Medical Ethics (DNSN)
Medical Ethics (DNSN) PHIL 148A
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This 7 page Class Notes was uploaded by Miss Blair Marks on Tuesday October 20, 2015. The Class Notes belongs to PHIL 148A at SUNY at Binghamton taught by Staff in Fall. Since its upload, it has received 28 views. For similar materials see /class/225529/phil-148a-suny-at-binghamton in PHIL-Philosophy at SUNY at Binghamton.
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Date Created: 10/20/15
Bio Ethics Final exam Main moral concerns about organ donation and transplantation One moral concern specific to postrmortem donations is whether or not its ethical to arti cially keep a brainidead person from experiencing cardiac death for the sole purpose ofpreserving desirable organs Another moral concern involving organ donation and transplanmtion is determining how to fairly allocate organs between patients Should there be a market for organs If not should there be a selection committee a lottery or a firstrcome firstrserve list Should the identity ofa potential recipient be a factor in determining eligibility For instance it is up for debate whether or not a recovering alcoholic should be eligible for a liver transplant Some may argue that an alcoholic lived life irresponsibly and should not be trusted to take care ofa new liver in highrdemand Others may contend that alcoholism is a disease in and ofitself and that a candidate should be rehabilimted and not discriminated against Due to scarcity of such an exotic lifesaving therapy should the identity ofa candidate be considered For exaInple a person with a longer remaining life expecmncy and a faInily to support should get precedence over an elderly individual living on his own Whether or not it should be legal to sell organ s is another moral concern Prohibiting the sale of organs creates a black market Organs sold in a black market are often justified by utilitarian thinkers Utilitarians argue that the life saved as a result of the sold organ is enough to justify breaking the rules Deontologists on the other hand adhere to rule based ethical principals Therefore deontologists would oppose black market organs It is often argued that allowing organs to be bought and sold inevitably leads to exploitation of donors The autonomy of the wouldibe donor could not possibly be preserved because the donor is coerced with money Black market donations also lead to organ theft providing incentive to murder for an individuals organs Living donors are often close faInily or friends with the patient in need of an organ Although rare live donors sometimes make altruistic donations to complete strangers as well The moral concern here is that many donors are inadequately informed of the risks and hardships of organ donation Donors undergo major surgery with no possibility ofbenefiting medically Studies show that many organ donors come to regret their decision soon after Donors are supposed to be offered every opportunity to change their mind but is their autonomy really protected when another s life is dependent upon the decision Such a highipressure situation can affect a donors ability to think rationally Organ donation emphasis on moral issues developing moral principals a Live vs dead Live can provide consent Dead a person can t b identity of recipient Where should an alcoholic be on a organ donation list Will he just mess it up again When the person dies does a person have an entitlement to his organs does a family have an opinion on who receives the organ c prohibition of selling ones organs Issue ofprofit d where it is going to be allocated who its going to go the rational self determination in distributing 2 active euthanasia Passive euthanasia a voluntary Involuntary b provide two different arguments grounded in different moral principals Active euthanasia occurs when doctors take direct action to end a patienfs life usually by giving them a lethal injection Passive euthanasia is failing to provide a medical intervention that might eXtend dying patients lives such as doing CPR or starting a course of antibiotics to treat an underlying infection These are most commonly differentiated as killing versus letting die The distinction is an impormnt one as it draws a line that physicians must not cross between letting nature take its course and actively ending patients lives Volunmry euthanasia a person takes hisher own life either directly or by refusing treatment Involuntary euthanasia ending another person s life contrary to that person s wishes Nonvoluntary euthanasia the decision about death is not made by the person who is to die OPPOSING arguments against euthanasia 1 Helping patients die violates the doctor s duty to save lives 2 Human beings do not have a right to take their own livesi this is playing God Argument 1 is convincing because it can be backed by the ethical principle ofbeneficence you should help people when you are able to do so you have a duty to actually benefit your patient they signed the hippocratic oath and thus agreed to help other people when you are able to do so Argument 2 I feel that this argument would not be convincing for all people that euthanasia would be applied to Different cultures and religions have different beliefs and not all people believe in God or any religion at all Thus this argument would not be one that could hold up for a broad spectrum ofpeople Arguments for Euthanasia 1 Doctors have a duty to prevent pain and suffering and helping terminally ill patients to die is just an extension of that duty 2 Each individual has a right to die and shouldn t be stopped by doctors 17 This could be supported also by moral beneficence the doctors should help patients if they can and in some cases killing them would help end their suffering Also benefit them by ending their suffering 2 This is not particularly convincing as the individual is not the only one who will be affected by decisions about whether they live or die Thus they should consider not only what they want but also their families and loved ones 3 Therapeutic