philosophy
examines fundamental problems about pretty much everything--existence, knowledge, values, the mind, etc.; doing philosophy involves critical examination of concepts, discussing reasons for and against accepting certain propositions, examining our preexist
ethics
branch of philosophy that specifically looks at questions concerning moral conduct (what is right? what is the best way for people to live?)
meta ethics
studies what ethical properties are; it answers questions like "what is the status of moral facts" and "can we have knowledge of what is right and what is wrong
normative ethics/moral theory
studies what makes actions right and wrong; it offers systematic ways determining the right course of action
applied ethics
the study of how to answer moral questions in real-life situations; applied ethics often uses theories from normative ethics to do so
the FIT FAT
F-acts, of the specific case, the context, and what we know from science)
I-ssue, what is/are the relevant ethical questions and issues
T-hesis, what is your/the author's stance on the issue
F-or, the arguments for your thesis, will appeal to moral theori
basic ethical theories
define what it means to act morally; because they define moral actions, they us a way to explain and justify actions
- explain action by showing that the theory required us to act as we did
- justify action by something that, according to the theory, we h
justifying a theory
does not (and should not) appeal to religion, faith, or non-natural factors--it should only involve rational persuasion
utilitarianism
do a cost-benefit analysis and choose action that maximizes benefit (happiness) and minimizes cost (unhappiness)
- consider the happiness of everyone (not just your own)
- need to look at situation as an objective, impartial observer
the aim of ethics is
example of utilitarian
10 dying patients in a small clinic in a village who have a rare blood disease and they urgently need blood transfusions from a healthy individual with blood type O. Coincidentally, a healthy individual with no friends or family walks into the clinic for
benefits of utilitarianism
- fairly easy to apply to decisions, gives a definitive result
- captures the intuitive idea that happiness/pleasure is good and should be maximized and that suffering should be minimized
problems with utilitarianism
- hard to precisely quantify
- can't calculate future consequences
- undermines love and friendship (doesn't allow us to have preference for loved ones)
- allows us to justify the suffering of a few people if it benefits the many (unethical research, peop
Kantian deontology
- a type of moral theory that holds the actions in themselves are right or wrong
- actions are right or wrong in themselves (the morality of the actions doesn't depend on the consequences)
- an action is right if its in accordance with the moral law and i
deontology; when is an action right?
- moral law is derived form the "categorical imperative": "act only according to that maxim by which you can at the same time will that it should become a universal law"
- when we act, we are endorsing a rule about action) a maxim. Imagine that everyone f
an implication of the categorical imperative is the humanity formulation
always act so as to treat humanity, either yourself or others, always as an end and never as a mere means to an end"
- moral action always respect the autonomy and rationality of ourselves and others--so lying and coercion are never moral
- every rationa
perfect duties
several things that are never okay under any circumstances:
- murder
- lying
- stealing
- breaking promises
- suicide (because you are using yourself as a means to an end--to end suffering/pain)
imperfect duties
duties we are only sometimes required to do, but NOT if they go against our perfect duties
- help others in need
- assist others in achieving their goals
benefits of kantian deontology
- clear rule to follow: all we have to do to figure out if an action is right is to test whether is satisfies the categorical imperative
- prohibits actions we tend to think are really wrong (murder, lying)
difficulties with kantian deontology
- seems like consequences should matter sometimes
- weird result when duties conflict (promise to meet a colleague but someone has just collapsed from a heart attack)
- our duties are to rational beings, but how do we decide who is rational? (fetuses? inf
Ross's ethics
- incorporates aspects of both utilitarianism and Kantianism
- deontologist view that recognizes that it is necessary to consider consequences
- what is right is not the same as what increases pleasure (increasing pleasure is nonmoral), but there is a con
prima facie duties
- bind all moral agents, and Ross thinks we can come to know them through intuition
- a list of some prima facie duties:
- duties of fidelity (tell the truth)
- duties of justice (prevent distributing happiness in a way that goes against what people deser
benefits of Ross's ethics
- lets us consider unique features of situations and factor these into our decisions
- accommodates both the intuition that some actions are right or wrong in themselves, and also the intuition that the consequences of actions matter as well
difficulties with Ross's ethics
- do we really all have the same intuition of prima facie duties (education and culture affects and beliefs duties, e.g. honor culture)
- hard to resolve moral disagreements: moral disagreements are the result of ranking prima facie duties differently, an
major moral principles
- instead of using a theory (can be difficult, especially in stressful situations that require quick decisions), its okay to appeal to moral principles
- like guidelines for making decisions
- uncontroversial and they are endorsed by all the major moral t
principle of nonmaleficence
- "we ought to act in ways that do not cause needless harm or injury to others"
- we have a duty to avoid harming people
- ways of violating this principle?
