate mothers. And human cloning - that's coming along pretty soon, too, I bet." ... Bobbi began to feel uneasy at Jim's enthusiasm for applying technology to having babies. "Perfect babies, cloning - where will it all end?" she thought to herself. "Are we asking for trouble with all of this?" ... Which statement most supports Bobbi's mother's position? 1. Legal rights are more important than moral rights. 2. Legal rights are more important than natural rights. 3. The rights of women outweigh the rights of men in the US. 4. The rights of actual persons outweigh the rights of potential persons.

4. The rights of actual persons outweigh the rights of potential persons. This is a typical argument to support the idea that abortion is permissible.

Which patters of distribution of wealth would conform to Rawls's difference principle? Distribution on the basis of promoting 1. Merit 2. Effort 3. Potential contribution to society 4. The welfare of the least advantaged

4. The welfare of the least advantaged This describes Rawls's difference principle.

Which potential problem is the worst danger of the community practice standard of informed consent? 1. The standard may become so stringent that most physicians cannot conform. 2. Physicians may have difficulty determining the requirements of the standard. 3. The standard may vary so much that some patients will receive less protection. 4. The whole community of physicians may conform to an unacceptable standard.

4. The whole community of physicians may conform to an unacceptable standard. Without a particular goal to be achieved, the entire specialty could drift to an objectively poor standard of informed consent. This is the danger of the community practice standard.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. According to Marcia Angell, what role does Jackson play in Camden's care? .. Jackson functions as 1. a mechanism for reducing medical costs. 2. an advocate for Camden's well-being. 3. a technician who follows instructions to attain a goal. 4. a double agent with conflicting obligations to Camden and the HMO.

4. a double agent with conflicting obligations to Camden and the HMO. The doctor is a double agent, working both for the patient and the HMO.

Which pair of moral principles best characterizes the conflict confronting a physician whose patients are also the physician's research subjects? 1. justice vs. principle of utility 2. beneficence vs. nonmaleficence 3. justice vs. respect for autonomy 4. beneficence to the patient vs. beneficence toward society

4. beneficence to the patient vs. beneficence toward society Physicians are obligated to work for the best interests of their patients, but this may conflict with the researcher's obligation to benefit society.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. .. The exchange between Mallitta and Jens implies that her rejection of Duplexa's proposal is based upon which philosophical platform? 1. lifeboat ethics 2. social ecology 3. ecological feminism 4. environmental justice

4. environmental justice Based on previous land damage by others and the lack of benefit for her people, Jens's promise of compensation is false to Mallitta. She sees continued use of the land benefiting only those who do not live on it or deal with the negative repercussions as a multinational example of environmental injustice.

Duplexa, a Swiss-based multinational pharmaceutical company, proposed a ten-year contract with the Brazilian government. In exchange for exclusive and unrestricted access to the Brazilian rain forest, Duplexa pledged to help local villages establish public schools and new medical centers and to cede to the Brazilian government 10 percent of the profits from the pharmaceutical processing of rain forest species. Local residents gathered to oppose Duplexa's plan. One woman, Mallitta, summarized their sentiments. "We are poor. We women eke out a living from land unjustly damaged by your logging companies, by tourists, and by other rich prospectors. Leave us alone! We do not want any more outsiders destroying the beauty and integrity of our land by taking plants and animals from their homes." The pharmaceutical company representative, Jens, replied, "But we will be bringing money and jobs to your village. We will help you establish schools and medical facilities. We will help you better your lives!" This statement brought little relief to the people. They had already seen multinational corporations enter and take advantage of nearby villages, causing serious land degradation. They did not believe the company would honor its promises. One young man, Benito, spoke vehemently, "These plants and animals have the right to live in peace. They are not ours to give and they are not yours to take!" Another young man, Suaravo, said, "If you take away these species, collecting them for your own purposes, you may disturb the delicate balance of our world. You don't know what roles these creatures play. We don't want you to disrupt the land our ancestors have shared for generations." Because of the controversial nature of Duplexa's proposal, members of the international environmental organization, Greenpeace, were also present at the gathering. Jennifer, a Greenpeace spokesperson, said, "These creatures have their own selves, their own trajectories. They contribute to the richness of life on earth, and gathering them violates their inherent value by treating them simply as a means, rather than as ends in themselves. Their interests are equal to all others!" Another Greenpeace member, Brenda, spoke as well, "The problem here is that capitalism once again rears its ugly head, disregarding the welfare of local people, encouraging the injustice of classism and racism, and seeking profit solely for individual or corporate gain." Another person, Albert, said, "This is just another exasperating example of human domination of nonhuman nature. We rich Westerners see ourselves as higher in the hierarchy; we think we are different from nature, and from these local people. And we believe this gives us the right to take whatever we want from them!" No compromise was reached. Which value is Jennifer most likely to favor? 1. anthropocentric 2. biocentric 3. instrumental 4. intrinsic

4. intrinsic Jennifer specifically mentions intrinsic value as a reason why all organisms are equal, and why she opposes the plan. Her statement evokes deep ecology and biocentric ethics that hold intrinsic value as core tenets.

