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205 Cards in this Set

  • Front
  • Back
1. What does the minimum conception of morality consist of?
1. The effort to guide one's conduct by reason

2. To do what there are the best reasons for doing, while giving equal weight to interests of each individual who will be affected by one's conduct
2. What do moral skeptics believe?
There is no objective truth to moral claims established by values, religion, etc.
3. What do moral realists believe?
There is objective truth to moral claims

There are moral facts
4. How do we resolve moral conflicts?
1. Get the facts straight
2. Get the concepts straight
3. Use examples and counterexamples
4. Make the reasons explicit
5. Analyze the arguments
5. What are the four levels of moral discourse?
Cases (concrete)

Rules and Rights (Codes of Ethics)

Normative Ethics

Metaethics (abstract)
6. What are "paradigm cases"?
These are agreed upon cases
7. How can one stay at the case level, which is the lowest most specific level?
If you agree upon what should be done in the paradigm case and can agree that the new case is similar in all relevant respects, they you can resolve the problem at the case level
8. What is casuistry?
This approach of relying on paradigm cases
9. Where does ethical reasoning begin?
Begins with the concrete case (like Bobby C)
10. What is the second level, the rules and rights (codes of ethic) level, consist of?
Specific rules in a context

What are rights of patients? (informed consent)
What are the obligations of the physician (Hippocratic Oath)
11. What does it mean if a rule or right is considered ethical?
It will be seen as grounded in a moral system, an ultimate system of beliefs and norms about the rightness or wrongness of human conduct and character
12. What are codes of ethics?
Groups of rules or rights-claims

They rest on the authority of the groups creating the codes
13. What would be a rule-like maxim?
A specific rule-like statement

"Always get consent before surgery"
14. What would be a rights-claim?
"A patient has a right to consent before surgery"
15. How do rules and rights-claims differ?
Rules are expressed from the perspective of the one who has a duty to act

Rights-claims are expressed from the vantage point of the one acted upon
16. How rigid are these codes?
These is a continuum of how seriously these rules and rights must be taken
17. What is legalism?
The view that there are no exceptions to the rules or rights

Almost no one actually holds this view
18. What is antinomianism?
View that every case is so unique that no rules or rights can ever be relevant in deciding what one ought to do in a specific situation

As implausible as legalism
19. What are the two intermediate views?

Rules of Practice View
20. What is situationalism?
Moral rules are merely "guidelines" or "rules of thumbs" that must be evaluated in each situation
21. What is the rules of practice view?
Holds that rules specify practices that are morally obligatory

Rules are stringently binding on conduct and exceptions are made only in very extreme circumstances
22. What is the normative level?
These are general principles that govern all actions in the social world

Broad, basic norms of behavior and character are discussed
23. What are the four principles in normative ethics?
1. Beneficence
2. Non-maleficence
3. Autonomy
4. Justice
24. What are the three questions in normative ethics and what answers these questions?
1. Actions: what principles make actions morally right? (four principles)

2. What kind of consequences are good or valuable?
(Value Theory)

3. What kinds of character traits are morally praiseworthy?
(Virtue Theory)
25. What is the value theory?
It asks what kinds of things are intrinsically valuable

Standard answers: happiness, knowledge, health, etc.
26. What is the virtue theory?
Worthy character traits (virtues) applying to the person engaging in the action

Good person?
27. What is the difference between benevolence and beneficence?
Benevolence is a virtue, the virtue of willing to do good

Beneficence is a principle of actions, the principle of actually acting in such a way that good consequences result
28. What does metaethics deal with?
The meaning and justification of ethical terms, how people know which principle or virtues are the correct ones, and the ultimate grounding of ethics

General source of ethics
29. What does metaethics ask?
What makes something right or wrong and how do we know it?
30. What is relativism?
In metaethics, the position that there are multiple sources or groundings of moral judgments such as the approval of various cultures to which any correct moral judgment must conform
31. What is common morality?
An agreement on many, indeeed most, ethical matters across culture, religions, politics, and time periods
32. What is bottom up reasoning?
Start with cases: is it clear what is morally right?
(case base reasoning - more popular now)

Move up the ladder
33. What is top down reasoning?
Start with a theory of ethics (utilitariansim, katntianism)

