Exam 2 Flashcards
(45 cards)
o Passive: another person withholds or withdraws life-sustaining treatment allowing the patient to die as a result of the underlying illness
o The patient explicitly chooses this; clearly their desire
o Direct permission either in a living will or in person
Voluntary passive euthanasia
o Passive: another person withholds or withdraw life-sustaining treatment allowing the patient to die because of the underlying illness
o The patient is unable to communicate her/his wishes, so someone else makes the choice on the person’s behalf and in their best interest
Non-voluntary passive euthanasia
o Active: another person administers a lethal dose or otherwise does something to directly cause the patient’s death
o Another person does something to end the patient’s life on their request
o Considered similar to murder and against the law
Voluntary active euthanasia
o Active: another person administers a lethal dose or otherwise does something to directly cause the patient’s death
o The patient is unable to communicate her/his wishes, so someone else makes the choice on the patient’s behalf
Non-voluntary active euthanasia
o A physician provides the means for the patient to actively bring about his or her own death
o Basically, the physician prescribes a drug and the patient takes it themselves
o This can only be voluntary!
Physician aid in dying (referred to in the text as Physician Assisted Suicide)
o If an action has two likely consequences (one good and one bad) the morality is determined by the agent’s intent
o Comes up often in hospice care and the distribution of morphine and pain killers
Principle of Double Effect
o Mainly to see if something is justified if the intent was for good, but had bad consequences.
o EX: using morphine to relieve pain even though it can cause death
How is the principle of double effect applied in end-of-life care?
The principle of non-maleficence is fundamental to a physician’s professional duty. In arguments regarding PAD, however, both sides appeal to this principle in the context of professional duties in support of their positions. Explain how each side (the pro and the con) apply non-maleficence in support of their positions on PAD
o PRO:
Duties of the doctor to alleviate suffering
By ignoring and refusing this is considered abandonment
o CON:
Primary job of the doctor is to care for the patient, not end their life
• This can be considered abandonment too
• According to Angell (in “The Supreme Court and Physician-Assisted Suicide – The Ultimate Right”) how is assisted suicide sharply contrasted with both active and passive euthanasia? (see p56, column 2)
o The sharp contrast is voluntary vs. non-voluntary
o With euthanasia someone else shuts off the machine or injects the medication so this can be questioned if it was voluntary or non-voluntary. With PAS since it has to be self-administered therefore it is always voluntary
• Angell argues that the “overriding duties of doctors to relieve suffering and to respect their patients’ autonomy” (p56, c1) outweigh the objections to PAS, and therefore PAS should be legal in certain circumstances. In her argument, she considers and rejects the several objections to PAS, including the following:
“Assisted suicide is not necessary. All suffering can be relieved if care givers are sufficiently skillful and compassionate, as illustrated by the hospice movement.” (p57, c1)
Suffering can be relieved: if expert palliative care were available then there would be fewer requests for PAS
There will always be a few patients whose suffering cannot be adequately alleviated and others who prefer suicide over other means available
“Permitting assisted suicide would put us on a moral ‘slippery slope.’” (p57, c1)
Slippery slopes are unavoidable
Need to make sure PAS is voluntary and the request is thoughtful and made freely
“Assisted suicide would be a threat to the economically and socially vulnerable.” (p57, c1-2)
Some may be coerced into doing this by family or doctors but this is at least as likely when it comes to withdrawing treatment
The question is not about whether a perfect system can by devised, but whether abuses are rare
“Doctors should never participate in taking life.” (pp57-58)
Doctors should be committed to life; PAS violates the profession’s mission
The highest ethical imperative of doctors should be to provide care in whatever way best serves the patient’s interest, in accord with each patient’s wishes, not with a theoretical commitment to preserve life no matter what the cost in suffering.
“People do not need assistance to commit suicide. With enough determination, they can do it themselves.” (p58, c1-2)
Most patients who are at the end of life are unable to commit suicide and need assistance
Angell tells the story of her own dad committing suicide, saying that if PAS was legal he would have chosen that
For each of the objections listed above, explain both the objection (how is that reason used in an argument against PAS) and Angell’s response (why, according to Angell, is that reason not a strong argument against PAS).
• Foley (in “Competent Care for the Dying Instead of Physician-Assisted Suicide”) argues that “Physicians do not know enough about their patients, themselves, or suffering to provide assistance with dying as a medical treatment for the relief of suffering.” (p63, c1-2) How does she support the components of this claim? (explain her arguments)
o The lack of education and training for end of life care
It’s not a big part of medical school
o There is more than physical pain that these patients are going through
• Explain why Foley thinks that legalized PAS would undermine care for the dying.
o If PAS was legalized it violate and undermine the respect for life perspective
o If PAS was legalized there wouldn’t be much incentive to care for the dying
Based on the text and class discussion, explain what you take to be the strongest reasons both for and against legalizing physician assisted suicide.