A governor has proposed that each state citizen pay an equal tax of $5,000 instead of paying a percentage of their income. Which response reflects an application of Rawls's theory of justice? .. The governor's proposal would make the state tax 1. more just because distribution would maximize utility. 2. less just because some citizens would use more state resources than others do. 3. more just because it would make the distribution of financial burdens equal for all. 4. less just because it would put a greater burden on citizens who do not have much money.

4. less just because it would put a greater burden on citizens who do not have much money. Rawls requires that financial burdens be distributed unequally in ways that benefit the least advantaged.

A fictional television program depicts a hospital's Board of Ethics committee making decisions about end-of-life care. The following plot is scheduled as the pilot episode. Tom Anderson, the new administrator of City Hospital, is about to conduct his first meeting with the hospital's Board of Ethics. The other members of the 4-member Board are physician Brown, nurse Carter, and professional ethicist Dillon. Today's order of business is to determine the end-of-life treatment for four patients. Each board member has one vote and three of four votes are necessary to justify euthanasia. Anderson's supervisor, the Chief Executive Officer, has ordered him to make cost saving his priority. The CEO has also told him that Brown is a conservative Catholic who always opposes euthanasia, so, before the meeting, Anderson decides to vote to discontinue all life-support measures for all four patients. The first case discussed concerns an older female patient, Easterly, for whom medical intervention, both quantitative and qualitative, appears futile. Three of the four Board members vote to disconnect Easterly's respirator. Only Brown votes no, arguing for transferring her to a hospice. The outcome of the next vote is also three to one in favor of discontinuing life-support measures for the second patient, a young male, Fisher, who has been unconscious since an automobile accident six months ago. Because he is not being mechanically sustained, the committee decides to withhold food and water. When Brown objects on the grounds that this might cause a slow and painful death, Anderson suggests administering an overdose of painkillers. But he withdraws this suggestion when ethicist Dillon and nurse Carter cast him disapproving looks. The third patient, a middle-aged woman, Graham, is conscious but in excruciating pain from incurable metastatic cancer. She urgently requests to be euthanized because she is expected to live another six months, with her pain only increasing. The committee votes three to one to honor Graham's request and decides to have her feeding tube removed. This will lead to death within a few days. "Since the patient is conscious and in great pain," suggests Anderson, "why not allow her to speed up her death by leaving her a bottle of sleeping pills on her bedside table?" Again, he withdraws this suggestion when Dillon and Carter stare at him in disbelief. Anderson considers the fourth patient, a man named Harper, to be an ideal candidate for discontinuing life support. Harper appears to be in pain, even though he does not display any of the higher brain functions. Anderson suggests removing his ventilator. Dillon and Carter join Brown in voting against euthanasia for Harper. "It's simple," explains Dillon, "He has no advance directive on file with this hospital." Anderson considers this a setback, but is still pleased with the outcome of the meeting. He feels that three out of four is a good start. Which term describes the form of euthanasia recommended by Anderson for Harper? 1. voluntary active euthanasia 2. voluntary passive euthanasia 3. nonvoluntary active euthanasia 4. nonvoluntary passive euthanasia

4. nonvoluntary passive euthanasia The action would be nonvoluntary, since the patient's wishes are unknown, and passive, because the ventilator removal allows the patient to die naturally.

Which term applies to the action of removing life support from an incompetent person who is terminally ill? 1. active voluntary euthanasia 2. passive voluntary euthanasia 3. active nonvoluntary enuthanasia 4. passive nonvoluntary euthanasia

4. passive nonvoluntary euthanasia Passive indicates withdrawing; it is nonvoluntary if the patient is incompetent.