Deduce to lower levels
34. What is contract theory?
A type of metaethics that maintains that the source of moral rightness or the way of knowing what is moral stems from actual or hypothetical social agreement
35. What is metaethics again?
The branch of ethics having to do with the meaning and justification of ethical terms and norms
36. What are moral principles?
General and abstract characteristics of morally right actions

The main elements of part of normative ethics called action theory
37. What are moral rules?
Concrete statements specifying patterns of morally right conduct

Sometimes believed to be derived from more abstract moral principles or created as summaries of patterns of individual case judgments
38. What are rights?
Justified moral or legal claims to entitlements or liberties often seen as taking precedence over considerations of consequences
39. What is universalism?
The position in metaethics that there is a single source or grounding of moral judgments such as the divine will or reason to which any correct moral judgment must conform
40. What is moral pluralism?

In order to interact successfully what three things do we need to do?
Different moral positions are held by people

1. Recognize diversity of view
2. Rationally defend our pov
3. Negotiate when can't agree
41. What did natural law contribute to medical ethics?
Doctrine of double effect

If an action had two effects, one good and the other evil, the effect was morally permitted if...
-action was good in itself
-good followed
-good was only intended effect
-important reason for performing the action
42. What is social contract theory?
It assumed that people are fundamentally self-interested and that moral rules evolved for humans to get along
43. What did Kant believe?

What is central to Kantian ethics?
Believed in the power of reason to solve human problems

Reason and will are central
44. What are the four distinctive elements of Kantian ethics?
1. Ethics is not a matter of consequences but of duty

2. A right act has a maxim that is universalizable

3. A right act always treats other humans as "ends-in-themselves" never as a "mere means"

4. People are only free when they act rationally
45. What is duty according to Kant?
It is freely imposing obligations on one's own self
(acting from obligation_

It is NOT following orders or doing what you feel is right
46. What is a maxim?
A rule that guides your actions

Never lie to your friends; it's okay to cheat if you have to
47. What does it mean to say a right action has a maxim that is universalizable?
Everyone should be able to do it if action is moral

What is universalizable is what should apply to everyone
48. What are the two types of imperatives?
1. Hypothetical Imperative
IF you want...THEN do....
- if you want to get an "A" then you MUST get high scores on all the tests. Study high get high scores...

2. Categorical Imperative
Unconditional and applies all the time.
(i.e always tell the truth)
49. What three things do Kantion Theories emphasize?
Focus on DUTY

Emphasis on RESPECT

Emphasis on REASON
50. What are the problems with Kantian ethics?
1. Regards Kant as supreme rationalist in ethics

2. Fails to tell us how to resolve conflicts between competing maxims
51. What are the four basic tenets of Utilitarianism?
1. Consequentialism
2. Maximization
3. Theory of Value
4. A scope-of-morality premise
52. What does consequentialism mean?
Consequences count, not motives or intentions

We are responsible for all the consequences of our choices
53. What is the morally right option based on consequentialism?
The option which brings about the most good, or the best consequences
54. What is the maximization principles?
The number of beings affected by consequences matters

The more being affected, the more important the result
55. What is the right action based upon the maximization principle?
The right action is one that brings about "the greatest good for the greatest number"
56. What is the "Utilitarian Calculus"?
Weigh up the pleasure and pain caused by alternative actions. That action which has the most pleasure/pain is the right action
57. What is the theory of value?
Good consequences are defined by pleasure or what people prefer or by some other good thing
58. What is hedonic utilitarianism?
Simplest theory of value that equates a good consequence with pleasure and harm with pain
59. What is negative utilitarianism?
Theory of value that focuses on relieving the greatest misery for the greatest number, as in famine relief
60. What is positive utilitarianism?
Theory of value that focuses on benefiting humanity
61. What is preference utilitarianism?
A compromise view that believes utility is maximized by furthering the preferences that people have
62. What is the scope-of-morality premise?
Each beings happiness is to count as one and no more, and beings who count are to be made explicit, whether these are only humans or all sentient creatures
63. Does utilitarianism imply selfishly getting pleasure?

