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262 Cards in this Set
- Front
- Back
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1. According to Tooley, if A has a right to X than what two things are necessary?
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1. A is the sort of thing that has experience and other mental states
2. A is capable of desiring X which means A must have concepts in order to understand X |
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2. If A has a right to X then what obligations to we have?
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Others are under a prima facie obligation to refrain actions that would deprive A of X
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3. According to Tooley when does an organism possess a right to life?
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Possesses right to life only if it possesses the concept of a self as a continuing subject of experience and other mental states
Self consciousness requirement for a right to life |
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4. Based upon what Tooley is saying about when a person has a right to life, do you think he supports abortion?
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He is in favor of abortion and infanticide because they don't have the conceptual resources necessary to desire life
Both don't possess the concept of a continuing self |
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5. Tooley says a kitten has a right not be tortured but not a right to life, why?
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Kitten doesn't have concept of a self so it cannot desire continued existence
Kitten does suffer pain so it has an interest or desire not be tortured |
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6. Who else would not be a person based on Tooley's definition?
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1. Physically impaired infants
2. Mentally impaired infants 3. Comatose adults 4. Adults of other species 5. Those who are sleeping? |
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7. What was the decision of Roe v. Wade in 1973?
How did the Court define personhood then? |
Ruled:
1. First trimester: decision of doctor and woman 2. Second trimester: state may regulate abortion in interest of health of mother 3. Third trimester: fetus is viable, state may regulate or prohibit in order to promote interest of "potential human life" They defended the gradient view of personhood so it is not an all or nothing but rather several degrees |
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8. What is viability?
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The point when the fetus is able to live outside the mother's womb
Said to be between 24-28 weeks |
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9. What is the standard anti-abortion argument that Thomson argues against?
(three premise and one conclusion) |
P1: Fetus is a human being, a person, from the moment of conception
P2: Evey person has a right to life P3: Mother has a right to control her body, BUT the right to life is a stronger right C: Abortion is morally not permissible |
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10. What does Thomson argue?
What is unique about how Thomson presents her argument? |
Argues that the right to life is not always stronger than the right to control one's body
She grants for the sake of argument that a fetus is a person |
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11. What analogy does Thomson use?
What case is this most similar to? |
Waking up and finding a violist attached to you using your kidneys and you gave no permission (in fact you were kidnapped)
Violinist's dependence on you and your kidneys is analogous to the fetus' dependency on mother and womb Most similar to the case of rape |
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12. In this case are you obligated to let the violinist use your kidneys since every human has a right to right and he is a human so he has a right to life?
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NO
Having a right to life does not guarantee the right to be given use of or right to be allowed continued use of another person's body |
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13. How does this transfer to is abortion morally permissible in the case of rape?
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The woman is clearly not responsible in the case of rape
Fetus did not result from a voluntarily act so aborting them is not depriving them of anything they have a right to and hence is not unjust *extreme view says abortion is wrong here |
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14. Why does the extreme view say abortion is still wrong even when it is to save the mother's life?
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Abortion would be directly killing an innocent child whereas if you do nothing you let the mother die
It is always wrong to kill an innocent person directly and this would be murder (which is always wrong) Similar to argument of passive versus active euthanasia (killing vs. letting die) |
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15. Describe the house analogy Thomson uses for the case of abortion to save the mother's life.
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Baby and mother are trapped in house. The baby keeps growing larger and larger.
Does the mother have the right to kill the baby so it's growth doesn't kill her? |
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16. So what is this example basically saying?
What does Thomson argue about a third party's intervention? |
The woman owns the house so yes she can
Third party should be able to accede to mother's request if so desires |
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17. When Thomson gives the example about a box of chocolate given to an older brother and he either shares or does not, what is she trying to imply?
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She is saying that there is a difference between what would be praiseworthy and what is morally required
It would be nice of the older kid to share but he is not morally obligated by any means to share because it's his box of chocolates |
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8. Instead of arguing that the fetus is independent in order to est. it's right to life, Thomson says that opponents of abortion should focus on what argument?
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Make the argument that the fetus is dependent on the mother
This would establish that she has a special responsibility to the fetus, which gives it rights against her that other independent people would not possess |
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19. How Thomson counter this argument in order to defend the morally permissibility of an abortion if a woman uses contraceptives?
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She was not trying to enter into this special relationship with the fetus where she has a responsibility to it
Remember he analogy of using mesh window netting to keep out the seeds that take root in the carpet ("people-seeds") |
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20. What is the difference between the Good Samaritan and the Minimally Decent Samaritan according to Thomson?
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Good Samaritan: Go out of his way, at some cost to himself, to help one in need of it
Minimally Decent Samaritan: example is someone who at least calls cops if witnessing a murder, rape, assault, etc. |
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21. How does the Samaritan relate to abortion?
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Women are called to be Good Samaritans to the fetus in most states
There is a great gap between X has a right to life and the claim that Y is obligated to do whatever is necessary to keep X alive, let alone be forced to do so |
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22. What is Thomson's conclusion?
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Except in some cases, nobody is morally required to make large sacrifices of health, other duties/commitments, etc. in order to keep someone alive
Abortion is morally permissible in some cases (exceptions would be 7 mo and want an abortion to take trip to Europe) *right to life means right not to be killed unjustly so this would be unjust killing but other cases are not unjust killing of fetus |
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23. In the anti-abortion argument is fetus person?
What do they argue is prima facie wrong? What is their broad principle? |
Fetus is person (life present from conception)
Prima facie wrong to take human life It is always wrong to take human life |
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24. In the pro-choice argument
is fetus a person? What do they argue is prima facie wrong? What is their narrow principle? |
Fetus is not person
Prima facie wrong to take life of member of moral community It is only wrong to kill rational agents |
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25. What does Warren argue in regards to abortion?
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It is always morally permissible
She uses the personhood argument |
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26. What five things are central to personhood according to Warren?
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1. Consciousness; in particular capacity to feel pain
2. Reasoning 3. Self-motivated activity 4. Capacity to communicate 5. Presence of self-awareness *she holds that fetus does not meet any of these criterion |
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27. What are two problems with this personhood criteria?
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1. It admits to personhood some we don't traditionally see as persons (i.e. apes since they communicate)
2. What about people whose cognitive ability is impaired (i.e. newborn, Alzheimer, comatose) |
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28. To what extent does the potential for becoming a person endow it with the same rights?
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Whatever rights a potential person may have, they are overridden in any conflict with moral rights of any person
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29. What analogy does Warren give to disprove the whole "potential person" claim against abortion?
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You are trapped by aliens who want to make more of you, but the only way to do this is by killing you
You have a right to escape save your life and deprive all of these potential people their potential lives *his right to life outweighs all of the potential peoples lives JUST AS rights of a woman outweigh whatever right to a life a fetus may have by virtue of being a potential person |
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30. What are the two senses of the word "human" that Warren discusses?
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Moral sense: full fledge member of moral community
Genetic sense: any member of the species Homo Sapien is human |
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31. What discrepancy arises in the anti-abortion argument when one assigns the meaning of human to the premises?
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Wrong to kill innocent people (moral human)
Fetuses are innocent human beings (genetic human) |
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32. According to Marquis why is killing wrong?
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Killing is wrong b/c it inflects the greatest possible loss to the victim - the loss of all future activities of value
Take away both what one values now and what one would come to value in the future |
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33. Based on this is abortion morally permissible?
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No, it is in the same category as killing an innocent adult
It has a "future like ours" so it is wrong to destroy it and deprive it of this |
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34. According to the "future-like-ours" criterion, is it wrong only to kill humans? What about aliens from other planets?