FOR:
• The patient won’t have to endure the pain of dying from serious illnesses
• Patient has the right to choose (autonomy)
• Even with good palliative care some suffering cannot be alleviated
• If it’s not legal, some people will end their own lives in a violent way or prematurely
• Duties of the doctor to listen to their patients wishes and alleviate pain and suffering
AGAINST:
• Lack of education when it comes to end of life patients; they don’t know enough to justify participating
• Slippery slope will lead to abuse of the vulnerable
• How do you know if it’s out of depression or not?
• Fundamental duty of doctors is to save/prolong life
o To aid in dying is violating nonmaleficence
o If you help them die, you are abandoning your patient
What ethical principle (or principles) supports the claim that access to healthcare is a basic human right?
o Respect for persons
o Respect for life
Explain the connection between the right to life and the right to health care.
o Right to life:
Right to be treated with respect and dignity
o Right to health care:
Assuring all people have their basic needs met
Food, shelter, water, health care
o Access to health care and basic quality of life coexist
Explain three reasons why access to emergency rooms does not provide adequate access to healthcare for people who are uninsured. (ER= assess and stabilize)
o Don’t provide follow-up care
o Don’t provide access to maintenance care
o Don’t provide access to preventative care
o Are required to see anyone who walks in the door, but only until they are stabilized
Explain the difference between a single-payer system and a multi-payer system for healthcare. Which type of system does the US have under the Affordable Care Act?
o A lot of the countries that have universal coverage have a single-payer system.
System in which the state, rather than private insurers, pays for all healthcare costs
o In the US, we have a multi-payer system
Two or more providers administer insurance and are usually in competition with each other
Private health insurance
Identify 3 aspects of The Patient Protection and Affordable Care Act (ACA) that were intended to provide better access to health care in the US.
o Young adults (up to age 26) can stay on their parent’s coverage
o Income-based subsidies
o Gender-neutral pricing
o Basically trying to make sure everyone is covered by something
What are “healthcare exchanges” (a.k.a. marketplaces)? How are these exchanges related to access to healthcare?
o Aspect of the Affordable Care Act to make it easier for people to pay for their own health insurance
o Healthcare exchanges (marketplaces)
Set up for the people that don’t get health care insurance through their employers
Places to compare plans
Gives you the subsidies (how much the government will cover)
o Related to access
Supposed to make it easier to compare and more affordable
Explain what is meant by health disparities and healthcare disparities. What ethical concerns are raised by these disparities?
o Disparities: when there are sufficient outcomes between groups
People who are insured vs. people who aren’t insured
o Health disparities: differences in health, itself
o Healthcare disparities: differences in access to health care
o Ethical Concerns:
Justice
Negative rights are rights against interference (e.g., freedom of speech, freedom of the press, freedom of religion, right to privacy). Positive rights are rights that impose a specific duty on some person or entity (e.g., right to education)
o Explain the difference between positive and negative rights and explain how this distinction, =when considered in terms of the “right to healthcare” is related to the discussion of whether the government (or some other entity) has a responsibility to ensure universal access to healthcare.
Negative rights are sort of a hands-off
• Government cannot interfere
Positive rights imply that there is some obligation that comes with the right
• EX: right to education; acknowledging the responsibility to provide the means for educationgovernment pays for the building, teachers, books (until college)
Right to healthcare
• Negative: everyone has a right to health care
• Positive: someone is obligated to provide it; just don’t know who yet
In the US, we have great facilities and highly trained professionals; yet many people don’t have access to regular preventative and maintenance care. Based on the lecture, online resources, and class discussion, explain at least two reasons for this lack of access in our current system.
o Access to health insurance
Not everyone can afford health insurance and this is your entry into most healthcare
o Demographics (your location)
o Ability to pay
Some reasons against the claim that government should ensure that everyone has access to basic healthcare include:
o It would be too costly
People can’t afford it
It would cost too much to cover everyone
o It would reduce the quality of care for those who currently have access.
If everyone had access, there would be problem with resources
Might not have enough time with their doctors, so increase in waiting time
o It is not fair that people who have more have to pay for people who have less.
Why should my taxes pay for other’s health care
I work hard to provide for my family, why aren’t other people
o Explain one response (or counter-argument) to each of the claims listed above.
1. If everyone had access to care then in the long run it will reduce cost since there won’t be a need for expensive care;
2. More mid-level providers, EX: PA who can help provide the basic care
3. If people had access they would be able to contribute more which would reduce the burden; the nature of the economy or nature of the jobs won’t let them afford it (they’re still working hard)
Some reasons in favor of the claim that government should ensure that everyone has access to basic healthcare include:
o Respect for persons includes ensuring all people have basic needs, including access to basic healthcare, met.
Everyone has the right to life and that coexists with healthcare
o Increasing access to preventative and maintenance care will reduce the overall costs of healthcare.
Fewer people needing to go back to the hospital
o Reliable access to care will allow people to get well faster and be healthier thus allowing them to continue working.
This would help contribute to society therefore putting money back into the economy
o Explain one response (or counter-argument) to each of the claims listed above.
1. Costs; can’t afford to add just everyone
2. Limited resources
3. The illegal immigrants are stealing citizens jobs
