Health ethics midterm
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School
Tulane University *
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Course
4950
Subject
Philosophy
Date
Apr 3, 2024
Type
Pages
12
Uploaded by ColonelOstrich2574
.MIDTERM
REVIEW
This exam [100 points total] consists of five multiple choice
Or true /false questions (2 points each); four short answer questions (15
points each); and one long essay (30 points). When answering a short answer
question, expect that you will need at least a paragraph to thoroughly explain
the concept or argument under discussion.Your long essay answer should be
about one and a half to two handwritten pages.Do not forget to bring an
official blue book
Intro to Ethical Theory
●
By what criteria might we assess competing ethical theories?
○
1. Is the theory internally consistent?
○
2. Are the implications of the theory largely reconcilable with our moral life?
○
3.Does the theory provide effective guidance in practice?
●
What is meant by the claim that act-utilitarianism can be rightly understood as a form of
“situation ethics”? Fully explain the act-utilitarian attitude toward moral rules.
○
Meant that when using act utilitarianism, one must make moral judgements based
on the entirety of a situation. More focused on the circumstances that surround the
issue. In regards to moral rules, act utilitarians believe
●
How is rule-utilitarianism different from act-utilitarianism? Which prominent criticism of
act-utilitarianism does it attempt to remedy?
○
To really understand act and rule utilitarianism, first we need to establish the
meaning of the word utilitarianism, which is to always act to maximize utility.
Though both are rooted in utilitarianism, act and rule have very different
meanings. For example, rule utilitarianism involves first assessing with moral
rules that are generally likely to maximize net utility, then acting in accordance
with said rules. Degrazia, Mappes, and Brand-Ballard wrote how rule
utilitarianism emphasizes how, “ a person ought to act in accordance with the rule
that, if generally followed, would produce the greatest balance of good over evil,
everyone considered” ( pg 13). This is different from act utilitarianism because
with this type, “ a person ought to act as to produce the greatest balance of good
over evil, everyone considered” ( pg 13). In other words, act utilitarianism is a
version of “situation ethics” and has the intent to calculate net utility for all
choices. This is the prominent criticism of this type of utilitarianism because it's
impractical. It's impossible to calculate all choices. Rule utilitarianism allows for
an indirect appeal to the principle of utility. Rule utilitarians, “ develop a moral
code on the basis of utilitarian considerations and then assess individual actions,
not on the basis of utilitarian considerations but on the basis of the moral rules
that have been established” ( pg 14).
●
What is the key principle of Kantian deontology? And why do so many find Kantian
deontology to be “intuitive”?
○
The key principle of Kantian deontology is respect for persons. Many people find
this to be intuitive because it 1) tries to root out subjectivity of fairness to make it
more universal 2) tries to acknowledge that others are rational beings like yourself
3) tries to act as if everyone were already treated a an end to themselves
●
How does Kant distinguish between “perfect” and “imperfect” duties?
○
“perfect”= absolute duties; can’t be altered or changed in any way
○
“imperfect” = duties that must enable others to act as autonomous beings
●
Why do virtue ethicists emphasize the importance of character? What are the benefits of
this approach to ethics? What are the potential limitations or weaknesses? Do you think
that virtue ethics should have a role to play in a biomedical context?
○
limitations/weaknesses: not all virtuous examples are gonna be examples that
produce moral action in every context
○
Benefits: more integrated into our own lives. More human, easily taught. Serves
as a pillar of the community.
●
Define autonomy then state and explain the four conditions on an autonomous act.
Finally, how does paternalism relate to autonomy? Why is it sometimes difficult to tell
the difference between a doctor respecting a patient’s autonomy and a doctor acting
paternalistically? Do you think physician paternalism is ever justified? Why or why not?
○
Autonomy: the state or condition of self governance. Living one's life in
accordance with one's own values and desires.
○
4 conditions: Intentionality, understanding, freedom from external constraints,
freedom from internal constraints
●
Is it ever justifiable to interfere with or limit the autonomy of another person? If so,when?
