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62 Cards in this Set
- Front
- Back
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What is patient-centered consequentialism? How has it led to medical paternalism?
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patient centered consequentialism- roots back to the hippocratic oath, providers evaluate their conduct based on their its consequences for the welfare of the individual patient (not larger sub-group).
It leads to med paternalism- considers patient's welfare only physically. Doctor must promote patient welfare so doctor can legitimately dictate a person's treatment if it benefits them physically. leads to deception, and not follow patient wishes. |
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What are the main reasons Alan Goldman gives against medical paternalism?
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fails to recognize the independent value of self determination and the respect people are entitled to as "choosing beings"
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What issues are raised in the case study, “Beneficence Today, or Autonomy (Maybe) Tomorrow”? Why does Bernice Elger think that Monica should be wakened? Why does Jean-Claude Chevrolet disagree?
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raises issues of whether to wake her and expose her to more suffering just for her to make decisions about her treatment that may not even qualify as autonomous because of her condition. She will also die anyway
Elger thinks she should be wakened because only patients can decide on the limit of suffering before autonomy becomes of secondary importance, also she may have unfinished business. Since there is no way to know what she would want unless they wake her they the doctors have to wake her. Jean-Claude believes she shouldn't be awaken because she will most likely not be autonomous, and making her decide between such horrible decisions while suffering so much just to allow her to be autonomous seems cruel. |
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What does Terrence Ackerman mean by “noninterference”? Why does he think that noninterference does not really respect patient autonomy? How does he think our understanding of autonomy needs to be revised in the medical setting?
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noninterference- people are entitled to their autonomous determinations without others interfering even if their judgments are mistaken. Doctors responsibility to state information
Why it doesn't respect patient autonomy- it fails to take into account the transforming effects of illness. He thinks doctors need to make sure that patient's understand their illness better and are not in denial, also the doctor must try to convince the patient or maybe the patient's family to try and get the patient to make the decision the doctor feels is right. He also believes doctors need to make sure patient's knows the quality of life and patient goals. |
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Explain the four models of the physician-patient relationship presented by Ezekiel Emanuel and Linda Emanuel. Does their interpretive model meet the criticisms lodged by Ackerman against noninterference? Does the deliberative model avoid the pitfall of physician paternalism?
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1. paternalistic model- similar to hippocratic oath, only considering patients well-being physically and therefor doctors can due what they want to make patient "better"
2. informative model- physician provides facts, patient is concerned with values 3. interpretive model- final decision making authority in the patient, emphasizes the problematic nature of of discovering patient values and preferences are. 4. deliberative model- like interpretive model, but patient is encouraged to choose best course involving health related value. The interpretive model does address Ackerman's criticisms against noninterference because it recognizes patient's values may not be easy to uncover and that the doctor must attempt understand the patients value to help the patient better. Yes deliberative model avoids physician paternalism because the patient has ultimate decision. |
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What is the principle of utility
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actions are right to the proportion that they tend to promote happiness, wrong as they tend to promote the opposite of happiness
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What are the alleged strengths (advantages) of utilitarianism?
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provides us with a decision procedure and gives us an answer to how we ought to act. Its impartial
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What are some of the criticisms that have been lodged against utilitarianism?
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1. Whether happiness is the greatest good
2. requires us to calculate probable consequences 3. you are wrong for not stoping others actions 4. conflicts with some basic moral intuitions (forced sacrifices, injustices) |
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How does rule-utilitarianism differ from act-utilitarianism? Does the move to rule-utilitarianism meet the criticisms lodged against utilitarianism?
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Rule utilitarianism- apply principle of utility to rules instead of specific acts
Does not satisfy criticism because AU collapses into RU |
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How does Baylis distinguish between unanticipated, unintentional harms inflicted on patients and medical errors? Why is it often difficult to determine if something is a medical error?
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Unanticipated and unintentional harms are unavoidable, while medical errors are avoidable and not due to statistical risks that are expected to occur in some cases.
It is difficult to determine if something is a medical error because medical errors are often multifactorial- many decisions and actions occur in a cluster of time. Also considering medical mishaps as error is also subjective sometimes depending on the social, professional or cultural context. |
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Why are physicians often loathe to disclose medical errors to patients?
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- the uncertainty that adverse outcomes are the result of their error
-in many, maybe most cases full disclosure of medical error serves no useful purpose, but only increases anxiety, suffering and diminishes confidence in physician. |
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Should doctors consider patients’ ethnicity in deciding whether to tell them the truth?
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research shows major differences between ethnic groups in wanting to know the truth about for instance a terminal diagnosis.
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Compare “Bioethics in a Different Tongue: The Case of Truth-Telling” with “Offering Truth.” Do the authors disagree about whether patients should be given dire prognoses, when their families do not want them to be told the truth?
