Bioethics

Question 1

Non-Hippocratic Codes

Answer 1

Codes were Hippocratic until the 1970s, were written by not medical ppl but came about by liberal politics

Question 2

Nuremberg Code (1946 after WW2)

Answer 2

Informed consent came about from the Nuremberg trials

Question 3

Universal Declaration on Bioethics and Human Rights

Answer 3

International standard for ethics (2005)

Question 4

Moral Standing

Answer 4

Is the moral status of a being, can have “full standing” (humans) or “limited standing” (corpses, egg/sperm, fetuses, non-human animals)

Question 5

Cardiac-Oriented View of Death

Answer 5

Individual dies when there is irreversible cessation of circulatory/resp function

Question 6

Whole-Brain View of Death

Answer 6

Individual dies when there is irreversible cessation of all functions of the entire brain (including brain stem)
- this is current law except in Japan, NJ and NY

Question 7

Higher-Brain View of Death

Answer 7

Individual dies when there is an irreversible loss of “higher” brain function; consciousness usually considered critical

Question 8

Abortion 3 Views

Answer 8

• acceptable until capacity for higher brain function exists (~ 24wks)
• acceptable until capacity for any brain function exists (~ 8-12wks)
• acceptable until capacity for cardiac function exists (conception)

Question 9

Capacity

Answer 9

Actual ability to carry out function

Question 10

Potential

Answer 10

Genetic program to develop the capacity to carry out the critical function

Question 11

Non-Human Animals

Answer 11

Western thought: sharp division btwn humans and other animals
Eastern thought: connections closer btwn humans and animals

Question 12

Speciesism

Answer 12

Belief that membership in a species per se is relevant to moral standing

Question 13

Principle

Answer 13

General characteristic of actions that makes them morally right

Question 14

Virtue

Answer 14

Character trait of a person

Question 15

Beneficence

Answer 15

Do good

Question 16

Nonmaleficence

Answer 16

Don’t do harm

Question 17

Utility

Answer 17

Measure of net good by taking into account both benefits (beneficence) and harms (nonmaleficence)

Question 18

Objective vs. Subjective Judgments

Answer 18

Hippocratic: clinician subjective judgment of facts/therapy
Modern: strives for objectiv judgment of facts, medical science can tell which therapy is best
Postmodern/contemp: pt’s values should take precedence

Question 19

Medical vs. Other Benefits

Answer 19

• if health is goal, pt math want to trade health off for other goods
• if total welfare is goal, physician’s skills are inadequate

Question 20

Conflicting Medical Goals

Answer 20

1. Save life
2. Cure dz
3. Relieve suffering
4. Promote health

Question 21

Conflicts over Relating Benefits to Harms

Answer 21

Hippocratic formula (arithmetic or geometric combining), Primum non nocere (“first of all, do no harm”)

Question 22

Fidelity (respect for persons)

Answer 22

Duty of loyalty
Confidentiality: hippocratic principle justifies breaking confidence to benefit pt
- fidelity supports duty to keep promises of confidence EVEN IF pt would benefit from breaking it

Question 23

Autonomy (respect for persons)

Answer 23

• Informed consent
• negative rights: liberty rights (right to be left alone)
• positive rights: entitlement rights (right to some good or service)

Question 24

Veracity (respect for persons)

Answer 24

Truth-telling and lying

Question 25

Avoidance of killing (respect for persons)

Answer 25

euthanasia

Question 26

British Medical Association

Answer 26

Abandoned hippocratic paternalistic exception for breach of confidence and replaced with: - exception of pt agrees, or formal public policy * 1971

Question 27

American Medical Association

Answer 27

Abandoned hippocratic paternalistic exception for breach of confidence and replaced with: - exception of threat of serious bodily harm, or applicable statute/ordinance * 1980

Question 28

Therapeutic Privilege

Answer 28

Clinician' privilege of withholding info that he/she believes will be harmful to the pt (re: autonomy)

Question 29

Professional Standard (for informing)

Answer 29

What competent physician similarly situated would disclose

Question 30

Reasonable Person/pt Standard (for informing)

Answer 30

What reasonable pt would want to know or would find important in decision making

Question 31

Subjective standard (for informing)

Answer 31

What specific pt would want to know

Question 32

Consent

Answer 32

Autonomy requires the use of the reasonable person standard modified by what the clinician knows or should be expected to know about the pt's unique subjective interests

Question 33

Veracity (for informing)

Answer 33

From 60s to 80s there was radical change from non-disclosure to disclosure of the dx (Veracity - truth-telling and lying)

Question 34

Active Killing vs. Letting Die

Answer 34

- consequences of active killing may be worse (wrong ppl may die) - autonomy can require clinician not to treat but does not require physician to actively kill - active killing is simply inherently wrong

Question 35

Stopping vs. Not Starting Tx

Answer 35

Feels diff to clinicians but they are ethically equivalent actions

Question 36

Direct vs. Indirect Killing

Answer 36

``` Direct = intended (active or passive) Indirect = unintended (active - anesthesia; passive - forgoing life support) ```

Question 37

Ordinary vs. Extraordinary Means

Answer 37

``` Ordinary = proportionally beneficial Extraordinary = benefits do not exceed burdens (turning an old woman over to prevent decubitus ulcer but it breaks her bones, etc.) ```

Question 38

Formerly Competent Pt

Answer 38

Have expressed wishes about terminal care while competent - moral: "autonomy extended" - legal: substituted judgment

Question 39

Never-competent Pt (w/o fam)

Answer 39

No one w/ standing to speak for the pt | - "best interest" standard is the legal principle, and usually best option

Question 40

Never-competent Pt (w/ fam)

Answer 40

Fam given standing to speak for pt (normally next-of-kin, until proven malicious, unreasonable, or unwilling) *limited familial autonomy: fam has autonomy w/in reason

Question 41

Principle of Social Utility | for allocating scarce resources

Answer 41

Action is justified if it produces as much net good in aggregate as possible considering all who are affected - problems: quantification and inequity (mainly equity)

Question 42

Principle of Justice | for allocating scarce resources

Answer 42

Action is justified if it strives for an "end-state pattern" of the distribution of the good (may not do as much good as principle of social utility) - modern "end-state pattern": effort or need

Question 43

Clinician's Role in Allocating Resources

Answer 43

- let clinicians abandon their pt's @ the margin | - give clinicians exemption from principles of social ethics

Question 44

Duty proper

Answer 44

.

Question 45

Prima facie

Answer 45

.

Question 46

Duty proper

Answer 46

.

Question 47

Prima facie

Answer 47

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