Medical Ethics PHIL 148 @ Binghamton University, Sum 11

4Jun/110

Group Leader Assignments and Notes

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[If you still need to complete some of the practice assignments, you can find them here, here, here, and here.]

We're done our first week (and if you're not done, please make sure to complete any remaining assignments by Sunday) and I want to make a few notes before we continue on.

First, Group Leader assignments are up under the Schedule.  Under every Case Study, News, and Debate Day is a bold Group Leader category listing the names of the Group Leaders for that day.  All of you should be a Group Leader on one Case Study, News, and Debate Day over the length of the course.  You should not be a Group Leader at all for one week of the course.

On Case Study Days, all students are assigned an ethical theory--you should adopt this theory and argue from that position for the day.  Your assigned ethical theory is in parentheses next to your name on all Case Study Days.

On Debate Days, all Group Leaders will be assigned to a specific stance on the debate question for the day and to respond to a specific person (fairly clear on most debate days, but I have still made it explicit).  What position you should take and who you should respond to are written in parentheses next to your name.

Please check over the schedule and make sure that you are assigned to one of each kind of assignment over the course of the class.

Notes

Here are some notes to help you out with discussion:

  1. When commenting on another comment, you can click (REPLY) under the comment.  This will "thread" the comment and visually make it clear who you are responding to.
  2. If you want to keep an eye on comments on a specific post and you like to use a feedreader (RSS), you can subscribe to a comment feed on a post by clicking ( subscribe to comments on this post ) directly above the comment box.  I personally use Google, but you can also use BloglinesNetvibes, or others.  Just copy the feed address into the feedreader (if you don't know what I'm talking about, don't worry about it).
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3Jun/1116

Jenn’s Short Bio

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Hello everyone! My name is Jennifer Bofah and I am currently a sophomore at Binghamton University. I applied to Binghamton with an intended career choice in medicine, hence a "pre-med" student, and a major in the field of biology. After a year's experience in college, however, I have decided to venture off into the school of nursing. This decision is in no way influenced by the detrimental courses of biology and chemistry (107 and 108), as I'm sure most who took the course would argue. My decision to become nurse practitioner is rather personal and was sparked by a realization of self and work/lifestyle preference. Either way, I am overly interested in the field of medicine and the numerous fields that accompany it.  This therefore constitutes to my main reason for taking this course.

3Jun/119

Sample Debate

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Below is a Position Post for a Debate Day.  It earned a 3.  Please write a Response Post critiquing this position.  Even without having read on this particular topic (you'll have a chance next week).  Use the ethical theories and concepts you have learned this week to talk about the issues raised by this post.  As a guide, here are some questions from the Learning Packet:

  • What is your position?
  • Do you think your position is clear to others?  Are you sure?
  • Is your argument clear to others?  Hint: Be explicit; spell everything out.
  • What details do you think are ethically relevant in the debate?
  • What do the other Group Leaders think is ethically relevant?
  • What facts support your side of the debate?
  • How can these facts be combined with ethical arguments to support your position?
  • Do these facts contradict or support one another?
  • Can these facts be used to draw other conclusions?
  • What ethical perspective are you arguing from?
  • What ethical perspective are the other Group Leaders arguing from?
  • What side of the debate do you favor intuitively?
  • What side do you find most convincing independent of your intuitions?

Debate Question: Should Doctor's Ever Lie to Their Patients?

Position Post: Despite popular belief, doctors should be able to lie and withhold information from their patients. When looking at the issue broadly, one may immediately think that the truth always prevails and that one should have control over their own body, but when different scenarios are examined, it is clear that in certain types of cases, withholding information is the most moral option. There are two ethical perspectives which would support withholding information. Utilitarianism says that the moral thing to do is what is best outcome for the well being of the most amount of people. It is not the motive of the person that matters, so the fact that a doctor is lying is not morally relevant. The doctor is producing the best possible outcome, and out of all parties involved, is best fit to analyze all options and choose what is best for the patient and the community. In the example provided in the Thomasma article, the author describes a situation in which a mildly retarded woman has ambiguous genitalia.  Disclosing the truth can only ruin this woman's life. There is no possible positive outcome from disclosing the truth; her condition is not life threatening; knowledge of her condition could not improve the quality of her life. It could only damage her feelings and self worth, and the relationships with those around her. In this case, utilitarianism would suggest that withholding the information is the moral thing to do.

