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Western University
Health Sciences
Health Sciences 2610F/G
Ken Kirkwood

HS 2610: Introduction to Ethical Theory Meta-Ethics ­ The fundamental beliefs and/or knowledge that contextualize your ethical beliefs ­ Meta-ethics: pure theory about right and wrong ­ Ethics: deciding what is right or wrong in situations (meta-ethics applied) ­ Action: following through o Actually doing what you think is right, not always the “right thing” ­ Talking about ethics- not ethical issues (theory not application) ­ Takes place outside ethics- before actual ethical discussion about a subject can begin ­ Foundation of your ethical beliefs o Must be consistency ­ Examples of meta-ethical questions o What is right and wrong? o How can someone know right from wrong? o Why behave ethically in the first place? o Where does moral authority come from o Is there a universal moral truth? o Realism vs. Anti-realism Realism vsAnti Realism ­ Realism: universal truth (facts) exist outside of mine (truth is “real”) ­ Anti realism denies that universal truth exists o Moral values are not like those facts ­ Most people are inbetween  figure out where you are ­ Your metaethical perspective helps guide your ethical beliefs and actions ­ Explain inconsistencies  your moral framework Ethics ­ The discipline or field of study itself – working with theory on issues ­ Doing or engaging in ethics ­ Takes place inside ethics ­ Ex is abortion an ethical medical practice? o This leads to “What is ethical medical practice?” ­ Applying knowledge to resolve how we feel about things or what are we going to do about it Unethical: judgment about an action or thought Non Ethical: unjustified/ unexplainable views (no justification) Morality: public opinion about ethical issues Basic Distinction in Ethical Thinking ­ Health science deal with o Matters of fact  Description  What is or is not factually the case  What was or will be factually the case  Can we genetically select the kinds of children we want?  Can we keep individuals in permanent vegetative state alive indefinitely  Expressed with statements  Admit of truth and falsity  Ex Hitler was a man  Ex abortion involves termination of pregnancy o Matters of value  Normativity  What should or should not be done  What ought or ought not be done  Should we genetically select the kinds of children we want?  Should we keep persons in a permanent vegetative state alive indefinitely?  “Hitler was an evil man”  “Abortion is morally wrong” Statements of Value ­ don’t come with statements of truth or falsity ­ come in two varieties o aesthetic (to do with the senses)  value something over something else o moral Judgments acceptable “Can to Should” Fallacy Definition of Ethics ­ “Ethics deals with questions of right or wrong conduct, and with what we ought to do and what we ought to refrain from doing. It considers issues of rights and obligations and how these are related to the social setting” o how is this different from law?  In law: what we should or should not do • Ex Rosa Parks: broke law but she is not immoral • Velma Demerson • Immoral and illegal overlap Descriptive Ethics ­ concerned with describing ethical behaviour ­ attempts to determine what, as a matter of sociological or psychological fact, we morally do or say ­ ex why did you cheat? Prescriptive Ethics ­ concerned with prescribing behaviour ­ subject to error ­ decides how you think you should behave and often advise people on what you think they should do ­ Descriptive becomes prescription with information ­ attempts to determine what, as a matter of obligation, we morally ought to do Meta-EthicalApproaches 1) Ethical Objectivism 2) Ethical Relativism 3) Ethical Non-Cognitivism Ethical Objectivism ­ Right and wrong are “objective phenomena” ­ Objective in nature (follow this and you will fine truth) ­ Feelings play no role because ethis is a rational scientific model ­ There are “moral facts” ­ Ethics is “objective in nature” ­ Things are morally right or wrong depending on the moral facts involved ­ Moral statements are true or false depending on whether they ‘correspond’with those moral facts ­ This correspondence exists independently of our subjective personal and cultural opinions Reasoning in Ethical Objectivism ­ There are objective moral facts! We can: 1. Know them 2. Speak meaningfully about them 3. Reason about them 4. Resolve disagreements by appeal to them Tenets of Objectivism 1) Cognitivist: there is an ethical reality we can know and speak about meaningfully 2) Rationalist: ethical disputes can be rationally resolved by logic and reasoning 3) Absolutist: there is an objective right or wrong answer for every ethical question Ethical Naturalism: “ ‘morally good’is what makes us happy” ­ Moral facts, natural facts ­ Are observable, measurable facts of the natural world Non-Naturalism: “ ‘morally good’is what God commands” ­ Moral facts are not observabke facts of the natural world ­ Require specialized intuitions (ex religion) ­ Affect not any different Ethical Relativism ­ Ethical statements are not objectively true or false in virtue of their correspondence with objective moral facts ­ Nothing is universal (limited) ­ Ethical statements are true or false relative to a particular subjective point of view ­ Ethical statements are cognitively meaningful but only relatively so ­ This is the default ­ Different cognitive meanings Three Scopes of Ethical Relativism Ethical statements are true or false relative to a particular 1) Person 2) Culture or Society 3) Historical or situational context Non-Cognitivism ­ Ethical utterances are not really statements that can be validated ­ They do not assert anything objectively true or false, they assert your opinion on the issue ­ Subjective statements but do not appeal to facts Ethical Theory ­ Why ethical theory? o To bring perspective to experience o To provide moral guidance that is  Clear  Rational  Systematic  Defensible Structure of an Ethical Theory Ethical Principle(s) + Statement of initial conditions Specific moral prescription Specific moral justification Requirements for Ethical Theory 1) Epistemological Requirements -based on evidence -accountable to evidence -(falsifiable or verifiable?) 2) Logic of Requirements -consistent -consistent also based on other situations 3) Practical Requirement -must be livable! -cant have a ridiculous moral belief that is not obtainable “Ought” implies “can” ­ “you should/not do this” it has to be true that you can/not do these things Richard John Neuhaus: ­ priest, bioethicist Peter Singer: ­ takes lots of controversial views, plays the devil’s advocate a lot ­ bestiality, debated that when ppl dip below a certain level of functioning they are not people anymore ­ Debate between two, Requirements for Ethical Theory 1) Epistemological Requirements -based on evidence -accountable to evidence -(falsifiable or verifiable?) 2) Logic of requirements -consistent 3) Practical requirement -must be livable! It IS difference when it’s YOUR mother (Singer and Neuhaus) Some Popular Approaches ­ Ethical Egoism and Psychological Egoism ­ Psychological egoism (descriptive) o Psychology, simply saying people will do things for themselves no matter what o People are inherently selfish o “important for ppl to be honest” but you lie anyway ­ Ethical egoism (prescriptive) o Selfishness is morally right o Here is what you should do in these situations, here is what will actually happen ­ Aryn Rand o Proponent of ethical egoism o Everyone should do the best thing for themselves o Do what helps you the most o Help inequity?? o Said “this is how it should be” o “Do what is good for you” ­ What is good for each individual is what is ethical for him/her to do ­ Do what is good for you – it’s the moral thing to do! ­ What if being selfish will hurt others? o Anarchy, doesn’t matter ­ “Be your own hero” o Be selfish, you do you o Be aggressive about getting the things you want Psychological Egoism ­ Even if it is wrong people will be selfish ­ Description of the way the world works ­ Doesn’t matter if we know what the right thing is, we will be selfish anyway ­ People will do what they want ­ Criticism: o Simon Blackburn – ‘irrefutability’ The Darley-Batson Good Samaritan Experiment ­ In 70’s ­ Biblical Story “you should help people in need” ­ Experiment: went to seminary (trains catholic priests) go to parishes and teach them about the Samaritan, then tell some of them theyre running late (variable of stress and selfishness) everyone encountered someone who was done up to look like someone in need (actors) ­ The ones who they told were late were 3 or 4x more likely to ignore the person in need ­ The priests with no time constraint more often stopped and helped ­ You can affect someone’s ability to do what is right by adding demands on them ­ Criticism of psychological egoism ­ Simon Blackburn- “irrefutability” o No matter what you do, you cannot say this is completely selfless o Compare against penis envy aka even if you are denying it you have it worse Maybe a hard case or two? ­ Bobby Sands o IRAterrorist/freedom fighter o Put in prison in Belfast o Went on hunger fast and died o Knew it would kill him o Self interest resolved in being a Martyr? o Is that selfish? o Did he die selfish?? ­ Classical Conditioning (from psych) o Ex shock collar, shock when you do something good o Any positive feeling for doing something good for someone irradicated o Avoid doing good things Fundamental Ethical Question ­ Ought implies can o Implies follow through ­ How difficult is too difficult when it comes to doing the right/good thing? o Doing the right thing is usually difficult most of the time ­ We have a tendency not to do things