curing a disease or restoring the patient to the best state of health possible Known as genetic treatment more ethically acceptable Nontherapeutic also known as enhancement genetic engineering to improve on a healthy body Enhancement therapy deals with drugs and procedures that employed by doctors not just to control illness but also to improve human capacities or characteristics Psychoactive drugsRitalin to surgical procedures liposuction to lifestyle drugs Viagra a Arguments for genetic engineering rNot playing God If one was to say that we were playing God then one would be inferring that we are not to interfere with the natural selection process at all That would then include medicine in general and other environmental and socieml changes This would rule out both negative and positive genetic engineering Genetic engineering seems much more drastic than that of environInental changes which may be why some see genetic engineering as playing a godilike role as one can alter the plan for their life I think this may provide a weak argument for genetic engineering as it lacks the explanation of negatively affecting potential human variety The group ofpeople controlling genetic engineering creates limited variety within a gene pool and who s to say that their limimtions should provide this boundary ofgenes rNeed a genetic supermarket Providing a genetic supermarket could in fact create more diversity rather than reducing genetic variety There would be a limitation to what parents could choose to be sure that the parents aren t picking genes to harm their children ex for religious reasons The genetic supermarket could meet the specifications ofparents within cermin moral limits This argument could positively be supported for therapeutic engineering as we know parents would not pick out harmful diseases for their children However this may also be in an ineffective argument for non therapeutic engineering It could create an unequal ratio of sexes Parents could also see children as being less successful if they weren t completive enough or selfish This could lead to a shift in genes that could negatively affect the social world and creating unnecessary and unwanted consequences b arguments against genetic engineering iless genetic diversity Picking out certain genes for a child is going to create less genetic diversity This idea is one of the top main arguments against genetic engineering Would people want to live in a world where everybody looked the same and acted in similar manners Most would argue no There is also the idea of natural selection Most people have accepted genetic change as a result of environInental change By deliberately trying to change one s genetic make up may result in a person who it not necessarily fit to survive the environment I think this creates a strong argument as I believe survival in life is much more important than vanity reasons ofliving life rtoo risky We may produce unintended results either because our techniques turn out to be less finely tuned than we though or because different characteristics are found to be genetically linked in unexpected ways In other words the results ofgenetic engineering are still unknown and the consequences could be highly unwanted Is this risk worth being able to directly manage the makeup of our genes 1 think this may only create a weak argument in that clinical trials are performed all the time and without any failures in science and medicine one cannot grow Many positive things have come out of trying out the unknown and testing the untreamble c Positive eugenics may cause more ofa more issue due to the fact that people are promoting the idea that one gene is better than the other In addition with negative eugenics people would usually not object to the use of eugenic policies in efforts to eliminate disorders in their children 4 ln therapeutic cloning the goal is to be able to generate cells tissues or organs For insmnce ifa person needed a bone marrow donation or a kidney then the idea is that with therapeutic cloning we would be able to grow a perfect fit like a spare part that would bring no risk of rejection In reproductive cloning the aim is to bring to life an offspring who is genetically identical to the somatic cell donor This applies to the Dolly the sheep case in 1996 where a female domestic sheep was the first maInmal to be cloned from an adult somatic cell a One argument for reproductive cloning includes a medical need such as cloning for those who are infertile Reproductive cloning would provide genetically related children for people who cannot be helped by other fertility treatments An additional argument for reproductive cloning is that it would allow lesbians to have a child without using donor sperm and would also allow gay men to have a child that does not have genes derived from an egg donor Ultimately reproductive cloning would allow nontraditional couples to have children that are genetically related to one of the parents I find these arguments to be ineffective because by using reproductive cloning you are not just providing parents with a genetically related child but rather a genetically identical child This can create a multitude ofproblems in the parentichild relationship such as making the child feel as though he or she is constantly trying to meet or surpass the standards set by the parent he or she is a clone of Additionally it would be impossible to extend reproductive cloning to lesbian and gay couples without extending it to the general population as this would be considered unfair to those who are simply infertile and not gay b The main argument against reproductive cloning is that it would diminish the sense ofuniqueness of an individual Those against reproductive cloning feel as though by using cloning you are threatening identity and individuality which the human population values extensively There is fear that clones will be devaluated in society compared to those who are noniclones Another argument against reproductive cloning is that it is medically risky and inherently unsafe It is