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2D03 Review 2 .doc

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McMaster University
Stefan Rodde

Part A Question 1 According to the Standard Model of autonomy four conditions must be met if a decision is to be autonomous. The four conditions include: 1.Patient is deemed sufficiently competent/rational to make decisions Problem: There should not be a benchmark as to what counts as “rational”. Everyone is different. 2.Patient makes reasonable choice from set of options- Who decides if it is a reasonable choice? 3.Patient has adequate info to make a choice- what if none of the choices include the patients wishes? What if the info isn’t relayed properly? 4.Patient is free from explicit coercion toward any of the options available- This assumes we have more control than individuals really have. Culture is socially constructed and we are products of our social environment Sherwins model 1.Autonomy is the skill/competency to be self directed 2.Autonomy is measured on a scale 3. Autonomy requires adequate social conditions 4. Autonomy requires the opportunity to develop these skills Sherwins arguments are very demanding and difficult to achieve. Question 2 Briefly outline Battin’s Justice Argument for active euthanasia. Do you think that this argument provides a good reason for legalizing this type of euthanasia? Explain why or why not. Battin’s JusticeArgument for active euthanasia outlines: 1. Medical and economic resources are finite. Due to this insufficiency, full treatment cannot be supplied to every person. Therefore we must come up with a principle of distributive justice to adjudicate among the competing claims for medical care (i.e., who lives and who dies). 1. When justice demands that we kill or let die because of a lack of resources, we are euthanizing and justice demands that we perform euthanasia. 2. The argument from justice favours permitting euthanasia on the grounds that those in which the claims of a dying individual to medical resources are overridden by the claims of others in medical need that have a higher chance of survival and recovery —the claims of the dying are weakest. The brain dead, permanently comatose, or unsalvageable patients’claims for care are so weak to have virtually no force at all, justice demands that they be killed, not simply allowed to die. Argument for active voluntary euthanasia solely based on the JusticeArgument: • In 1981, the average intensive care unit bill for patients living out the end of their lives (e.g., permanently comatose, brain dead, or irreversibly nonsapient patients) was $15, 874. Alarge proportion of medical costs are incurred during the final year of life. Due to improved medical resources and technology, the cost to keep these “unsalvageable” patients in the ICU today must cost an even greater amount than it did in 1981. Therefore patients should be allowed to die and these resources given instead to those who have a medically treatable and curable condition. • The argument from justice is usually employed to justify the denial of treatment, that is, passive euthanasia. However, it can be argued that passive euthanasia doesn’t provide the most just redistribution of medical resources because “allowing” a patient to die may still involve enormous expenditures of money, scarce, supplies, or caregiver time. The quality of care can be increased if medical personnel and supplies could be used on people whose lives can be saved rather than continuing life for those who wish to die (in terms of increasing available hospital beds for in-patient care which shortens the waiting list). This also supports the patient’s right to self-determination. • The final years of a patient’s life are the most expensive. Shortening this period using active euthanasia at the request of the patient would relieve the pressure on medical resources, family finances, and economic resources. Argument against active voluntary euthanasia solely based on the JusticeArgument: • Legalizing active euthanasia based on the reason of fair distribution of resources places a great deal of social pressure on the vulnerable to “volunteer” to terminate their life to free up medical resources because of the perception that they are a burden to society. There’s pressure to take the “honourable” choice and save another person’s life who is in dire need of medical treatment who is more likely to survive and benefit from the procedure. So is this really voluntary active euthanasia if the vulnerable patient feels an immense amount of indirect coercion to impose an earlier death upon themselves? • It undermines the financing and provision of quality palliative care. It also undermines the financial distribution and research into improving pain relief treatments (which are options that substitute active euthanasia if the patient is requesting to terminate life based on suffering and pain). It also discourages the research for new cures and treatment options because a lethal injection is the easy, quick, and clean way out. If active euthanasia is legalized because it’s the cost-effective way to treat the terminally ill then it risks falling down the slippery slope of legalizing involuntary and non-voluntary active euthanasia because it is “cost-effective.” In turn this would introduce the issue of giving physicians an immense amount of power in determining at what point the claims of a dying individual to medical resources are overridden by the claims of others in medical need. Question 3 4 Standards of Proxy Decision Making 1) Subjective: - What the patient themselves do - Incompetent persons who was previously competent (Accident, illness)? 