if they are “too difficult” ­ Is it a question of moral integrity? o You have the strength of character to stand up for what you believe even when it is difficult ­ Is it an impossible choice or do we lack some degree of moral integrity? Moral Integrity ­ The moral character to stand up for what you believe is right, especially in difficult circumstances ­ Is it actually something that you can’t work around? ­ Moral distress sometimes because people perceive that they are not supported Moral Dilemmas ­ You have two (or more) choices, both being good or bad, and you must do only one of them (‘the lesser of two evils”) o Each might be good or bad o If you do one good thing but you are not able to do the other thing o One thing has to happen o Ex you have one good organ and two transplant candidates ­ Dilemmas can be solved by an appeal to method: description + foundations (meta ethics) + theory = appropriate choice o Anything in your fundamental/ethical beliefs that may help you o Anything that you believe based on fundamentals that may help you o Ethical dilemmas often resolved and highly unsatisfactory Deontological Theories ­ Immanuel Kant (1724-1804) ­ Duties and obligations not outcomes ­ Think about ethical view (honesty) tell truth but if it causes harm then lie o This is outcome based o Duty says you are responsible for your behaviour not your outcome o You are obligated to be honest ­ Duty based moral obligations more important than outcome-based (teleological) o Obligation to be honest ­ Duties are categorical – they are universal and absolute for all o Everyone has same obligations ­ Two classifications of duties: perfect and imperfect o Perfect duties can never be breached (e.g. tell the truth)  Morally unquestionable obligation o Imperfect duties aim towards moral outcomes (beneficence) and are always superseded by perfect duties ­ Perfect duties can be determined by the categorical imperative: 1) Act in a way that should be everyones duty 2) Never use people ONLY as a means to your own ends (aka the practical imperative) -When you get into a cab (relationship is only for transport): Only treat as a means of transportation you are violating the practical imperative If you acknowledge them as another person you are respecting the practical imperative Utilitarianism ­ All about outcomes ­ Jeremy Bentham o “Good” = pleasure (Hedonism) o “Pleasure Principle” (if it feels good, you should do it for the greatest number of people) o Most certain thing you can do is what gives you pleasure o Unbelievable equation about how to determine if something was good or not ­ J.S. Mill o Pleasure has problems attached to it o More you indulge the less pleasurable they become o Good = Happiness o Pleasure in moderation with other things o Aristotle: Happiness through a balance o Mills borrows from that; happiness is a balance of things (cant have happiness without pleasure but you cannot have too much pleasure) o Mill argues that by “happiness” he means pleasures that are both intellectual and sensual. However, Mill thinks we have a sense of dignity which has us prefer intellectual pleasures over sensual ones ­ Most common form of teleological ethics (outcome-focused) ­ Utilitarianism is based on the principle of utility ­ “One should always act in such a way as to bring about the greatest good and the least harm for the greatest number of people” ­ Maximize the good for the greatest number ­ Can demand sacrifice for the greater number ­ Meta-ethically Bentham and Mill had same theory but couldn’t decide on what good was Utilitarianism Different Ways of Applying the Principle of Utility ­ Act—determine what is good in each circumstance and then do what is good ­ Rule—determine what would be good more often than not, and then follow it as a rule 1. Act—determine if giving money to him/her will promote the good ­ Positive: you can evaluate the evidence first-hand ­ Negative gives people the chance to not do what is good (through false claims) 2. Rule—sharing money with the poor is good ­ Positive: universal, no one can wimp out of doing what is good ­ Negative: doesn’t allow for unique circumstances (rules don’t allow for exceptions) Ethical Principalism ­ Rule of thumb ­ “important to be honest with people” ­ J. Childress ­ T. Beauchamp ­ They based this theory on “minimally objective content” ­ From this, they created 4 principles to guide moral practice by medical professionals o Universal principles o Objective moral content 1. Beneficence (benefit people) 2. Non-Maleficence (don’t harm people) 3. Justice 4. Respect forAutonomy (you have the right to decide for yourself) ­ Principles work as “guides” rather than rules o Vague, because the context should inform what you should do ­ Categories of values that help determine behaviour in complex cases ­ These 4 principles are considered “common morality” = the