Each individual is to count equally in applying the Utilitarian Calculus

Your own pleasure or pain counts that same as another person's pleasure or pain
64. What are the problems with Utiliarianism?
1. Difficult to calculate the net good of our actions since what is good is up to each person

2. Distributive inequalities
65. What are the moral principles?
66. What is autonomy?
Refers to the right to make decisions about one's own life and body without coercion by others
67. What is beneficence?
Chose actions that bring about good, rather than harm

Grounds compassion
68. What is non-maleficence?
Do not do harm to others
69. What is justice?
Socially, treating similar kinds of people similarly

Politically, refers to distributive justice

Medicine, allocation of scarce medical resources

*treat equals, equally
70. According to Kantian ethics should Bobby C get transplant? Why?
-Want to treat humans as ends in themselves
-Autonomy: physician should only treat when benefit to individual's free and rational will is likely
71. According to Utilitarianism ethics should Bobby C be treated? Why?
Yes (get transplant)
-physicians should only treat when benefits are greater than costs for all persons
72. What is the difference between personal life, morality, public policy, and legality?
Persona life: purely private, affects no one else

Morality: someone else is affected

Public Policy: actions affect other people's interests, but negative actions are not necessarily condemned as immoral (tolerated)

Legality: society promotes certain actions and discourages other actions
73. What is the definition of euthanasia?
Killing of one person by another for merciful reasons
74. What is the definition of suicide?
A competent adult without a terminal illness causes his or her own death

*Bouvia and McAfee cases would be classified as suicide
75. What is the definition of forgoing treatment?
An underlying disease is incrementally leading to death in choosing not to do everything possible patient accepts death at an earlier date
76. What is the general outline of Elizabeth Bouvia and Laryy McAfee?
They were both non-terminal with phyiscal disabilities

They decided they no longer wanted to live BUT they couldn't kill themselves so they asked for help
77. What was wrong with Elizabeth Bouvia?

What did she want to do?
She was 25 yrs. old and almost totally paralyzed from cerebral palsy

She wanted to die by starvation basically b/c she refused to eat
78. What was the legal case regarding Bouvia?
Doctors wanted to force feed her by intubation of a feeding tube
79. What was wrong with Larry McAfee?

What did he want?
He was 29 when he was almost completely paralyzed in a motorcycle accident

He designed an IV line that would allow him to take lethal drugs by blowing and sucking in a specific pattern
80. If we say that individuals have the right to self-determination and these rights extend to medical context what can we conclude?
Conclusion: Individuals have the right to refuse medical treatment
81. What is the moral rule regarding this conclusion?
Physicians should respect the decision of patients to refuse treatment even if it means that treatment would prolong life and lack of treatment will hasten death

*respect autonomy of person
82. If we use the same two premises mentioned before what else can we conclude?
(two things)

How are these conclusions different from the previous?
1. Indivduals have right to euthanasia

2. Individuals have right to compel physician to assist in suicide

*These involve others whereas the first only involves one's self
83. In regarding individual decisions what was the ultimate ruling in Elizabeth Bouvia's case?
A competent adult patient had a constitutionally guaranteed right to refuse medical treatment

Also, no criminal or civil liability attaches to honoring a competent, informed patient's refusal for medical service
84. What issues arise for making public policies that are not issues in making individual decisions?
1. Moral pluralism in population

2. Implications for other social concerns

3. Regulating procedures or effectiveness
85. What are the stats with assisted suicide?
Illegal in 35 states

9 states have common law about it

Ohio - not a crime

Not clear in 3 states

Legal in Oregon
86. What was Kant's take on suicide?
He opposed it b/c

1. suicide cannot be universalized b/c motive is self-interest

2. Immoral b/c people should always be treated as ends in themselves never as mere means
87. What was John Stuart Mill's take on suicide?
He said basically so long as others are not harmed we can do whatever we want with our own lives and bodies

He distinguished between self-regarding and other-regarding acts
*only censure others for their other-regarding acts
88. Applied to the right to die what does autonomy mean?
A person who has not been proven incompetent has an autonomous right to end his or her life
89. What are the problems with uncritical acceptance of autonomy regarding right to die as pointed out by the famous SUPPORT study?
1. Predictions about end of life care usually don't predict what one later finds acceptable or unacceptable as quality of life

2. There is an adaptation effect in which after some time patients adapt their views about acceptable quality of life
90. How do the Bouvia and McAfee cases illustrate social prejudice toward physical disabilities
The cases show how a prejudiced system destroys the independence of disabled people, rather than nurturing it
91. These two cases suggest that society often gives disabled people what three limited, grim choices?
1. Become a burden on their families or friends