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Wrong to kill them
The theory opposes the claim that only life that is biologically human has great worth |
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35. Is it wrong to kill other non-human mammals based on this criterion?
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The theory would need to offer additional account of what it is about our future that makes it wrong to kill us
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36. Is active euthanasia wrong based on the "future-like-ours" criterion?
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It does not make A.E. wrong
If you wish to die, you will not be suffering a loss if you are killed It is the value of a humans future which makes killing wrong |
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37. BUT WAIT, can you make a counter pro-choice claim once you start saying "it is the value of a humans future which makes killing wrong"?
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YES!
For one's future to be valuable, one must value it Since fetuses cannot value their futures, their futures are not valuable to them Hence, therefore Bartholomew it doesn't seriously wrong them to deliberately end their lives |
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38. Critics of Marquis attack what makes killing wrong. What two alternative theories are given for why killing is wrong?
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1. Discontinuation account: People value the experience of living and wish for that value to con't so killing is wrong b/c you discontinue that experience
2. Desire account: Killing is wrong b/c it interferes w/ the fulfillment of a strong and fundamental desire to continue to live |
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39. Is abortion wrong if you argue the desire account?
What is a problem with the desire account? |
NO because the fetus lacks a strong desire to live
It is seriously wrong to kill people who have little desire to live, the unconscious |
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40. Is abortion wrong if you argue the discontinuation account?
What is a problem with the discontinuation account? |
No, because fetuses do not have experiences, projects, etc. to be continued or discontinued
It would be wrong to kill someone in sever pain with no possible relief in sight - it needs to make some reference to the pos value of person's experiences |
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41. What is the standard pro-life argument?
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P1: Every human being has a right to life
P2: A human embryo is a human being C: Therefore, the embryo has a right to life |
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42. Why do we think killing humans is more serious than killing pigs, cows, or dogs?
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There is a morally relevant difference: human being generally possess mental qualities
Human being is fully rational person (i.e. self-awareness, autonomy, moral sense, etc.) |
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43. Based on this we must revise premise 1 of the pro-life argument to what?
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Every [human] fully rational person has a right to life
*in order for the same conclusion to be draw we must say embryo is a [human] fully rational person |
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44. Why does Singer object to the standard pro-life argument stated originally?
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The argument is invalid because there is equivocation
on meaning of "human being" In P1, human being is fully rational person In P2, human being is member of species Homo Sapiens |
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45. What is the moral relevance of species membership to killing?
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There is not one
Species membership does not seem to be morally relevant to the wrongness of killing |
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46. According to Singer why does the standard argument fail?
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Sense in which embryo is human
being is not the sense in which we should accept every human being has a right to life |
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47. How is the argument for potential set up?
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P1: Every potential human being has a right to life (*this is not self-evidently true)
P2: A human embryo is a potential human being C: Therefore, the embryo has a right to life |
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48. What is the argument behind why it is wrong to kill a potential human being?
Is this really true for all potential X's? |
A is potentially X, so has the right of an X
No, remember Prince Charles is a potential king, but he does not have the rights of a king |
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49. How can you argue the potential person is harmed?
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Person who might have lived is harmed by destroying the embryo that would develop into them
Destroying embryo prevents X from existing, thus harming X Destruction of embryo cause us to lose something of value |
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50. What is wrong with this whole potentiality argument according to Singer?
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Potentiality is a matter of degree
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51. Finally, what is the uniqueness argument that anti-abortionists give?
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It is wrong to destroy embryo b/c it already contains unique genetic basis for particular person
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52. How can the uniqueness argument be countered?
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Before fertilization (when becomes embryo) an egg and sperm unite
Can you throw this away? It's not an embryo? If you do throw it away then you can't attribute much moral significance to the existence of a genetically unique entity |
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53. What is Singer's solution to the question of when does an embryo acquire rights to not be harmed?
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When it is something that can be harmed i.e. a sentient being that can feel pain or pleasure
Based on this you can't harm it once it has developed a brain and nervous system |
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54. What is the "primitive streak" that Singer refers to?
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Period at which the first indication of the development of a nervous system begins to form
Up to this stage, there is no possibility of embryo feeling pain *problem is we all disagree when embryo can feel pain (some say 14 days after fertilization, some say 28th week of gestation) |
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55. Is Singer a follower of consequentialism or Katian ethics?
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He's a consequentialist
Fetus doesn't have pleasure or pain so you don't have to take it into consideration |
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56. Define zygote, embryo, and ectopic pregnanyc?
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Zygote: successful union of egg and sperm
Embryo: implants on uterine wall after traveling down the fallopian tube for 3 days Ectopic pregnancy: embryo grows in fallopian tube (life-threatening to mother) |
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57. What are the 4 steps in the process of in vitro fertilization (IVF)?
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1. Ovarian stimulation and monitoring
2. Egg retrieval 3. Fertilization 4. Embryo transfer |
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58. How many couple cannot conceive after trying for 2 years?
What percent of live babies are born per retrieval in IVF? |
1 out of 12
Delivery of live babies per retrieval is approx 20%, recently successful pregnancy rate of 40% |
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59. Is IVF harmful?
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It can be risky but is any form of conception risk free
Some call it "unconsented experimentation" on person The first baby born by IVF (Louise Brown, 1978) may have been unethical b/c there was no guarantee Louise would be normal |
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60. What are the two different senses of the word harm?
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1. Baseline Harm
2. Abnormal Harm (normality concept of harm) |
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61. What is baseline harm?
Can an unborn child be harmed according to this definition? |
Adverse change of condition so that someone is made worse off (hit by car and lose leg)
If you don't exist yet you can't be harmed b/c there is not baseline from which change can occur |
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62. What is abnormal harm?
Can an unborn child be harmed according to this definition |
A developmental norm that isn't met (child is born w/o arm)
Someone can be harmed by being brought into existence with some defect that could have been avoided if reasonable precautions were taken |
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63. Which sense of harm can apply to the fertilized eggs in the petri dish at the IVF lab?
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IVF can harm baby according to abnormal harm concept
IVF cannot harm baby according to baseline harm concept |
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64. What meaning of harm is applied in wrongful life and wrongful birth legal cases?
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Wrongful life cases are rejected by assuming baseline concept of harm
Wrongful birth suites appeal to the abnormal concept of harm |
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65. How do consequentalists and Kantian's view harm?
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Kantian ethics focus on motives of parent (remember it should be a universal maxim)
What matters to consequentalists is that baby is not harmed |
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66. What arguments are given for if commercialization (i.e. surrogate eggs for $) is wrong?
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Intrinsically wrong: kantian and religious premises
Indirectly: have bad consequences |
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67. Why is it intrinsically wrong?
Why is it indirectly wrong? |
The inherent value of a human being is incompatible w/ being priced in the market
Slipper slope argument that commercialization of sperm, eggs, and gestation will spread to other areas (i.e. selling of organs) |
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68. What is the "compassion trap" that is mentioned in regards to commercialization for sperm, egg, etc.?
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Compassion trap is that only good, unpaid, altruistic women should be allowed to be surrogates (same for donating eggs or sperm)
It implies that woman who bear children for $ aren't compassionate but just greedy Would you go through egg donation (painful/intrusive) or surrogacy for altruistic reasons (hasn't worked in other areas of medicine like organ donation) |
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69. What are some harmful consequences of IVF?
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1. There is twice the rate of birth defects (4% verses 2%)
2. Multiple births |
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70. What are some harmful consequences of donor sperm or donor eggs?