- intentional harm, negligence, not possessing the proper skills or knowledge
- violation dose not
principle of beneficence
- "we should act in ways that promote the welfare of others"
- duty of a physician to act for the sake of the patient's good--provide appropriate treatment, make reasonable sacrifices
- imposes social duties as well--society should promote the health of i
principle of utility
- "we should act in such a way as to bring about the greatest benefit and the least harm"
- can be used as a way to balance between principles of beneficence and maleficence: can help us rank social needs and find the way to do as much good as possible
-
principles of distributive justice
- distributive justice concerns the question of how we should distribute social benefits and burdens like medical services, welfare payments, and taxes (e.g.- is everyone in society entitled to receive health care, regardless if they can pay?
- theories o
principle of autonomy
- "rational individuals should be permitted to be self determining"
- each person is uniquely qualified to decide what is in her own best interest. we are free to determine our own actions and pursue our own aims
- we each have inherent worth, and other p
restrictions on autonomy
- sometimes restricting autonomy is justified, principles that justify it:
- harm principle: restrict freedom of action to precent harm to others
- paternalism: restrict a person' freedom to avoid them harming themselves (forced treatment, drug laws)
- le
Dax Cowart
- got in an accident and asked to die as soon as it happened but his mother consented to the treatments
In 1974 (accident happened in 1973), when he was transferred, he still refused treatment. He was found by a psychiatrist to be fully mentally competent
paternalism
- a principle that can justify conditions in which we are permitted to limit autonomy
- acting in a way that is believed to be best for another person, even if such action goes against the person's desires or limits their freedom of choice
- in contrast w
personal paternalism
the patient-physician relationship
- patients have a dependent role--patient is in need of knowledge and skills physician has, not visa versa-so some paternalism seems warranted
- the patient surrenders some of his autonomy and does what the doctor deems
confronting death
- Burt argues that it is more important that physicians don't simply implement a patient's desires-instead they should ask why the patient wants what she wants; permissible for physicians to take time to argue with their patients
- "we define one another
framing effect
- cognitive bias
- lots of cognitive biases and they all affect our ability to make classically rational, logical decisions
state paternalism
- control over a person exerted by legislature or government through laws, licensing requirements, and regulations
- licensing for physicians protects people from being treated by someone who is incompetent
- what about treatment regulations? should peopl
vaccine controversy
- science has rejected the vaccine hypothesis of autism, but some of the public has held onto it
- many parents accept the idea that vaccines damage the immune system and result in brain damage
- all states have laws requiring vaccination before school, b
parent autonomy
- conflict between the parent's authority and autonomy when it comes to determining what is best for their child and the child's entitlement to have the opportunity to develop into an autonomous adult
- Jehova's Witness dilemma: child needs blood transfus
micro allocation decisions
allocation decisions that directly involve individuals (like who gets a transplant)
allocation and moral theory
Kant
- each individual has inherent moral value, so we shouldn't choose to sacrifice somebody based on any criteria about them (like age, social worth, etc). A purely random lottery would be morally acceptable
Utilitarian
- We should take into account the
anna's "rationing schemes for organ transplantation
- We need to use some rationing scheme to choose between potential transplant candidates
- Argues that an allocation scheme should be efficient, fair, and respect the value of life.
the market approach
- provide an organ to everyone who could pay for it with their own funds
- high value on individual rights, low value on equality and fairness
- problematic because transplantation technologies have been developed with public funds, financial success is a
committee selection process
- a committee is set up that decides which patients will receive transplants
- allows people to consider all the relevant factors without having to rely on specific criteria that may ignore context
- problematic because the committee is vulnerable to choo
lottery approach
- potential recipients are chosen at random
- emphasizes equality--all candidates have an equal chance of being selected
- however, it may not be considered fair because it doesn't factor in the survival potential of the candidates, their quality of life,
customary approach
- Individual physicians select patients based on medical criteria or clinical suitability
- Lets society avoid explicitly making choices about allocation
- Problematic because this often includes many hidden "social worth" criteria�sufficient family to he
anna's approach
Says a socially acceptable approach to allocation needs to be fair, efficient, and reflect important social values
1. initial medical screening�to determine probability of success transplant. Needs to be independent of social worth
2. After passing screen
prisoners
- prison inmates are entitled to medical treatment (8th amendment that prohibits fed. government from imposing cruel or unusual punishments)
- treating prisoners is very costly
- death row inmates eligible for transplants?
arguments against:
- 1: social w
social worth
- "When it comes to healthcare 'bad people' are as equal as the rest of us"
- All the authors agree that social worth judgments shouldn't be considered in medical allocation decisions�why?
