Untitled Deck

Question 1

What is Coercive Paternalism as defined by Conly?

Answer 1

Coercive Paternalism advocates for state intervention to prevent individuals from harming themselves, particularly when such decisions are likely to lead to future regret. It’s based on the idea that just as the state can prevent harm to others, it can prevent self-harm.

Coercive Paternalism emphasizes the state’s role in safeguarding individuals from their own potentially harmful decisions.

Question 2

What are Conly’s three main arguments against paternalism and her counterarguments?

Answer 2

1. Argument 1: Unnecessary, Because Choices Reflect True Desires.
   
   • Counterargument: This claim is based on flawed assumptions about human rationality.
2. Argument 2: Liberty Valued Over Happiness.
   
   • Counterargument: The value of liberty varies; society accepts many restrictions that provide benefits.
3. Argument 3: The Slippery Slope.
   
   • Counterargument: This fear is exaggerated; paternalistic measures would be carefully calibrated.

Conly challenges common notions of autonomy and rationality, advocating for a nuanced understanding of paternalism.

Question 3

How does Conly propose reframing paternalism?

Answer 3

Conly suggests that paternalism, when implemented wisely, is not disrespectful to individual autonomy but rather a form of true respect. It helps people achieve their life goals and avoid preventable harm.

This reframing positions paternalistic interventions as supportive rather than controlling.

Question 4

What is the core definition of Autonomy in English Law (Coggon)?

Answer 4

Autonomy is often equated with self-determination, specifically the right to control one’s bodily integrity. Judges emphasize the patient’s right to autonomy in common law and under the ECHR (Article 8).

This definition underscores the legal emphasis on personal agency within healthcare.

Question 5

What are Coggon’s three philosophical understandings of autonomy?

Answer 5

1. Ideal Desire Autonomy: Aligns with objective values or universal rational ideals.
2. Best Desire Autonomy: Guided by one’s deeper, reflective value system.
3. Current Desire Autonomy: Reflects immediate or impulsive desires.

These distinctions illustrate the complexity of autonomy in ethical and legal discussions.

Question 6

How does the Mental Capacity Act 2005 (MCA) define capacity (Auckland, Chapter 1)?

Answer 6

Under Section 2(1) MCA, a person lacks capacity if they are unable to make a decision due to an impairment or disturbance in the functioning of their mind or brain. Section 3(1) specifies the inability must be to:
* (a) Understand relevant information.
* (b) Retain the information long enough.
* (c) Use or Weigh the information as part of the decision-making process.
* (d) Communicate their decision.

These criteria establish a framework for assessing decision-making capacity.

Question 7

What is the MCA’s intended approach to capacity assessment, and what is the associated critique (Value-Neutrality)?

Answer 7

The MCA test is designed to be value-neutral, focusing on cognitive processes rather than the content or reasons for a decision.

Critique: Assessing the ability to use or weigh information often implicitly requires understanding the values underlying the decision, challenging true value-neutrality.

This critique raises concerns about hidden biases in capacity assessments.

Question 8

How does mental disorder challenge normatively neutral accounts of autonomy (Freyenhagen & O’Shea)?

Answer 8

Mental disorders can distort a person’s values, emotions, or worldview, posing a challenge to neutral accounts that respect an individual’s internal standards.

This raises questions about the authenticity of autonomous decisions made under the influence of mental illness.

Question 9

What are the two types of situations where respecting autonomy might lead to a decline in welfare, according to Molyneux?

Answer 9

1. Altruistic Autonomous Choices: Sacrificing personal welfare for others’ benefit.
2. Imprudent Autonomous Choices: Harmful decisions not altruistic in nature.

Molyneux argues that respecting autonomy can have moral significance even with negative welfare outcomes.

Question 10

What does Section 4 of the Mental Capacity Act 2005 (MCA) require when making a decision about a person’s best interests?

Answer 10

A decision must not be based only on age, appearance, or a condition that might lead to unfair assumptions. Decision-makers must consider:
* Likelihood of the person regaining capacity.
* Encouraging and supporting participation in decisions.
* The person’s past and present wishes and feelings.
* The beliefs and values influencing their decision.
* Other factors the person would likely consider if capacitated.
* Consulting named individuals or deputies.