Care ethics could also be used to argue for the right to lie and withhold information. According to Beauchamp, care ethics stresses that individual attachments are what is morally relevant. He says that without the basic level of care, there would be no human race. Plus, the ability to put another before one's self is an important point in care ethics. In lying to a patient, a doctor is really putting the patient's well being before his own. A doctor can very well be sued by a patient who finds out that a doctor lied about their condition or withheld information. The doctor didn't lie to be mean; he wasn't lying for any personal gain because he was putting his own career at risk because he believed that lying would really be better for the patient's well being.  Doing such an act is selfless and is putting the patient before his own career and legal standing in the medical field. Plus, the relationship between the doctor and patient can sometimes become really close, and a patient may choose that they wouldn't want to know something. A doctor and a patient they have been treating for a long time establish a high level of trust, which lets the doctor in on how a patient might react.

Sometimes, offering a patient full disclosure is a death sentence, even if their condition isn't necessarily a death sentence. Patients are often stressed with their medical issues and can't make objective decisions or handle new information that must make them reexamine their life. As a person who is not sick, I know there are situations in which I would not want to know the full details of a hypothetical condition if I faced it. In the case Thomasma described in which a dying victim of a car accident asked about their other family members who were already dead, lying is most definitely the moral thing to do. The man may very well die himself in the next few hours, plus even if he has a chance to get better, devastating news like that will only make him further deteriorate and not get better. It is only cruel to tell him such news that his entire family is dead. Sometimes, motivation is what is needed to improve a patient's condition, and such can only be provided through false information. Putting positive thoughts into a child's head who has cancer sometimes helps them progress more quickly, which is not done by giving the child every detail and statistic of their condition. This concept can be applied to adults and might speed their recovery if some of their autonomy were taken away.

Thomasa also stresses that although truth is essential for healing an illness, it may not be as important for curing a disease. Illness and disease are two separate entities which must be treated differently, and most of the time when truth is withheld, it is only temporary. When doctor's take a Hippocratic oath, they swear to do what is good for their patients and treat them to the best of their ability. In reality this sometimes involves actions like lying or withholding information. The idea of necessary paternalism deems it necessary for doctors to sometimes act to protect patients from harm.

3Jun/1121

Lecture 06/03>Ethical Concepts and Principles

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Today, we move on to general moral concepts and principles. Just like the ethical theories we looked at yesterday, these concepts and principles are tools for understanding the various issues we’ll be talking about this semester. The three general concepts are autonomy, beneficence, and justice. They each have various related principles which I’ll talk about in relation to each concept.

Autonomy is one of the major concepts we’ll be dealing with in the class. Autonomy, at its most basic, is an individual’s right to control and make decisions about their own life. It seems like a given, but it immediately becomes more complex once we start considering the embedded-ness of human life. All of us exist alongside and with other people. The result of this is that decisions about our own lives affect the lives of others. The questions, again, becomes “when is this effect morally relevant?”  Mandatory organ donation is one example where autonomy becomes problematic.  Think if everyone was required to be registered as a kidney donor and they could be called upon to donate that kidney at any time.

The harm principle is the first and most obvious autonomy-limiting principle. It seems to make intuitive sense that we should prevent one person’s exercise of autonomy to interfere with another’s exercise of autonomy. Yet, this is a matter of degrees. If one person will die without a kidney transplant, shouldn’t the healthy individual with two kidneys be forced to give up one kidney? After all, the option for one person is death, while the option for the other is simply recovery time. On the other hand, why should one individual suffer for the life of another? So, the harm principle becomes a question of what harms are allowable and what are not. What about forced blood donation? Such a small harm could benefit many.