2. Live miserably in a large public institution

3. Kill themselves
92. McAfee and Bouvia also illustrate the "rule of rescue". What is this?
When one person's plight is made prominent by the news media, society tend to fell compelled to rescue that person, even if the rescue entails spending enormous amounts of scarce medical resources
93. What are some good consequences of public policy regarding competent patients request to die (i.e. assisted suicide)?
1. Competent patients who currently want active help in dying would get it if policy allowed it

2. Reassure those who believe they should have the right, even if they are never in a position to use it

3. End suffering of those who are in pain
94. What are some good consequences of public policy regarding competent patients request to die (i.e. assisted suicide)?
4. Relieve psychological suffering

5. Create a context of humane, dignified death, so patient remembered as they were in life, not in pain
95. What are some negative consequences of public policy regarding competent patients request to die (i.e. assisted suicide)?
1. Conflict with fundamental moral and professional commitment of physicians as heelers

2. Weaken our commitment to provide optimal care for dying (euthanasia my be cheaper)

3. Erode current right to refuse treatment
96. What are some negative consequences of public policy regarding competent patients request to die (i.e. assisted suicide)?
4. Make patients worse off since with choice available they may be pressured to request death or be required to justify choosing life

5. Weaken prohibition against homicide in general

6. Might slip from voluntary to involuntary active euthanasia
97. How can we promote the good and avoid the bad consequences?
1. Give patient all relevant information

2. Procedures should ensure patient's request is stable & fully voluntary
98. How can we promote the good and avoid the bad consequences?
3. All reasonable alternatives must have been explored for improving quality of life and reducing pain

4. Psychiatric evaluation should be done to make sure decision is not result of impairment like depression
99. What is the AMA's view on euthanasia?
Intentionally terminating someone's life (mercy killing) is contrary to that for which the medical profession stands

Cessation of extraordinary means to prolong life of body when biological death is imminent is decision of patient and/or family
100. So basically what is justifiable and what isn't according to them?
Intentional termination of life is unjustifiable (active euthanasia)

Withhold treatment or stop extraordinary means is justifiable (passive euthanasia)
101. What is Rachel arguing in his paper?
There is NOT a moral difference between passive euthanasia and active euthanasia

*this is all he argues not if one is right or wrong
102. So if there is no moral difference then we cannot say what two premises?
1. P.E. is sometimes morally permissible

2. A.E. is never morally permissible, even when P.E. is
103. When would these two premises be true?
Both would be true if there is a moral difference between P.E. and A.E.

BUT there isn't according to Rachels
104. What is Rachel's first argument?
The moral principle justifying P.E. is prolonged suffering BUT this same principle justifies A.E.

In respect of being justified by prolong suffering, A.E. and P.E. are equivalent
105. So in a nutshell if the moral principle is that it is wrong to prolong suffering what can be conclude?
That both active and passive euthanasia are justified
106. What is Rachel's saying in his second argument?
The we permit people to make decisions about who live or die based on irrelevant reasons
107. What example does Rachel's give to illustrate this argument?
Down Syndrome baby example

If Down syndrome babe is born with intestinal blockage (which can be easily fixed) then it's justified to withhold treatment and let die

If Down syndrome baby is born without intestinal blockage than actively euthanasia is unjustifiable
108. Rachel's argues that this decision is being based on what?
Being based on quality life

Whether baby has intestinal blockage is irrelevant to the argument
109. Based on what is really affecting the decision are P.E. and A.E. the same?
Both are either justifiable or unjustifiable based upon what you believe the quality of life for the Down syndrome baby will be

High quality- both unjustified
Low quality- both justified
110. What is Rachel's third argument?
Difference between active and passive euthanasia is the difference between killing and letting die

BUT killing and letting die are not morally distinct therefore active and passive are not morally distinct
111. What is the argument by analogy given to illustrate Rachel's third argument?
Case 1: Smith drowns cousin in bath to gain cousin's inheritance

Case 2: Jones does nothing to save cousin when drowning in tube (kid hit his head) so he can get cousin's inheritance
112. Is Smith doing something morally different from what Jones is doing?
No moral difference here

Both were wrong in this case regardless that one actively killed the boy while the other passively let the boy die
113. According to Rachel's what is it that does matter then?