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1. Won't know biological parents BUT if keep donors confidential instead of anonymous solve problem
2. Older parents 3. Selectivity for specific traits |
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71. Selectivity for certain traits can be view as wrong but how might you counter this argument?
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People are selective of certain traits b/c they want to maintain semblance of normal family
Also, isn't this what people do with adoptions (choose for race, ethnicity, etc.)? Why isn't it wrong in this case? |
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72. Reproductive technologies allow us to do what three things?
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1. Produce embryos by IVF, for the benefit of infertile couples (problem is have spare embryos)
2. Embryonic or therapeutic cloning 3. Reproductive cloning |
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73. What are the two main objective to IVF?
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Create spare embryos
Unnatural |
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74. What is a spare embryo?
What is a research embryo? |
Spare: left over after successful IVF
Research: created specifically for research (harvest stem cells) |
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75. What did the Ethics Advisory Board that was created in 1977 say about federal funding for embryo research?
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Some research w/ embryos is morally permissible
Never said what kinds of research w/ embryos could be federally funded The board was created in hopes that it would mute criticism from anti-abortion groups |
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76. What did the Reagan administration do in 1981?
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Reagan and then Bush failed to renew EAB
They said destruction of embryo equaled destruction of fetus This meant no federally funded research on embryos |
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77. Then good old Bill came into office and what did he allow in regards to this topice?
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Allowed fed funds for research on tissue from aborted fetuses
Also revoked regulations requiring EAB approval of embryo research |
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78. In 1994 the NIH form the Human Embryo Research panel. Into what 3 categories did they divide possible research w/ embryos into?
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1. Acceptable for fed funding
2. Unacceptable 3. Needing further review |
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79. What decisions did HERP make?
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1. Rejected research on spare embryos (embryos from unsuccessful IVF have higher rate of genetic abnormalities)
2. Permit research on research embryos 3. Said fed funding would improve success and safety of assisted reproductive technologies 4. Rejected twinning human embryos and cross-species fertilization |
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80. What happened to the recommendations make by HERP?
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They were rejected in 1995
Nevertheless, there still is always private funding |
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81. In 1996 more restrictions came. What is did the Dickey-Warner Admendment added to the NIH's appropriations bill?
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No funds made available may be used for research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death greater than allowed for research on fetuses in utero
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82. What are stem cells?
Who discovered how to create an immortalized stem cell line? |
Primordial cells that can develop into any kind of differentiated cellular tissue
Gearhart and Thomson; learned how to continuously produce stem cells rather than derive them from minute amounts of tissue from embryos or fetus |
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83. How did Gearhart and Thomson create immortalized stem cell lines?
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Gearhart used tissue from aborted fetuses
Thomson used spare embryos from IVF |
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84. What's the situation today regarding stem cell research?
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2001 Bush vetoed fed funds to create research embryos
Allowed fed funding on 60 stem cell lines created from spare embryos (only less than 12 lines could be used) 9 of the 15 European nations have banned stem cell research on embryos 2006 Senate voted to expand fed funding of stem cell research - Bush vetoed |
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85. If you believe a person is a human at conception what are the implications?
What if you think a human is a person based on sentience? |
No destruction, no research on fertilized ova
After 14 days (maybe more) have to weight the harms and goods to the sentient being in calculating what is right and wrong (Singer's argument) |
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86. What is the slippery slope argument against embryo research?
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Empirical slippery slope argument predicting that acceptance of the deaths of embryos will generalize to acceptance of deaths of fetuses
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87. What objection is made against both abortion and therapeutic cloning (using spare embryos)?
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You are destroying the embryo in both
Argument for potentiality again - after conception there is a potential person |
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88. What are some of the problems with potentiality?
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When does potentiality begin?
Aren't individual ova and sperm potential persons? Should fertilized eggs that do not implant "naturally" be treated as deaths, should they be names, baptized, buried? |
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89. How has cloning put a new twist on the potentiality argument?
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Cloning shows that any cell of the body can become a person
Put nucleus of differentiated cell into enucleated human egg, spark applied, new embryo |
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90. Is this the death blow to the potentiality argument?
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It does show that the concept of dignity of the embryo begins to collapse into concept of dignity of the cell
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90. Is there any way to conduct research on human embryo?
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Yeah, do it with respect (similar to animal experimentation)
If treat embryo w/ respect then prevent slippery slope (i.e. minimize pain and psychological terror) |
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91. What are the four types of cloning?
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1. Molecular cloning: string of DNA duplicated in host bacterium
2. Cellular cloning: copies of a cell are made (cell line) 3. Embryo twinning: normal diploid embryo split into two 4. Somatic cell nuclear transfer: nucleus of adult and cell and implanting in egg cell where nucleus has been removed (how Dolly made) |
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92. What are three reasons against cloning because it is intrinsically wrong?
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1. Individuals should be unique
2. Individuals should have open future (assumes parents will have expectations for child - preconceived career) 3. It is unnatural (playing God, narcissistic person who want a clone) |
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93. What are some problems with the argument individual should be unique so cloning is bad?
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1. There are identical twins who share 99.9% of their genes
-is their right to a unique identity violated by being twins 2. Assuming one's genes is their identity -forgetting that environment and experiences contribute to personhood along with free will |
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94. What rebuttal can you make to the argument individuals should have an open future so cloning is wrong?
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Expectations certain traits can be psychologically damaging to the child
BUT many parents have expectations for their kid before birth and if they love their child then they realize you can't go against a child's natural desires |
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96. What are some problems with the argument that cloning is unnatural and hence bad?
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1. You are assuming that was is natural is always the best
2. You are assuming bad motives on the parents part (oh they're narcissistic) |
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97. What are three reasons against cloning because it is indirectly wrong?
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1. It harms the child - abnormalities
2. It harms society - creates wider inequalities 3. It diminishes diversity in the gene pool |
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98. How does the argument that cloning is bad b/c it harms the child work?
How does it not work? |
The techniques now are not perfect by any means so no experiment on a child is justifiable w/o compensating benefits (none exist)
If we ban this because it harms the child then shouldn't we criminalize smoking and drinking while pregnant |
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99. How is the argument that it harms society valid?
How is it invalid? |
Would created biological inequality in that families could create strong, talented, clever dynasties that 'normal' people can't compete with
We don't usually curtail our personal liberty to create a more equal society -if we did shouldn't we ban private schools and make all go to public so we don't create wider inequalities in education |
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100. Why does the argument that it diminishes the gene pool not work?
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Next generation will still mix its genes w/ other generations resulting in new combinations
Also, do you think everyone is going to give up sex? HELL TO THE NO!!! |
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101. What are three arguments for cloning?
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1. Good for the child
2. Good for the parents -lets some have genetically related children who otherwise couldn't (i.e. lack sperm or eggs) 3. Good for society -increases freedom of choice in reproductive matters |
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102. How can cloning be good for the child?
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Knows that he/she is wanted
Has best chance of NOT having disease or having valuable traits -won't recreate genotype of adult with congenital disease |
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103. What are bad axioms according to Boone?
What is the goal of Boone's paper? |
They are bad ways to think about something
They are catch phrases that get used wrongly in an argument (exaggerated) He wants to reveal the partial truths in these bad axioms |
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104. What are the five bad axioms that Boone presents?
Is the axiom a pro-cloning or anti-cloning argument? |
1. Playing God (anti)
2. Slippery Slope (anti) 3. Interfering w/ nature (anti) 4. Science is ethically neutral (pro) 5. Genetics is the answer (pro) |
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105. What is the argument for playing God?
