Phil exam 4

Question 1

Active euthanasia:

Answer 1

Agent (oneself or another) provides
effective treatment to cause and
hasten death

Question 2

Passive euthanasia:

Answer 2

Agent refuses / withdraws / withholds
life-sustaining treatment and allows
patient to die by “letting nature take its
course

Question 3

modes of euthanasia (vin mode)

Answer 3

1. Voluntary euthanasia
2. Nonvoluntary euthanasia
3. Involuntary euthanasia

Question 4

varieties of euthanasia (variety of vans can be active or passive)

Answer 4

1. Voluntary passive euthanasia
2. Nonvoluntary passive euthanasia
3. Voluntary active euthanasia
4. Nonvoluntary active euthanasia

Question 5

currently legal euthanasia

Answer 5

“voluntary	passive	euthanasia”
is	accepted	as	morally	/	ethically	legitimate	
in	the	U.S,	as	is	“nonvoluntary	passive	
euthanasia,”	within	the	confines	of	
substituted	judgment	and/or	decisions	
made	in	best	interests	of	paCent.

Question 6

reasons to support active euthanasia (Ha)

Answer 6

Humanitarian grounds: AE may be the most
merciful and humane approach to relieving
paCent suffering, vs. letting-die.

Appeal to patient autonomy: Honoring a
competent patient’s request for AE, in view
of patient’s suffering, is a perfect expression
of respect for the other’s autonomy

Question 7

case against AE

Answer 7

1. AE is murder of an innocent person and
   inherently wrong.
2. AE lies well outside the scope of a physician’s
   professional role, purposes, and responsibilities.
3. Social policy allowing voluntary AE would
   have disastrous side consequences (devaluation
   of human life; social reluctance to provide lifesustaining treatment, pressure to accept AE;
   slippery slope to nonvoluntary or involuntary
   AE)

Question 8

James Rachels: He proposes that…(Rachel is good this time)

Answer 8

active euthanasia should be accepted as morally
legitimate:
– Because: There is no morally significant
distinction between active and passive
euthanasia;
– That is, actively killing and allowing-to-die
achieve same result: one intends a
hastened death in either case

Question 9

james rachels con’t (Rachels motives were good, and AE is better than PE)

Answer 9

And because: the moral value of the act lies
not in its outcome but in its motive (selfish
gains vs. humanitarian interests);
– Thus, if passive euthanasia is morally
acceptable, then we should also accept
active euthanasia when properly motivated;
– In fact, in many cases, AE might be more
humane and effective than PE—quick and
painless end, vs. protracted and difficult
allowing-to-die;
– And AE pays more complete respect to
patient autonomy

Question 10

Daniel Callahan (Daniel the D)

Answer 10

Argues against the moral legitimacy of active euthanasia:
– The distinction between active killing and
passive letting-die is morally significant,
contra Rachels

Question 11

Daniel Callahan - Metaphysical reason (self is not master in metaphysical)

Answer 11

To ignore the
distinction between killing and letting die
wrongly assumes that the Self is responsible
for all things, and “has become master of
everything within and outside of the self”

Question 12

Daniel Callahan - moral reason (D says you’re responsible)

Answer 12

Rachels views PE as being
equivalent to AE, in terms of our moral
culpability for causing a death by passive
means. Yet, this view neglects the
difference between what causes death and
who’s at fault for it. Physical causality is
one thing; moral culpability is another.
Thus, just because we allow someone to die
(from natural causes) it doesn’t mean we’re
morally culpable, as we would be in a case
of actively killing that person.

Question 13

daniel callahan - medical reason (medical is doctor)

Answer 13

Physicians	should	not	
be	placed	in	a	position	to	kill	paCents	
by	active	means;	this	is	a	misuse	of	
their	expertise	and	abilities:		“only	to	
cure	or	comfort,	never	to	kill.

Question 14

physician assisted suicide

Answer 14

AKA “Aid in dying”: Intentional termination
of one’s life by active means, with the
assistance of a physician who provides
information, means of death, or both.