How does this relative to active and passive euthanasia?
A person's motivation or intention to end the life of another is what matters

Since both passive and active have same intention there cannot be a moral difference
114. In his fourth argument what does he say is the claim people assert about the difference between PE & AE?
Active = direct causal role

Passive = indirect causal role
115. What does he argue though?
That direct and indirect casual role is NOT a moral distinction therefore active/passive is not a moral difference
116. In short what is Rachel's saying?
You still are performing an action when you don't do something
117. If the prognosis is right that the patient will die is there a difference between actively killing with injection and passively let die by removing respirator?
No, patient dies in both scenarios

There is no difference
118. When might casual difference make a moral difference?
Prognosis is wrong and patient will not die

If passively remove respirator patient doesn't die
BUT if actively kill with lethal injection patient dies
119. What was Karen Quilan's condition?

What was her medical treatment?
Had anoxia; irreversible brain damage

She was not brain dead but in a coma (PVS)

She was put on a respirator and then feeding tube (had 1 in million chance of recovery)
120. What was the traditional definition of death?
Where the body stops breathing and the person is declared dead

It was indirectly assumed brain death to be inevitable but no respirators prevent this
121. What was the legal process regarding Quinlan's case?
7 months after admission, doctor was made legal guardian and that respirator was NOT to be disconnected

1yr, 2mo later- reversal and guardians could decide to let patient die by disconnecting life support
122. Why were the doctors on Quinlan's case worried about charges of criminal misconduct?
1. At time AMA equated withdrawing respirator for death to occur with euthanasia and then equated that with murder

2. Feared if Quinlan's later changed their minds, they could sue for malpractice
123. What was the medical treatment that Karen Quinlan ultimately received?
Parents "weaned" from respirator

After 10 yrs in a nursing home Karen's body was declared to be dead
124. What two things did the Court base it's decision on in the Quinlan's case?
1. Right to privacy, a right that in medical contexts would presumably apply only to competent patients

2. Standard of substituted judgment (family/friends substitute their judgment for that of an incompetent patient)
125. What was Nancy Cruzan's condition?

What was her medical treatment?
Anoxia, PVS

Feeding tube was used (no respirator)

Continued in PVS for 7 yrs
126. What was the legal process associated with Cruzan's case?
Issue of standards of evidence

Missouri required "clear and convincing evidence" of patient's wishes
127. What did the Supreme Court decide when reviewing the Missouri decision?

(Three law changes in 1990)
1. Competent patients have right to decline medical treatment even if they'll die

2. Withdrawing feeding tube doesn't differ from withdrawing respirator

3. Regarding incompetent patients, states can (but not need) pass a statue requiring clear, convincing standard of evidence about what patient would want
128. What are the three standards of evidence?
1. Preponderance of evidence (minimum standard): there is more evidence one way than the other

2. Clear and convincing evidence: more rigorous standard & w/ dying it requires an advanced directive (living will) or durable power of attorney

3. Beyond a reasonable doubt: most rigorous standard used in serious felonies
129. What was Tero Schiavo's condition?

How was she medically treated
She 27 yrs. old in a coma due to anoxia

She had a PEG tube, experimental surgery, and intensive rehab up to 1994
130. What started the whole ordeal with Terri Schiavo?
In 1998 her husband asked to remove the PEG tube

Her parents disputed claim of what Terri would have wanted saying she would have want to remain living
131. How did the legal process proceed in the Schiavo case?
2000: Court decided in favor of removing PEG

2001: Appeals Florida Supreme court did not reverse
132. What did Florida pass in 2003?

What did this mean?
Passed "Terri's Law"

Allowed Governor to issue a one-time stay of a judge's order to remove a feeding tube in certain cases where a patient was PVS

*Of course good old Jeb Bush immediately issued a stay
133. How did the legal battle proceed from here?
2004: FL Supreme Court ruled "Terri's Law" unconstitutional

2005: US Supreme Court chose to not intervene in appeals

Public, Congress, and News frenzy for more appeals
134. How did this all end?
March 31, 2005 Terri Schiavo's body stopped functioning

She was PVS for 15 yrs when PEG was removed
135. What is a patient like in a coma?
1. Totally unconscious

2. Unresponsive

3. Unaware

4. Un-arousable

5. Don't respond to external stimuli

6. Don't have sleep/wake cycls
136. What causes comas?

How long is someone in a coma?