What is the truth in this argument? |
Playing God is associated w/ pride and arrogance
Must be clear that when used in the religious sense its not an act against morality but rather one's religion The truth in the axiom is that it's good to be cautious in the face of uncertainty |
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106. So instead of saying we shouldn't play God, what would be a better argument?
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The response in not that we shouldn't play God, but that we do so intelligently
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107. What is the truth behind the axiom that cloning is interfering with nature?
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The truth behind it is that you should check your motives and examine external world for impacts/outcomes in physical, social, cultural environment
It's not whether we interfere but rather if our incursions enhance or diminish the human prospect |
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108. What is the slippery slope argument against cloning?
What is wrong with this slippery slope argument? |
If eugenics removes "disease" it is inevitable that we would support removing "undesirable" characteristics
There is a big difference between treating leukemia and enhancing one's I.Q. To recognize this difference is the purpose of moral reasoning |
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109. What truth does Boone say there is behind the slippery slope axiom?
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It's necessary to make a stop at therapeutic cloning (don't cross boundary into eugenics)
If you do allow permission for one eugenic measure than we establish principle of permission for others |
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110. According to Rawls what does justice apply to?
What are principles that are just? |
Justice applies to acts against the basic structure of society
Principles that are just are those that are chosen under the "veil of ignorance" where individuals don't know what their natural assets or social assets are |
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111. When does Rawls' Difference Principle advocate strict equality?
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If a system of strict equality maximizes the absolute position of the least advantages in society
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112. When does the Difference Principle prescribe inequality?
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If is possible to raise the position of the least advantaged further by inequality of income and wealth
The Difference Principle prescribes inequality up to the point where the absolute position of the least advantaged can no longer be raised |
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113. What does Rawls forbid by the state?
How does his theory of justice relate to the genetic future? |
He forbids state coercion
His theory of justice obligates people to improve the genes of future children b/c it is wrong to choose lives for future people that make them much worse off Want to have greater natural assets and prevent the diffusion of serious defects |
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114. What are the consequences of the technology of IVF and cloning?
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IVF
-benefit: helps infertile couples -harm: non-standard parents Cloning -benefit: negative eugenics -harm: defective infants, positive eugenics, gene pool effects |
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115. Who did the Nazi's research on?
What kinds of experimentation did they do? |
Experimented on gay men, convicted criminals, Russion officers, Polish dissidents, Jews, and Gypsies
They did high altitude experiments, freezing experiments, experiments with malaria, mustard gas, sulfanilamide |
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116. Who was the awful Nazi doctor?
What did he claim about the horrendous experiments he performed on people? |
Josef Mengele
Claimed it wasn't his fault that Jews had to die as Auschwitz, so why not use them to advance medical knowledge - SICK |
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117. Where the Americans innocent in regards to human research during WWII?
What did they do? |
No
Experiments on orphans and retarded inmates, and patients as mental institutes (vaccine development - injected shigella into them) Secret chemical experiments - exposed US troops to poisonous gases |
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118. Who established the Committee on Medical Research?
What was the committees mentality? |
Roosevelt did during the war
Committee had a wartime mentality that carried over into researchers' mentality Viewed disease as the enemy and themselves (researchers) as the soldiers |
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119. Why was the Nuremberg Code of 10 principles created?
What is the first and main principle in the code? |
Created for experimentation on captive populations
Voluntary consent of the human subject is absolutely essential Included in the principle is that volunteering should not be coerced, the person should know what is being done to them (in what matter) and the purpose of the study |
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120. Briefly describe the remainder of the Nuremberg Code.
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2. Exp. should yield results that will benefit society
3. Design and base exp on results of animal experiments 4. Avoid unnecessary physical and mental harm or suffering 5. Do not conduct exp if death or disabling injury is believed to be possible 6. Risk shouldn't exceed determined humanitarian importance |
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121. Describe the Nuremberg Code.
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7. Need proper preparation and adequate facilities to protect subject
8. Exp should be conducted only by scientifically qualified personal 9. Subject should be able to withdrawal from exp at any time 10. Researcher must be willing to terminate study at any time if they believe harm will come to the subject |
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122. What happened in the Tuskegee Study?
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It was a 1931 study that identified 339 black men that tested positive for syphilis (all had latent syphilis)
The study was done to observe how untreated syphilis progressed *they did not treat the men just observed them |
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123. Why did they chose these particular men to be in the study?
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They were poor, uneducated, and unlikely to leave the area
Basically they were very vulnerable and unlikely to object to the study |
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124. Why was the design of the experiment described as being poor?
(Four reasons) |
1. There was no control group and test group division
2. The quasi control group (200 who initially tested neg) was not controlled -subjects in no treatment group were often mixed up with controls -many controls contracted syphilis 3. No data from 1939-1948 4. Some subjects did get treatment |
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125. What did the researchers do to determine how far the syphilis had progressed?
How did they get the subjects to consent to such tests? |
Did spinal taps
Had no informed consent -offered incentives (free lunch, transportation, medicine) to get them to come -used deception if incentive failed (told them they had bad blood and this was the treatment) |
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126. What happened in 1966 that was the beginning of the end of the Tuskegee Study?
But then what happened in 1969? |
1966 - Peter Buxtun criticized the study, which was now being run by the CDC
1969 - Doctors at CDC reviewed the study and decided to keep it secret |
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127. When and how did the story hit the press?
How many years did the study go on for? How many people who had syphilis died? |
1972 story hit press b/c Buxtun informed press
Press said US federal agencies did studies on poor, uneducated AA and used them as guinea pigs Study went on for 40 years 28 men died |
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128. What were the consequences of the Tuskegee Study?
(Four things) |
1. Class action suit against fed gov and survivors and their families received monetary compensation
2. Institutional Review Boards required for institutions that conduct medical research and receive federal funding 3. Clinton apologized in 1997 4. AA came to distrust medical experiments |
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129. Was there harm in withholding treatment?
Give both arguments for if harm was caused to these men? |
No, subjects would not have gotten treatment anyway
Yes, because you can't prove they wouldn't had gotten treatment, maybe a charity would have donated Neosalvarsan or Penicillin (available by 1948) Can argue Penicillin won't do anything for latent syphilis BUT it could have affected the prognosis for 12.5% |
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130. According to Kantian ethics was there harm done to the participants?
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Yes, the subjects were mere means to an end (guinea pigs) and you cannot universalize such behavior as a maxim
The researchers deliberately willed harmed on subjects |
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131. What is informed consent?
When did the Unites States Public Health Service (USPHS) require informed consent by law? |
The process by which a fully informed patient can participate in choices about her health care
No required until 1966 |
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132. What principle(s) is behind informed consent?
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Autonomy - originates from the legal and ethical right the patient has to direct what happens to her body
Also from ethical duty of physician to involve the patient in her health care |
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133. In determining how much information is considered
"adequate" in informed consent there are three standards. What are these? |
Reasonable Physician Standard
Reasonable Patient Standard Subjective Standard |
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134. What is the Reasonable Physician Standard?
Is this standard adequate? |
It allows the physician to determine what info is appropriate to disclose
This standard is probably not enough b/c most physicians tell patients very little Considered inconsistent w/ goal of informed consent b/c it's focus is one the physician and not what patient needs to know |
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135. What is the Reasonable Patient Standard?
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It asks what would the average patient need to know in order to be an informed participant in the descision?
This standard focuses on considering what a patient would need to know in order to understand the decision at hand |
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136. What does the Subjective Standard ask?
