Medical Ethics - Semester One

Front 1

Precisely state the Principle of Nonmaleficence.

Back 1

One ought to not do harm or evil.

Front 2

Precisely state the Principle of Autonomy.

Back 2

One ought to respect self-regarding decisions made by competent others.

Front 3

What are the three different sources from which the conflicting duties in any dilemma typically derive?

Back 3

Past behaviour, role-related duties and morality for everybody.

Front 4

According to Rachels, what is the moral differecne between active and passive euthanasia?

Back 4

He states that there is no moral difference between active and passive euthanasia.

Front 5

Very briefly, what are the main differences between the Health Care Proxy and the Living Will?

Back 5

The health care proxy is a person that is designated as the decision-maker if a person becomes incompetent. The living-will is a document that states what a person would want to happen should they become incompetent in certain situations.

Front 6

According to Buchanan, what fundamental social fact makes it pointless to argue about whether managed care organizations currently meet their social obligations?

Back 6

MCOs operate in an institutional setting in which no connection can be made between the activity of rationing and the requirements of justice.

Front 7

Briefly, according to Englehardt, what are two key differences between a freedom based approach to justice in health care and a goals-based approach?

Back 7

Freedom based approach is the distribution of goods with the consent of individuals involved, and people are respected as free indviduals. A goals based appraoch focuses on the achievement of the good of individuals in a society.

Front 8

According to Gostin, what "transcending value" should guide the government's allocation of resources toward and within health care?

Back 8

It must be based upon improved health outcomes for the population, based upon objective measures of morbidity and morality.

Front 9

According to Daniels, what four general problems about rationing plague the Oregon health care plan?

Back 9

The fair chances/best outcomes problem, the priorities problem, the aggregation problem, and the democracy problem.

Front 10

According to the minority dissent in Tarasoff, what three reasons support confidentiality in the practice of psychiatry?

Back 10

Deterrence from treatment, full disclosure, and successful treatment

Front 11

According to Winston, in what circumstances is it permissible to disclose a patient's HIV status without his or her consent?

Back 11

Is the person specifically vulnerable? (Are they someone who faces a significant risk of exposure to the infection, and, will revealing confidential information to them assist them in reducing this risk to themselves or others?

Front 12

Briefly, according to Faden and Beauchamp, how do "sense-1" and "sense-2" informed consent differ?

Back 12

Sense 1 is an actively authorized proposal, whereas sense 2 is a submission to treatment without authorization.

Front 13

According to Kamm, what simple, three step argument morally justifies VAE?

Back 13

1) If it relieves pain because death is sometimes a lesser evil & pain relief is a greater good
2) Intend other lesser evils to the patient, for the sake of the greater good
3) Therefore, when death is a lesser evil, it it sometimes permissible for us to intend death in order to stop pain.

Front 14

According to Fleck, in what sense has the Oregon plan failed?

Back 14

It didn't meet requirements of just, democratic decision making.

Front 15

Briefly, what are some principal problems with the traditional "Living Will"?

Back 15

It has many gray areas. It cannot possibly cover every situation which may ever occur to a person, which causes the doctor to have to decide based on the living will what a person might want in a situation which wasn't exactly specified.

Front 16

According to Kass, is there a right to die?

Back 16

According to Kass, on both moral and legal grounds, there is no right to die.

Front 17

Briefly, according to Callahan, what role should age play in treatment termination decisions?

Back 17

He states that age as a medical standard should be rejected, while age as a person-centered standard can be used.

Front 18

Briefly how is a "substituted judgment" decision made?

Back 18

It is what the doctor believes the patient would want based on what he/she knows about the patient. It is based on the patients values, gathering facts about the case, and using a neutral mind to make a judgment.

Front 19

Briefly, according to Callahan, what is the role of emotion in ethical decision making?

Back 19

Emotion should tutor reason reason and that emotion should monitor emotion. The ideal goal is to come to an ethical decision through a personal equilibrium in which emotion and reason are both activated and in accord.

Front 20

Exactly what level of care did the DHHS "Baby Doe Rule" require for handicapped infants?

Back 20

No child should be denied life-sustaining medical treatments simply based on the basis of his or her "handicap" or future quality of life.

Front 21

According to Hardwig, what role should the family have in end-of-life medical decisions?

Back 21

The family is often more affected by an end-of-life decision than the patient is, so the family should have a large say in the decision.

Front 22

According to Blustein, what role should the family have in end-of-life medical decisions?

Back 22

The majority of the decision should lie with the patient, but the family should be able to give advice to the patient and help them make the decision.

Front 23

Exactly what is the WHO definition of health?