These criteria ensure a holistic approach to determining best interests.

Question 11

What is an Advance Decision to Refuse Treatment (ADRT) under the MCA 2005?

Answer 11

An ADRT is a decision made by a capacitous person (18+) stating that specific treatment must not be carried out or continued in the future if they later lack capacity to consent.

ADRTs can be withdrawn or changed at any time while the person retains capacity.

Question 12

What are the key factors courts consider when weighing an incapacitated person’s wishes and values in Best Interests decisions, according to Auckland?

Answer 12

Courts often consider:
* Authenticity of the agent’s wishes.
* Strength and consistency of the wish expressed over time.
* Impact of frustration if wishes are ignored.
* Whether respecting wishes would preclude future enjoyment in life.
* The degree of incapacity.

These factors help balance individual autonomy with welfare considerations.

Question 13

What is the ‘cliff-edge’ approach to capacity, and how does Auckland argue for softening it?

Answer 13

The ‘cliff-edge’ approach refers to the law’s rigid binary: a person either has or does not have capacity. Auckland argues for softening this cliff-edge by:
* Introducing a rebuttable presumption in favor of giving effect to an agent’s wishes.
* Acknowledging that capacity assessments are fragile.
* Emphasizing that even if a person lacks legal capacity, their authentic values must be considered.
* Proposing reforms to Section 4 and 5 MCA.

This approach aims to respect individual preferences while ensuring safety.

Question 14

What is the ‘personal identity problem’ in relation to Advance Directives (Buchanan)?

Answer 14

The ‘personal identity problem’ questions the moral authority of advance directives when a person becomes severely incompetent, arguing that if the individual who authored the AD no longer metaphysically ‘exists,’ then the directive has no moral authority.

Buchanan argues that setting a low threshold for psychological continuity preserves the moral authority of most ADs.

Question 15

How has English law’s approach to best interests and patient autonomy evolved since Re F (1989) to Aintree v James (2013) (Jackson)?

Answer 15

• Re F (1989): Established the doctrine of necessity for treatment based on medical opinion.
• Aintree v James (2013): Shifted to a patient-centered approach, emphasizing wishes, feelings, values, and beliefs.

This evolution reflects a growing recognition of patient autonomy in legal decisions.

Question 16

What is the current legal threshold for court intervention in children’s medical care disputes in England and Wales, and what is the proposed alternative threshold?

Answer 16

• Current Threshold: Courts intervene based on the child’s ‘best interests’.
• Proposed Alternative: A ‘serious risk of significant harm’ threshold.

This proposed change aims to enhance parental authority in medical decisions.

Question 17

What is the ‘Gillick competence’ standard?

Answer 17

‘Gillick competence’ refers to a child under 16 having sufficient intelligence and understanding to make their own medical decisions, including refusing treatment, regardless of parental wishes.

This standard empowers minors in healthcare decision-making.

Question 18

How did cases like Re R (1991) and Re W (1992) lead to a ‘retreat’ from the principle of Gillick competence for adolescents?

Answer 18

These cases introduced the ‘concurrent consent doctrine’ and the ‘legal flak jacket’ metaphor:
* Concurrent Consent: Refusal by a Gillick-competent adolescent can be overridden by those with parental responsibility.
* ‘Legal Flak Jacket’: Consent from any party holding authority suffices for treatment legality.

This shift prioritizes welfare over adolescent autonomy in medical decisions.

Question 19

What are the arguments for and against giving special or overriding moral authority to parental views in medical disagreements for children (Archer)?

Answer 19

• For Parental Authority:
  
  • Parents know and care for their children best.
  • Value pluralism supports parental discretion.
  • Emotional and financial consequences are borne by parents.
• Against Parental Authority:
  
  • Child is not parental property.
  • Parental knowledge is defeasible.
  • Courts are best suited to determine best interests.

These arguments highlight the tension between parental rights and children’s welfare.

Question 20

What were the outcomes and key reasoning in the high-profile cases of Charlie Gard and Alfie Evans?

Answer 20

In both cases, parents wished to continue life-sustaining treatment while hospitals argued for withdrawal based on the child’s best interests.
* Charlie Gard: Court ruled for the hospital, finding continued treatment not in Charlie’s best interests.
* Alfie Evans: Court found withdrawal of life-support was in Alfie’s best interests.