Is this an easy or difficult standard to impose? |
What would THIS patient need to know and understand in order to make an informed decision?
Most challenging standard to incorporate into practice b/c it requires tailoring info to each individual patient |
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137. How does the AMA define informed consent?
|
More than getting a patient to sign a written consent form
It's process of communication bwt a patient and doctor that results in the patient's authorization to undergo a specific medical intervention |
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138. What information must a physician disclose and discuss w/ a patient according to the AMA when getting informed consent?
(Six things) |
1. Patient's diagnosis, if known
2. Nature/purpose of treatment or procedure 3. Risks and benefits 4. Alternatives 5. Risks/Benefits of alternative 6. Risks/benefits of not receiving any treatment |
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139. What does the moral principle of respect for persons mean?
What is a way in which this principle can be applied? |
People should be treated as autonomous agents and persons w/ diminished autonomy are entitled to protection
Apply it through informed consent - subjects must be given the opportunity to choose what will or will not happen to them |
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140. The consent process must include what three elements?
|
Information
Comprehension Voluntariness |
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141. How can the moral principle of beneficence be applied to medical practices?
How does it apply to medical research? |
Assessment of risks and benefits in a systematic way
Remember beneficence is not harming others so in research you would maximize possible benefits and minimize possible harms |
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142. What does the moral principle of justice mean in the context of medical research?
How can this principle be applied? |
It means the benefits and risks of research must be distributed fairly
Apply it in the selection of subjects - must have fair procedures and outcomes in the selection or research subjects |
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143. What is the biological definition of race that Root gives?
(Three parts to definition) |
1. A conjunction of physical characteristics divide the races
2. These characteristics are heritable and express genetic differences 3. The genetic differences result from difference in descent |
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144. Is this definition accepted or rejected today?
Why? |
Rejected today
If race is biologically different at all, it is only by a few genes (all ppl are more than 99.9% identical) There is no cluster of genes possessed by all individuals in only a certain race Biological differences between populations (that we id as different races) are statistical - not essential |
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145. Why can race never be biological?
What is race really more like? |
There is too much breeding bwt
populations to give biological races (population must be isolated for biological races) Race is like marriage |
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146. How is race like marriage?
|
Nether are "in our genes"
We invented both categories Invented the idea of matrimony and then put people into categories ("husband", "wife", "single") |
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147. Does race seem to be important epidemiologically?
|
Rates of diseases are different between blacks, Asians, and whites
Black in US are 7x's more likely to die of TB Race can mark the risk of a biological condition (diabetes) even though there are no biological races |
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148. What is a proxy? What is an example?
What is race a proxy for? |
X is used as proxy for Y when X takes the place of Y in decisions about an individual fact I
(X can be measured, Y cannot and there is a correlation between X and Y) SAT scores proxy for college grades for admission officers Race is a proxy for genetic diseases and treatment responses |
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149. What are we doing when we use race as a proxy in this sense?
Is this okay? |
Racial profiling
Like when cop pulls over a black guy b/c he's black Race as proxy for disease is different though b/c there is evidence that race correlates w/ disease |
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150. What are some problems with using race as a proxy for genetic trait/disease such as sickle-cell anemia?
|
1. Over predicts disease in blacks and under predicts it in whites
2. Encourages belief that race is a genetic category 3. Unequal risk of discrimination -different requirements for testing (black required to get test for sickle-cell anemia) -positive results could lead to loss of job |
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151. Why is using race as a proxy for treatment response problematic?
(Five problems) |
1. Ignores interracial differences in response to drug
2. Assumes race is better predictor than any environmental factor or family history 3. No reason to treat race as independent variable since there is no race gene 4. Substitute race for ancestry 5. Who is which race? Doc may assign different race to someone than they would assign themselves (esp interracial) |
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152. What are two cases that people make for why racial profiling is okay?
|
1. People objected to applying findings from studies with white males, esp w/ heart drugs, to females and blacks (see race and sex matters)
2. Divide patients by race to give them the best treatment and to ignore race would mean that doctor is not using best available evidence |
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153. What is wrong with the first case for racial profiling?
|
People claiming this are overlooking the sex difference
Sex is a genetic/biologically relevant variable whereas race is not Need to study sex differences b/c there is a sex gene |
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154. What is wrong with the second case for racial profiling?
|
Assuming that statistics on race and treatment response are the only and best available information
Statistics on ancestry and family history are much better evidence |
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155. What two conclusions can be draw from Root's article?
|
To be fair to the patient, physician should treat them as an individual rather than a representative of a racial group
If there are other genetically relevant ways to study response, race will turn out to be not as good predictor |
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156. What are seven things that eugenics incorrectly assumes
|
1. Reductionist assumption (each trait caused by a gene in a one-to-one ratio)
2. Genes cause disease in simple 1 gene to 1 disease way 3. Ignorance about recessive inheritance 4. Ignorance of environmental effects on expression of genes 5. Naivety to ease of controlling reproduction in couples 6. Ignorance of mutations and chromosomal breakage 7. Ignorance of population genetics (regression to mean)I |
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157. What is meant by regression the mean?
|
Inherent tendency in stable populations to return to an average value over time
Creating a mean value in a population will eventually normalize any deviant values |
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158. Why might someone get genetic screening?
|
1. Get testing to hear only good news
2. Get tested so can allow for early intervention (breat cancer BRCA 1 & 2 genes - if have it avoid birth control) 3. Feel it is duty to their family (not have children, obligation to spouse) |
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159. Is it always good to get tested, especially if reason is to hear good news?
Do families always want a member to get tested? |
Self-knowledge isn't perfect so you don't know how you will
react Testing can tear families apart b/c by testing yourself you are testing the family and each member |
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160. What is a genetic disease?
|
An inherited disorder caused by either a dominant gene or homozygous recessive gene
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161. Do genes alone determine malfunction (disease)?
|
No, environmental inputs can affect gene expression (nature-nurture argument)
Multiple paths to a disease (CF is not caused by a single type of mutation) Also, a gene for something can be a pre-disposition (no writing on the wall that it's final) |
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162. Describe the top down vs bottom up approaches to PKU disease. Can you see how the description of the disease may vary.
|
Top Down:
symptoms biochemistry Look for causes(genes/enviorn) Bottom Up Genes Enzyme deletion Look for effects (inability to metabolize phenylalinine |
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163. What are some facts about abnormalities, carriers, and abnormal genes?
|
1. Abnormalities are not equally distributed in population
2. Carrier doesn't mean all your offspring will have disease 3. Abnormal gene can lead to varying degrees of severity in disease 4. Abnormal gene does not always mean you'll inevitably have the disease |
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164. How do we get the information in genetic screening?
