Biomedical Ethics Practice Test 2 – Flashcards

False. Brody advocates for transparency model - means that the physician has a responsibility to make his reasoning transparent to the patient. Recommendation - explain reasoning. Doesn't necessarily need to explain risks.

Conversation. Katz thinks joint decisionmaking is the ideal, where doctors disclose and advise and patients choose. This is the result of a meaningful conversation (give and take). This requires that alternative treatments be discussed, not just potential risks of the treatment.

Experimenters have an obligation to offer the fruits of their study to the participants of their study but not to the countries in which they experiment. "no subjects are denied any treatment that should otherwise be available in the country in question." Studies aren't exploitative if after the studies, the subjects themselves are given access to any treatment proven effective.

A) The doctor has a hunch about which treatment will be most effective B) The medical community has determined which treatment is most effective C) They aren't in a state of equipoise if they are in a state of equipoise D) Both A and B, but not C If applying the question just to the Hellman's, the answer would be "D". However, since the question is inclusive of Benjamin Freedman, the answer is only "B"

True. "Marquis suggests that you can recommend what's in your best judgment and still offer alternatives which include RCTs." (random clinical trials)

Mary Anne Warren "If F=P, then abortion is wrong" Mary Anne Warren is the only one who explicitly states this argument. However, she argues that the fetus is not a person. F not equal to P is the argument she believes

False. She believes that infanticide is not murder, but it is also not morally acceptable.

The DNA of the fetus. He concludes, fetuses as humans have rights. This is not to say that abortion is always immoral. The humanity of the fetus has value. But those values have to be weighed. In cases like cancerous uterus and ectopic pregnancy, when the life of the mother is at risk and the fetus has little chance of survival anyway, it seems quite simple.

Sense1 = Really understand, real informed consent Sense2 = Bureaucracy (the legal signing of paperwork, etc.) It is possible to have 1 without the other. Examples: Age, have sense1 but not sense2. Vice versa also possible.

2nd formulation: Don't treat people only as means. People signing up for an RCT means they may not get treatment. If this is the case, they are being used as means.

Because doctors are supposed to commit to giving their patients the best care. Clinical trials often involve physician-researchers not giving what they judge to be the best care to their patient-subjects. Freedman would disagree. He says that RCTs do not respect the right of the patients (the right to treatment), and rights should be respected. However, not everyone has a right to treatment. Well people don't. People for whom treatments don't exist don't. "Such a right must in reason be grounded in patient need ... and in medical knowledge and capability..."

The experimenters had to promise treatment to the subjects in exchange for participation in the study. Therefore, the subjects did not seek treatment because they believed they were already being treated.

It is possible to make the wrong decision. There are wrong reasons to choose an abortion (selfish decisions) No one else can decide though. No one know the situation better than that particular woman. No one else is in a position to judge.

Sense1

Sense2

"arguing for a moderate position on abortion, Callahan finds good reasons to reject both the notion that the unborn has no more value than a piece of tissue as well as the view that abortion is the immoral destruction of a human person. The fetus has at least some moral value, "an important and valuable form of human life." The moral status of the fetus demands a bias "against a routine, unthinking employment of abortion." But a woman also has a moral obligations to "herself, her family and her society," so in some cases an abortion may be justified.

"English stakes out some middle ground in the abortion debate. Echoing points made by Judith Jarvis Thomson, she argues that whether or not a fetus is a person, a woman may be justified in some instances (most notably in early pregnancy) in having an abortion as a form of self-defense. But an abortion is not always permissible, for even if a fetus is not a person, it still has at least martial moral status - a status that increases the more the fetus resembles a person. So in the late month of pregnancy, abortions seems wrong except to spare a woman from great injury of death."

Sense 1 Vs. Sense 2. Faden and Beachamp distinguish two common views of informed consent and argue that only one of them reflects the true meaning of the concept. Real informed consent involves more than a patient's merely agreeing to, or acquiescing in, some suggested course of action. The other common meaning of the term is defined legally or institutionally and does not refer to autonomous authorization. Faden and Beauchamp also believe that the tendency to equate informed consent with shared decision-making is confused. Decision-making, which has been linked historically to informed consent, is not enough.