• Versus active euthanasia: In AE, physician
would perform the acCon that causes death
(e.g., administer an injection of life-ending
med’s); in PAS, the patient performs that
acCon, using means and/or information
provided by physician.

Question 15

key points - euthanasia (strongest argument FOR euthanasia is…)

Answer 15

• Passive euthanasia (both voluntary and
nonvoluntary) is legal.
• The strongest argument for active voluntary
euthanasia is derived from the principle of
autonomy.
• Those who oppose euthanasia often draw a
sharp distinction between killing and letting
die

Question 16

Brock - 2 ethical values

Answer 16

same two
fundamental ethical values supporting the
consensus on patient’s rights to decide
about life-sustaining treatment also support
the ethical permissibility of euthanasia.

Question 17

Brock - self-determination

Answer 17

It is a person’s interest in making
important decisions about their own lives
for themselves in accordance to one’s own
values and/or conceptions of the good life.
It also has to do with being left free to act
on one’s own decisions

Question 18

self determination entails…(Brock)

Answer 18

taking responsibility for one’s
own life and for the type of person they
will become. It also includes a high view
of human dignity as it pertains to a
person’s capacity to direct their own
lives.

Question 19

Brock - pluralism (no one answer)

Answer 19

For many patients near death, maintaining
the quality of one’s life, avoiding great
suffering, maintaining one’s dignity, and
insuring that others remember us as we wish
them…But there is no…objectively correct
answer for everyone as to when…one’s life
becomes all things considered a burden and
unwanted.

Question 20

Brock - a fundamental value (fundamental in SD)

Answer 20

Brock thinks that if self determination is a
fundamental value, then it is
especially important that individuals
control the manner, circumstances,
and timing of their own death.

Question 21

Brock - individual wellbeing (wellbeing is a burden)

Answer 21

Life itself is commonly taken to be a
central good. But when life is no longer
considered a benefit by the patient, but
now has become a burden. The same
judgment underlies a request from
euthanasia: continued life is seen by the
patient as no longer a benefit, but now a
burden.

Question 22

arguments against Brock (ethics and legality)

Answer 22

1) In any individual case where
considerations of the patient’s
SD and well-being do support
euthanasia, it is nevertheless
always ethically wrong.
2) In some individual cases
euthanasia may not be ethically
wrong, but, nonetheless, public
and legal policy should never
permit it

Question 23

response to argument that euthanasia is always killing (waiving that right)

Answer 23

The right not to be killed, like other rights,
should be waivable when the person
makes a competent decision that
continued life is no longer wanted or a
good, but instead worse than no further
life at all. In this view, euthanasia is properly
understood as a case of a person having
waived his or her right not to be killed

Question 24

response to argument that euthanasia should never be legalized

Answer 24

1. If euthanasia were permitted it
would be possible to respect SD.
2. Polls show that many people would
support the legalization of
euthanasia to have more control.
3.If euthanasia were permitted, then
those with untreatable severe pain
could benefit.
4. If euthanasia were permitted and
death accepted, then it is more
humane to end life quickly and
peacefully, when that is what the
patient wants.

Question 25

argument against the legalization of euthanasia - Brock

Answer 25

``` 1. It is incompatible with a doctor’s commitment as healers to protect patients. 2. It would weaken society’s commitment to provide optimal care for dying patients. 3. It could threaten the rights of patients or their surrogates to decide about and to refuse LST. 4. A few others but the more serious one is the “Slipper Slope” objection. ```

Question 26

gay-williams - natural inclination

Answer 26

``` “natural inclination to continue living.” Furthermore, such a practice is opposed to our own self-interest and is a risky step on a slippery slope leading to widespread abuse. ```

Question 27

gay-williams - principles (human nature)

Answer 27

``` P1 All euthanasia is acting against our human nature. P2 All acting against our human nature is a denial of our human dignity. P3 All denial of our human dignity is morally wrong. C Thus, all euthanasia is morally wrong ```

Question 28

gay-williams on dignity (seek dignity to the end, gay)

Answer 28