2) Objective: - What a reasonable person would do - Wants what the ideal person would want, holds non-rational people to rational standards 3) Substitute judgement - Make judgement from patients POV - Best interest must be determined by putting yourself in their shoes, preserve autonomy 4) Balances coefficient - Balance relative quality of life considerations of hypothetical outcomes from similar cases What should be used in cases where the patient was never competent? Depends on what your opinion/view is. Question 4 Explain why according to Stiegel a liberal egalitarian view of society does not support a 2 tier healthcare system? · Liberal egalitarian theories of distributive justice argue that a central goal of public policy should be to secure equal opportunities for all individuals. · According to Stiegel, a 2 tier system of healthcare would fail to provide equal opportunities for all individuals’part of society.Atwo tier system would mean that some basic services are made available to all members, while some services are exclusively offered to those that are able to afford it.According to Stiegel, the biggest flaw with such an approach is to adequately distinguish the basic services from the others. · Stiegel argues that each persons need is determined by their current situation, and that the needs for different people will always be subject to change. For example, a particular medical service might not be required for a person until a certain illness presents itself, after which a person may become heavily dependent on that service while others may not necessarily need the same treatment. · The people who are economically advantaged would be able to afford medical resources under most circumstances; however it is the ones that are unable to afford these services that rely on the system. A two tier system may hence mean that a person who was at an economic disadvantage, in that they are unable to afford sufficient medical treatment for themselves and relied on the healthcare system, would be even further disadvantaged under the new system since they will now be required to pay extra money for treatments once available for free. Hence limiting equal opportunities to society · Another factor is that some medical services are now available publicly and are based on technology currently being developed which is expensive.Atwo tier system would mean that such expensive newly developing technology be made unavailable to consumers under the basic health care package · Under the current healthcare system, all members are treated equally in terms of healthcare provision which entitles all members of society an equal opportunity to be treated. With a two tier system, this feature of equal opportunity for all will be taken away and members will be subject to financial limitations in determining the level of healthcare they receive. While the two- teir healthcare system does have advantages in terms of efficiency and resource management, the barriers to equality posed by the two tier healthcare system are contrary to the requirements of a liberal egalitarian society. As a result of equal opportunity being an important requirement of a liberal egalitarian society, a 2 tier system is not supported by such an arrangement, according to Stiegel - Don’t we currently have a two-tier healthcare system in Canada? I know that there are private hospitals Question 5 Marquis StandardAnti-AbortionArgument: Afetus has characteristics (eg. Genetic code) that is necessary and sufficient to qualify as a human being, this shows that abortion is morally akin to murder. It is always prima facie wrong to take a human life It is always prima facie wrong to take the life of a fetus through abortion Valuable FutureArgument: The loss of my biological life is a loss to me of all the experiences, etc which would otherwise have constituted my future life These experiences, etc. are prima facie valuable The loss of my biological life is the loss to me of all that is prima facie valuable about my future Depriving someone of all that is valuable about the future is prima facie wrong For Marquis, killing is wrong because it deprives someone of a valuable future Marquis is saying that depriving someone of a future is enough to make killing wrong, not that this is the only contributing factor ‘What primary makes killing wrong is neither its effect on the murderer nor its effect on the victim’s friends and relatives, but its effect on the victim. The loss of one’s life is one of the greatest losses on can suffer. The loss of one’s life deprives one of all the experiences, activities, projects and enjoyments that would otherwise have constituted one’s future personal life. Therefore Killing is wrong because the killing inflicts the greatest possible losses on the victim. What makes killing wrong is that a killing brutalizes the one who kills. Killing is wrong because it is the great loss others would experience due to our absence. Children and infants we believe will have futures of values. Therefore it is important that the wrongness to kill defenceless babies Marquis also notes that it is seriously wrong to kill persons who have little desire to live or have no desire to live. This will also help with Part B - Question 3 Question 6 1) Sentience - Only sentient beings should have the full rights of personhood o