What happens as time goes on?
Result from widespread trauma to the brain

Usually last a few days to a few weeks

Some patients gradually come out of the coma, some progress to vegetative state, and some die
137. What is a patient in a vegetative state like?
1. Unconscious and unaware of surroundings

2. Have sleep/wake cycles

3. Can have periods of alertness
138. How does patients in a vegetative state differ from those in a coma?
In vegetative state, patients often open eyes and move, groan, or show reflex responses

In coma, patient's eyes are closed
139. What is a persistent vegetative state (PVS)?
A generic term covering a type of deep unconsciousness that, if it persists for a few months, is almost always irreversible
140. What are the odds of recovery for coma/PVS recovery?
7 of 434 with PVS from head trauma recoverd some normal quality of life

Some recover from PVS in 1 yr, 1 in a 1000 after 3 yrs, none after 4 yrs

Some recover after a long term of deep coma
141. What are the different criteria of life/death?
1. Whole body standard: absence of breathing or heartbeat

2. Brain Death
142. What are the four different standards of brain death?
1. Harvard Criteria

2. Cognitive Criteria

3. Irreversibility Standard

4. Uniform brain death act
143. What is the Harvard criteria for brain death?
Loss of nearly all brain functioning

Unaware of external stimuli, lack body movement, no spontaneous breathing, lack of reflexes, two isoelectric EEG reading 24 hrs apart
144. What is the cognitive criterion for brain death?
Core properties (reason, memory, agency, self awareness) are needed to be a person
145. What is the irreversibility standard for brain death?
Unconsciousness irreversible PVS lasted over i yr

Death occurs simply when unconsciousness is irreversible
146. What is the uniform brain death act?
Death is the irreversible loss of all brain function
147. What are the two arguments about whether treatment should ever be terminated if incompetent patient will die w/o it and live w/it?
Mercy Argument

Fallibility Argument
148. Is there a difference between removing respirator and removing feeding tube?
Casual Chain:
1. Injury/Disease
2. Brain malfunction
3. Feeding tube/respiratory
4. Maintain life

-removal of ether will cause death
149. Is there a difference in the cause of death regarding the removal of feeding tube vs removal of respirator?
Remove feeding tube: die via starvation
(BUT injury/disease caused inability to take in food or water)

Remove respirator: die via anoxia (again injury/disease caused inability to breath)
150. When should the patient make the decision about medical treatment?

When information is provided about consequences of treatments and no treatments

Principle of Autonomy
151. When should the family make the decisions?

When patient is not competent and they are acting in the best interest of the patient

Principle of autonomy combined w/ belief in ability of family to know patient's wishes
152. When should a physician make the decisions?

When patient is incompetent and the family cannot agree or is absent, or is clearly not thinking about the best interest of the patient

He has knowledge of consequences of treatment or no treatment
153. When should a judge make the decision about treatment or no treatment?

When patient is incompetent and family disagrees or family and physician disagree

State has interest in preventing abuse of patient by family or physicians so it can act in the best interest of the patient
154. In 1986 the AMA changed its policy from before stating what?
It is ethically possible for a doctor to withdraw ventilators and feeding tubes from an irreversibly comatose patient after consulting with family
155. What is a living will?
Informs physicians about conditions under which a person would or would not want medical support continued
156. What is a values inventory?
Specifies what a person values in life and may be useful to a patient's family and physicians if they must make decisions for that person
157. What is a durable power of attorney?
Assigns to someone else the right to make financial and life and death medical decisions if the person becomes incompetent
158. What do Weisbard and Siegler warn about in their article?
Families and physicians may have mixed motives for wanting a quick death for comatose patients

SO give these patients every benefit of the doubt
159. What do W & S claim about the "death with dignity" movement?
It is making it increasingly acceptable to permit avoidable deaths by dehydration and malnutrition
160. How does death from withdrawal of respirator differ from death from removal of feeding tube according to W & S?
Not providing food/water is killing by starvation or dehydration

Not providing respirator or organ transplant is letting individuals die from their disease
161. How else is withdrawal of a feeding tube or fluids different from removal of respirator?
Underlying obligations of providing food & drink to those who need it is roote in our human responses of caring, nurturing, etc