``` Our dignity comes from seeking our ends…[euthanasia] denies our basic human character and requires that we regard ourselves or others as something less than fully human.” ```

Question 29

gay-williams self-interest

Answer 29

``` P1 All euthanasia is action containing the possibility that we will work against our own interests. P2 All action containing the possibility that we will work against our own interests is morally wrong. C Thus, all euthanasia is morally wrong. ```

Question 30

gay-williams - practical effects argument (practically would never happen)

Answer 30

``` P1 All cases of euthanasia are cases that could have a corrupting influence on doctors and nurses. P2 All cases that could have a corrupting influence on doctors and nurses are morally wrong. C Thus, all cases of euthanasia are morally wrong. ```

Question 31

The Uniform Determination of Death Act | (UDDA) - definition

Answer 31

is the current federal law outlining the definition and criteria of legal, clinical death. State laws adhere, and specify testing protocols, etc.

Question 32

two criteria of UDDA (death)

Answer 32

cardiopulmonary and neurological (“cardiac death” and “brain death”), as sufficient conditions for pronouncement of death. These criteria derive from the definition of “death” as “the cessation of functioning of the organism as a whole

Question 33

Cardiopulmonary criterion:

Answer 33

“Permanent cessation of heart-lung functions” indicates death (UDDA). - Traditional criterion, traditionally viewed as both a necessary and sufficient condition to pronounce death: Anyone lacking CP func.on is dead, and anyone with CP func.on is alive…

Question 34

``` “Brain Death” or “Whole Brain Death” as specified by the Uniform Determination of Death Act (UDDA): ```

Answer 34

- “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead. –Various testing protocols, by state: test for coma; absence of brain stem reflexes; apnea test; flat EEG of x minutes, y times in 24 hour period; etc.

Question 35

– Even if PT possesses sustained cardiopulmonary functions, via ventilator and allied technologies, she is...

Answer 35

pronounced dead if the neuro criterion is satisfied by specified tests. (Either criterion is sufficient

Question 36

criteria for death - organ donation (heart or brain death)

Answer 36

``` At this point, if organ-donation consent is provided, organ procurement may proceed by “heart-beating donor” or “Donation after Brain Death (DBD)” protocols ```

Question 37

whole brain position (whole brain is whole event)

Answer 37

Death is essentially what we recognize it to be in common usage; technical or theoretical definition must not stray too far; – Death must be a unitary and complete event, not a process and Death is a biological, vs. socio-cultural phenomenon; – “Death” applies only to higher vertebrates and – only to organisms, vs. persons; –Death is irreversible.

Question 38

“higher brain dead” patient may

Answer 38

retain CP function (“breathe on her own”), but with the permanent loss of consciousness, subjectivity, the individual, as “a being like you or me,” is dead: no longer exists

Question 39

implications for higher brain dead transplants

Answer 39

``` donor PT might be candidate for DCD (donation after cardiac death), but only abdominal organs are typically procured, and DCD donations are less viable than DBD (donation after brain death) donations ```

Question 40

Whole brain” position (the whole brain is just an organism)

Answer 40

Death is a physical event that occurs in an organism, not to be confused with the “death of the person

Question 41

–Higher brain position

Answer 41

The ongoing function of an organism is irrelevant to the loss of existence of the person, “the being like you or me,” : Death is the nonexistence of me (vs. my body)…

Question 42

karen ann quinlan (quinlan is lower)

Answer 42

“lower” brain activity was recorded; condition did not satisfy criterion of whole brain death. Dad won in court and ventilator was removed.

Question 43

Nancy cruzan (cruise to advanced directives)

Answer 43

Missouri Supreme Court overturned trial court authorization: placed severe restrictions on surrogate family-members making decisions on behalf of incompetent patients, requiring “clear and convincing” evidence of patient’s preferences, such as living will. Physicians and family testified and feeding tube was removed. She started movement for advanced directives.

Question 44

Terri Schiavo

Answer 44

husband wanted tube removed, parents did not. Husband won.

Question 45

DNR/DNAR Orders (“Do not Resuscitate”/Do | Not Attempt Resuscitation”

Answer 45

• No medical benefit; physician may decide alone; • Poor quality of life after CPR; patient consult/consent needed; • Poor quality of life before CPR; patient consult/consent needed

Question 46

2 kinds of advanced directives (PI directive)

Answer 46

proxy directive and instructional directive

Question 47

Instructional directives:

Answer 47

Competent person specifies instructions about her care in the event that decision making capacity is lost; when directed to issues of LST specifically, often called a “living will.

Question 48

Proxy directive:

Answer 48

Competent person specifies a substitute decision maker (i.e. a health-care agent) to make health care decisions for her in the event that decision-making capacity is lost

Question 49

Substituted-judgment standard:

Answer 49

Proxy is expected to represent and uphold the patient’s expressed preferences, values, and desires, to the extent known;

Question 50

Best-interests standard

Answer 50