- Involves measuring people according to an individuals own values
alcoholics and liver transplants
moral:
- Alcoholic cirrhosis is brought on by a person's conduct�their choice to drink heavily over their life. Therefore, they shouldn't get a liver over some one whose liver disease was not under her control at all
- Alcoholism is a moral failing, it in
required response laws
- laws that promote organ donation which involve declaring if you want to be an organ donor when you renew your license
- signing donor card provides legal consent, but OPO often asks family for permission
- federal "required consent" law requires hospita
opt- in vs. opt-out ("explicit" consent vs. "presumed" consent)
- America has an opt-in process for organ donation�you have to give explicit consent
- Other countries have "presumed consent"�you have to explicitly opt out of being a donor
- About 50% of Americans are registered donors whereas 90+% of donors in opt-out
voluntary donations
- allow for living people to donate parts of their organs
- donation is risky
- allowing living people to donate organs poses an ethical challenge" it violates the principles of nonmaleficence because physicians are causing risk to the healthy donor for n
selling organs
- exploitation of the poor vs. autonomous choice
- social justice (rich get things poor don't)
- commodifying human life
- open the mark for selling organs
Objection 1 to selling organs: it exploits the poor. How?
- Choice to sell is not genuine because (
conscription from cadavers
- take all usable organs from deceased people without requesting their consent
for:
- dramatically increase # of organs available for transplant = more lives saved
- less costly (don't spend resources trying to convince people to donate)
- alleviate stres
healthcare crisis
- US spends 2.5 more than OECD average
- 2010, 20% of americans lacked insurance (many denied due to preexisting conditions)
- 85 billion annual cost of uncompensated care (hospitals required to stabilize critically ill)
- ACA attempt to address problems
why let society pay for HC?
- 1: practical reasons: will cost less money overall to have a single-payer system
- 2: moral obligation: society has a moral obligation to provide access to adequate care because health is essential to well-being and opportunity
- 3: moral right: each pe
rights vs. obligations
moral right vs. moral obligation:
- we might say that the government has a moral obligation to provide adequate HC, which would mean that society morally ought to provide care, and it would be subject to moral criticism if it didn't. but this does not mea
claim rights
- duties or obligations on someone else on behalf of the right-holder (e.g.- if I have a claim right to X, this means that other people have a duty to allow me to do X or provide me with X)
- legal right are usually claim rights (example-If I pay someone
moral rights
- rights that are derived from a moral theory
- if I have a moral right to X, this means that others have a moral duty to see that I receive X
- moral rights are a kind of claim right, but the source of justification is different--from moral principles/th
political rights
- rights that are required by our political commitments or principles
- american is often seen as being committed to individual autonomy, equality and justice
- but where do we get political rights form? usually moral theory
- to say HC is a political rig
HC is a moral/political right
- just societies are societies that respect and uphold people's rights
- if HC is a moral or political right, then a just society has a duty to provide HC
- if HC is not a right, then we may be imposing on people's autonomy when we require them to pay for
is HC a right?
- two issues:
1- what does a just society involve? is a just society more concerned with preserving autonomy and freedom or is it more concerned with fairness and equality?
2- is HC a commodity? if we think of medical care as a commodity, then we might th
justice and rights
- whether or not HC is a right might depend on what you think a just society looks like
- libertarian theories of justice: based on the idea that we only have negative rights--rights not to be harmed; emphasize personal autonomy (prohibit taking person's
why is HC a right on welfare theories of justice?
- find it permissible for there to be inequalities in access to commodities, so the question of whether or not HC should count as a commodity matters
Daniels "equal opportunity and HC
- HC is necessary for maintaining normal functioning, why is this important?
- Normal Opportunity Range
- the array of life plans reasonable people in a given society are likely to construct for themselves
- the portion of this normal array that is open t
Nielsen "autonomy, equality and a just HC system
- "liberty cannot flourish without something approaching the equality of condition"
- if we value autonomy, we have the accept that the life of every autonomous agent matters and matters equally
- power needs to be shared so one group cannot dominate anot
sum up
- welfare theories say HC is a right because it is required in order for people to get their fair share of opportunity
- libertarian theories say HC is not a right because the only rights are rights not to harm peoples life, liberty and property
- BUT it