It cannot be seen as easily as "letting nature take its course" so there is a heavier burden of guilt and moral responsibility on doctor or family
162. What do they argue will happen if we permit killing by not providing food and/or water?
We will begin to permit killing by other means
(slippery slope)
163. What kind of slippery slope argument do W & S present in the end?
Once we permit third parties to decide that another individual's life is not worth living b/c of PVS or severe pain, then we will decide on other grounds (mentally ill, old, disabled) that another individual's life is not worth living
164. What are the two types of slipper slop arguments?
1. Factual inductive argument

2. Moral logic argument
165. What do factual inductive arguments claim about legitimizing some form of killing (starvation and dehydration)?
If a population legitimizes some forms THEN it WILL legitimize MORE or ALL forms of killing
166. What evidence is cited for factual inductive arguments?
-Nazi policy: not evidence

(physician-assisted suicide)

-US since Quinlan and Cruzan rulings
167. What does a moral logic argument say about this same topic?
If we legitimize some forms of killing (starvation and dehydrations) THEN we WILL NOT be able to resist the reason for legitimizing MORE or ALL forms of killing
168. Which kind of slippery slope argument is just plain stupid?
The inevitable slippery slope arguments
169. What is the form of "horrible-result" slippery slope arguments?
P1: Consequence Y is horrible
P2: Consequence Y might follow from adopting policy X

Therefore, adopting policy X is wrong
170. What are some characteristics of bad "horrible-result" slippery slope arguments?
1. Involve scenario where Y is really bad

2. Provide little evidence for the strength of the 'might' (i.e. risk) in P2

*they are just 'scare mongering' w/o empirical evidence to substantiate risk in P2
171. Thus, what are the main features of good horrible-result slippery slope arguments?
1. Aim at modest conclusions

2. Give empirical evidence to suggest that the move from one step to the next, to the next, and so on is likely
172. How do we decide for those who are not currently competent to say for themselves what quality of life is too "low"?
1. Medical directive

2. Substituted judgment

3. In the best interests of the patient
173. In Fletcher's article what does human mean and what does person mean?
Human denotes mere biological form of humans

Person denotes a human with mental capacities and a right to life
174. What is the cardinal or homogenizing trait upon which all other human traits hinge?
Neocortical function
*key to definition of a human being

Without the synthesizing function of the cerebral cortex (w/o mind or thought) the person is nonexistent
175. What are the four traits in Fletcher's paper that are esse of humanness?
1. Neocortical function

2. Self-consciousness

3. Relational ability

4. Happiness
176. What is neocortical death?
Both self-consciousness and other-orientedness are gone

Non-self consciousness and inability to relate to others does not mean neocortical death though
177. Is the neocortical indicator medically determinable?

Why does this definition work so well?
It is medically determinable

Neocortical death necessarily covers all other criteria b/c they are impossible when neocortical function is gone
178. In terms of choices and actions between patient and doctor what would be passive euthanasia?
Patient refuses all treatment

Physician does not initiate treatment or withdraws treatment
179. In terms of choices and actions between patient and doctor what would be physician assisted suicide?
Patient request means for limiting suffering BUT this is a life terminating procedure
180. What would be considered active euthanasia then?
Patient requests physician to administer life terminating procedure
181. In 1973 the Dutch Medical Association in agreement with the Dutch legal authorities laid out what four guidelines for physician assisted suicide?
1. Only competent patients can request death
2. Patient's request must be repeated, un-ambivalent, unpressured, and documented
3. Doctor must consult another doctor for opinion
4. Patient must be in unbearable pain or suffering w/o likelihood of improvement
182. The Remmelink Report in 1990 concluded what things about physician assisted suicide in Holland?
1. No support for the supposition that Netherlands are "going downhill" w/ regard to life-terminating treatment by physicians

2. No signs indicating an increase in life-terminating treatment among vulnerable patient groups
183. What did the Remmelink Report find?
1. Virtually 100% of patients killed were terminal

2. Physicians turned down 66% of requests for death from competent patients
184. What aspects of the Dutch experience caution against easy generalizations to N. America?
1. Everyone in Holland has free medical care