Back 23

Complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Front 24

Briefly, in his analysis of informed consent, how does Levine distinguish the positions of "universalists" and "pluralists"?

Back 24

Universalists believe that all research, no matter where it was conducted, should be justified according to universal standards.

Pluralists accept some standards as universal, but that others must be adapted to accommodate the mores of particualr cultures.

Front 25

According to Justice O'Connor, what question did the Supreme Court's decision in Cruzan settle?

Back 25

Did the state violate the Constitution in requiring clear & convincing evidence to withdraw treatment that normally would not be declined, like nutrition and hydration?

Front 26

Exactly how does the UDDA define death?

Back 26

An individual who has sustained either irreversible cessation of circulatory and respiratory function or irreversible cessation of all function of the entire brain including the brain stem, is DEAD.

Front 27

According to the U.S. Supreme Court decision in Vacco v. Quill, what five "valid and important public interests" support the distinction between refusing medical treatment and assisting suicide?

Back 27

1) Prohibiting intentional killing and preserving life
2) Preventing suicide
3) Maintaining the physician's role as the healer
4) Protecting vulnerable people from indifference, prejudice, and psychological and financial pressure to end their lives
5) Avoiding a possible slide towards euthanasia

Front 28

According to Scofield, how can consent be useful when resuscitation isn't?

Back 28

Consent is useful because resuscitation is futile; consent respects the autonomy of the patient.

Front 29

According to Bernat, Gert, et al., what are the main advantages of PRHN over PAS and VAE?

Back 29

When there is no medical treatment keeping the patient alive, stopping food and fluids may be the best way of allowing a patient to die. It is usually painless, it takes long enough for the patient to have the opportunity to change his mind, but is short enough that significant relief from pain and suffering is gained.

Front 30

Briefly, according to Bayer and Stryker, why should physicians deny or withdraw antiviral therapy from "noncompliant" HIV patients?

Back 30

We should not treat HIV patients whom are non compliant because of the greater good of the population. People can be immune which would create a new strain of the virus.

Front 31

According to Fleck's analysis of the Oregon Plan, what are some of the characteristics of a better process for making health care rationing decisions?

Back 31

1) We must all belong to one or another Accountable Health Plan
2) Belonging to the plan must mean that there is a single health budget to purchase all health services for plan members
3) We must know the budget cannot cover all likely demands for health services
4) We must limit demands on the budget through a priority-setting process and mutually agreed upon rationing protocols that apply equally to all members of the plan
5) WE must be largely ignorant of our future health care needs, which is largely true for most of us most of the time.

Front 32

According to Lynn & Childress, in what circumstances it is ethical to withdrawl or withold nutrition and hydration?

Back 32

1) Futile treatment - when food and water would be detrimental
2) No possibility of benefit such as persistant vegetative states or comas
3) Disproportionate burden - patient won't benefit from improved nutrition and hydration.

Front 33

According to Guenter et alia, what are two or three of the biggest ethical issues in international HIV vaccine trials?

Back 33

1) Self determination vs. protectionism
2) Achieving research objectives vs. preventing HIV infection
3) Treatment and care for participants contracting HIV
4) Global social injustice
5) Access and availability of a proven HIV vaccine
6) Urgency for vaccine development vs. protection of human subjects

Front 34

According to Caplan & Cohen, what two false beliefs seem to underlie the common feeling that withdrawing a treatment is morally different than withholding the same treatment?

Back 34

1) Stopping treatment is less justified than not starting it
2) It is more likely to lead to civil action than withholding that same treatment.

Front 35

Briefly, according to Daniels, what does a "right to health care" encompass?

Back 35

There are social obligations to design a health-care system that protects opportunity through an appropriate set of health-care services. If social obligations to provide appropriate health care are not met, then individuals are definitely wronged. It is a basic tier of services adequate to protect normal functioning - if not, then injustice is done to them.

Front 36

Briefly, according to Doerfinger, what are the main reasons not to legalize assisted suicide?

Back 36

1) respect for one's intrinsic worth
2) Euthanasia/suicide destroy's an individuals future earthy freedom
3) Slippery slope - it would open the doors for acceptance.

Front 37

Briefly, why, according to RM Sade, is it absurd to claim that anyone has a "right" to health care?

Back 37

If there is a right to health care, then someone has to provide this health care, and they must provide it whether they want to or not, making them a slave.

Front 38

Briefly, according to Szasz, why is it NOT unjust that the rich get better health care than the poor?

Back 38

The rich get better and more health-care and the poor get worse and less health-care. That is the definition of rich and poor.