basically an experiment on the resulting children and many of the mammalian cloning experiments have resulted in miscarriages stillbirths and liferthreatening anomalies I feel as though the arguments against reproductive cloning are effective because they are concerned with the wellbeing and healthiness of the resulting children rather than the satisfaction of those being cloned Both arguments are based on the idea that the cloned children will not be as well offin society as those who are not cloned I think that when all reproductive technologies are discussed the main concern should be about the resulting children which is what arguments against reproductive cloning deal with c Genotype is the internally coded inheritable information carried by all living organisms This stored information serves as a blueprint for building and maintaining a living creature The genotype is the genetic makeup ofa cell Phenotype is the outward physical manifestation of the organism Phenotypes result from the expression of an organism s genes as well as the influence of environmental factors and the interactions between the two In reference to people s fear that human cloning will result in a lack ofuniqueness or individuality we must consider both genotype and phenotype When using reproductive cloning the resulting child has an identical genotype to that ofits parent The genetic makeup of the parent is identical to the child s and thus internally they will have the same genetic code However phenotype is largely dependent on the environmenfs interaction with an organism For instance the parenfs phenotype may be expressed differently than the child s due to the different environmental interactions The child may express different behaviors and habits despite having the saIne genotype as their parent Ultimately I feel as though reproductive cloning is neither safe nor ethical despite creating opportunities for the infertile or the possible differences in phenotype from the parent Healthcare is a limited resource due to a lack ofmedications time labor locations and funding Many people have suggested that health care should be limited based on the age of the patient Others feel as though everybody has a right to healthcare regardless of age a I feel as though we should not limit healthcare for the old and that age should have nothing to do with how we ration healthcare Everybody ages regardless ofwho we are and I think that regardless of age people have a right to healthcare Just because one is aging does not mean that he or she does not have anything to offer to society Many people feel as though they contribute most to society after having gained wisdom from life experiences I know personally I have gained a great deal from the elders in my life and that they continue to live their lives to the fullest despite their age As long as an individual wants to continue living life I think they have a right to healthcare and various medications and treatments that will help them do so While healthcare is limited I think it should be dispersed equally and not just concentrated on the younger generations b Autonomy is one of the principle foundations of the American healthcare system Autonomy demands that each rational competent person be given the right to make medical decisions that affect his or her life Just because somebody has aged does not mean they do not have the right to continue living He or she has the right to make medical decisions such as what treatments they receive or for how long they wish to be treated While healthcare is limited I think that people no matter their age should have equal access to resources as long as they wish to extend their lives Beneficence is the idea that one should do good for patients and that the whole purpose of medical practice is to make lives better to improve patients situations and to make people well again My beliefs coincide with this principle because by treating people regardless of age the ultimate goal is to improve their situations Usually ending ones life is not improving their situation or helping to make them well again While there are exceptions to this idea patients who still have a chance to live longer should have access to healthcare that will help them do so The principal of nonmaleficence states that above all healthcare providers should do no harm By denying a patient treatments or medications because of their age healthcare providers are not abiding by this principal In fact they could quite possibly be causing harm and suffering Ifa patient wishes to be treated and to extend his or her life a physician should not be able to deny them of treatment because they are elderly These three principles support my feelings that patients should have equal access to healthcare regardless of age c I feel as though usually the ends ofmedicine should include the attempt to extend life As long as the patient has a desire to continue living and continue undergoing treatment he or she should have the right to extend his or her life Only if the patient expresses fatigue from treatment or has lost a will to live should extending life no longer be the concern of the physician If the patient will experience a great deal of suffering following methods to extend his or her life then it is not fair to the patient ifhe or she has lost quality oflife to increase quantity oflife 6 I believe that as an illegal immigrant the doctor should take a certain measures in taking care of this women Many may argue that she has violated a law by entering the US illegally However does breaking a law constitute not being able to receive health care Many people break laws daily such as working off the books and getting paid without taxes These people however aren t punished by not being able to receive health care One must consider the fact that we have a limited resources and that taxpayers are feeling the blunt of care for the illegal immigrants Because of this fact I believe that there should be a limit to how much I as a doctor could help the women out There are the extremes ofpaying for all her bills