Late-term fetuses and newborn infants have visual and auditory experiences o Infants turn away from bright lights, fetuses have similar reaction with intrauterine photography o Respond to touch, taste, motion, etc - REJECT: not sufficient since other clearly-sentient creatures (mice, etc) that we are not prepared to ascribe equal moral standing 2) Self-awareness - Self-aware beings should have full rights of personhood - REJECT: although newborns are seen as persons, they lack law and common moral conviction and certain mental capacities that are typical of persons 3) Viability - Full rights when can survive outside the womb - REJECT: viability is relative to the medical care available to the mother and infant - Many premature babies can survive before the average age of viability because of sophisticated neonatal intensive care Opinion: - up to you! Question 7 • Sandel believes that human enhancement destroys our appreciation for giftedness and the ability to recognize human talents as something not subject to human will • He examines giftedness in sports and parenting to help establish its significance 1. Sports - Sandel acknowledges that a star athlete does not become a star through training, but through their own natural aptitude for the sport - The use of performance enhancers would decrease the amount of effort that athletes would need to put in in order to succeed - Sandel emphasizes that human enhancement in sports would eliminate the need for athletic giftedness 2. Parenting - Enhancing children promotes transformative love and not accepting love - Both types of love are considered important - Can leave the impression in children that they are not good enough they way they are – need enhancement in order to meet their parent’s expectations - May lead to self-esteem issues and other negative consequences that could follow the child into adulthood • Decreases the amount of effort and hard work traditionally needed to succeed in something • Undervalues individual’s natural capabilities and creates a society where everyone can be as good at something at they wish QUESTION 9 1. Outline the disease and the willpower models of addiction and explain why Foddy and Savulescu reject them. Do you agree that these models are flawed? Explain why or why not. Addiction – Key Concepts Disease o Distinction between normal and abnormal functioning - Physiological Disease o Addiction is a brain state or function caused by an adaptation from drug use Literal Compulsion - Addiction = “uncontrollable compulsion to seen and use drugs” o Addiction is non-voluntary o Addicts are not responsible for actions Debunking the Disease View - Disease View – addiction is a function of “abnormal” brain adaptations or behaviors 1) Framing Bias - Disease view involves “implicit assumption that addictive behaviors are abnormal? P1) “Addictive drugs work by eliciting the excitation of dopamine receptors… the process is different with every drug but the result is the same” P2) When the brain’s reward system is activated the neural pathways that are active are strengthened, and the person is more likely to repeat the rewarding behavior P3) But all pleasure seeking behaviors do this – they are biologically and behaviorally very similar - Therefore, C4) the distinction between addictive and non-addictive behavior cannot be based on the disease model of abnormal brain function - Since either A)All pleasure – seeking behaviors are abnormal, which is trivial Or b) none are, and such brain adaptations are within the normal operation of brain adaptation Willpower - Addiction is a failure of self-control - Addicts suffer from an impairment of their decision making process, even if it is not literal compulsion Willpower View - Willpower view – addiction is a struggle against desires or to delay temptation for a drug of choice and addicts typically loose due to lack of willpower - Assumes that addiction is characterized by a loss of control - Evidence of willpower view: A) Our own everyday experience with willpower and overcoming temptation But we need more evidence than just our intuitions B) “Claimed wish to abstain” Addicts often claim that they want to abstain but are unable to - But this testimony might not be al that convincing - Pressure to avoid stigma - Metaphorical language C) Intuition that addicted people lack control over their actions when they use - But possibility of “willing action”? - Everyday willing addiction is compatible with procedural account of autonomy If you agree or not is up to you (: Question 10 Evidence based medicine • Evidence based medicine (EBM) is the conscientious, explicit use of the best current evidence in making decisions about the care of individual patients. • This is done through evaluating the best research available, usually focusing around the efficacy of treatments. • One reason that Rodgers believes EBM may not provide better treatment for women is that there is inherent gender discrimination built into the research EBM is based upon. ◦ claims that there are recognized sex differences in the cause, response to treatment, and prognosis of diseases, due to different biological and social factors surrounding the two genders. ◦ Uses the example of how the research focuses on the efficacy of the treatment, (during pregnancy procedures for example), but not the well being of the mother during these procedures. • This doesn’t point to a problem with EBM as a whole, more so just a part of EBM. • Since EBM is based on the best research available