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Bioethics- Dr. Gray. Chapter 1-2.

by: Kimberly Belle

Bioethics- Dr. Gray. Chapter 1-2. PHL 116

Kimberly Belle
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These notes cover the first three weeks of class, which is about half of what will be covered on the tests. It includes descriptions of the cases we covered in class, as well as important terms to ...
Jason D Gray (P)
Class Notes
bioethics, Gray




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This 9 page Class Notes was uploaded by Kimberly Belle on Monday February 1, 2016. The Class Notes belongs to PHL 116 at University of Alabama at Birmingham taught by Jason D Gray (P) in Summer 2015. Since its upload, it has received 23 views. For similar materials see Bioethics in PHIL-Philosophy at University of Alabama at Birmingham.

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Date Created: 02/01/16
Bioeithics Notes. 1.14.16 2 Important Philosophers Immanuel Kant. German, 1724-1804 Moral obligation were like law like duties. Deontological ethics, or Katian logics. Deontos in greek means duty. the consequences do not determine whether or not the action is moral or immoral. Categorical ethics. Kant believed: 1. Every moral duty mist be capable of being universal. Maxim which you could will that everyone lese acted on in the same way you do. 2. You may never treat humans as a “mere means” only! They must always be treated as an ends in themselves. Because we all have the capabilities to self govern. **animals are not included. True grounds of ethics is in rationality. For Kant, ethics cannot be varied depending on persons, but should be the same for all persons. Like 2+2=4, it will always be 4, and cannot equal 5 for another person. Truly moral beings are rational beings that use cognitive thinking to set the moral law, or self govern, not depending on God. Create a maxim, or a principle, that you feel everyone should follow. Must be universally true. If it fails in some way, then it cannot be a maxim. True maxims can and should be acted on, in theory. Needs to be coherent, not contradictory, and not self-defeating. Example: Lie to someone when you need something. But this defeats the purpose of getting approved for a loan, and ends the loans totally. So once bankers start realizing everyone is lying, than they expect everyone to by lying and will defeat the purpose of lying in the first place. John Stewart Mills Consequentialism (utilitarianism, or rule utilitarianism) For Mill, what matters most: 1. Consequences. Motives, intentions, and happiness come second. Most concerned with well-being: 2. Maximization of the good (however that is understood). The number of beings affected counts, including animals. Greatest good for the greatest number. 3. A theory of good (for early utilitarian it was just the ability to experience pain/pleasure, Mill agrees but it more nuanced; higher order pleasures are more important or significant. ) 4. Everyone counts the same! Ex: Someone wears a color you don’t like, they ask you how they look, you choose it is better for their well being to tell them they look fine, so lying is justified. Rule utilitarianism: Have set rules, like don’t lie, don’t cheat, don’t steal, that support for a greater good, but the rules can occasionally be broken under certain circumstances. So the rules are loose. Think of I before E, occasionally except after C. Jeremy Benthem: father of utilitarianism. Said ethics need to be empirical, or grounded in something measureable. What can determine good and bad, like pleasure and pain. You are doing something wrong if you are needlessly inflicting pain on something like an animal without the intent of a greater good. Classic examples of problems: Counter approaches. KANT and the murderer at the door Mill and the sacrificial lamb Calculation problems—how to quantify how much pain or pleasure is inflicted to ensure the best utilitarianism options is made. Fallacies of reasoning: Slippery slope of two kinds:  Logical --- a to b to c to d to e (e is clearly unacceptable so a is not acceptable) However we can draw lines even if somewhat artificially, we know there are rich and tall people, sick and well.  Empirical --- Allowing one person to do it opens the door to a flood… once one person speeds everyone else will follow. 1.19.16 More fallacies: Ad hominem “to the man” X is a jerk so I don’t listen to what he says Y is making a case for abortion, but she says she would never have an abortion herself Attack the argument, not the person Premises- true or false arguments. Together premises are supposed to support a conclusion. Tu quoque “you too) Literally you too in Latin Pointing fingers and looking for justification because someone else has done it too Example: A teenager caught smoking, but tells parents, well you do it too, so why cant I? Basically denying the conclusion of the other person’s argument. Hypocrisy. If someone tries this, you need to argue so what? That’s not my argument of hypocrisy, I am arguing … Straw man/ Red herring  Straw man- attributing to your opponent an argument he or she would not makes because it is so weak. Often occurs in unfair representation in arguments and debates.  Red herring is a distracting thing that may look related to an argument but it is not: Ex: If someone says healthcare is substandard for Africans, and someone says it is also the substandard with women in other places, it is not relevant to the argument.  