(Seven genetic tests) |
1. Gene tests: examine DNA
2. Biochemical tests for gene products (enzymes, proteins) 3. Chromosome screening 4. Carrier screening 5. Prenatal diagnosis 6. Newborn screening 7. Susceptibility screening |
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165. What is the difference between genetic screening, genetic counseling, and genetic engineering?
|
Screening: detection and diagnosis of heritable disease
Counseling: advise those who are afflicted or carriers Engineering: manipulate either genetic material or reproductive acts or capacities of a person |
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166. Who should be given the information from a genetic screening and why?
|
1. Individual possibly "at risk" - prevention possibility, relief of testing negative (nothing is worse than uncertainity)
2. Family - may discourage you from having children, spouse/child should know so can prepare 3. Can have test banked for other scientific research |
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167. Who should we avoid giving the information from a genetic screening to and why?
|
1. Employer - could keep you from being promoted
2. Insurance company - they may raise your premiums if you test positive for pre-symptomatic test (or say won't insure you for cancer if you have BRAC 1 or 2 gene) |
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168. Briefly describe the Nancy Wexler story?
|
Her mother had Huntington's Disease
Nancy worked hard to help discover a test for disease Once test was available, she chose not to have it |
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169. Why might Nancy and other people not want know if they have a genetic disease?
|
1. Devastation of testing positive (uncertainty or "hope" is better than knowing worst)
2. Social pressure to undergo testing and have abortions 3. Possible harm to those at risk to develop a "sick identity" 4. Self knowledge isn't perfect: could test positive and can't predict how you would react |
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170. What are the factual differences between PKU and Huntington's disease?
|
PKU: recessive, sever mental retardation, dietary treatment
Huntington's: dominant, neurological deterioration, no treatment Should genetic screening be mandated or individual choice? |
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171. What is the purpose of genetic counseling according to Macklin?
Should a counselor even assert their opinion or should they be neutral? |
Help people make informed choice that is consistent with their values
When the decisions are straightforwardly medical (need medical expertise) then counselor should give opinion |
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172. Should they ever withhold information from people?
Why withhold this information? |
It might be better if they withheld some info like the chromosomal XYY anomaly
May treat the child different because they know their child's genetic endowment is associated w/ overly aggressive behavior |
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173. How could a genetic counselor be seen as a consequentalist?
|
They should perform the act likely to produce the least harm to everyone
Hard for everyone to agree though on which course of action (inform someone or not) will produce the least harm |
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174. What is reductionism?
|
It is reducing complex facts to overly simplistic maxims, such as "It's all in the genes"
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175. According to Proctor, what is biological determinism?
What does he say is wrong with biological determinism |
The view that a large part of human talents and disabilities is anchored in our biology
Danger b/c the root cause of onset for a disease is shifted from environment to individual (its a genetic defect) *Can't blame genetics for every human folly or vice |
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176. What are some of the dangers of exaggerating the role of genetics in diseases such as cancer?
|
1. There is a continuum of susceptibility (not just yes or no)
2. Figures for predisposing genes are speculative (esp cancer) - base them on extent to which disease runs in family, BUT families share common exposure to mutagens 3. Distracts from fact that it is a disease, like cancer, whose incidence varies w/ occupation, diet, lifestyle |
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177. What are some dangers in general of having a simplistic view of genetic research?
|
1. Genetic discrimination
2. Differential treatment 3. Eugenics 4. Genetic determinism |
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178. When was the first wave of eugenics?
What was the goal of it? Where was it implemented? |
1880's-1950's
Goal was to increase the "fitness" of a nation by increasing births amongst the "fit" and decreasing them among the "unfit" Social Darwinism was part of movement to improve society Originated in Britain, most heavily implemented in US and Germany |
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179. What is Social Darwinism?
|
Elitist held that social advantages implied biological superiority
Based on this upper class would prevail in any competition |
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180. In what ways was eugenics implemented in the US?
|
1. National and state level laws (involuntary sterilization, Immigration Restriction Act of 1924)
2. "Fit Family" and "perfect baby" contests 3. Eugenic research centers in universities, eugenic academic journals, societies, and conferences 4. Taught in high school and college, common topic for press |
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181. What was the Supreme Court ruling in the Bell vs Buck case?
|
Supposedly retarded like her mother, Carrie (who was institutionalized) gave birth
Virginia wanted to sterilize Carrie and the Supreme Court upheld the legality of the Virginia Law forcing Carrie's sterilization An influential geneticist testified that Carrie's retardation was hereditary b/c she had a "feeble look" |
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182. What are the arguments for positive eugenics
|
It is a program for improving the species
Create "better" gene pool Make people smarter, happier, etc. |
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183. What are the arguments for negative eugenics?
|
Eliminate disease, mental illness, and crime
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184. What are five arguments against eugenics?
(1-2) |
1. We are too ignorant to do it right
-we are ignoring the value of a gene to a given race or species -we only know how the gene works on the individual level and only in instances where the effect is severe -also, if we alter the gene pool independent of environ we change it to present day conditions BUT environ changes faster than our gene pool creating a disaster 2. In any case, we are likely to alter the gene pool for ill -eliminate heterozygote advantage |
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185. What are five arguments against eugenics?
(3-5) |
3. Negative eugenics can't possibly work unless carriers are eliminated, but this would soon eliminate the entire species
4. Some methods of genetic engineering carry grave moral risks of mishaps -difficult to alter one's gene by direct chemical change to his/her DNA and it poses a high chance of error 5. All methods of genetic engineering are dehumanizing in basic ways |
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186. What is heterozygote advantage?
|
Individuals who carry two different forms of the same gene, heterozygous, appear to have an advantage
For example with sickle-cell anemia, those who are heterozygous for the gene are protected more than normal from the effects of the most malignant form of malaria1 |
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187. What problems did we have with the American eugenics movement?
|
1. Difficulty of defining traits - subjective to what is good and what isn't
2. Ignored social and environmental influences (it's not all genes) 3. Something that is socially beneficial must be viewed in terms of a range of freedom and autonomy - eugenics movement did not provide this |
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188. What is mental illness?
(three ways of explaining it) |
Physiological - have physical cause in brain
Mental: disorder of thought or mood (cognitive impairment) Problem in living (then it's a myth and not a disease) |
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189. In 1973 what ruling did the court make about the treatment of a committed mental patient that resulted in mass de-institutionalization ?
|
Patient either must receive treatment or be released
To receive treatment it is necessary to have, 2 psychiatrists, 12 RNs, and 10 aides per 250 patients Most states failed to meet requirement |
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190. In 1975 the O'Conor decision ruled that what two conditions were necessary for involuntary commitment?
|
1. Suffering from mental illness
2. Being dangerous to others or oneself -said that evidence of danger to oneself consists of threats of suicide and/or gross neglect of basic needs |
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191. What third condition was added as people became more interested in the patient's rights?
|
Provision of the least restrictive environment by the institution
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192. Why were 50%-75% of patients in most state institutions de-institutionalized in the 1970's?
(Four reasons) |
1. Could not provide individualized care as required by 1973 Johnson ruling
2. New psychotropic meds became available 3. Tighter budget and psychiatrists wanted lighter work load 4. General distrust in authority during the 1970's |
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193. Why did de-institutionalization fail?
(Five reasons) |
1. Government funds were never allocated for community homes
2. Communities rejected such homes (not in my backyard) 3. Mental health services were fragmented bwt county, state, and federal agencies 4. Housing was scarce 5. Legal pendulum had swung towards patient's rights |
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194. Describe the case of Joyce Brown.
|
Homeless women who panhandled in a rich New York neighborhood
Even though she urinated and defecated on the street and shouted abusive things at times, she said she was not insane and didn't want psychiatric treatment First ruled that she could be involuntarily committed (found coherent and logical through testimony) Appellate court overruled initial ruling and said she could be committed |
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195. What did Project Help do in 1987?
Why did people criticize it? |
It broadened standards beyond legal requirements and added 2 new conditions that allowed involuntary commitment:
-self neglect -need to be treated Accused it of targeting areas seen by tourists and inhabited by rich (homeless are more of a public nuisance, they're not trying to help them) |
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196. What is paternalism?