at the time, it is up to those conducting the research to ensure the objectives are fair and clear. • EBM as a whole is a good research based method for determining the efficacy of different treatments. Part B - Question 1 Should biotechnical human enhancement be banned? Discuss in relation to Sandel and/or Bostum. Thesis: Biotechnical human enhancement should be banned because it is unfair deprives humanity of its self-worth. · Biotechnical Enhancements is developing or altering faculties through experimental measures, whereas natural enhancement is developing faculties through one’s own efforts. · It is okay to use gene therapies or enhancement mechanisms to repair or cure a disease that may result in muscle dystrophy for example, but it is wrong when it comes to going beyond natural health and enhancing just for the sake of being better than everyone else. · Sweeny’s bulked up mice experiment. o Discuss the implications that it has; both pros and cons. o These mice are far more superior than a normal one and in a society, this will create competition which can only be matched through the biological enhancement. · Sandel argues that biotechnical enhancements are wrong because it is unfair to the individuals who do not have access to these resources, it creates an underclass of citizens or a new biological class of super athletes and it is self-defeating due to the fact that no one will ever have to put any effort into obtaining a goal such as getting fit, because they can easily have that altered for them without making any changes in their lifestyle. · Cognitive enhancement is identical to physical enhancement in that it allows for everyone to obtain extreme results with absolutely no effort of their own. o This is extremely unfair for people who naturally excel above others, or have put a lot of time and energy to excel above others. o Not everyone is fortunate to have certain traits and allowing for biological modification of the sort causes everyone to be on an equal playing field, regardless of talent. o Although equality is a good thing, this makes people unappreciative of these abilities o Athletes are so highly praised because of a combination of their drive and training, but more than anything it is because of their natural aptitude for the sport, and these enhancements will render no competition because everyone will be on the same level. · People don’t just strive to be good at something, we are driven by the motivation to be better than everyone else at something. This gives pleasure and satisfaction to know that our hard work pays off. These enhancements take away from that. · If these enhancements were allowed, then this could result in a crisis in parenting as well. o According to sandel, parenting involves both accepting love and transforming love. With these enhancements parents will not feel a necessity to motivate their children to be the best they could be, because they can just get altered to do whatever they want. o It could be used for selfish gains: § It might not be available to everyone or might be too expensive § It can be used to forcefully obtain political power or resources from people that do not have access to it § Referring back to the mouse experiment, it would require a greater intake of food which means that this can increase the disparity in the global food crisis (lead to more people being malnourished because there isn’t enough food to go around); and it can increase aggressiveness which will lead to more violence and disregard for the rules, since everyone will feel superior to the rules. Question 1 I did this question in a somewhat point form format so that you could take what I have thought of and structure it in your own way however you like Should biotechnical human enhancement be banned? Discuss in relation to Sandel and/or Bostum I chose to use it in relation to Sandel Biotechnical human enhancement should be banned. · Each individual has their own human genetic DNA · We are gifted through the characteristics we receive and acquire upon and after birth · We would be losing our appreciation of human talent if everyone was perfected through biotechnical enhancements Sandel says that biotechnical enhancement is unfair because those individuals who are enhanced have an unfair advantage over those who aren’t · We can use the sports example in class to relate to this. · Some may abuse the use of biotechnical enhancement to make their abilities stand out more over others · This gives a social inequalities for those who would be ranked in the same category (for example athletes) · Those who are not biotechnically enhanced may feel they are of lesser value than those who are Sandel goes on to say that enhancement is self defeating because of the fact that it makes a person want to be better than everyone else. · If everyone was given the fair opportunity to become enhanced and chose to do so, then this though would vanish · However if people chose not to biotechnically enhance, then those who have chosen may feel superiority and it would cause a class divide within our society With biotechnical enhancement we tend to lose the appreciation of giftedness that is given to us · We tend to lose sight of acceptance for the characteristics we have when we see the potential for perfection that can be through changing and enhancing ourselves · We tend to lose appreciation when we find out something is not natural but happening because of an enhancement · And all of these losses of appreciation comes negative