These cases illustrate the courts’ focus on objective welfare determinations over parental wishes.

Question 21

What is Miller and Truog’s central argument about withdrawing life-sustaining treatment (LST), and why do they call the traditional view a ‘legal and moral fiction’?

Answer 21

Miller and Truog argue that withdrawing LST is an act that causes death, unlike withholding LST, which is an omission. They call the traditional view a ‘legal and moral fiction’ because it fails to recognize the active role of withdrawal in causing death.

This perspective challenges conventional understandings of medical ethics regarding end-of-life decisions.

Question 22

What do Miller and Truog argue about withdrawing life-sustaining treatment (LST)?

Answer 22

Withdrawing LST is an act that causes death, unlike withholding LST, which is an omission.

They consider the traditional view that withdrawal does not cause death a ‘legal and moral fiction’ used to maintain a moral bias and shield doctors from liability.

Question 23

What are the two main ethical arguments supporting voluntary active euthanasia according to Brock?

Answer 23

• Self-determination: Competent patients should have the right to decide about their own death.
• Individual Well-being: Euthanasia can promote well-being for those whose life is a burden and causes unbearable suffering.

Question 24

What is the ‘mismatch’ observed in the UK’s debates on legalizing assisted dying?

Answer 24

Individuals who litigated to change the law often would not qualify under proposed eligibility criteria.

This mismatch occurs due to practical considerations and parliamentary opposition.

Question 25

What is the 'vulnerability argument' against legalizing assisted dying?

Answer 25

The argument expresses concern that vulnerable groups might face coercion to choose assisted dying. ## Footnote Some sources reframe vulnerability to include internal pressures like maintaining control and avoiding loss of autonomy.

Question 26

What are the main arguments for extending physician-assisted death (PAD) to patients with treatment-resistant major depressive disorder (TRD)?

Answer 26

* Parity of suffering: Mental suffering can be as debilitating as physical suffering. * Self-determination: Respecting choices for suffering adults. * Authentic self: Judgments about life's worth should be respected. * Lack of alternatives: TRD patients often have little hope of improvement.

Question 27

What are the main arguments against extending PAD to TRD patients?

Answer 27

* Uncertainty of diagnosis/prognosis: TRD lacks a clear definition. * Professional integrity: It could compromise the physician's role. * High likelihood of mistakes: Potential for false positives. * Availability of alternatives: VSED is a tolerable alternative. * Social meaning: It might reinforce problematic societal attitudes.

Question 28

What is Burin's 'bright line of birth' argument?

Answer 28

Burin argues that full legal rights are ascribed at birth, signifying crucial changes in state and status. ## Footnote These include physiological changes, neurobehavioral changes, and the establishment of a separate corporeal identity.

Question 29

What does Section 1(1)(d) of the Abortion Act 1967 allow in the UK?

Answer 29

It allows abortion at any gestational stage if there is a substantial risk of serious handicap to the child. ## Footnote Key controversies include vagueness, discriminatory messages, eugenic overtones, and lack of parental support.

Question 30

What is Michael Tooley's core argument regarding personhood and the right to life?

Answer 30

Tooley argues that foetuses and neonates are not 'persons' and therefore do not possess a right to life. ## Footnote His definition of personhood requires capacity for non-momentary interests and self-conscious desires.

Question 31

How does the UK legal system prosecute self-induced or assisted abortions?

Answer 31

It criminalizes self-induced or assisted abortions under the Offences Against the Person Act 1861 and the Infant Life (Preservation) Act 1929. ## Footnote Criticisms include disproportionate impact on vulnerable women and outdated legislation.

Question 32

What are three novel reproductive technologies discussed by Romanis & Brown?

Answer 32

* In Vitro Gametogenesis (IVG) * Mitochondrial Replacement Techniques (MRTs) * Artificial Placentas (Ectogestation)

Question 33

How do novel reproductive technologies challenge the UK's legal framework of parenthood?

Answer 33

* Deconstructing Reproductive Biosex * Reimagining Relatedness * Disembodied Reproduction * Gendered Terminology

Question 34

What was the key legal question in *McConnell v Registrar General*?

