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PHL 223 Week 2

by: Paola Araque

PHL 223 Week 2 PHL 223

Paola Araque
GPA 3.29

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These notes cover the lectures from the second week of Medical Ethics, including the readings assigned by Dr. Rachels
Medical Ethics
Stuart Rachels
Class Notes
medical ethics
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This 3 page Class Notes was uploaded by Paola Araque on Friday January 29, 2016. The Class Notes belongs to PHL 223 at University of Alabama - Tuscaloosa taught by Stuart Rachels in Summer 2015. Since its upload, it has received 63 views. For similar materials see Medical Ethics in PHIL-Philosophy at University of Alabama - Tuscaloosa.

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Date Created: 01/29/16
Medical Ethics Notes: Week 2  Lecture  ● Karen Quinlan Case (continued):  ○ Quinlan’s lawyer argued that Karen should be allowed to die.  ○ NJ Supreme Court held that the right to privacy includes a family’s right to let an  incompetent patient die by withdrawing life support. So withdrawing life support is  “letting die” under the law.  ● Nancy Cruzan Case (1983)  ○ Nancy Cruzan was involved in a car accident and lost control of her car. She was  thrown 35 feet into a ditch.   ○ The result from the accident was anoxia (oxygen to the brain) and was in PVS  (persistent vegetative state)  ○ For 7 years, the state of Missouri kept her alive.   ○ Cost: $910,000  ○ Her parents sought to remove her feeding tube.   ■ This is an example oPassive Euthanasia.    ○ The Missouri Supreme Court held that under Missouri Law, there must be “clear  and convincing evidence of the patient’s wishes” for medical support to be  withdrawn.   ○ Advance directives:  ■ living will, values inventory; durable power of attorney.   ○ They also held that Cruzan’s feeding tube could not be removed.   ○ The U.S. Supreme Court upheld Missouri’s law; and also held in 1990, that  competent patients may decline medical treatment, even if this leads to their  death.   ○ Cruzan’s feeding tube was removed legally in 1990 after a friend had said that  those were Cruzan’s wishes.   ● Defining Death: What’s at stake?  ○ Closure for family  ■ End of emotional drain.  ○ Expense of treatment  ○ Saving lives through organ harvesting  ○ Hope of recovery  ■ after 1 year in PVS: 1.6% chance of waking up, however the patient can  never fully be healthy again.   ■ after 3 years: 1 chance in 1,000 of waking up.  ■ after 4 years: there is no record of a patient waking up.   ■ Doctors don’t know which patients might recover.   ● Definitions of death:  ○ Legally, the definition varies from state to state.   ○ Whole Body Standard  ■ In the old days, everything would go at once.   ○ There is no “magic moment” of death.  Assigned Reading  ● Autonomy  ○ A person’s rational capacity for self governance or self determination.   ○ It is fully exercised when our choices and actions are truly our own.  ○ Respect of autonomy is practiced throughout all of bioethics.  ● Autonomy Principle  ○ Autonomous persons should be allowed to exercise their capacity for self  determination.   ○ Fundamental standard that can be violated only for good reasons and explicit  justification.   ● Violating Self Determination  ○ Physically restraining a patient.  ○ Misinforming a patient about the seriousness of their illness.  ● Paternalism  ○ Overriding of a person’s actions or decision making for his/her own good.   ○ Inspired by Hippocratic tradition of devotion to the welfare of patients.  ○ Two types of Paternalism: Weak and Strong.   ● Weak Paternalism  ○ Paternalism directed at person’s who cannot act autonomously  ○ Patient is psychotic, retarded, dealing with depression, or addiction.   ■ It is morally acceptable to override these patient’s action because it is  protecting people from harm.   ● Strong Paternalism  ○ Overriding of the person’s actions even though he/she is substantially  autonomous.   ○ Wrong because it violates the rights of patients to make their own choices of what  is good and what is right.   ○ ex) “A woman who needs a life saving blood transfusirefuses it on religious  grounds, but when she lapses into a coma, surgeons operate and give her the  transfusion anyways. (Chapter 3 of Bioethics: Principles, Issues, and Cases By:  Lewis Vaughn)  ● Refusing Treatment:  ○ When patients refuse treatment the question of whether or not it is morally  permissible for a physician to treat a patient even if it is against his/her will arise.   ○ In the 1980s court rulings said that a competent patient has the right to reject  recommended treatments, even if the treatment could potentially save their life.   ○ What if the patient is a child, and the parents refuse the treatment because of  their religion?  ■ 1944 Supreme Court decision said that although parents have the right to  decide what is best for their children, they do not have the right to refuse  treatment for the child if it will bring serious harm to them.       ● Futile Treatment:  ○ The patient wants a treatment that the physician does not want to provide, for  good reasons.   ○ “Physicians are not required to provide treatments that are inconsistent with  reasonable standards of medical practice” (Vaughn 76). 


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