Test 1 Study Guide

Test 1 Study Guide Paternalistic Deception 1. I give you a case – you tell me if it’s an example of selfish or paternalistic deception.  Selfish Deception – When a physician deceives a patient for the physician’s benefit.  Paternalistic Deception – When a physician deceives a patient for the patients benefit. 2. How many ways can a doctor paternalistically deceive their patient (that we discussed in lecture)?  Way 1: Lie to Patient  Way 2: Withhold (part of) the truth. 3. What is Collins’ and Lipkin’s Reason 1?  Telling the whole Truth – Claim: Physicians should often not tell patients the whole truth. 4. What is Collins’ and Lipkin’s Reason 2?  What Patients want – Claim: Patients often don’t want to know the truth. 5. What is Collins’ and Lipkin’s Reason 3?  Harming Patients – Claim: telling the whole truth can be harmful and deceiving can be beneficial. 6. What is Collins’ and Lipkin’s Reason 4?  Autonomy – Worry: deceiving patients violates their autonomy.  Response 1: Deceiving promotes autonomy.  Response 2: Deceiving limits autonomy, but the benefits outweigh. 7. What do Cullen and Klein say about selfish deception and paternalistic deception (see their argument)?  Selfish Deception is wrong.  Selfish deception is wrong because it violates your patient’s autonomy.  Paternalistic deception also violates patients’ autonomy, which means it’s also wrong. 8. What do Cullen and Klein say about telling the whole truth?  Obviously, can’t tell patient everything.  But still need to tell patient what they need to know to make informed decisions (disease, seriousness, risks, benefits etc.)  Same in other professions. 9. What do Cullen and Klein say about what patients want?  Default Position: assume patients want to know.  Explicitly doesn’t want to know. Can withhold info but shouldn’t lie. 10. What kind of evidence do Collins and Lipkin use? What kind of evidence do Cullen and Klein use?  Collins and Lipkin- Telling the truth can be harmful and deceiving can be beneficial. Personal Experience  Cullen and Klein- Overestimating benefits of deceiving. Underestimating benefits of telling the truth. Studies Euthanasia 1. I give a case – you tell me if it’s active euthanasia, passive euthanasia, or physician-assisted suicide.  Euthanasia: Directly or indirectly bringing about another’s death for their sake.

 Active Euthanasia: Euthanizing a patient directly (mercy killing). You kill the patient By performing some action.  Passive Euthanasia: Euthanizing a patient indirectly. You allow the patient to die. By not doing something to prolong their life.  Physician-Assisted Suicide: Patient takes their own life, but they do so with the aid of the physician. Physician provides resources and instructions on how to commit.  2. I give a case – you tell me if it’s voluntary, nonvoluntary, or involuntary euthanasia.  Voluntary: When patients consent to Euthanasia. Competent and disclosed their preferences when competent.  Nonvoluntary: When patient cannot consent to euthanasia. Incompetent and didn’t disclose their preferences.  Involuntary: Goes against patients consent. 3. According to Brock, what 2 values support voluntary active euthanasia?  The value of individual autonomy, us making our own decisions for our own lives  The value of individual well-being supports voluntary active euthanasia, sometimes life can be burdensome. 4. Brock argues that withdrawing life support kills a patient, instead of letting them die. What hypothetical case does he create to defend his argument?  Both Sound like killing  Killing doesn’t automatically sound worse than letting die.  Voluntary active euthanasia is special. But why is killing so bad? 5. What does Brock say about the potential consequences of legalizing voluntary active euthanasia?  Good Consequences – Respects patient autonomy. Reassures everyone that they don’t have to endure awful dying process. Relieves pain and suffering. Sometimes, a quick death is more psychologically humane than a slow one.  Bad Consequences – Patients could lose trust in their physicians. Potential for abuse. Others ..... 6. Some say lethal injections violate the point of medicine. What is Brock’s overall response regarding the point of medicine, lethal injections, and withdrawing life support?  The point of medicine is to preserve and promote human health. But Injections don’t preserve and promote human health, they eliminate human health.  Withdrawing life support preserve and promote human health. It eliminates human health, but is said it doesn’t violate medicine- why? It values autonomy and well-being. 7. Why does Callahan say autonomy does not promote voluntary active euthanasia?  Voluntary active euthanasia is not just about the patient’s autonomy. Mutual decision between physician and patient. Can’t waive your right to life. 8. According to Callahan, do lethal injections kill patients or let them die? Does withdrawing life support kill patients or let them die?  One is killing, the other is letting die. Difference: cause of death. Shouldn’t make it legal for physicians to be killers. 9. What does Callahan say about the potential consequences of legalizing voluntary active euthanasia?  Law would be used. Netherlands: Substantial amount of nonvoluntary active euthanasia. Holland: casual and indifferent attitude towards abuse.  Safeguards would not protect against abuse. Hard to write and enforce. 10. According to Callahan, what is the point of medicine about?

