Chapter 1
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Labiba Rahman
Section 003
Chapter 1- Good and Bad Ethical Reasoning: Moral Theories and Principles
1.
List and explain the 5 main characteristics of good reasons
(or good reasoning
) in ethics.
The 5 main characteristics of good reasons in ethics are relevance, evidence, truth, validity, and consistency (1, 2).
2.
Ten of the major mistakes in ethical reasoning are listed in chapter 1. Describe the following 3 for credit:
a.
Slippery slope
b.
Appeal to authority
c.
False dichotomy
Slippery slope: the idea that a small change can lead to dramatic results. This simply cannot be true of all changes, because "we can make a small change without going all the way down the slope" and change does not necessarily have to be negative, it can be progress (4-5).
Appeal to authority: the tendency to quote authority on information that is not relevant to the topic discussed (6).
False dichotomy: the fallacy in which people only discuss two extreme, opposing views or situations without considering a "gray area" (7).
3.
What does moral truth depend on in moral relativism? What is one major flaw with the idea that moral truth is relative?
Moral relativism is the indication that no universal truths exist across cultures but instead, what is right and what is wrong is defined in each society. This proposes an issue, because what may be considered morally correct in one society may be objectively morally wrong. Example: Nazi physicians "cleansing" population during Holocaust and killing numerous amounts of Jewish people (8-9).
4.
What are the four aspects of a right act in utilitarianism? Explain the “trolley problem”. Explain how a utilitarian physician would “triage” their patients.
Utilitarianism is the idea that right acts produce the greatest amount of good for the greatest number of beings. It follows 4 tenets: consequentialism, maximization, the theory of value, and the scope-of-morality premise. There are a few problems that arise when considering the 4 tenets
of utilitarianism. Utilitarianism often includes animals in their as actual beings when determining
the greatest amount. When testing on animals, if the animal has a high calculated utility, then it would be immoral to test on the animals. Additionally, maximization becomes an issue of morality as well. It seems as though saving more lives is much better than saving fewer; however, it would cause for good reason to violate the traditional sanctity-of-life principle to save more people. Pence's example of sacrificing the organs of one perfectly healthy individual to save the life of 4 patients who needed them to live is a perfect demonstration of this problem.
As far as triage is concerned, maximization is the most applied aspect of utilitarianism in public health. It is good practice to give priority to the patients who are between life and death. With this ideology, it would be useless to treat someone who is already dying as well as someone who will live without treatment (9-11).
5.
Explain Kant's ideas about duty, universalizability, ends-in-themselves, and autonomy. How would Kant direct the distribution of a scarce resource, such as an organ or rare medication?
The Kantian ethical idea that right actions follow from maxims that are universalizable means that an act is only just if it were also just when everyone did it as well. The Kantian idea of treating humans as ends in themselves and never as mere means considers how we treat life in relation to how much it can benefit anything. Kant would make the argument that a person has infinite self-worth, so it would be wrong to utilize one person for the sole benefit of another solely because the original person is able to. The main problems involved with Kantian ethics are
that there is a possibility that certain maxims can be contradicted, causing controversy between maxims. Additionally, it is impractical to assign all people with infinite value because there's no guideline for tradeoffs. As far as ethics in medicine, Kantian ethics provides an understanding of why participating in medical experiments is still prevented regardless of informed consent due to
the idea that people are only free only when acting rationally (11-12).
6.
The ethics of care (aka feminist ethics) emphasizes notions of trust, cooperation, nurturing, and bonding. Explain how a feminist minded physician would care for his patients.
The core notions of the ethics of care are more "feminine" virtues and thus relate to a more family-orientated than the more conventional medical ethical theories. The notions of trust, cooperation, nurturing, and bonding are used to focus the theory around the family unit rather than the individual. (12-13)
7.
What is virtue ethics, according to the Greeks? What kind of person will make ethically sound decisions according to this theory?
According to the Ancient Greeks, virtue ethics were the skills necessary for an individual to perform a role well, an example being a physician and virtues such as compassion and healing. To Ancient Greek scholars, the four great human virtues were human courage, temperance, wisdom, and justice - the cardinal virtues of being ethically sound. (13)
8.
Natural law theory in ethics attempts to make rules of ethics similar to scientific laws by having all of these: discoverable by reason, apply to everyone in the universe, and given by a "Law-Giver."
a.
What is one major issue with equating that which is “natural” with that which is “moral” (consider the case of homosexuality)?
b.
What is the doctrine of double effect and how could an abortion be justified on this view?
c.
What is the principle of totality and how could it be applied in the medical setting?
a)
One major issue associated with equating "natural" and "moral" is that what is moral may
not be consistent over the course of time. The example given by Pence is the argument on
homosexuality; the moral standing on homosexuality has varied from acceptable in ancient societies, such as the Greeks, to condemned under the Thomistic teachings, to now gaining more acceptance as a natural in the modern world. This exemplifies a clear disconnect between natural law and morality (13-14).
b)
The doctrine of double effect states that if an action results in both a good and evil effect, the evil effect is permitted if the action itself was good, the good effect followed as immediately as the evil, only the good effect was intended, or if the action was just as important as the result of allowing an evil effect. An abortion can be justified through this
view if the case is that keeping the child would threaten the life of the mother (14).
c)
The principle of totality states that the human body can only be altered to ensure its proper function as the body does not belong to an individual and is rather held in trust from god. This means that an individual can amputate a limb or perform a surgery that will directly keep him or her alive, but it also brings up the argument of setting a limit. Are we following the principle of totality if we begin to genetically alter the human body to be more efficient, live longer (14-15).
9.
The following theories of justice focus on distribution of wealth and how this distribution
affects medicine: Libertarianism, Rawl’s Theory of Justice, and Marxism. For credit, explain Rawlsian contractarianism and explain why he would judge the American healthcare system as unjust.
Rawls would find the American health care system to be very unjust. As it stands, the health care system in America is firmly rooted in free market, Capitalist beliefs - everyone is responsible for their own health and we do not subsidize throughout the population and the healthy are not responsible for the unhealthy. Rawls view is that the Golden Rule should be mandated at a societal level and that the fair treatment of the poor and unhealthy is a matter of justice, not personal choice. (15-16)
10.
Four Principles of Bioethics
a.
Explain the principle of autonomy. What is the harm principle?
b.
What is paternalism?
c.
What is the primary idea of the principles of beneficence and nonmaleficence in medical ethics?
d.
What is the principle of justice as it relates to medicine? a)
Patient autonomy is the principle that patients should be able to make their own decisions
about their body and treatment without treatment being forced upon them. Harm principle
is that the only way that some type of power can be forced onto someone is to avert causing harm to others (16-17).
b)
It is rejected for paternalistic doctors to impose their firm opinions for treatment on patients who may have other ideas of how to get treated (17).
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c)
Beneficence is to treat the patient with the intent of helping them. Nonmaleficence is the idea of not harming others; for example, unqualified doctors should not perform certain procedures if they haven't mastered those skills yet (17).
d)
The principle of justice can be applied both socially and politically. In medicine, socially, it means that doctors should treat patients with similar illnesses in a similar fashion regardless of the patient's' insurance. Politically, it refers to the distribution of sparse medical resources - therefore, it guarantees patients with insurance treatment (18).