Ms. Williams, a 44-year-old single woman with no children, has been drinking alcohol heavily for the last 25 years. As a result, she now has cirrhosis of the liver. She also has an inflamed pancreas and experiences occasional seizures, resulting from her alcohol use. These factors lower the likelihood that a liver transplant would be a long-term success. However, a liver transplant is her only hope for long-term survival and she has been on the transplant waiting list for nearly 200 days. During this period, a few organs have become available but they have gone to healthier patients. The longer she must wait for a liver, the worse her condition becomes, and the less likely she will be chosen to receive an organ that becomes available. ... Mr. Alvarez, a 30-year-old married man with two young children, is a patient in the same hospital. He, too, has cirrhosis of the liver, caused by accidental poisoning in his workplace. The other effects of the poisoning have been treated successfully, but his liver has been hopelessly damaged. He has been on the transplant waiting list for 33 days. ... A liver has become available and the transplant committee holds a meeting to decide which of these two patients will receive it. Ms. Williams's doctor claims that since both patients are reasonable candidates for the transplant, the decision should be made on a first come, first served basis. Ms. Williams should receive this organ because she has been waiting longer. Ms. Williams's social worker adds that Ms. Williams is finally making a serious effort to get her drinking and related problems under control. Therefore, the social worker argues, Ms. Williams should receive the liver while it can still be of benefit to her. ... Mr. Alvarez's doctor disagrees, saying that his patient should be given the liver. After all, the doctor points out, Mr. Alvarez is not to blame for his medical problems and is an asset to the community; Ms. Williams has caused her own problems and is a burden to the community. Dr. Smith, the chair of the transplant committee, points out that the entire Alvarez family depends on Mr. Alvarez while no one depends upon Ms. Williams and so Mr. Alvarez should receive the liver. ... Under which moral theory would Williams and Alvarez be equally entitled to receive the transplant? 1. intuitionism 2. utilitarianism 3. virtue theory 4. rationalist deontology

4. rationalist deontology Kant would not take into account the size of the patient's family.

Why would an industrial planner choose to locate a toxic waste incinerator in an American city's minority neighborhood? The industrial planner 1. is acting on institutionalized racism. 2. is being paid by taxpayer families in middle class neighborhoods. 3. knows the World Bank will fund the proposal if the site choice is economically feasible. 4. realizes that it is efficient to place environmental hazards where people have the least earning power.

4. realizes that it is efficient to place environmental hazards where people have the least earning power. Cost/benefit analysis shows that it is more efficient to build toxic industries where individuals have the least earning power. Often, these areas also have lower property values. Thus, it is often cheaper to build such industries in poor, minority areas.

Why do many people consider sustainable development to be an appropriate lifestyle? ... Sustainable development 1. improves the current standard of living. 2. provides a viable substitute to overreliance on self-interested actions. 3. is a practical alternative to classical economics for resource allocation. 4. sees the economy as dependent on the natural environment for resource production.

4. sees the economy as dependent on the natural environment for resource production. The key to sustainable development is that it recognizes that the economy is dependent upon the natural environment.

Callicott argues that the moral status of a species requires membership in which type of community? 1. biological 2. linguistic 3. regional 4. social

4. social Being a part of the community of creatures that includes those who deliberate and make moral decisions confers moral status on its species members.

According to the practice guidelines of a large health-maintenance organization (HMO), Mrs. Camden, a 57-year-old widow, is medically ready to be discharged from the hospital. Her physician, Dr. Jackson, knows, however, that she will need some assistance and support when she is at home, particularly during the first few days. Unfortunately, Mrs. Camden has no one at home to provide her with this help. Her daughter and son-in-law, who live in another city, have agreed to come for the weekend to take care of her, but today is only Thursday. Sending her home to an empty house would involve serious risk of injury. Dr. Jackson's first response is to keep her in the hospital for another day and then send her home when her daughter arrives. But Mrs. Camden's HMO refuses to pay for an extra day, claiming that it is medically unnecessary. Mrs. Camden has no savings, lives on a small pension, and is unable to pay out-of-pocket for another day in the hospital. As it is, it will be very difficult for her to make her co-pay. .. Arthur Beckley, the hospital social worker, is angered by the HMO's decision, saying that it violates Mrs. Camden's right to adequate health care. This comment irritates Dr. Jackson and she asks who has the obligations that correspond to patients' rights. "Should doctors be required to provide treatment regardless of patients' ability to pay, or regardless of doctors' willingness to treat those patients?" Mr. Beckley acknowledges that the health care system needs to consider the autonomy of doctors as well as that of patients. "But," he continues, "that shouldn't mean that Mrs. Camden should be discharged before she is well enough to take care of herself. Why not just keep her in the hospital for one more day? Then later, the HMO can go through the appeals process to see if it will have to pay for it after all." Dr. Jackson is not enthusiastic about this suggestion. She knows from experience that the appeals process is lengthy and difficult, and that the appeal often fails. Furthermore, although she does not mention it, Dr. Jackson knows that if the HMO reverses its decision, it would probably result in a smaller payment for her later on. The HMO uses financial incentives to encourage doctors to limit the cost of patients' care. In Mrs. Camden's case, Dr. Jackson has a financial incentive to keep the hospital stay as short as possible. .. How does Camden's HMO differ from a system in which patients receive all beneficial care? .. Camden's HMO 1. is less fair. 2. is less efficient but more flexible. 3. would see health care costs rise more quickly than costs in the other proposed system. 4. would be less expensive or more financially stable than the other proposed system.

4. would be less expensive or more financially stable than the other proposed system. Approving all requested care would greatly increase costs. These costs would be passed on to patients as higher premiums or the system would go bankrupt.