Both lack relevance. Post hoc, ergo propter hoc Every time I drop my pen someone somewhere on the Earth, someone does within the next 10 minutes. Just because something happens in sequence, does not mean there is a causal connection between the two events. Correlation doesn’t mean causation. Appeal to authority It is alright to appeal to authority, of they are an authority on the subject (although it doesn’t mean that they are free from all scrutiny.) It is not uncommon to find quotes from Einstein about politics that he is not in an area of specialty. Appeal to feelings/ upbringing When you become an adult, you are in control of yourself and your feelings. How you are brought up is not relevant unless you are seven. Ad Populum The every body does it fallacy. Need to appeal more closely to yourself. False dichotomy Falsely narrowing choices. Either you do it, or someone else does it to you. “You’re either with us, or against us.” Usually only giving two options, without thought of other options, like being neutral. Equivocation Using language in an unclear way, Ex: Police help dog bite victim. Use a particular word in an ambiguous or vague way, making their argument unclear. Ex: there are different senses of good, like being morally good and the other is capable. Begging the Question Not begging a question to be ask but rather assuming what you mean to prove God inspired the bible Everything God inspires is true The bible claims God exists. Therefore, God exists. Also, called circular reasoning. They already know conclusion, and make arguments to support the conclusion. The Principles of Bioethics 1. Autonomy: respect for an individuals right of self determination (when possible) Some are obligated to respect, some are not obligated to respect. Ex: Anyone refusing treatment with a rational decision with competent person fully aware of the consequences. There is negative, right of refusal which is free reign, and positive, very limited. 2. Beneficence: helping others/ compassion. Key to bioethics, you cannot fail to recognize this in the medical field as a doctor or nurse. 3. Nonmaleficence: Not doing something that causes more harm than good when the harm is intended or when prudent measures would have made the harm avoidable. Sometimes in medicine you have to cause some pain to cause a greater good. Incidental side effects. Ex: Surgery to remove a cysts, which can cause some discomfort afterwards. 4. Justice- social and political. Status/ ethnicity/ gender/ socioeconomic standing.. no grounds such as these should justify difference in the quality of medical care. Chapter 2 Important points, 3 cases of nonterminal patients who want to die.  Elizabeth  Larry Macafee  Varieties of Euthanasia Assisted suicide is different from euthanasia because there not need be a belief that death is ultimately of benefit to the person taking their own life. Euthanasia- x intentionally kills y or permits y death for y benefit Active- giving medication directly and passive-withholding medical treatment.  Voluntary Euthanasia; the competent patient fully agrees to end life based on suffering. But just because something wants something or agrees to something, doesn’t mean it is voluntary. If not giving the correct, or all information, then they cannot make a rational decision to end ones life.  Non-voluntary- when life support is removed from a patient in a persistent vegetative state. They are not able to dismiss or approve euthanasia.  Involuntary Euthanasia- A patient says they do not want to die, that they want to live, but yet someone makes a decision that it would be in their best interest to die. 1/21/16 Request to Die; Non-terminal Patients. Elizabeth Bouvia: 1986 Parents divorced when 5. 10 she was placed in childrens home by mother. She had graduated, she was married, had a miscarriage. Her mother abandoned 18, Her father didn’t want to fund her care, she was on her own. Had been accepted to master program, but wasn’t allowed to pursue the type of work she wanted. Cerebral palsy, declining. Checked into Riverside general hospital voluntarily 1982. Original doctor Habeeb Bacchus, he argued that other patients may also wonder is they are next slated to be allowed to die” She was also clinically depressed. Tried to starve herself to death. She lost her first case because a psychologist said she was not capable to make decision because of her clinical depression. Still refused force feeding by the tube, bit through the first tube that was in her mouth, then it was inserted in nose. Checked out of riverside, went to Mexican hospital, with no luck. She started to eat again. and lived in nursing homes. Her brother and mother died, she had another miscarriage, and she checked into another hospital wanting to die again. Federal court always trumps state court. Developed arthritis, checked back into hospital and given a pump of morphine in her test. Young, no terminal illness, articulate. Also given a tube in her nose to force feed her, but she didn’t want it. She didn’t want to starve to death and leave the burden to the doctor or nurse to take legal responsibility of her death, but she did want to die. She wanted to live with a physician, who would administer morphine to keep her comfortable, outside the hospital, but would agree not to give her synthetic means of trying to keep her alive, such as a feeding tube, she would feed herself. The leader of the ethics board agreed her would do this. She didn’t necessarily want to die, but she didn’t want to live the rest of her life in pain. Supreme court of California ruled that the case turned on a right to privacy in the courts, a ruling supporting the decision. The ruling reads, in part: “the right to refuse medical treatment is basic and fundamental. It is recognized as part of the right to privacy.. its exercise requires no one’s approval. She did not end her own life and as of the writing of the book, seems to still be alive. 