It’s important to note that all of these justifications so far are consequentialist. It seems doubtful that a deontologist could allow forced donation of anything for the simple fact that it would treat the individual as a mere means. On the other hand, however, a deontologist likely could argue that an individual should donate a kidney if they are able. This is a difference between positive and negative duties. [Don’t confuse positive here to mean posited (as some of you may have heard it used in Phil 146).] A negative duty is something that one should avoid doing. In the consequentialist examples above, one should avoid harm. A positive duty is something one should do. In the deontologist example above, one should do good. If something is a negative duty, it would be immoral to perform the stigmatized action. If something is a positive duty, it would be immoral to not perform the action. Positive duties are usually considered to create a heavier burden than negative duties, but this is not always the case. For instance, if one argues that there is a duty not to abort a fetus, does this create a corresponding positive duty to adopt if one is able? And which of these duties is truly greater?

Paternalism points out a potentially important detail that underlies autonomy: autonomy to function fully has to fulfill a certain standard of information. If an individual is operating under false information or does not have enough information to make a proper decision, it is sometimes considered appropriate to make the decision for the individual.  What the text would say interferes with understanding. This kind of attitude was extremely pervasive in the medical field even a few decades ago. It was not uncommon for doctors to withhold information from cancer patients in order to prevent them from becoming depressed or for nurses to strap women in labor into their beds so that they couldn’t get up and move about--a violation of the condition of freedom from external restraint.  Today, paternalism still exists, but often in different, less explicit forms. For instance, is it paternalism to present information in a certain way that paints a more positive picture than if the information was presented in a different way? How many potential side effects should be listed to a patient for a new drug? Is there such a thing as too much information? In most cases, medical professionals have control of the information that a patient needs.  How should that information be presented? What ways of presenting information constitute paternalism (if any)? These are just a few questions that arise on this topic.

Alternatively, paternalism is sometimes (perhaps often) invoked in cases where a person is not considered rational. In these cases, the individual’s autonomy is thought to be appropriately limited because of a lack of rationality on that individual’s part. For instance, if a person attempts to commit suicide this is often taken to be a sign that they are irrational and they are committed for their own protection. Yet, some argue that there are circumstances where it is perfectly rational to commit suicide. Likewise, patients are free to refuse treatment. Yet, doctors and other third parties may seek a court order to force a certain course of action.  In this case, the external constraints are justified because there are supposed more problematic internal constraints.

The next two principles largely operate the same. Legal moralism and the offense principle both think that autonomy can be limited where an individual’s actions are immoral or offensive—the difference being that something can be offensive for more reasons than simply being immoral (think indecent or socially inappropriate). Interestingly, it is not always so simply to separate legal moralism and the offense principle from paternalism. Especially notorious is the history of the treatment of mental illness. It has largely been recognized that most historical treatment of mental illness was based more around the immorality or offensiveness of the patient’s behavior than any actual ailment—those with different religions, sexualities, opinions were the victims of this kind of thinking. Although the situation today is much better, it is difficult not to imagine that in the more difficult topics of medical ethics (still today including mental illness) the line between straight paternalism and legal moralism and the offense principle is blurred.

There are further concepts not covered in the text (but assumed by the text.  These are beneficence and nonmaleficence.  Nonmaleficence is a purely negative duty that demands simply that no harm be done. Beneficence is a positive duty of varying strength that demands that some action be done for the benefit of another. Of course, as with all these other principles, neither beneficence nor nonmaleficence is as straightforward as these simply statements make them out to be.

What complicates nonmaleficence is the same thing that complicates the harm principle: what do we consider to be relevantly harmful? Certainly some mental harm is done to an individual when they are told that they have only a limited time to live, but it is considered a necessary harm. Likewise, one is technically harmed when one is given a shot (there is pain involved), but it is, again, considered a necessary harm. Things become more complicated when risk becomes an issue. If a pharmaceutical trial is the last available possibility for a patient with chronic pain, but will involve a good possibility or failure and definite unpleasant side effect, should the doctor bring up the possibility? (Again, notice the problem of autonomy coming up in this problem.)

With beneficence, the question becomes to what degree a medical professional is obligated to others. Are they merely obligated to help prevent harm? What kind of harm? Are they obligated to actually help others as much as they can? Further, to whom are they obligated? How far does their obligation extend? Something like the social welfare principle is simply an extension of beneficience: how far can you go to help others?  Questions of extension (to whom they are obligated) and breadth (how great the obligation) are all integral to making sense of issues of beneficence.