consequences for society · It would have a lessened effect on solidarity and humility while increasing our responsibility to become biotechnically enhanced With that I believe that biotechnical human enhancement should be banned Part B - Question 2 euthanasia Thesis: (Battin): Euthanasia should be practiced/legal in Canada on grounds of mercy, autonomy and justice. • believes that this opposition to euthanasia (that being against) is in serious moral error • mercy, autonomy, justice • argues for the rightness of granting a person a humane, merciful death, if that is what they please • on the counter: from another perspective, there must be a safer way to discharge our moral duties than relying on physician assisted suicide. Body 1: Mercy Principle of Mercy (POM): where possible, one ought to relieve the pain or suffering of another person, when it does not contravene that person’s wishes, where one can do so without undue costs to oneself, where one will not violate other moral obligations, where the pain or suffering itself is not necessary for the sufferers attainment of some overriding good, and where the pain or suffering can be relieved without precluding the sufferer’s attainment of some overriding good. • medical contexts that require mercy sometimes require euthanasia as a way of granting that mercy, either by direct killing, or letting die. (Active vs Passive) • a doctor does few things that are more important than relieving pain wrote one doctor in the Battin article • physician is in the position to grant mercy to the patient • although we are all obligated to grant mercy, physicians have a more weighted relationship with this duty as they have frequent exposure to pain and specialized treatment through specialized training • the principle of mercy holds that suffering ought to be relieved unless the suffering itself will give rise to some overriding benefit • it might be argued tho that life itself is a benefit always an overriding one, that we prize • life is a benefit that we prize yet we must not lost sight of the fact that life the reason why life is such a benefit, because of the experiences and associations and interests associated with it • for the most part this is heavily valued, but life is not a benefit at all. life contains a minimum basic of goods, when these goods are not present life becomes a negative benefit, everyone has their time • basic goods as written in Battin article consist of not being forced to work beyond one's capacity, having the support of a family or community, being able to more or less satisfy one's hunger, having hopes for the future and being able to lie down to rest at night when these are missing the connection between life and good is broken, which cannot be counted as a benefit to the person whose life it is that is being preserved - POM establishes two component duties - 1. the duty not to cause further pain or suffering; and - 2. the duty to act to end pain or suffering already occurring - when analyzing the first duty, this may require a physician to extend mercy to a suffering patient, which may mean to refrain from painful procedures that causes further suffering/pain - provided of course that this treatment offers the patient no overriding benefits. - meaning they must suspend tests, therapies or surgeries when these do not contribute to the patients overall improvement - it is difficult though to determine when survival is unprecedented (Notes from Class on Mercy: Body 1) - Principle of mercy (POM): One ought to try to relieve the pain/suffering of another person provided that: - 1.Does not contravene the persons wishes (patient wants it cannot go against wishes) - 2. It does not impose undue costs to oneself - 3. Does not violate other obligations - 4. Pain is not necessary for a higher good - 5. Pain relief doesn't prelude attainment of a higher good - Subordinate Duties to POM - do not cause further pain/suffering to patient - act so as to end pain/suffering already occurring - second duty may obligate us to euthanize a patient - Premise 1: if we can relieve pain without violating the mercy conditions, we ought to - P2: There are cases where the pain can only be alleviated by ending life of the patient - P3. alleviating pain by ending life of patient can be consistent with the mercy conditions - C4. there can be cases where we ought to end the life of a patient - problems with MA? - P2. there are cases where the pain can only be alleviated by ending life of the patient - problem: there are always alternatives to death - but: in extreme cases the alternatives are often not much different from death P3.Alleviating pain by ending life of patient can be consistent with the mercy conditions Problem: euthanizing violates mercy condition - condition 3: euthanizing violates other obligations (not to kill, not to harm) - Battin: No it doesn't P5.Alleviating pain by ending life of patient can be consistent with mercy conditions - problem: euthanizing violates mercy condition - condition 5: euthanizing patient precludes them from attaining higher good (further life) - battin: how do we know whether pain outweighs the value of remaining alive? - patient must decide if they cannot argument does not attain Body 2: Autonomy - second principle supporting euthanasia is patient autonomy: one ought to respect a competent persons choices, where one can due so without costs to oneself, where doing so will not violate other moral obligations, and where these choices do not threaten harm to other persons