Medical ethics

Question 1

How did Fletcher define a person?

Answer 1

He described personhood as self control, self awareness, a sense of past and future, concern for others, the ability to relate to others, communication and curiosity.

Question 2

How is personhood important in medical ethics?

Answer 2

It is at the center of many ethical debates, most would consider it wrong to kill a person but not a non-person, but how do we define an ex-person, someone who is brain damaged, a fetus, someone with dementia?

Question 3

What is the quality of life argument?

Answer 3

The overall well-being of a person is the defining factor in making life or death situations. Life is not intrinsically sacred.

Question 4

What is the sanctity of life argument?

Answer 4

The traditional Christian view that all life is sacred and we never have a right to end it.

Question 5

What is singer’s position on the SOL and QOL arguments?

Answer 5

He rejects the SOL principle as outdated and absolutist, he also argues against the idea that humans are in any way special and sees animals as our equals.

Question 6

What does Glover argue in Causing Death and Saving Lives?

Answer 6

A universal moral system is impossible to achieve as most of us would agree that killing is wrong, but may make exceptions for brain dead people and fetuses.

Question 7

What does Glover think about the pro life stance on abortion and euthanasia?

Answer 7

It is untenable, modern science can keep people alive who would have previously died, but in some cases their quality of life is too poor to justify. Broad legislation on euthanasia is difficult as we need to make a carful assessment of each case.

Question 8

Give the three stages of the embryo

Answer 8

1. Conception-14 days=pre embryo. 2. 14 days-8 weeks=embryo. 3. 8 weeks onward=fetus.

Question 9

Give five different options as to when life begins

Answer 9

1. Conception. 2. Implantation. 3. When brain activity begins. 4. When it becomes viable. 5. At birth.

Question 10

What is the dualist perspective?

Answer 10

A person is made from body and soul, the soul is implanted by god and takes place from conception.

Question 11

What are stem cells and embryonic stem cells?

Answer 11

Stem cells are the building blocks of life. Embryonic stem cells are found in the blastula (an early embryo of less then 100 days which can’t survive unless implanted into the womb.)

Question 12

What is the UK law on embryos?

Answer 12

Testing on embryos can only happen up to 14 days after fertilization.

Question 13

Give the two opposing arguments on embryo research

Answer 13

1. Embryos have none of the psychological, physical or emotional properties of a human and unless implanted into the womb, the blastula will not survive. We need them for medical progress. 2. Destroying the blastula to harvest its cells is destroying an unborn child, the embryo is a potential person.

Question 14

Give three reasons why we need to create embryos

Answer 14

1. Embryonic stem cell research can aid us in finding cures for genetic illnesses. 2. In IVF, an embryo is grown in a lab then transferred to the womb, more embryos then necessary are created and those with the highest potential to survive are implanted. 3. PGD involves creating an embryo in a lab and removing a cell from it after 5 days to check for genetic conditions.

Question 15

Why do we need embryonic stem cells?

Answer 15

Cord blood, found in the umbilical cord and placenta is characterized as an adult stem cell, which can only differentiate into a limited number of cells, embryonic stem cells can differentiate into any type of cell, so are much more useful.

Question 16

What is the catholic view on embryo research and organ donation?

Answer 16

1. They completely reject embryo research as it involves procreation outside marriage and fertilization that does not happen as god intended it. 2. They support organ donation and the therapeutic use of stem cells, as long as no embryonic life is destroyed.

Question 17

What is the current debate over cord blood?

Answer 17

How should it be made available, should couples keep their own to possibly use in the future for themselves/their family, or should it be donated to a blood bank for anyone to use?

Question 18

What are the three criteria that have to be met in order for an abortion to be carried out in the UK?

Answer 18

1. It has to be agreed to by 3 doctors. 2. It can take place up to 24 weeks. 3. It can be done after 24 weeks if there is a substantial risk to the mother or the child will be severely disabled.

Question 19

Give three catholic views on abortion

Answer 19

1. Only god can decide when someone dies. 2. All life is sacred and should be protected. 3. Life is god given and once a form of taking life has been legalized, all life is under threat.

Question 20

What does Islam say about abortion?

Answer 20

It is wrong, but not punishable if performed in the first 120 days of pregnancy, if life is at risk or if the fetus is unviable.

Question 21

What does the pro choice argument say?

Answer 21

A woman should be free to decide whether to have an abortion, the fetus is part of her body until it is capable of independent life, she can decide if it lives or not because its life is potential, not actual. Giving birth must be viewed within her overall financial, social and familial circumstances.

Question 22

How does personhood link to abortion?

Answer 22

Is the fetus a potential person, or actual person? Does the fetus have rights and how should we balance these against the mother’s?

Question 23

What thought experiment is used by Judith Jarvis Thomson to support abortion?

Answer 23

You wake up one morning and have the circulatory system of a famous violinist plugged into yours, he has a kidney ailment and your system is being used to extract the toxins from his blood. If you unplug him now, he will die, but in 9 months he can be safely unplugged.

Question 24

What does Thomson say abut unplugging yourself?

Answer 24

You are allowed to, the right to life does not entail the right to use another’s body. The fetus’s right to life is not violated by abortion as it merely deprives the fetus of the ability to use the woman’s body, something it has no right to anyway.

Question 25

Give three objections to Thomson’s argument

Answer 25

1. There is a moral difference between killing and allowing to die. 2. The pregnant woman has a special obligation to sustain her offspring. 3. If the woman has voluntarily engaged in sex, she is responsible for the fetus’s need to use her body.