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offering truth believes people should be offered the chance to know the truth no matter what, while the other author is asking the question whether or not they should be told and isn't sure.
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What is patient confidentiality? Why is it “a basic requirement of medical practice” (p. 53)? How can it create conflicts?
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information shared with physicians is very sensitive and can do great harm if that information were to be known by the wrong people. Its creates problems like people who are HIV positive get care from family and are in contact with their blood, also when psychologist are told about potential harm to others.
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In Tarasoff, the defendants contended that “they owed no duty of care to Tatiana or her parents and that, in the absence of such duty, they were free to act in careless disregard of Tatiana’s life and safety.” (117) Why did the California Supreme Court reject this contention?
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duty of care is owed when the person is in foreseeable danger. If that danger is from another person than then they only owe a duty of care when they hold a special relationship to that person who will potentially harm someone. Therapist/patient relationship satisfies that requirement so the therapist owed tatiana a duty of care.
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Why did the defendants contend that the duty to exercise reasonable care to protect third parties was unworkable? How did the court respond to this claim?
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The defendant claimed it was unworkable because therapists cannot accurately predict whether or not a patient will resort to violence.
The court responded saying therapist are not liable for not predicting violence, but in this case the therapist did predict violence but was negligent in failing to warn. |
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Writing for the majority of the court, Justice Tobriner said, “We conclude that the public policy favoring protection of the confidential character of patient-psychotherapist communications must yield to the extent to which disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins.” (p. 120). Why did Justice Clark dissent?
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he dissented because imposing a duty on psychologist will offer virtually no benefit to society, but will frustrate psychiatric treatment, invade fundamental patient rights and increase violence.
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How is the case study “Please Don’t Tell!” similar to Tarasoff? In what ways is it different?
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Its similar because in both cases upholding patient confidentiality puts innocent others at risk.
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What conditions does Fleck think must be met for a breach of patient confidentiality to be justified? Are these the right conditions?
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1. an imminent threat of serious irreversible harm
2. no alternative to averting that threat other than breaching confidentiality 3. proportionality between the harm averted by this breach of confidentiality. He does not feel they are met in the case with the HIV positive patient and therefor should uphold confidentiality. |
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Why does Angell disagree with Fleck?
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she believes confidence must be overridden when it poses a major threat to others, and there is no data proving the risk the the HIV patient's sister is very small.
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What are the conflicting values or rights in this case?- misattributed paternity
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not telling the parents would not be full disclosure and not respect patient autonomy, but telling them could destroy their families
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What does Lainie Friedman Ross think should be done, and why?- misattributed paternity
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she believes the genetic counselor has a duty to tell both parents, because failure to do so would be undermining the parents autonomy.
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Who are “the young invincibles” and what do they demonstrate about the ineffectiveness of our current health care system?
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What is a “community rating system” and how does it affect the ability of young, healthy people to get health insurance?
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requires health insurance companies to offer insurance to everyone in a certain territory at a certain rate. This boost the price of health insurance for younger individuals who are healthy and would normally pay less.
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Why don’t emergency rooms and public clinics solve the problem of uninsured people?
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Emergency rooms are very expensive and because uninsured people can't pay the bills the hospital has to make up that lost money by charging those who have insurance more money which increases premiums on those who have insurance.
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What is the downward spiral that people without health insurance can often get into? What is the impact on society in general?
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What is the primary reason for acknowledging a right of conscientious objection for health care professionals?
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We live in a democratic society that respect peoples rights. Pharmacists' rights are not overridden because of their profession. They are aloud to have choices which includes whether or not to give plan B pills
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Why do Cantor and Baum reject the idea that pharmacists can refuse to prescribe emergency contraception?
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The believe professional autonomy has its limits. It is a pharmacists duty to use their special skill in the interest of their clients above their own interest. When a pharmacists objection directly affects a patients health, it follows the patient should come first. Pharmacist know this when they chose the profession and adopt those obligations when they enter the field.
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Is emergency contraception a form of abortion? If this question cannot be answered definitively, what are the implications for the right of refusal?
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Research isn't conclusive that it isn't abortion. This would imply that when pharmacist give out plan B they might very well be giving out abortions, which ideologically is very different then a contraception, because if fertilization has occurred some will consider that a life.
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Why do Cantor and Baum reject both an absolute right to object and no right to object? What is their “middle ground” solution?
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Pharmacists can object to giving the medication, but should arrange with another pharmacy of a reasonable distance to provide service to the patient promptly. Pharmacies that stock Plan B should try to make sure at least one pharmacist who does not object is on duty. Pharmacists that don't carry the drug should state it clearly perhaps on a sign.