The ideal of informed consent with its presumptions of autonomy and joint decision-making is yet to be fully realized in practice, says Katz. The concept has been legally recognized, but genuine patient self-determination is still not the norm. Physicians acknowledge it but are likely to see it as a perfunctory fulfillment of legal requirements or as an enumeration of risks. The goal of joint decision-making between physicians and patients is still unfulfilled. Physicians must come to see that they have a "duty to respect patients as persons so that care will encompass allowing patients to live their lives in heir own self-willed ways."

Brody observes that the theory and the practice of informed consent are far apart and that accepted legal standards send physicians the wrong message about what they are supposed to do. He thinks that a conversation standard of informed consent does sent the right message but it probably legally unworkable. He propses instead a "transparency standard," which says that "disclosure is adequate when the physician's basic thinking has been rendered transparent to the patient."

The Hellmans contend that randomized clinical trials place physician-scientists (physicians who simultaneously act as scientists) in a terrible ethical bind. As physicians, they have a duty to look out for the best interests of their patients; as scientists, they have an obligation to ensure the integrity of the research. But often they cannot do both, the Hellmans say, Before or during a trial, if a physician-scientist believes that a new treatment is better (or worse) than the alternative treatment, she has a physician's duty to communicate this judgement to her patient-subjects and ensure that they get the best treatment. But if she does so, the validity of the research will be compromised. Thus randomized trials often put the good of patients against the good of society. The authors "urge that such situations be avoided and that other techniques of acquiring clinical information be adopted."

Defenders of randomized clinical trials claim that physician-scientists do not violate a duty of fidelity to patients if the effectiveness of the treatments being tested is unknown and if the physicians are therefore in doubt (in a state of equipoise) about the treatments' merits. But critics say that if a physician suspects even for flimsy reasons that one treatment is better or worse than another, he cannot be in equipoise. Freedman thinks this view of equipoise is mistaken. He argues that true equipoise does not depend on uncertainty in the physician but on genuine disagreement in the medical community about a treatment's value because of a lack of good evidence gleaned from randomized clinical trials. When this kind of doubt exists, randomized clinical studies are permissible.

Marquis addresses the well-known ethical dilemma of randomized clinical trials: A physician has a duty to see that her patients get a treatment that she judges best, but, if she enters them in a clinical trial, they may not receive the treatment she prefers. He argues that a solution to the problem lies in the use of informed consent. By taking informed consent seriously, "a physician can both recommend a treatment and ask whether the patient is willing to enroll in the randomized clinical trial."

Brandt recounts in detail the abuses of human rights and the deliberate harm perpetrated in the infamous Tuskegee Syphilis Study, probably the most egregious example of unethical research in American history. Brandt declares that "the Tuskegee study revealed more about the pathology of racism than it did about the pathology of syphilis."

Angell maintains that randomized clinical trials comparing two treatments are morally permissible only when investigators are in a state of equipoise - that is, when there is "no good reason for thinking one [treatment] is better than another." So studies comparing a potential new treatment with a placebo are unethical if an effective treatment exists. If there is an effective treatment, subjects in control group must receive the best know treatment. By this standard, some ongoing trials in the Third World must be judged impermissible - namely, the trials testing regimens to prevent mother-infant transmission of HIV infection. The studies use placebo control groups even though a proven preventive exists. Angell concludes that the research community needs to bolster its commitment to the highest ethical standards "no matter where the research is conducted."

Brody responds to major doubts raised about the ethics of some Third World clinical trials conducted to evaluate a regimen to prevent mother-to-infant transmission of HIV. He argues that the use of placebo control groups was ethical because no subjects were denied "any treatment that should otherwise be available in the country in question." According to a reasonable understanding of coercion, he says, no subjects were coerced into participating in trials. Finally, some have claimed that the trials exploit developing countries "because the interventions in question, even if proven successful, will not be available in these countries." But such trials will not be exploitative, Brody says, if after the studies of the subjects themselves are given access to any treatment proven effective.