What problems arise with competence? |
Treatment of adult patients as incompetent and who do not know their best interest
The problem with competence is it's not all or nothing with the mentally ill What constitutes proof of competence or incompetence |
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197. What is the legal model standard for when involuntary treatment is allowed?
|
Narrow model:
1. Have a diagnosable mental illness 2. Dangerous to others (physical harm) or self (suicide, neglect) |
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198. From the legal perspective where is the emphasis for justification for involuntary treatment?
|
On the danger posed by said person
Can be danger posed to public order, safety, or life of person Society is the main focus of concern |
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199. According to the medical model standard, when it involuntary treatment allowed?
|
Broader model
1. Diagnosable mental illness 2. Symptoms causing serious disruption of functioning both interpersonal and intra-psychic 3. Requires care and treatment |
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200. From a psychiatric perspective, what justifies involuntary commitment?
|
It is considered to be in patient's be interest
|
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201. How is being homeless relevant in the legal model?
How about in Project Help's broadened criteria? |
Anyone (homeless or not) is to be committed if meet insanity, dangerous, and least restrictive environment for treatment criteria (if don't meet it, not committed -homeless or not)
Project Help intended to broaden criteria to apply different standards only to homeless people (dangerous to sleep on streets of Manhattan, so must be insane to sleep there) |
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202. Why was Kendra's Law passed in 1999?
What did it say? |
Passes in response to violence committed by the mentally ill
Psychiatrist or relative can force hospitalization on someone who... -has been hospitalized in last 3 years -who has a history of violence -and who will not take their medication |
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203. Did Joyce Brown benefit from commitment?
|
She didn't want to be committed and there was no "treatment" for her
Saying commitment is justified to end suffering assumes there is suffering in the first place - how can we tell if another is suffering? Is commitment really going to ease that suffering? |
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204. What is the narrow conception of mental illness?
What is the broader conception of mental illness? |
Narrow: organic, physical disease
Broader: negatively valued by society, by nonvoluntariness and by being best dealt with by medicine |
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205. According to abolitionists, what is mental illness?
|
Either organic in which case it is physical illness, not mental
Or not organic in which case it is not illness but "problem with living" |
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206. According to abolitionist what should we value more highly liberty or mental health?
What does this mean about how they view treating mental illness? |
Value liberty more highly than mental health (never deprive of freedom for sake of mental health)
Should never involuntarily commit someone - as long as voluntary psychiatric treatment is okay |
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207. According to the medical model of psychiatrist, what is mental illness?
|
Organic illness
Forms of social deviance Nonvoluntariness of behavior (overt message of not wanting help may be hiding covert message that they are desperate and want help but can't ask) |
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208. Do they think involuntary commitment is wrong?
|
No its wrong to let a patient die with their rights on or allow them liberty which is so
destructive its actually a form of imprisonment |
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209. According to the reductionist view, what does it mean to say that mental illness is a real illness?
|
Aberrant behavior is cause by an organic, physical disease (brain tumor, genetic anomaly, chemical imbalance, etc.)
|
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210. According to the functionalist view, what does it mean to say that mental illness is a real illness?
|
Aberrant behavior is caused by internal condition mental disease that may bot be identical with a common physical disease
|
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211. What are the positive and negative features of schizophrenia?
|
Positive: hallucinations, changes in thought formation, bizarre delusions, changes in behavior or social functioning
Negative: restriction of range of emotions (blunting), decreased ability to initiate thoughts/ideas (poverty of thought) |
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212. What are the proposed causes of schizophrenia?
|
1. Disorders of family communication
2. Life events 3. Biochemical problem 4. Genetic contribution 5. Neurodevelopment hypothesis - result of early brain insult |
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213. Recall the criteria for involuntary hospitalization based on the medical model.
|
Mental Illness
Disruption of functioning Need for care and treatment |
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214. What are some objections to this criteria?
(1-2) |
1. Whole structure ignores fact that mental illness is a myth (no one can satisfy condition)
2. Ignores importance of autonomy as supreme value, not overruled by existence of mental illness, only by dangerousness |
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215. What are some objection to this criteria?
(3-4) |
3. Determining 1 & 2 are "subjective" judgments of soft science
4. Commitment procedures in hands of psychiatrists can be abused |
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216. What counter can be made about saying condition 1 & 2 are "subjective"?
|
In the legal criteria,
"dangerous" is fuzzy Also, who's to say lawyers and judges are less fallible than psychiatrists |
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217. How can abuse by psychiatrists be prevented?
|
1. Have judicial reviews
2. Abandon indeterminate commitment 3. Make sure patients have access to competent and compassionate legal care |
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218. Recall the O'Connor or legal standards.
|
1. Suffering from mental illness
2. Dangerous to others or self 3. Provision of least restrictive environment by institution |
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219. What are some objections that the medical model makes about the legal model?
(1-2) |
1. Deprives mental ill person of protection and treatment they require by concentrating on dangerousness
as sole criteria *Also, psychiatrists are not great at predicting dangerousness so commitment would be stringent 2. Difference between physical and other kinds of self-destructive behavior is artificial, unrealistic, and unworkable |
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220. What are some objections that the medical model makes about the legal model?
(3-4) |
3. Emphasis on dangerous to others is contrary to "right-to-treatment" movement (prevent hospitalization and thus treatment)
4. Involuntary commitment shifts from civil to criminal procedure - turn psychiatrists into policemen |
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221. What are some objections that the medical model makes about the legal model?
(5-6) |
5. Increases de-institutionalization by emphasizing dangerousness rather than helplessness and mental disability (not being rehabilitated)
6. Disguised way of ending involuntary hospitalization entirely |
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222. What are the moral issues against involuntary commitment as a whole?
(six reasons against) |
1. Can't specify what mental illness is
2. Subjectivity of what normal functioning is 3. What is dangerous 4. Autonomy of individual 5. Abuse of either criteria 6. Is force treatment really a benefit? |
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223. What are some arguments for voluntary commitment in general?
(five reasons for it) |
1. Medication could benefit
2. Protection of individual and society 3. Incompetence (if they could ask they would) 4. Do you really have freedom if you are trapped within a disease 5. Would non-treatment be neglect of the weak, needy, and vulnerable in society |
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224. According to Szasz what is the evidence that commitment does not serve the purpose of helping or treating those who's behavior deviates?
(Three things) |
1. Mental illness is a metaphor and since they do not
suffer from any sickness it's impossible to "treat" them 2. An individual "owns" his body (autonomy) and commitment in incompatible with this moral principle 3. Commitment practices were around long before there where psychiatric "treatments" of "mental diseases" |
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225. What does Szasz say to refute the statement that "commitment of the mentally ill is necessary for protection of mentally healthy"?
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1. Mental illness is not a disease so therefore it is not contagious
2. Main ingredient is coercion which is an exercise of power and a moral/political act (no medical justification) 3. It's society's scapegoats who are committed (see it in history with those who's religious beliefs differ) |
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226. How does commitment shield the non-hospitalized members of society according to Szasz?
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1. Don't have to accomodate themselves to the annoying demands of certain members of the community who haven't violated any laws
2. Don't have prosecute & try lawbreakers who might not be convicted or retained as long in prison as in a mental hospital (ship them to crazy house) |
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227. What is the difference between the state using it's power to punish lawbreakers and commit people to mental hospitals?
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The "insane" are being subjected to coercive control b/c they have been labeled "psychotic"
Criminals are being subjected to the same legal rules applicable to all equally |
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228. Therefore, what must justification for commitment rely upon?
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Therapeutic promise and potential
BUT if this is being accomplished by robbing the person of their liberty then involuntary commitment is just a form of punishment |
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229. How are the slaves and the mentally ill similar?