values that “moral” people share worldwide ­ This model has become the most popular ethical model for ethical codes for healthcare professionals ­ Should be universal, they are widespread ­ Some cultural differences ­ Is the dominant model Autonomy JS Mill said: ­ “We should never interfere with a persons freedom except in three situations…” 1) He or she doesn’t know or understand what is happening 2) He or she is going to harm you 3) He or she is going to harm another person FourAspects 1) Free Action 2) Effective Deliberations 3) Authenticity 4) Moral Reflection 1. Free Action ­ Want to do something and you can do it ­ Can be linked by internal and external forces ­ Autonomy is not automatic: you must demonstrate the ability to self rule ­ Society sets standards and limits by saying what is “poor” or “reasonable” self rule ­ Very little restriction 2. Effective Deliberations ­ If you are making decisions for yourself your decision will be based on some thought or knowledge ­ Aperson “ruling him/herself’shows good judgment ­ Good = reasoned (logical, sensible, intelligible) ­ Don’t have to agree with your reasoning but they will understand it (as a patient) ­ Ineffective deliberations can be caused by: o Misinformation (deception, lies) o Missing information o Mental/cognitive issues (delusions/compulsions) 3. Authenticity ­ Be able to make decisions for YOU, for your best interests not influenced by outside sources ­ You being who you truly are, freed from external (and internal!) constraints 4. Moral Reflection ­ Autonomy involves being able to clearly articulate your values ­ You understand what your values are ­ When you do right or wrong why are you doing it? ­ What are the reasons… which has an impact on who you are ­ Ability to reflect on things morally ­ Do you know why you would choose x? ­ Or is it something you’ve adopted unconsciously and uncritically? Respect forAutonomy ­ When you respect someone’s autonomy it places a demand on the individual to not interfere and help support decision making ­ If you support the autonomy of your patient you are taking extra steps to ensure they understand ­ We can’t respect a patients autonomy by simply not breaking any rules o Consent rules for example ­ Suggest a virtuous commitment to support the patients autonomy – to advocate for it ­ Jane Storch: o “…kept in command of themselves” o If in process they are getting overwhelmed you can see confusion, change your track Informed Consent ­ If we have the right to self-determination in medical matters and we are free to choose whatever option we want for ourselves o It is logical that we should be treated like medical decisions are our choice as patients  Be reasonably informed  Be allowed to make our own decisions  Have those decisions respected ­ If you’re free to make your own medical decisions then it is ok to assume (Mill) you are reasonably informed ­ Informed consent is often considered a protective device against lawyers ­ Asignature on a form might be legally compelling, but it is the ethical minimum (in medicine and research) What is ‘fully informed’? ­ No set standard, not possible to be fully informed? ­ Referred to as a “fairytale” by one bioethicist ­ “threshold concept” (in ethical discussions – a threshold is that place where you cross from right to wrong—or hopefully, from wrong to right) o you reach the point that the person is sufficiently informed ­ Health Care Consent Act 1996 ­ Elements of consent: ­ Consent must… o Relates to treatment o Be informed o Be given voluntarily o Not be obtained through misrepresentation ­ Consent checklist: o Nature of treatment o Expected benefits o Material risks o Material side effects o Alternatives o Likely consequences Royal College of Physicians and Surgeons of Canada ­ “Physician has primary responsibility for ensuring that such communication (consent clarity) occurs” ­ Wordplay warning: “primary” is not = to absolute or total, but the weight of the responsibility is on the doctor o No stated limit to how much effort you must put into helping a patient understand the procedure they are going to offer/decline consent to o Not absolute responsibility but PRIMARY ­ Sometimes its better not to have the physician do it ­ What is appropriate information that informs consent? o Provide patients with all reasonable data o Possible alternatives o Risks of all possible procedures o Without coercion o Should encourage patients to make their own decisions o Restrict your comments to your area of expertise The Noble Lie ­ To tell a lie that benefits the deceived person ­ This is moral behaviour ­ Beneficence is more important than honesty in this case ­ Beneficence higher than autonomy ­ Be clear: lying to save your own ass is not a noble lie according to Plato How prevalent is lying? ­ Community members lied in 20% of their social interactions; students, 