Genetic Enhancement 1. What is a treatment and a gene therapy?  Treatment: Keeping you at or bringing you back up to normal health.  Gene Therapy: Manipulate your genetic material for the purpose of treatment. 2. What is an enhancement and a genetic enhancement?  Enhancement: Brining you beyond normal health.  Genetic Enhancement: Manipulate your genetic material for the purpose of enhancement. 3. What does Glannon say about genetic enhancements being unfair?  It would give competitive advantages to those who got them.  Chances are, not everyone could afford genetic enhancements.  Not a fair playing field. 4. According to Glannon, would giving everyone access to genetic enhancements make things better? Why or why not?  Getting your career, income, and social status is competitive. It’s abou t competing against others.  If everyone gets genetic enhancements, then your competitive advantages are the same. 5. What does Glannon say about genetic enhancements and valuing equality?  We often think equality (in some sense) is valuable. Social harmony and stability.  Imagine what would happen if some people had genetic enhancements.  Genetic enhancements wouldn’t work on everyone, so its worse to give to everyone, not better. 6. What does Glannon say about genetic enhancements and agency?  Agency: Suppose we could enhance us to make us better people.  We want generosity to come from within us and not from an outside source. 7. What does Savulescu say about genetic enhancements and equality?  Neglectful Parents: wrong not to give. Don’t give supplements to keep stunning.  Lazy Parents: wrong not to give. Parents don’t give supplements to make stunning.  Genetic Enhancements: wrong not to give. Switch “supplement” and with “genetic enhancement”.  Genetic enhancements can make more equal.  Not about enhancements, but social instiutions. Problem is how people in our society treats people with disabilities and enhancements. 8. What does Savulescu say about genetic enhancements and competitive advantages?  But what about education? We still want to give people access to education.  It’s not just about competitive advantages. About enjoying life better. About having a better society. 9. What challenge could Savulescu make to Glannon about genetic enhancements and agency?  In all cases generosity was chosen by outside sources.  They still have free will, and that counts for something. 10. According to Savulescu, what should guide societal health decisions?  Health matters because it enables us to live well. So that’s what should guide our societal health decisions.  We should allow both treatments and enhancements.

Health Care Rights and Systems 1. What does a right to health care include (for this course)?  Access to an adequate range of health care goods and services  Comparable quality of these goods and services, regardless of race, gender, etc.  Protection from medical debt, regardless of ability to pay. 2. I will describe a health care system – you tell me if it’s non-universal, single-tier, or multi-tier.  3. What Rawlsian principle does Daniels take and apply to health care?  The principle of equal opportunity - don’t have different opportunities because of their race, gender etc. 4. Why does Daniels say we have a right to health care?  We have a right to health care because it preserves and protects equal opportunity. 5. Why does Daniels say non-universal health care is NOT okay?  We all have a right to health care to help maintain and restore us back to full health.  Only reason we wouldn’t is if we didn’t have resources, but the United States has an abundance. 6. What are Daniels’ reasons to prefer single-tier health care?  Multi-tier system may pull resources from basic tier to provide better health care for wealthier people.  It may worsen social solidarity. 7. Why does Engelhardt say we don’t have a right to health care?  It would be nice, but society does not provide you with health care. Only responsible for you needing healthcare. 8. Engelhardt considers 4 goals a health care system could have. What problem does Engelhardt have with a system that tries to achieve all 4 goals?  We can’t have a system that does all that.  Goals 1 & 2 would be impossible for society to pay.  Goals 3 & 4, you can’t give everyone the same health care while also giving people the freedom to choose other health care. 9. Why does Engelhardt say single-tier health care is not okay?  It Violates our property rights. It violates peoples right to use their money as they choose. 10. Engelhardt says multi-tier health care is a compromise between what 2 values?  Gives everyone affordable access to basic tier but allows people to spend their money on better or quicker access to health care.