Question 26

What does Don Marquis say about abortion?

Answer 26

It is wrong as it denies the fetus a future like ours. This idea removes the issue of whether a fetus is a person or not, if its wrong to kill a child because it deprives them of a future, then the same applies to a fetus.

Question 27

What is the problem with Marquis’ argument?

Answer 27

It suggests abortion is alright only if the fetus is disabled or if it would not be able to have meaningful future experiences.

Question 28

Explain the difference between euthanasia and assisted dying

Answer 28

Euthanasia is allowing doctors to end the lives of patients, assisted dying is when the patient controls their own death with the help of a third party, both are illegal in the UK.

Question 29

What is voluntary euthanasia and what it the problem with it?

Answer 29

It is carried out at the request of the patient. Opponents of it say the patient may not be thinking clearly as they could be depressed, not thinking clearly or in pain. Legalizing it could lead to a slippery slope where people are pressured by family members into being euthanized.

Question 30

What is non voluntary euthanasia and what is the problem with it?

Answer 30

When the patient is not able to understand the choice between life and death (a baby, someone with severe dementia), the choice is made for them in their best interests. Just because they don’t understand the choice, doesn’t mean they have no quality of life.

Question 31

What is the role of Michael Wilcockson?

Answer 31

In ‘euthanasia and doctors’ ethics’ he looks at the issues surrounding the blurred lines of euthanasia such as autonomy, the slippery slope argument, QOL and SOL, acts and omissions and the interpretation of the law.

Question 32

How does Wilcockson consider euthanasia?

Answer 32

He looks at it from a medical ethics perspective and considers why it is illegal in the UK. The BMJ says there is a difference between ending someone’s life (active euthanasia) and allowing someone to die (passive euthanasia.) They support only the latter.

Question 33

Give two case studies for euthanasia

Answer 33

1. Tony nicklinson had a stroke in 2005 and was paralyzed from the neck down, he wanted to have his treatment withdraws, but medical institutions refused, saying he still had QOL, he lost his court case in 2012, but died six days later. 2. Charlie Gard had a rare life limiting condition, doctors at GOSH said it was in his best interests to withdraw treatment, his parents disagreed, but lost their court case and his medical ventilation was withdrawn, he died at 11 months in 2017.

Question 34

Explain ‘acts and omissions’

Answer 34

They stem from the Hippocratic oath. An act is performed by an agent who intervenes to bring about an outcome- active euthanasia. An omission is failure to act with an awareness of what the outcome will be- passive euthanasia. Wilcockson says a failure to act doesn’t absolve you from responsibly and the Catholic Church argues that there is no distinction between the two.

Question 35

Explain the ‘doctrine of double effect’

Answer 35

It allows a distinction between foreseeing an outcome and acting to bring about said outcome. Ergo, giving a patient a potentially dose of drugs to ease their pain is legal, so long as the intention is not to kill them. Wilcockson criticizes this, it could be easily abused and there is no real difference between intending to act and foreseeing the consequences of an action.

Question 36

Explain ‘ordinary and extraordinary means’

Answer 36

In most circumstances, we have a duty to accept healthcare, but do not have to go to extremes to keep ourselves alive. Extraordinary means are any treatments that are not going to work in the long run and whose burdens outweigh their benefits.

Question 37

What is the Catholic perspective on ordinary and extraordinary means?

Answer 37

They follow the natural law and argue that someone who refuses food/water is committing suicide, which is wrong. But refusing life prolonging treatment when there is no chance of recovery is not, it is moral and is simply letting nature take its course.

Question 38

What does Wilcockson say about proportionate and disproportionate means?

Answer 38

It is a better criteria to use then ordinary/extraordinary as it allows doctors to decide on a case by case basis what is best for each patient.

Question 39

What is the difference between proportionate and disproportionate means?

Answer 39

1. Disproportionate means- any treatment that offers no reasonable hope and carries burdens disproportionate to its benefits. 2. Proportionate means- any treatment which offers a reasonable hope to the patient when judged holistically within their circumstances.

Question 40

When does the distinction between proportionate and disproportionate means become difficult?

Answer 40

When the patient is non competent, such as an ill baby, the SOL would argue that the doctor must make the baby as comfortable as possible, without prolonging its suffering.

Question 41

What is the law based upon and what implications does this have?

Answer 41

Mill’s harm principle, suicide is not illegal, but helping someone commit it is. I have a right to make my own decisions about my treatment owing to the principe of personal autonomy.

Question 42

What is the difference between law and morality?

Answer 42

Law- rules prescribed by the state to protect society, we have a moral duty to obey these laws. Morality- it deals with issues of right and wrong. There is public morality, which is a matter of law, but the law should have no say in what people do in private. Law should be divorced from motility to avoid the formation of a tyranny of the majority.

Question 43

What does Wilcockson say about the law trying to avoid a tyranny of the majority?

Answer 43

It may not be possible as the law takes into account the general moral feeling and laws are decided on the basis of how the majority of society morally feels.

Question 44

Explain the thin end of the wedge argument

Answer 44

Legalized euthanasia would lead to other forms of killing being accepted and legal. Singer disagrees with this and points out counties like the Netherlands where euthanasia is permitted and this has not occured.

Question 45

Exlain the idea of undermining personal autonomy

Answer 45

The BMA is concerned that legalizing euthanasia to respect autonomy could actually undermine it if the individual is vulnerable. The trust between a patient and doctor would be broken and the attitudes of society to illness and disability would change.