or parties - grounds a persons right to have his or her own choices respected in determining the course of medical treatment, whether the patient wishes treatment that will extend life but also may inflict more suffering, whether he or she wants the suffering relieved, either by being killed or being allowed to die - a competent adult has a right to refuse medical treatment on religious or personal grounds even if it means he or she could die, but not allowing this to occur it would be stripping the patient of autonomy, potentially causing them more suffering which is not supported by autonomy, for making decisions for an adult, and not supported by the POM either as it would be inflicting unwanted pain to a patient - the patient has a right to refuse a component of a course of treatment - support for autonomy in matters of life and death is partially reflected in the US law, in which a patients right to passive voluntary euthanasia (not called by this name) is established in a long serious of cases, much of this should be reflected in Canada as well - In many states, the law recognizes passive voluntary euthanasia of the no longer competent adult who has sign a refusal-of-treatment document which still competent, this protects physician from further legal action later on down the road - Canada should adopt this strategy as it has been working in the states - also the durable power of an attorney permits the patient or person to designate a relative, friend or other person to make treatment decisions on his or her behalf after they are no longer competent and can include decisions to refuse life sustain treatment - these decisions are designed to protect the patients voluntary choice to refuse life prolonging treatment - legal mechanisms for refusal of treatment all protect patient autonomy in matters of euthanasia, but these only protect passive and not active - this can be somewhat controversial as in many states legislation states (unlike passive) it is stated explicitly “nothing in this [act] shall be construed to condone, authorize, or approve mercy killing” - living will only directs the withholding or cessation of treatment, in the absence of the patient will die - legal mechanisms are sometimes said to protect the right to die but in hindsight it is important to see that this is only the right to be allowed to die - it has been seen that allowing to die is sometimes less merciful than direct, humane killing: the principle of mercy demands the right to be killed, as well as to be allowed to die. - protections offered by legal mechanisms need to incorporate the principle of protecting not only the patients choice of refusal of treatment but also a choice of a more active means of death - sometimes choices within euthanasia are erroneously made. One version of this can be physician error - physicians may be uninformed of potential treatment options or may prematurely diagnose a patient as terminal although even terminal cases have been shown in the past to be associated with some sort of survival, and although the physician may not know a treatment or cure is about to be discovered or is on the way - additional factors of physicians can be emotionally involved, inexperienced, uninformed or incompetent - a second argument that highlights the possibility of erroneous choice on the part of the patient asserts the very great likelihood of impairment of the patients mental processes when very ill - impairing factors can be depression, anxiety, pain, fear, intimidation by authoritarian physicians or institutions, and drugs that effect mental status - a person in good health would be capable of the decision of euthanasia so the view holds, but the person as the patient does not - depression is the main culprit here as depression is extremely common in terminal illness and tends to narrows ones view of the possibilities still open; it can make recovery seem impossible - a choice of euthanasia in terminal illness probably reflects largely the gloominess of the depression not the genuine intention to die - It is indeed true that a lot of requests to die can really be seen as pleas for better care or improved conditions of life, but it is unfair and does not establish the fact thatALL euthanasia requests should be ignored - sometimes the choice of euthanasia, though made at an impaired irrational way, may seem to serve that person’s own good better than remaining alive - There is a balance in understanding that the patient’s diagnosis may be wrong or right and the patient’s plea to die may really be a plea for better care/prognosis or may in fact be a true plea that they would rather not be alive - but in fact cases where the diagnoses is right and the cure does not materialize, are much more frequent than cases in which the cure arrives and diagnoses is wrong, thus the “there is always hope” argument used to help sway a patient away from euthanasia is morally irresponsible, unless there is a VERY good reason to think there is hope - but the “diagnosis could be wrong” argument against euthanasia is a good one in areas or specialties in which diagnoses are frequently inaccurate. - whoever attempts to interfere with a patients choice of euthanasia must weigh the enormous suffering of those to whom unrealistic hopes are held out against the benefits to those very few whos lived are saved this way (that being the miracle cure may be developed tomorrow argument) - we must appeal to the individuals ow
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