1.26.16 Larry Macafee. In 1985, he was completely paralyzed by a motorcycle accident and was ventilator dependent. First year he had a million dollar insurance policy. The first year was very high quality. He was known as a demanding patient. His care during this ordeal was by his own account substandard and he was essentially “warehoused.” (doing nothing, not given any further consideration, not being let out) Not a good system for patient care. He was thought of as a mechanism, Moved to Ohio, RUSS FINE** a disability advocate and director of the injury control research center at UAB in 1989, took up his case, (he found him in a room with no TV and no voice activated phone. He could only stare at a ceiling. ) He expressed a wish to die, even in Ohio. Macafee had also sued in courts to be allowed to die. He won the right in Fulton county courts in 1989 to have his ventilator removed and that he could be sedated before the procedure. There was a time when he had complication and his ventilator cut off and he almost died, but he didn’t want to die at that moment, he had a tear roll down his face. He didn’t pull the plug, he decided not to end his own life. He suffered medical complications from a backed up urinary catheter that caused two strokes… He died in 1995 in a long term nursing home in GA. He was an undergrad when the accident happened. When he reached Ohio, he wasn’t being supported or visited at all. He didn’t want to burden anyone. DAX COWART Suffered burns over 2/3rds of this body, he was treated against his will for 14 months in Parkland hospital in Dallas. Included 4 degree burns, through the skin revealing bone. He wanted to die, it was so painful. JFK died in Parkland hospital*** After 14 months, he recovered. Still had pain, and is still alive. He married and became an attorney, yet he argues to this day that the decisions made by the physicians to keep him alive was cruel. Patient autonomy should be the basic of your ethics as a doctor. Real, genuine autonomy may sometime lead to bad consequences, but you should still not dismiss it. But we must be careful when we respect autonomy and not just simply bowing to the wishes of a temporarily distressed person. Paul longmore thinks some courts falsey assumes a handicap wants to end their life because of their disabilty 1. St Augustine. Killing is only okay when commanded by God. Anything else is wrong. aAquintas said suicide is wrong because it left no time for repentance. 2. David Hume: “any suicide is insignificant to the workings of the universe and it’s a blasphemy to think otherwise. 3. Kant (deontological) 4. Stewart Mill Philosophy is all about justify what you do at the end of the day. 1.28.16 Requests to Die: Terminal Patients Holland “Act” 1. Patients must be competent 2. Requests repeated and non-ambivalent 3. Physicians must consult other physicians 4. Patients must be in unbearable pain without likelihood of improvement. Oregon’s Death with dignity act: Patient must be: 1. Clearly competent 2. Have less than 6 months to live 3. Wait 15 days before filling prescriptions designed to cause death (to avoid hasty or rash decisions)  About 60-90 requests for lethal dose prescription per year and about 30-50 used. The doctor can not give you medicine, but he will prescribe the medication. Wait 15 days before filling the prescription.  Physicians can oversee a suicide, but if it does not work, then he must intervene to save you, and then you try again later, but never to actively assist in the suicide. Dr. Jack Kevorkian Methodology of the caregiver is important too. Made famous by assisting 100 Americans to die. Dr. Kevorkian ran a sort of “mobile” suicide clinic. He thought if he helped people who wanted to die, he could do a double positive by helping them, and preserving their organs to donate to those that needed transplants, (there was a shortage at the time.) He did not active seek patients. Eventually a lawsuit. Spends a day with them, He then used a recorded to document the patients consent to die, then a few days later they die. Other doctors were diagnosis the terminal patients We assume he got medical records, and not just relying on the patient’s word, but the background and case of the patients could be lost in the process he is doing. He adjusted his suicide machine have a button or leaver easy enough that even is most feeble of patients could push the button themselves. Passive euthanasia. **Given our discussion about the last chapter, can you think of a reason a doctor specializing in only assisted dying might not be the best choice for helping a patient die? Timothy Quill Helped his patient “Diane (who had terminal leukemia) die in 1990. Not indicted by a grand jury, but his case seems different. He knew his patient well and head treated her for a long time. He pursued a course of treatment designed to help her survive and then assisted in ending her life privately without publicity and then published his actions in a medical journal, opening it up for criticism. Prescribed her an overdose of medication. Similar to death row, saline solution, the patient presses a button, then sedative, and then potassium chloride. Also carbon-monoxide. The Nazi Argument People are inclined to compare the practices of the Nazis who claimed to be killing certain groups out of mercy with the modern practices of euthanasia. The comparison is frequent and wrong headed. It often implies a slippery slop fallacy (that the euthanasia of the late 1930S lead to the holocaust, which is historically inaccurate.) They did not care about wellbeing, just about bettering of the genetic pool in Germany.  Hospice care- cease to treat a illness that will very likely lead to their death; attempting to give dying patients control over their lives during the final months of life, it may involve patients residing in a hospice facility or may include nurses visiting patients at home.. Treatments for the disease leading to death are discontinued.  Palliative care- does not necessarily mean discontinuing all treatment for an underlying disease but the primary emphasis is on a patients psychological well- being. Recent legal developments: In 1994, a federal judge struck down a Washington state law banning assisted euthanasia… the us supreme court reversed this decision.. that doesn’t mean that you have a constitutional right to assisted suicide.. or the constitution leaves it up to the states. Ethical issues: The most direct argument against physician assisted dying is that it is wrong in itself (malum in se) Malum prohibitum a wrong in the law Killing vs letting die The central question is this: is there a moral difference between me letting you die (when I can save you) and actively killing you?


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