The last major principle that you will need to be concerned with is justice. Justice can be characterized as what is considered as fairness and equality. But this alone (as with everything else so far) is not enough to really tell us enough to get us anywhere morally.  We need further specifications. The potential specifications are utilitarianism, egalitarianism, and libertarianism. Utilitarianism solves justice the exact way utilitarianism solves all problems: something is just so far as it maximizes utility. Egalitarianism (in its most basic form) claims something is just so far as there is an equal distribution of goods throughout the system. Egalitarianism runs a range of views. Lighter, more complicated versions of egalitarianism, such as John Rawls’, modify the degree to which everything must be equal--advocating some, but limited inequality--but are very careful to stray too far from the egalitarian ideal.

Libertarianism may be the most familiar and most popular view in society at large. It is famous for its small government rhetoric. In the matter of justice, libertarianism holds that inequality can be justified so far as that inequality is the result of nature. Redistributive schemes (which equalitarian schemes favor) are only just in cases where human constructs have caused the specified harm. This is particularly relevant in matters of medicine, as illness is largely taken to be a natural occurrence. According to libertarians, it would be unjust to take money from individuals who have earned it to help treat individuals who are suffering from a natural affliction.

We will talk more about these matters of justice when we get to Week 4: Health Care and Justice. For now, consider the different ways these various concepts and principles can be applied. Look at what you intuitively think and try and figure out what principles you incline towards naturally. Then, examine your own views and try and think up some potential objections to your own position.

3Jun/110

Practice Quiz

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Ethical Theories and Principles

This week we covered the various ethical theories and principles we will be using throughout the course. Test your knowledge of the readings using the quiz.

Instructions

Each week a quiz will be provided on the second Reading Day (Tuesday. Don't let this practice quiz on a Friday throw you off!). You can use this quiz to test your textual knowledge and reading abilities and to guarantee a firm foundation for the Group Leader activities during the week. Although these quizzes are only 2% of your grade, take them seriously, as they are a good supplement to the overview of the week's lecture.

After you've completed the quiz, email the instructor the percentage answered correctly and receive full credit.

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Congratulations!

You have completed Ethical Theories and Principles, the first quiz of the semester.  Please remember to email the instructor your percentage score below to receive full credit.  If you are not happy with your score and would like to review the questions again, you can do so by reloading the page.

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3Jun/110

Practice Day, Part 3 (Due: 6/3, Midnight EST)

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Note: If you just registered for the class, go back and do the assignments here, here, and here.

Ongoing Discussions

Always keep an eye on ongoing discussions.  During a regular course week, Case Study discussions run from Weds to Fri, News discussions run from Thurs to Sat, and Debate discussions run from Fri to Sun.  While most of the discussing will, I suspect, be done during the week.  You need to keep an eye on all ongoing discussions.  Especially if you are a Group Leader.  Under the Assignments heading to the right, I always note what discussions are currently ongoing.

Make sure you've responded to all those who've commented on your post.  And if you commented, why don't you go check out the responses?

Reading Days>Lecture

Read Fundamental Concepts on the Readings site.  No Initial Comments or Responses required, but remember that they will always be required on Reading Days over the next four weeks.

Instead, comment on today's lecture.  On every Reading Day, Part 1, you will be required to make at least one comment--this can be a simple question, a general comment, an attempt to answer the questions posed at the end of the lecture, something else, or some combination of the above.  Go ahead and comment now.

Reading Days>Quiz

The night before each Tuesday, I will post a quiz on the week's readings.  The purpose of these quizzes is to test your textual knowledge.

Today's quiz is on this week's readings.  Please follow the directions before and after the quiz to get full credit.

Practice Debate

Last night, I posted a sample Position Post, like a Group Leader would post on a Debate Day.  Your job is to write a Response to the Position Post.  Post this Response as a comment on the Position Post.  This is the description given in the Learning Packet:

This is the negative element of each Group Leader’s contribution. Here, each Group Leader should argue against the other Group Leader’s position by accepting at least some of the assumptions of the other Group Leader. Do not try to defeat the other side on your terms. Instead, determine what perspective they are arguing from and what proof they put forward and use their own perspective and proof to defeat their argument.

Response WORD COUNT: 400-600 words

Use the questions in the Learning Packet to help you figure out what to write.

Coming Soon

Next week the course proper begins.