2. Physicians make house calls to Dutch patients so there is a good trust between physician and patient
185. What extension was made in 2002 the euthanasia laws in the Netherlands?
The euthanasia law was extend to 16-18 yr olds and 12-16 yr olds (with consent of parents)
186. What is the Gronigen protocol that began in March 2006 require?
Required that in order for children under the age of 12 (esp babies) to be killed the parents, at least 2 physicians, and social workers must agree that further treatment is futile

After a waiting period of several days, during which time the parents say goodbye, the child is killed
187. What principles were the backbone for the regulation of end-of-life decisions in the Netherlands?
Autonomy: this was starting point for legalization of euthanasia

Beneficence had important role in the process of regulated the termination of life
188. How is Nazi Germany used as a slippery slope argument for legalization of euthanasia?
Began with mercy killing of sick and disabled

Eliminated "life unworthy of life" in children and babies

Eventually killed anyone with mental retardation, physical deformities, mental disease,

Finally killed all who did not posses German citizenship or were not of German blood (Jews, Negroes, and gypsies)
189. In what ways does the Nazi "euthanasia" program mislead people?
Had nothing in common w/ competent patients who are dying and who voluntarily request assistance from physicians

Obviously, Nazi "euthanasia" were murders and aren't relevant physician assisted suicide
190. How did Dr. Kevorkian begin the controversy he started?
1990 he helped Janet Adkins die (she was in initial stages of Alzheimers)
191. How did his career of helping people die continue?
1991: double suicide of two women

1998: had helped 100 ppl commit suicide and was acquitted in 3 trials involving 5 deaths

1998 helped Thomas Youk die and aired tape on 60 minutes
192. What finally happened to Jack Kevorkian?
1999 he was convicted of 2nd degree charge and sentenced to prison

When he aired tape of Thomas Michigan had made physician assisted suicide illegal
193. How did the Oregon Death with Dignity Act fair?
1994: 51% approved act (49% disapproved)

1997: Oregon legislature repealed act

1997: voters approved it again (60% to 40%)
194. What restrictions did the act have?
1. Must be clearly competent

2. Have less than 6 mo to live

3. Wait 15 days before filling prescription to avoid impulsive decisions

*physicians couldn't administer fatal dosage just prescribe it
195. What did Attorney General John Ashcroft do in 2001?
He instructed agent to go after doctors in Oregon who prescribed lethal drugs to terminal patients

Patients appealed for injunction, which was granted
196. And how did the legal battle continue in 2002?
Jan: Oregon Att. Gen. files for judgment

April: US District Court upholds Death w/ Dignity Act

Sept: Ashcroft files appeal to overturn
197. What occurred in 2004?
May: 3 judge panel upholds DWD act decision

July: Ashcroft files appeal rehear w/ 11 judge panel now

Aug: request denied

Nov: Ashcroft appeals to US Supreme Court
198. What occurred in 2005:
Feb: US Supreme Court agrees to hear it

Oct: US Supreme Court hear Gonzales v. State of Oregon
199. What was the Supreme Court's decision?
They upheld District Court decisions

Oregon's law remains in effect
200. What were the final regulations in Oregon's Law?
1. Must be competent (at least 18 yrs old)
2. Dying of terminal disease (confirmed by 2 doctors)
3. Ask twice with 15 day in between
4. Wait 15 days before doctor can prescribe fatal dose of drugs
201. What have been some of the consequences of the Death with Dignity Act?
Since being passed in 1997 292 patients have died under the terms

Participants were more likely to have cancer and have more formal education

More patients died at home and were enrolled in hospice care
202. What are the most frequent end of life concerns?
1. Loss of autonomy
2. Decreasing ability to participate in activities that made life enjoyable
3. Loss of dignity
4. During 2006, patients became more concerned about inadequate pain control
203. In regards to practical issues is alternative care adequately encouraged?

Are there many botch physician assisted suicides?

In about 6% in Holland and Oregon there are problems (i.e. vomiting drugs)
204. Are those without insurance and access to hospice care forced to opt for physician assisted suicide?
In Oregon, terminally ill citizen have access to hospice even if not insured
205. What are some moral concerns with physician assisted suicide?
Empirical or factual slippery slope

Which will it be more like: Nazi Germany

Do terrible consequences have to occur if adopt a policy of physician assisted suicide