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Why did the FDA initially approve Avastin for advanced breast cancer? Why did it later seek to rescind approval? Why did the Wall Street Journal recommend that the FDA maintain approval of Avastin for end-stage breast cancer, and why do Miller and Joffe reject that recommendation?
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They approved it in it's accelerated program because the drug prolonged progression-free survival. It later wanted to retract that approval because clinical trials failed to confirm a favorable risk-benefit ratio. WSJ wanted the FDA to maintain the approval because they felt the government was only trying to save money at the expense of peoples lives. Miller reject that recommendation because they believe science has shown that Avastin has low benefits but extremely high costs which come from tax payer dollars or insurance premiums so its a huge burden on society.
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Is the cost of a medication relevant to the policy decision regarding licensing it? To the question of whether Medicare should pay for it? Why is this a matter of ethics and values, and not merely science?
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By federal law, Medicare is not allowed to consider the cost of a drug or treatment in deciding whether to pay for it. What is the reasoning behind this policy decision, and is it defensible?
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What kinds of cuts to Medicare do Emanuel and Liebman reject? What kinds do they advocate, and why?
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They reject large scale indiscriminate cuts, but they support cuts to specific treatments that are proven not to save lives. They also support cuts to treatments that are more expensive then other treatments but have same effect.
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How is the financing and delivery of health care in the U.S. dysfunctional? In what ways is the quality of care in serious trouble?
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cost have increased tremendously making it unaffordable to large portion of the population. Also doctors who see medicare, and medicaid patients are clinically financially and administratively uncoordinated.The quality of care is in serious trouble because clinics are short staffed, and many avoid having need medical procedures even when they have health insurance because they are under-insured and it would cost too much
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What are the basic opposing ideas driving what Sade calls “central planners” and “free market advocates”?
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central planners-thinks society has a responsibility to provide health care
free market health care- advocates believe individuals have a responsibility to provide their own health care. |
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What moral ideals underlie those in the central planners group?
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Equality- health is a necessary condition for those to pursue their goals, and all Americans should have equal opportunity so health care is a basic requirement.
Justice-injustice in people who are denied opportunities, suffer or die due to lack of health care in the richest country. Justice also implies people must give towards public good depending on ability to pay, and scare resources must be dispersed wisely. Liberty- cannot be exercised if one is ill. If one engages in unhealthy behaviour it is their liberty and they shouldn't be denied care. Community- members of a community share responsibility for fellow members. A national health care system for everyone will help bind us together as a broader national community |
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What is the inconsistency Sade finds in the central planning ideology?
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central planners don't support autonomy when it comes to making health care decisions and forcing people to give money towards it, but want autonomy when it comes to providing health care
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How does Sade use natural rights to critique the ethics underlying central planning?
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The goal of people is to flourish, and to flourish they need to be able to pursue self-dired behaviors. It is the gov't job to create a legal system to protect an individuals right to self-direction, and must not force sacrificing their flourishing for that of another.
The natural right Liberty is a metanormative principle, which isn't concerned with what kind of choices people make or if they flourish. It also implies people cant force others to make sacrifices. Central planning doesn't make distinctions between normative and metanormative principles. By forcing people to pay into health care you are infringing on their natural right of liberty to decide what they value for them to flourish and make self directed behaviors. |
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Why does he think that the fundamental flow in the reasoning of central planners is the failure to recognize this distinction?
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The goal of people is to flourish, and to flourish they need to be able to pursue self-dired behaviors. It is the gov't job to create a legal system to protect an individuals right to self-direction, and must not force sacrificing their flourishing for that of another.
The natural right Liberty is a metanormative principle, which isn't concerned with what kind of choices people make or if they flourish. It also implies people cant force others to make sacrifices. Central planning doesn't make distinctions between normative and metanormative principles. By forcing people to pay into health care you are infringing on their natural right of liberty to decide what they value for them to flourish and make self directed behaviors. |
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According to Sade, a lack of options does not constrain one’s freedom to choose. Why does he think this and is he right?
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Depending on whether the limitation is imposed by the facts of reality or by forceful inter- ference by others. When a fact of reality removes an option, one cannot think of that fact as an obstacle to the freedom to choose that option
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Why does Sade think that government programs to help the needy are immoral?
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Funding for these programs come from taxes that come from peoples pay. So people are then forced to involuntarily servitude for the benefit of others. That seems immoral to do.
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Why does Sade think that there can be no right to health or health care?
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a right to health care is contradictory to the principle that every individual is an end in himself who cannot not be used without his consent as a means to an ends of others.
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What does Sade think is the fundamental cause of health care price inflation? Why does he think that the free market is the solution? How does Menzel respond?