State and explain at least Two possible liberty-limiting principles.
○
Paternalistic actions can sometimes be justified for example when a patient is not
in a condition where they can be trusted to make a rational decision. Not all
paternalistic actions can be justified.
The Professional- Patient Relationship
●
Explain Pellegrino’s three- tiered system of obligations for physicians? Why does he rank
these different obligations hierarchically? What does it mean to say that the hierarchy
proceeds in “ascending order of ethical sensitivity”?
○
Pellegrino’s three-tiered system of obligation for physicians is 1) legal obligation
2) observance? Fulfillment of moral rights and duties 3) the practice of virtue
●
What is the key danger of virtue-based ethics, according to Pellegrino? By contrast, what
is its potential benefit? When or in what context would the application of virtue- based
professional ethics be most beneficial?
○
Virtue ethics are not sufficient to explain why people should act rightly, that virtue
ethics is not necessary to account for the intrinsic value of the “admirable type”
when, intuitively, our ethics should be motivated by the opportunity to improve
the lives of others. The potential benefit however is that virtue ethics strongly
emphasizes that individuals can be trained in the virtues so that they develop
excellent habits of mind. Virtue ethics recognizes that resolution of difficult
problems depends, above all, on the character of the people who make decisions.
The ethics are based on a positive view of human nature. It would be most
beneficial for surgeons or people who are in high ranking medical positions who
have control over a life or several lives.
●
State and explain each of the five models or metaphors of the doctor patient relationship
discussed by Childress and Siegler. (NOTE: You will be responsible for memorizing
these)
○
The five models of the doctor patient relationship are 1) parent or paternal 2)
partnership 3) rational contractors 4) friendship 5) technician
○
Paternal: the locus in decision making is the healthcare professional who has the
“ moral authority” within the relationship
○
Partnership
:
a model that stresses that healthcare professionals are and their
patients are partners in the pursuit of a shared value of health
○
Rational contractors: healthcare professionals and their patients are related or
should be related by a series of specific contracts. Both parties agree to exchange
goods and and services
○
Friendship: the patient expresses trust and confidence in the physician while the
doctor uses that trust to give effective technical help
○
Technician: the physician provides technical service to patients who are
“consumers”. Doctor only presents facts.
●
How, according to Ackerman, is the imperative of respect for patient autonomy typically
understood? What does autonomy mean to most practitioners? And what has been the
main consequence of this interpretation?
○
The imperative of respect for patient autonomy is typically understood as
allowing patients to make their own choices, which is generally understood as
non-interference to most practitioners. The main consequence of this
interpretation is that it reduces the role of the physician from one with some
choice to that of a technician who has to blindly follow the customer’s desires.
Additionally Ackerman acknowledges that the state of being sick is extremely
transformative and is a state of wounded humanity, meaning that you don’t
necessarily have the mental capacity to make rational decisions.
●
Which liberty limiting principle is Ackerman suggesting doctors should appeal to more
often when making decisions about patient care? Ultimately, what does he think is
necessary in order to “return control” to the patient? Do you agree with him? Why or why
not?
●
According to Newton, what are the “peculiar virtues” of the traditional nurse? Why does
she reject the idea that nurses should serve as patient advocates? Do you agree with
her?Why or why not?
○
Believes that the role of the nurse being an “autonomous professional”
undermines efficiency. Quality care in a hospital setting ( roles is to provide
emotional, motherly support)
○
Peculiar virtues are:
■
1) hospital bureaucracies require clear roles and lines of authority
■
2) only physicians are properly trained to handle medical emergencies
■
3) nurses main role should be to humanize care and provide emotional
support
●
What considerations are most important in establishing a duty to warn? Also, do you
agree with the following statement: “The risk that unnecessary warning may be given is a
reasonable price to pay for the lives of possible victims that may be saved.” Which
ethical theory is implicitly appealed to here?