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Both groups are or were incarcerated
Both are usually the poor and socially unimportant (not the VIP's in life) |
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230. What economic similarities are there according to Szasz between slavery and involuntary commitment?
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1. Economic strength: lay in hands of slave owner and psychiatrist
2. As plantation owner owns more slaves his power rises (more slaves and land) ; as institutional system rises the psychiatrist bureaucrat rises 3. Slave owner could rely on the state to help him recruit slaves and maintain them just as psychiatrists can rely on the state to recruit/maintain hospital inmate population |
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231. Why is health a public problem?
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1. Health is a primary good or an important freedom that is essential for well being and functioning
2. We're not willing to go w/o health care & can't justify doing it to others 3. Some factors that shape health must be pursued collectively (sanitation) 4. Without govern intervention some won't have access to health care |
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232. What is the current US situation like as far as employer and private medical plans?
(six facts) |
1. Good for large employers - bad for small ones
2. When you leave a job, you're no longer insured 3. Hospitals shift costs to those who are insured b/c they don't get reimbursed for treating the poor 4. Cost of insurance is high 5. Employers save money by hiring part time workers (no benefits) 6. Illness leads to loss of job |
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233. What is medi-care?
What id medi-aid? |
Medi-Care: over 65 or diasbled
-get 80% of care paid by gov't (via tax deductions on young and healthy) Medi-Aid: for poor (< $12,000) -SCHIP is to cover children of parents earning more than M-aid max but too little for insurance -Bush vetoed bipartisan legislation to reauthorize SCHIP |
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234. What do veterans get in term of medical coverage?
What is the Emergency Medical Treatment and Active Labor Law (EMTALA)? |
Military personnel and families are covered both when
in active duty (see military doctors are military facility) EMTALA requires hospital emergency rooms to treat anyone w/ or w/o insurance |
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235. How should people get health care then?
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1. Market solution - same way people get other "goods" (buy health care w/ own money, no insurance & no reimbursement)
2. Government solution - provided as social service paid for by taxes (Americare, an expanded medicare) 3. Mixed soln - some private some paid for by govern |
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236. What are the argument favoring Americare?
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1. Greater efficiency - cut overhead/waste of multiple private insurers
2. Eliminate experience rating (where charge individual rates based on characteristics of person) - use community rating (all charged same premium) 3. Justice and fairness (principle of justice - treat equals equally) 4. Market solutions won't work 5. Not socialized medicine (socialized means public owned & we have lots of that) |
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237. Why would a free market for health care never work?
(three reasons) |
1. When you heard you have cancer you don't always make the best decisions
2. Many people who can afford care may not make the wise decision (oh I'll get that car and wait on the hip replacement) 3. Patients and doctors would no longer work together overcome illness but would bargain for best cost |
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238. If universal coverage is not socialized medicine then what is it?
(Four answers) |
1. Single payer system (tax all Americans and govern reimburses docs)
2. American medical service - doctors work for federal gov't 3. Employer-mandated system - like Oregon and MA 4. Voucher system - govern gives vouchers to buy health care directly from hospitals or insurers |
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239. What are the arguments against Americare?
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1. Another federal bureaucracy
2. Health care is not a right 3. Out of control costs - people seek more and more medical care as health care is seen more as a right 4. Socialized medicine reduces liberty |
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240. What is the Libertarian view of justice?
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Liberty is the ultimate moral ideal
Individuals have moral rights to life, liberty, and property that any just society must respect |
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241. What is an egalitarian view of justice?
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Social equality is moral ideal
Individuals have rights to life, liberty, and pursuit of happiness which society must promote |
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242. What is a liberal view of justice?
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Both individual freedom and equality are important
Those that have more than enough have obligations to help those in need, some inequalities are justified |
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243. What is Oregon's Health Plan like?
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1980's use Medicaid fund to provide health coverage to all
NOT ALL kinds of health care though - not low priority care (IVF, experimental therapies, heart transplants) In 2003, reduced benefits and increased premiums to save money - too expensive |
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244. What is the plans in Massachusetts and Vermont?
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Required everyone to have health insurance (like having care insurance)
Begins in 2008 and is a combination of single payer and employer paid |
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245. What are the principles in utilitarianism ?
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Choose system which creates greatest good for greatest #
Concern is with total satisfaction, but is indifferent to the distribution of satisfaction Maximize the total benefit |
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246. According to Rawsian social contract theory what could maximizing utility do?
What are valid principles of justice? |
Could violate basic individual freedom and rights that ought to be guaranteed
Valid principles are those to which we would all agree if we could freely and impartially consider the social situation |
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247. In social contract theory what is impartiality?
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Veil of ignorance
Assume you do NOT know all the particular characteristics you will have in the society |
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248. What is the egalitarian principle?
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Each person should be permitted the maximum amount of equal basic liberty compatible with similar liberty for others
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249. What is the difference principle?
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Once equal basic liberty assumed, inequalities in social primary goods are allowed only if they benefit everyone and only if everyone has fair equality of opportunity
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250. How does maxim apply to health care?
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Adopt the distribution of health care that maximizes the X for the least well off
Maximize the benefit to the least well off |
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251. What is the egalitarian position on health care?
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1. Equal amounts of health care
-too high, drain on resources -too low, some benefits would be w/held from those who wanted them 2. Equal degree of health care 3. Equal access to same amount according to need |
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252. What is meant by equal degree of health?
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Everyone must receive ALL health care that is of benefit to them
What standard of health? -minimal: prevent death -maximal: be like Hines Ward |
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253. What is Gutman's argument?
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A principle of equal access to health care demands that every person who shares the same type and degree of health need must be given an equally effective chance of receiving appropriate treatment of equal quality so long as the treatment is available to anyone
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254. What does justice mean?
What does equals mean? What does treated equally mean? |
Justice: equals should be treated equally
Equals: equal in need Treated equally: equal effective access to health care (no discrimination in favor or against those who differ in sex, race, wealth, ect) |
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255. Does this mean you can't buy more health care than what everyone gets equally even if you have the money?
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Right you cannot according to Gutman
Equal health care access is matter of equal respect |
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256. What are some problems for the egalitarian health care system?
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The market alternative
-Differences in desire for health care are subjective -Best way to make everyone happy is let people freely buy or not buy what they want -Anything else - sabotages freedom of choice |
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257. What are some restrictions that would be on freedoms?
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Need to tax ourselves to pay for all this equal health care
No one can buy more health care above the level publicly provided |
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258. How does beneficence impact health care?
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Beneficence directs us to want to help, but we face a coordination problem
If we are rational agents, getting the benefit to those in need is difficult to do by individual acts of beneficence |
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259. What is an argument for this coordination problem?
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P1: Beneficence principle: I should act to help others
P2: Applied to health care: I should help those who need health care but cannot get it P3: Fact: large scale system to deliver decent min care for all better than individual act of charity Question: should I voluntarily contribute |
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260. How can you answer the question should I voluntarily contribute?
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A. Enough other people will give to big project that my contribution is not needed
B. Not enough other people will give to big project so my contribution will be wasted Conclusion: Rationally, I should not contribute |
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261. Okay, so reason says no but beneficence says yes so what other conclusion can we draw?
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We should force ourselves to give to big project (health care benefit to those in need) or else no one would give
Do this through taxed |
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262. What is one big objection to treating everyone equal?
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Should equal need be the only consideration
What about those who choose to smoke or ride bikes? We would need to know a lot that we don't know for modifying an egalitarian system in this way to make the system more fair |