33% ­ Lying more common in phone calls than in face to face interactions ­ 1/7 (14%) was discovered—as far as the liars could tell ­ a tenth of the lies were merely exaggerations, while 60% were outright deceptions. Most of the rest were subtle lies, often of omission: “He and I discussed sex acts that I had performed, but he assumed they had been performed with a woman.” ­ More than 70% of liars would tell their lies again What kinds of lies are there? ­ “False positives” o lies in which people pretend to like someone or something more than they actually do o want them to feel positive o ex your muffins are the best ever o 20-30 times more common than false negatives ­ “False negatives” o lies in which people try to present a lesser opinion of something or someone o slam someone but it is not true ­ “The Truth but not the whole Truth” o factually accurate but incomplete o lies by “commission” and “omission” o commission is an action, nothing they have said is false but it is still bias Autonomy—Why? ­ Why has autonomy become such a strong concern in health care? o History of patient misuse and abuse o Rise of individualism and commercialization o Rise of “informed” patients Truthfulness and the Rise of Autonomy ­ From a strongly paternalistic/maternalistic model to a more “autonomous” patient model ­ The traditional view of medicine was to emphasize beneficence and truth was dependent on patient welfare Truthfulness vs Beneficence ­ Patients who remain uninformed about their condition may fail to obtain medical attention when they should ­ They may also make decisions affecting their lives that they would not make if they were aware of their condition ­ In addition, telling patients their diagnosis early in the course of a serious illness such as MS can be helpful simply because “some people find comfort in the knowledge that the doctors and nurses can name their problem” ­ In protecting the patient from the truth: o Often the reaction is much less negative than feared ­ The question of how one can “self rule” when also being deceived Autonomy –FourAspects 1) Free Action 2) Effective Deliberations ­ Limits the effectiveness ­ Working off false information so how effective is your deliberation? 3) Authenticity ­ Not free of outside control 4) Moral Reflection ­ Interferes with the contents of the reflection Not all are entitled to the truth… ­ The Supreme court of Canada has granted that there may be narrow exceptions to truth telling o Ex when the patients emotional condition is such that the disclosure of bad news could cause harm o Arato v. Avedon 1993 o Hopp v. Lepp 1980 Truth-Telling can have positive outcomes… ­ Patients adhere to treatment better ­ They have much higher satisfaction rates ­ They have reduced co morbidity (less pain etc) ­ They need less interventions In the event of error… ­ Ligitation ­ Hostile patients ­ College or hospital discipline ­ Studies show that patients who receive an apology are much less likely to sue… Confidentiality ­ “we have a right to privacy” o confidentiality comes from that right o it also comes from autonomy and conflicts with autonomy… o the root of autonomy lies in the fact that social stigma or persecution could interfer with your accessing healthcare services  it is an essential part of successful health care o it also comes from autonomyAND conflicts with autonomy Autonomy ­ J.S. Mill said o We should never interfere with a persons freedom except in 3 situations  He or she is going to harm you  He or she is going to harm another person  He or she doesn’t know or understand what is happening Confidentiality ­ Atrue story ­ “Mr. T” o 35 year old man, married 12 years o has had unprotected sex with prostitutes on two occasions o though asymptomatic, fears he has VD o Finds out he is HIV+  Do you tell his wife? Informed Consent in Research Why conduct research? ­ Research involving humans is premised on a fundamental moral commitment to advancing human welfare, knowledge, and understanding and to examining cultural dynamics ­ Some research you conduct can be contrary to this ­ Typically publicly funded research is like this Why do we Need Research Ethics? 