○
When thinking about one’s duty to warn, there are 2 considerations that come to
mind. Those conditions would be 1) if the threat is foreseeable and 2) if the threat
is severe 3). In regards to a foreseeable threat, Tobriner argues that,” a defendant
owes a duty of care to all persons who are foreseeably endangered by his conduct,
with respect to all risks which make the conduct unreasonably dangerous” (pg
111). This means that if someone has reason to believe that another’s life could
be put in harm's way very soon, then they have a responsibility to tell said person.
As for the severity of a threat, it's most important to consider the public interest
and safety from violent assault and this principle must be thought of when
considering warning someone of a possible threat. Tobriner goes into greater
detail on page 109 when he says, “ when a therapist determines that their patient
presents a serious danger of violence to another, they incur an obligation to use
reasonable care to protect the intended victim against such danger.” The statement
listed above is one that I have to agree with. One should not gamble with another
person’s life, especially when there is reasonable doubt. If I put myself in this
situation, I’d want someone to tell me if they heard some troubling news about a
possible attack on my life. This is not a question of morality, it’s now a question
of obligation. I believe you are obligated to tell someone when their life is at risk,
even if it may be hard or cause other issues in your personal life. At the end of the
day, uncomfortableness is a simple cost to pay when the price could be someone’s
life. The ethical theory that’s applied here would be Pellegrino’s “ The virtuous
Physician”. This theory says that we should combine a duty- based and a
virtue-based approach to medical ethics. He thinks this because he believes that
physicians who merely abide by the law and respect patient rights are doing the
moral minimum. This model promotes selfless acts in the care of others, which
could be applied to others who are in need of help even if they don’t know it. One
question I have for the other would be if they think there are other cons
●
State and explain the key concern at the heart of Justice William P. Clark’s dissent from
the majority opinion in the Tarasoff case.
○
The very practice of psychiatry depends on the reputation in the community that
the psychiatrist will not tell. If it's violated then care will be less effective, there
will be an increase in violent crime, and it will make less people want to
go/believe in therapy.
●
Do you think that the duty to warn is sufficient cause to breach doctor-patient
confidentiality in the scenario at issue within “Please don’t tell: A case about HIV and
confidentiality”? Why or why not?
○
Contested Therapies and Biomedical Enhancement
●
Do you think that the use of cochlear implants constitutes ordinary or extraordinary
care?What does Tucker think of this? How does she defend the claim that pre-lingual
deaf children should have the opportunity to hear and learn English, in addition to ASL?
○
Personally, I think the use of cochlear implants constitutes ordinary care. When
someone first finds out their child is deaf, it’s a normal reaction to do everything
possible in order for them one day to have the ability to hear. Wanting your child
to have some sense of hearing, even if it may be small, is what most parents
would do. In reality, many people don’t know ASL or have any familiarity in the
deaf community world. Not everyone has the funds or resources to support a fully
deaf child. For most, people go with what’s familiar to them, and that would be
communicating with others verbally. Cochlear implants are not extraordinary care
because the idea would be the first instinct for many people when faced with this
decision. In addition to that, Tucker would classify implants as a way to, “expand
the range of opportunities available to deaf children whereas hostility to
mainstream hearing culture narrows those opportunities” (pg 162). She defends
the claim that pre-linguistically deaf children should have the opportunity to hear
and learn English as well ASL because, “ the inability to hear is genuinely
disadvantageous and learning both gives the child a better chance to overcome
those disadvantages” (pg 162). It wouldn’t be beneficial to isolate deaf and
hearing people because at the end of the day, they could learn something from one
another. One question I’d have is if you think hearing people learning ASL would
also do just as good as deaf people hearing and learning English?
●
Whose argument (Crouch or Tucker)do you think could more reasonably be characterized
as paternalistic? Explain and justify your view?
○
Crouch’s argument seems more paternalistic since she doesn’t want the patient’s
autonomy to be violated. She says that the CI robs them of enjoying the values of
ways of life of the deaf community. A parent would want their child to enjoy life
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