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People were getting their employees to pay for health care, and did not consider the bill, then unemployed people relied on Medicaid, which made hospitals charge higher rates to those who had insurance to make up for lost money from Medicaid
- He thought a free market is the solution because then insurance companies and hospitals would be competing for consumers giving them incentives to try to appeal to consumers with good rates and quality care. |
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What is his argument to show that there is in the US a culturally embedded moral right to access to a basic minimum of health care?
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1.we accept culturally it would be wrong for hospitals to turn people away from care because they can't pay for it
2. We support anti-free riding 3. We all support laws against banning for pre-existing condition |
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What is EMTALA and how has it led to “cost shifting”?
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EMTALA gives people the right to basic health care so hospitals cant turn down people in an emergency if they can't pay for it. It led to cost shifting because people without health care cant pay for that care, so hospital charge more to those who have health care.
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Menzel writes, “...some of the uninsured are working families and young singles; when they need emergency care and get it at little cost, other economically similar persons who have chosen to insure invisibly foot part of the cost. Receipt of benefit without bearing any share of the cost that other similar people share is unfair free riding.” (6) Explain. After reading “The Young Invincibles,” do you think it is correct to say that the people in the story were tempted not to buy insurance because they are assured of receiving emergency care, and therefore are guilty of unfair free riding?
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Some probably, but not all. They weigh the risks and benefit and decide health care is to expensive, and if they were to need health care it would be covered by emergency care.
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How does the inefficiency of using ERs for primary care make the cost shifting associated with EMTALA “all the more galling and unfair”?
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Free riders use the ER so they can get free care, but that further increases the cost of premiums for those who have insurance.
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What are the only two ways to prevent the insured from bearing more than their fair share of health care costs?
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One way is through mandates. People would be mandated to getting basic coverage. These mandates would have to be affordable though.
Another way would be to drop EMTALA and not give those who dont have insurance care at all |
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Why is health insurance a classic example of “market failure”?
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Because health insurance companies often try to avoiding insuring the sick or high risk populations who need it the most, and those populations get priced out of the market.
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Why won’t prohibitions on preexisting condition exclusions solve the problem of market failure?
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In a free market less healthy people would get health coverage, because it might not be worth it for them since they most likely will not use it. People who are sick or are more likely to get sick will try and get insurance. If companies don't prohibit those with pre-existing conditions then the pool of people insured become unhealthy, so insurers will have to increase premiums, resulting in less people being insured
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Why is a mandate to buy insurance necessary to solve the problem of market failure?
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If the mandate is low enough then all people will be paying for the basic care everyone feels everyone has a right to. Then the cost of that basic care wont increase insurance premiums so more people can get insurance since it will be cheaper.
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Why does Menzel think that life support for PVS patients should not be included in the basic care insurance that everyone is required to obtain?
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the value of the extended life is low even to those who profess to place high value on such life. The value is low from a much wider array of perspectives than just the perspective of those who explicitly object to investing in such care. The value of PVS is negligible and therefore we shouldn't waist resources on it, and if people want it they can add it to their issuance.
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ethical relativism and why it fails as an argument
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We should be tolerant of other cultures and should not intervene them. It fails because it leaves no room for reform and what if a societies cultures is to not have tolerance, and to intervene other cultures.
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natural rights
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stems from being human, independent of culture- called human rights now
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cultural rights
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rights entitled to because of culture you live in, not necessarily legal right.
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What reasons does the President’s Commission give for saying that “health care is special” and what moral implication does it draw from this?
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Healthcare is different from other good and service because it is crucially related to one's level of well-being, helping ward off pain, suffering, and premature death.
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Why does the President’s Commission reject prohibiting people with higher incomes from purchasing more care than everyone else?
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The commission believes that society is morally obligated to provide some care, but that does not mean that everyone is entitled to an equal amount of health care. Not all inequalities in health care constitute inequalities.
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Why does the President’s Commission reject providing everyone with all the health care they need?
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The commission insists that the social obligation to provide health care isn't unlimited; it must take into consideration the costs and burdens to society in meeting it.
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What does the Commission mean by “an adequate level of health care,” and why does it think that this is the right goal?
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By adequate level of health care the commission a "decent level". The commission believes if it succeeds in supplying this decent level of health care it will have fulfilled its moral obligation.
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Why does the Commission think that securing equitable access to adequate healthcare is a societal rather than an individual responsibility?
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- Health problems can significantly affect the range of social opportunities open to an individual.
- Health problems are often to difficult to predict and to prevent, and they are widely, but unevenly distributed among society - Therefore they believe the free market cannot be counted on to meet the cruicial levels of health care needed because |
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Why did the Commission decide not to assert a right to health care, and does this make sense in light of its claim that society has a moral obligation to secure equitable access to adequate healthcare for everyone?
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Not sure why?, but it does not make sense after the arguments they presented in the commission. It seems as if they were in favor of right to healthcare.
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