Answer 34

Whether a transgender man with a Gender Recognition Certificate who gave birth could be registered as the child's 'father' or 'parent'. ## Footnote The Court of Appeal dismissed the appeal, citing existing law.

Question 35

How does Davis's 'queer perspective' approach legal reform?

Answer 35

It challenges cis-heteronormativity and critiques the notion of a 'right' way to live, exploring two approaches to reform: working within the system and rejecting the law. ## Footnote The tension lies in engaging with exclusive legal systems versus creating conditions for queer flourishing.

Question 36

What are Stem Cell-Based Embryo Models (SCBEMs)?

Answer 36

3D models of embryos created using human embryonic stem or induced pluripotent stem cells, modeling key stages of embryonic development. ## Footnote They are significant because they help study difficult stages like implantation and gastrulation.

Question 37

What are Stem Cell-Based Embryo Models (SCBEMs), and why are they considered significant for research?

Answer 37

SCBEMs are 3D models of embryos created using human embryonic stem (hES) cells or induced pluripotent stem (iPS) cells. They model key stages of embryonic development and are significant due to: * Scalability * Standardization and Control * Regulatory Flexibility * Potential Clinical Benefits ## Footnote They enhance understanding of embryogenesis, miscarriage, and congenital abnormalities.

Question 38

What is the legal status of integrated SCBEMs under the UK's Human Fertilisation and Embryology Act 1990 (HFE Act)?

Answer 38

The HFE Act does not explicitly address SCBEMs, and they are assumed to be not embryos under the Act, leading to a regulatory gap that raises issues such as: * Regulatory Gap * Moral Status * Chilling Effect * Clinical Use Concerns ## Footnote This situation creates uncertainty regarding the ethical implications of research and application.

Question 39

What are the moral limits of brain organoid research concerning potential consciousness?

Answer 39

Brain organoid research raises ethical concerns due to the potential for these structures to acquire consciousness. Key aspects include: * Moral Threshold * Detection Challenges * Ethical Constraints ## Footnote Ethical principles involve the 3Rs and ensuring expected benefits significantly outweigh harms.

Question 40

What are the translational possibilities of In Vitro Gametogenesis (IVG) for reproductive medicine?

Answer 40

IVG promises to transform reproductive medicine by: * Patient-specific gametes * Fertility restoration * Mitochondrial disease prevention * IVF paradigm shift * Broader access * Novel family structures ## Footnote It can benefit individuals who lost germ cell function and provide options for female same-sex partners or single women.

Question 41

What is the black box problem in medical AI, and why is it a concern for patient autonomy?

Answer 41

The black box problem refers to the lack of understanding of how AI algorithms arrive at conclusions, raising concerns about: * Informed Consent * Transparency and Trust * Bias Identification ## Footnote This opacity complicates patient autonomy and the ability to ensure ethical medical practices.

Question 42

What is the problem of many hands regarding liability for medical AI errors?

Answer 42

The problem of many hands refers to the difficulty in assigning responsibility for errors involving multiple stakeholders, including: * Software Developer Companies * Clinicians * Hospitals/Healthcare Systems * Additional Actors ## Footnote AI's opacity complicates the identification of accountability when harm occurs.

Question 43

What is the concept of a moral crumple zone in the context of AI liability in healthcare?

Answer 43

The moral crumple zone describes the tendency for clinicians to absorb full responsibility for AI errors, despite limited control over AI's decision-making process. ## Footnote This results in an unjust disconnect between accountability and control.

Question 44

What are the four interconnected sources of algorithmic discrimination in healthcare?

Answer 44

The four sources are: * Discrimination from Design * Discrimination from Biased Inputs * Discrimination from Data Deficits * Discrimination from Actuarially Sound Disparate Impacts ## Footnote These sources lead to biased outcomes and reinforce existing inequalities.

Question 45

What is risk pooling as a proposed solution for AI liability in healthcare?

Answer 45

Risk pooling is an approach where losses from AI-related harms are shared across stakeholders through a mandatory insurance scheme, aiming to: * Provide rapid patient compensation * Promote shared responsibility * Incentivize safety ## Footnote This model contrasts with the current fault-based liability system.