to receive treatments and medicines to bring her fully back to health and then there s refusing to help completely I believe that there is a happyimedium within these two extremes in which this women could be helped without costing taxpayers too much money Having to report an illegal immigrant is also a violation of the patienfs con dentiality which is part of the doctor s Hippocratic Oath Having to turn in an illegal immigrant has no relations to that ofhealth care nor does not require medical expertise Because of this I think that one shouldn t ruin the women s life and report her as illegal as it is not a responsibility ofa doctor I believe it to a be a matter of social responsibility as a human to provide the women with a basic human right of health care Illegal immigrants often come to this country and perform the worst job for the lowest wages Although they may have voluntarily agreed to this instead of returning home in most cases it is the better of the two choices This is why I believe it is our social responsibility to provide health care to those who are opted into our capitalist economy Although they may be illegal they are still social members who work hard and participate in different aspects ofvarious communities Autonomisti needs to be rational and cannot have outside inflictions 7 Directrtoiconsumer advertising DTC advertising usually refers to the marketing of pharmaceutical products but can apply in other areas as well This form of advertising is directed toward patients rather than healthcare professionals Forms of DTC advertising include TV print radio and other mass and social media There are ethical and regulatory concerns regarding DTC advertising specifically the extent to which these ads may unduly influence the prescribing of the prescription medicines based on consumer demands when in some cases they may not be medically necessary In general the advertisements are directed towards patients not doctors When a patient wants a drug they will rotate through doctors until they get the drug they want Patients aren39t as quali ed as doctors to choose what prescription drugs they want also Arguments for Without the profits drug companies make from advertising prescription drugs to consumers those companies would have less money to develop lifeisaving and lifeiimproving medications Prescription drug advertisements inform consumers about potential medical conditions they may have and about drugs that could help treat those conditions A consumer better informed about medical issues is more likely to contact hisher doctor to discuss the condition or related drugs These ads therefore provide a helpful public health service Arguments against Potentially harmful side effects and interactions are not sufficiently detailed in the drug advertisements The average person cannot adequately research all the scientific studies done to evaluate the effectiveness of new drugs Patients therefore find themselves requesting prescription drugs based on advertisements with little knowledge of all the relevant medical information Patients seeing prescription drug ads can lose trust in doctors and the medical establishment when it seems that the medical comInunity including pharmaceutical companies is more interested in taking their money than improving their health Most convincing Potentially harmful is most convincing Reason Being the way they advertise things they urget the entire population and give general statements for when you should use their medication Such as Have you ever felt down Wellwill cure you and etc What happens is a patient will rotate through doctors until they obtain the drug and when they do they develop side effects worse than what they smrted out with Most of the time these are anti depressants but people are very easily convinced they are depressed and so believe they are when they are not Asking for medicine when you don39t need it A legal way of obtaining drugs that make you feel good about yourself my opinion 8 Public health is the overall health ofa community whereas individual healthcare specifically focuses on the healthcare of an individual or family Potential conflicts within the public healthcare system stems off the idea social welfare versus individual autonomy This includes individual decisionimaking privacy and paternalism versus individualism Paternalism versus individualism can be considered the most important because the other two concerns would not be mentioned without paternalismindividualism A patient must decide whether to make his or her own informed decision or to follow the doctor s advice the paternalistic view This can affect the patienfs decision because heshe may be torn on whether to follow the advice ofa specialist or to follow their own thinking Possible ways to ration the allocation of resources i Prioritize preventing new infection ii Prioritize essential medical and scientific personnel iii Prioritize health and safety infrastructure iv Prioritize those with the greatest medical needs v Prioritize based on life cycle vi Prioritize the chronically underserved vii Prioritize early detection and response globally viii Prioritize transparency and public cooperation Prioritizing early detection and response globally is the most convincing because if nations work together to find diseases and prevent them from an early start there will be no worries on becoming susceptible to new diseases etc There is a conflict between the physicianipatient relationship and the duties ofa physician during a public health crisis If there is a pandemic occuring and the physician knows that a patient could be the root cause of the problem it is up to the physician to decide whether to report the patient or keep medical histories confidential In making this decision it is also important to keep in mind the future of the patientiphysician relationship lfa patient is turned in by the doctor the patient may see this as an act ofmistrust and refuse to see the physician again therefore the physician has a loss ofa patient or patients Also breaking the Hippocratic oath