In this classic essay, Thomson argues that even if a fetus is a person at conecption, at least some abortions could still be morally permissible. A fetus may have a right to life, but this right "does not guarantee having either a right to be given the use of or a right to be allowed continued use of another person's body - even if one needs it for life itself." A woman has a right not to have her body used by someone else against her will, which is essentially the case when she is pregnant due to no fault on her own (as a result of rape, for instance). The correct lesson about the unborn's rught to life is not that killing a fetus is always wrong, but that killing it unjustly is always wrong. Violin example

Women get abortions for a variety of good reasons. The specifics of the woman's life are so varied that it is unrealistic to think that someone outside of those circumstances could make a better judgment about whether the circumstances offer a moral justification for abortion. The woman may get it wrong, but no one else is in a better position to judge. "It is, therefore, improper to grant others the authority to interfere in women's decisions to seek abortions."o This assumes that there are some circumstances that could possibly justify abortion (which is a very common belief). If there are some circumstances, then no one will know better than the women whether these circumstances qualify. "Many perceive the commitment of the political right wing to opposing abortion as part of a general strategy to reassert patriarchal control over women in the face of significant feminist influence." Do women always have control over when they're having sex? The cases where most people agree that abortion is moral are cases of rape and incest. Why incest? "Women are socialized to be compliant and accommodating, sensitive to the feelings of others, and frightened of physical power; men are socialized to take advantage of every opportunity to engage in sexual intercourse and to use sex to express dominance and power." Discuss how this affects the significance of access to abortion. Do women always have control over when to leave their relationships? Personhood is a societal category. The fetus only has relationship to the woman, and the woman is in control of the relationship. If she decides to end the relationship, then that is the end of the personhood of the fetus. "There is no absolute value that attaches to fetuses apart from their relational status determined in the context of their particular development." This is the rational for distinguishing between pre-birth and post-birth. Others are then capable of relating to the fetus without the mediation of the mother.

Fetuses are humans. So abortion is wrong. What's the missing premise? He equates humanity with 'having rights', or with 'counting', but he never does this explicitly. He seems to equivocate. His criterion: "If you are conceived by human parents, you are human." 1. Dependency/viability is first simply denied as a criteria for having rights. And humanity is simply asserted. Then he gives a practical difficulty with viability. It depends on the limits of our technology. 2. Experience could be supposed to be a distinction. Seems silly to me. 3. "Appeal to the sentiments of adults": an unsure guide to the humanity of others. 4. Sociability/social convention. A fetus can't interact with others. If others have to recognize you as human in order for you to be human, then whole groups could be dehumanized. We have to draw lines. Probabilities help: "If a spermatozoon is destroyed, onne destroys a being which had a chance of far less than 1 in 200million of developing into a reasoning being, possessed of the genetic code, a heart and other organs and capable of pain. If a fetus is destroyed, one destroys a being already possessed of the genetic code, organs, and sensitivity to pain, and one which had an 80 percent chance of developing further into a baby outside the womb who, in time, would reason." [what confers rights?] DNA confers humanity He concludes, fetuses as humans have rights. This is not to say that abortion is always immoral. The humanity of the fetus has value. But those values have to be weighed. In cases like cancerous uterus and ectopic pregnancy, when the life of the mother is at risk and the fetus has little chance of survival anyway, it seems quite simple.

Warren claims that the unborn is not a person but merely a human. Two theses: 1. We cannot establish that abortion is acceptable (to the satisfaction of the antiabortionists) if we accept that the fetus has rights / is a person. 2. The fetus doesn't have rights/ isn't a personON 1. "What are we to say about the woman who becomes pregnant not through rape but as a result of her own carelessness, or because of contraceptive failure, or who gets pregnant intentinonally and then changes her mind about wanting a child? With respect to such cases, the violinist analogy is of much less use to the defender of the woman's right to obtain an abortion." ON 2. "How are we to define the moral community, the set of beings with full and equal moral rights...?"Points out Noonan's equivocation/question-begging (human sometimes means biology, sometimes means person; you need an argument that shows that biological humans are always persons). If a space traveler arrived, would it be acceptable to kill him? Not if ... (the concept of personhood is roughly about these traits) 1. Consciousness / capacity for pain 2. Reasoning (developed) 3. Self-motivated activity 4. Capacity to communicate (with indefinite topics/content) 5. Self-awareness (1 & 2 together are probably necessary conditions). Fetuses satisfy none. Objection: But nor do infants. Answer: Infanticide isn't murder (she says), but it is still wrong most of the time (like destroying works of art). (exception for infants unvalued or overly burdensome on society at large). Objection: Can't you say the same about fetuses. Answer: Yes, except that keeping the fetus alive against the mother's wishes violates her "rights to freedom, happiness, and self-determination".