1. Correct past problems and abuses 2. Prevent new problems and abuses 3. Law is not enough a. Lots of people were volunteers, but we needed a regulatory body run by researchers for researchers Past Abuses? ­ Two major atrocities in the 20 C led to codification of research ethics o Nazi Science  Used people as involuntary research  Used jews, gypsies etc  Killed people in testing ex hypothermia, oxygen stimulation o Tuskagee Institute (Alabama) Tuskagee Study 1932-1972 ­ Dr T Clark ­ Macon County, Alabama (Public Health Clinic) ­ 1931 USPHS Survey Results ­ Did not treat or tell them they had it ­ 399 untreated syphiliticAfricanAmericans ­ “study in Nature” ­ Observe natural history of disease ­ Watched how syphilis killed people ­ Did not offer treatment, told them they had these made up conditions so they could watch how they died ­ “An unusual opportunity to study the untreated syphilitic patient from the beginning of the disease to the death of the infected person” ­ This was a widely circulated published study ­ Was not done secretly Nuremberg Code 1947 War Trials in Nuremberg ­ “The voluntary consent of the human subject is absolutely essential” ­ Without voluntary consent it is assault Declaration of Helsinki 1964 World MedicalAssociation ­ Physician and Treatment Focus ­ Experimental treatments, patient thought they were getting effective treatment ­ Still happens today ­ Therapy and Research: 1. Distinction between research where aim is 2. Diagnostic or therapeutic for the patient 3. Purely scientific without implying therapeutic value to the person subjected to the research ­ Amended in 1996 Right to Standard of Care 1996 ­ Every patient including those of a control group, should be assured of the best proven diagnostic and therapeutic method ­ People have the right to the best possible treatment ­ Once you become aware that one treatment has more effective results, trial should be broken and people should have access to the best treatment TPS (Tri Council Policy Statement) aka Tri Council Code ­ Joint policy expresses the continuing commitment of the three councils to the people of Canada, to promote the ethical conduct of research involving human subjects ­ Condition for research you have to pass it ­ Abiding by TPS is a condition for public funding of research o Many universities have similar rules for private funding for its researchers Four Basic Ethical Principles of the Tri-Council Code 1. Respect for Persons 2. Non Maleficence 3. Beneficence 4. Justice ­ People who take all the risks must also be benefitted Guiding Ethical Principles 1999 1. Human dignity 2. Free and informed consent 3. Vulnerable persons ­ Know when a population is being influenced 4. Privacy and confidentiality 5. Justice and inclusiveness ­ Is this only for a certain group of people 6. Balancing harms and benefits 7. Non maleficence 8. Minimizing harm 9. Maximizing benefits Informed consent kind of the same as medical research Fundamental difference… ­ As a patient your consent must be respected ­ If you have a disease or something you are presented with treatment options and you can either have or not have a treatment ­ As a research subject your consent must be scrutinized – and can (and in some cases must) be rejected o Not as absolute ­ The difference in the two different informed consents is based in rights: o You have the right to medical care o You do not have the right to be a research subject  It is your free choice but not guaranteed to you as an inalienable right ­ When you appear in a lab to be a research subject, the researchers obligation is to determine if there is any coercion at work in your decision o Is your consent legitimate ­ The researcher is obligated (Freedman) to examine your consent for hidden reasons ­ If one becomes apparent the researcher should refuse you o Your consent to experimentation is not the same as it is for medical treatment Research Experiments on Inmates ­ Good way to get parole faster ­ Participating because they think there is a reward for them ­ Can also be threatened into doing it ­ Such a unique environment Coercion ­ Expectation of favour – reference for parole, example of good behaviour, coincides with treatment ­ Give something you cannot refuse ­ Vulnerable populations are groups who have structural/systemic vulnerability to the powerful who may want to research using them Vulnerable populations 1. Institutionalized disparity of power 2. Inability to respect their own best interests 3. If the population have to consider punishment or rewards before participating 4. Susceptibility over power ­ can the person follow through on a threat Coercion vs Inducement ­ Coercion = forcibly against your will o Threat of force is almost always not allowed in research participation or recruitment ­ Inducement = reward, ultimately your choice o Are allowed, so ling as they are not “undue” ­ Ezekiel Emanuel o Defines coercion and inducement differently 1. Something good, a gift a reward etc 2. Seems irresistible 3. Inducement causes taking of unusual risk 4. This risk taking must create unethical or excessively risky situations ­ ^ These are problems ^ “Voluntariness” ­ Can be addressed in the case of coercion or inducement ­ “Would I do this is I wasn’t going to have this bad thing or harm happen?” ­ “Would you participate in the research if it turned out that the inducement was ‘out’?” Kirkwood’s Case Study of Research Ethics ­ Do survey if you do it +1% ­ If you don’t -1% coercion Reproductive Ethics The concept of personhood & its relationship with abortion Issues: the status of the fetus ­ Is it a person? o Sentient being, have feelings, thoughtful, have expectations in life, can respond to stimuli in a meaningful way etc ­ Can it be terminated? Should it be terminated? Why is a definition of personhood so important? 