``` When patient’s preferences are not clearly known, expectation that proxy will exercise judgments that defend the best interests of the patient for whom she is speaking. ```

Question 51

POLST (polstergeist w/ the doc)

Answer 51

Physician Orders for Life-Sustaining Treatment • CA legislation, 2009, establishing POLST as recognized legal documentation of patient-physician planning • POLST, unlike advanced directive, is signed by both patient and physician and constitutes ongoing medical orders • POLST incorporates advanced directives and establishes different levels of preferred care

Question 52

medical futility - principle (medically futile w/out ben & mal)

Answer 52

``` No obligation to provide a futile treatment (as an expression of beneficence), and every obligation not to provide one, if harms outweigh benefits (nonmaleficence). ```

Question 53

physiological futility

Answer 53

Treatment is futile if “physiological systems have deteriorated so drastically that no known medical intervention can reverse the decline.

Question 54

quantitative futility (the quantity is low)

Answer 54

A judgment that a treatment has an unacceptably low statistical probability of producing a given effect: it’s futile because “Chances are, it won’t work.”

Question 55

qualitative futility (low quality)

Answer 55

A judgment that the effect produced by a treatment is of low or no value in and of itself, in the context of this PT’s condition (relative to broader goals of treatment): it’s futile because “Even if it will work, it won’t do any good.”

Question 56

Libertarian - rationing

Answer 56

Focuses on rights to social and economic liberty, emphasizing fair procedures rather than substantive outcomes.

Question 57

Communitarian - rationing

Answer 57

These rely on practices that have evolved through the traditions of a community

Question 58

egalitarian - rationing

Answer 58

``` These focus on how some people fare relative to others, and that a situation is just when there is equal access to certain goods, when access is necessary to meet people’s claims of need, and when these claims are given equal weight across people. (see John Rawls) ```

Question 59

QALYs can be criticized...

Answer 59

on the ground that they fail to consider the needs and values of the lives of the elderly and the disabled.

Question 60

The United Network for Organ Sharing (UNOS)

Answer 60

has devised a point system that incorporates considerations of both fairness and efficiency in the allocation of organs. The aim is respect people’s claims of need for organs, while at the same time promoting good outcomes of transplantation. (Note: “Autonomy cannot be separated from responsibility.

Question 61

two-tiered healthcare

Answer 61

Fairness is giving more weight to stronger claims of need, and pertains to a decent minimum of care (DMC), not optimal care. Glannon thinks that if people have reached a DMC, then they would have no moral claim to receive the same care as those who can purchase additional care above the level

Question 62

Glannon on rationing (Glannon is fairly efficient)

Answer 62

fair and efficient health care system must be more sensitive to the needs of the elderly and the disabled. But no health care system can meet everyone’s claims of need.” Medical rationing needs to reasonably balance between fairness and efficiency

Question 63

Brock - active euthanasia is definitely killing - so why isn't it wrong? (good consent isn't wrong)

Answer 63

You have patient consent and you have good intentions