1. For abortion: the status of the fetus is critical 2. For end of life scenarios: when – if ever – does one lose personhood? 3. For our treatment of other creatures – are higher order mammals “people.” Uncontroversial – ‘normal’adult human beings More controversial: ­ Fetuses, infants, children ­ Animals ­ Robots, artificial intelligence, computers ­ Mentally disabled, severely physically disabled ­ Alzheimer’s patients Personhood is easy when you look at beings and say you are a person however it becomes difficult looking at fetuses, children, those who are comatose etc Humanity ­ Is the biological category from which personhood is derived ­ Species ­ People are a subset of us ­ Humans have rights too (human rights) ­ Most rights are enjoyed by the legal status of people o Ex children cannot vote because they are not ‘legally’people ­ We don’t desecrate bodies when they are dead Personhood ­ Is a legal status, not a biological one ­ Ethical status ­ Aperson is not a thing ­ Aperson has rights and responsibilities, endowed with dignity, deserving respect ­ This distinguishes a person from other creatures Historical Overview ­ Aristotle thought that there were four varieties of “soul”, and that only humans had all four, but lesser creatures (intelligent mammals) had three, but plants had only one o Varieties of soul, essences of being o Because we have four we are the supreme creatures ­ John Locke (1632 – 1704) suggested that a “person” was a being capable of following laws, and feel both happiness and misery o Aperson can understand and follow rules which distinguishes us from animals as well we have a broad spectrum of emotions o Animals have limited emotions if at all ­ Descartes believed that since humans were the only creatures to contemplate their souls and not be slaves to their physical needs, that humans were the highest form of being (the equivalent of our ‘personhood’) o We develop religions because we can contemplate high minded things like eternity and our souls and things beyond our own existence ­ Personhood became an issue in matters of voting o To not be qualified as a person it could limit you from everything ­ Ancient Greece, only citizens could vote (non-citizens were lower forms of life – working class, or slaves) ­ Renaissance: the exercise of reason was the mark of a higher degree of human (the origin of personhood?) ­ The ability to reason was thought to be a male trait not a womans ­ Therefore women could not vote because they were too emotion and unreasonable, too volatile, women were irrational ­ Mary Wollstonecraft (Shelley) – a Vindication of the Rights of Women o Made one of the first claims that women were female and therefore should be able to enjoy all the rights of people o Wrote Frankenstein???? Research her** ­ The response was that why not give the vote to chimps? o Women were too emotional and tied to hormonal to be rational, so in that regard, they were not people o Women were not legally recognized as people in Canada until 1929 ­ In the US the Supreme Court in Scott v. Sanford (1857) decreed that freed black slaves weren’t legally people, thus recognizing their human form (biological) but still denying them their rights as people o Trying to decide what to do with freed black slaves o Trying to determine their legal status o 3/5 of a person o Different enough that we can exclude them from all the basic rights that White men were entitled to How we decide questions like this are critical because rights of those who can’t speak for themselves are at stake Terry Schiavo ­ Women who had a heart attack (prev eating disorder) ­ Caused her severe brain damage ­ Her husband and her parents fought over who could control her fate ­ Husband had legal rights, wanted to pull the plug, parents did not want this to happen ­ Persistent vegetative state ­ Pictures would come out of her responding to someone emotionally, general public changed their opinion because she could feel these emotions and saw it as a sign of ‘being a person’ Different Perspectives on Personhood 1. Religious 2. ‘From reason’ 3. ‘From biological sciences’ Religious ­ Religions have different views about “when” personhood starts (“ensoulment”) o When does the creature have a human soul ­ Different religions have different standards of it ­ 40 days, 120 days, conception – not implantation, sperm’s rights? o In certain religions, you should not even interfere with conception o Human in potential is not something you should mess with ­ The a priori here is that your life comes from God (is a gift) and you should treat it as something to be protected at all costs ­ Once personhood had been reached, many religions don’t believe you ever lose it – brain damage, or terminal illnesses are also from God, and should be met to demonstrate dignity, not to be halted o Once a person always a person, even preconception o Should always enjoy the rights as a person ­ Your life isn’t really yours – it’s a loaner, and you cant abuse it or take it on your own (suicide) From Reason ­ Philosophers of the Renaissance ­ The main distinction between men and non-men was their intellectual activity ­ Men shared behaviour with animals: procreative, excretory, physiological systems ­ But the superior minds of men made them better ­ So to be a person, you had to be able to exercise reason (to the highest form of intellect) ­ You could be a human, a man even, but lacking reason made you “mad” (insane) and thus subhuman and institutionalized From Biological Sciences: ­ This is where the future challenges to personhood will come from: ­ The emphasis is on finding traits of fetuses or comatose people that are similar to ‘persons’ o Find ways to communicate with them o If you could relay something to a fetus and have it respond a stimuli you could create the possibility that a fetus is a person, this could create enormous moral issues Examples: 1. Music appreciation by fetuses 2. Cognitive abilities of the comatose So your working definition of personhood would have to provide answers for the following: 1. Abortion (when does personhood start?) 2. Euthanasia (when does personhood end?) 3. Animal rights (who should be included in personhood…only humans?) 4. Enhancement (can you fundamentally alter yourself until you are no longer a person?) “MorningAfter Pills” ­ Modern varieties work only in a 72 hour period after sexual intercourse ­ Some work on inducing a menstrual period out of sequence ­ If this is an interference with implantation—is it the same ethical issue as abortion? ­ Surveyed 1145 women: o 68%were having their first abortion; 23% their second; 9% their third o Average age 23 o “White” 86% o Canadian-born 85% o 616 (55%) of the women reported using birth control prior to this pregnancy, 60% of those were due to condom failure “Emerging” Ethical QuestionsAround Reproduction ­ More aspects of FAS and how bad it is to drink excessively while pregnant o Lots of cases where pregnant women drink lots but rates of FAS is low o Is alcohol consumption the only variable that matters? o Related to healthcare system? o Should bartenders and liquor services be charged if they refuse to serve to women who they perceive are pregnant ­ Genetically modified babies o Egg donors? Selecting traits that you want? ­ Premature babies o Grey area survival wise, cannot usually survive without support o 28 weeks can be viable outside of mother, 24-28 weeks it is questionable o Ask these women about resuscitation, what is the babies status, is their life worth saving? ­ Artificial reproduction, older people having children o Should MDs be involved in this? Genetics 1. Eugenics: a brief history of… 2. Arguments about banning or allowing genetic enhancement and therapy research ­ The word “eugenics” was coined in 1883 by Sir Francis Galton ­ eu meaning good and genes meaning born ­ “The science which deals with all influences that improve the inborn qualities of a race; also with those that develop them to the utmost advantage” (Galton, Eugenics: It’s definition, Scope andAims) o eliminate problems that are passed down o promote breeding that brings the most genetic good o belief that certain races had desirable genes and others did not o this referral to race means something specific Plato (ca. 427 – 347 BC) ­ In The Republic, discusses the need to supply society with genetically improved human beings and how this could be done ­ Only the best people can make babies and pass down genes ­ Only certain people can make babies because we have excellent genes and will make great genetic beings Rome and Sparta ­ Infanticide to weed out “weak” babies ­ Don’t want disabled people to make babies because they will/may pass down their undesirable genetics ­ Someone who is disabled will take more than their fair share of resources to survive Two types of Eugenics ­ Positive eugenics: measures to increase reproduction in families with desirable traits ­ Negative eugenics: measures to limit reproduction in families with undesirable traits (sterilization), this was the predominant views o Was thought that sterilization was good because any offspring of those deemed unfit would have to be taken care of by others and thus was more of a burden on society Eugenics was influenced by… ­ Origin of Species: Natural Selection ­ “Survival of the Fittest” ­ Mendel’s studies on the inheritance of traits ­ Agriculture/Animal Breeding o For thousands of years people noticed that whe
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