2Jun/118

Bio info

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Hi everybody. Here is my short biography, looking forward to reading yours.

My name is Shaaron Elisha. I am a biology major. My interests and hobbies are broad. There is a question I enjoy asking people: Would you rather master one thing or be good at many things? The answers that I have gotten vary considerably but I personally have chosen the latter. I devote my time to different hobbies rather than master one. I enjoy basketball, football, soccer, guitar, piano, carpentry, hiking, painting, gardening. I am happy with the degree I chose. Biology was always my favorite subject ever since I was 10 years old but it is not my passion. My dream is to one day own a vineyard. If carpentry or farming were a more respectable and well paying job I would be happy doing that for the rest of my life. I am an introvert but I am not shy. I am going into the army in August and I am both anxious and excited for the difficult but rare experience it will give me. It is something I've wanted to do for some time now. I am not a big fighter and I don't agree with war but I know that it is inevitable as it always has been, and I cannot stand aside and let other people fight for me, it makes me feel weak and helpless. I think another reason I wished to join was because I was always fascinated by older war stories and the way their characters were portrayed as having honor, respect, bravery, and chivalry. I guess I hoped to emulate their ways. Wishing everyone a happy and healthy summer and good upcoming semester.

2Jun/110

Practice Day Part 2 (Due: 6/2, Midnight EST)

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Note: If you have just registered for the class, please go back and do the activities from the last two days: here and here.  Otherwise, read on.

Yesterday, we did two kinds of assignments: the Initial Comments on the readings and an introduction post from each student (and me).  Today, we will comment on each of these assignments.

Response Comments

Each week there are two parts to the Marginalia assignment: the Initial Comments and responses to these comments.  Yesterday, each of you did an Initial Comment on one reading (although normally you would be required to comment on three readings).  Today, each of you should respond to at least two other student's Initial Comments, just like you will during the next four weeks.  As the Learning Packet says, "Build on, critique, correct, debate or something else entirely."  In other words, discuss the meaning and importance of the texts.

Introductions Cont'd

Find out more about your classmates by commenting on their introductory posts.

You can comment on posts on the main site in three ways: by clicking on the number under the date, by clicking comment count at in the footer of the post (x Comments or No Comments), or by going to the full text of the post (by clicking the title or "Continue Reading") and scrolling down to the bottom of the post.  In all cases, you will be taken to the bottom of the post.

Click in the text box and write your comment.  If you write multiple paragraphs (as you might on actual discussion oriented days) make sure that you put a line (hit enter twice) between each paragraph.  [Posts automatically format your writing this way, but comments do not.  Putting the space between the paragraphs makes them easier to read.]  When you are done, hit the gray "Submit" button below the text box.  Your comment will appear.

You are required to comment on two posts (but you can, of course, comment on more): the post by the people above and below your name on the "People" page.  If you are at the bottom of the list, the person below you is the top name of the list.  If you are at the top of the list, the person above you is the person at the bottom of the list.   Clicking on the person's name on the People Page will give you a list of their Posts and Comments.  This way you can find the post you need to respond to easily.

Your comment should include one question for the poster.  You can also comment in general on what they wrote.  Again, keep in mind that this is a public forum.

Then, respond to those who comment on your post.  If they respond late, that's okay, respond tomorrow.

And, yes, I will be open to questions, as well.  So, if I am the person above or below you on the list, ask away.  I'll be doing the same.

Coming Soon

Tomorrow we have our first quiz, a practice debate, a lecture, and more readings.  Then we take a breather before the next week begins.

1Jun/115

Hello Everybody

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What's up guys. This is just a little insight into my life, so here goes...

My name is Ralph Puthota, and I am currently a senior at Binghamton University.  I am pursuing my Bachelors in Accounting and plan on staying for 5 years to finish up my Masters in Accounting.  I am Indian by nationality, and I came to the United States when I was 2 years old.  I grew up in Queens, NY and then moved to Long Island later on in my life.  My family consists of my parents, my younger sister, and my younger brother.  I am a lover of all sports, and I play basketball and football in my spare time.  I am taking this course purely out of interest in the medical field.  My mom is a physician, so I guess it stems from her.  A couple of my friends took this class during previous semesters and said good things, so I decided to finally take it when I had the chance.  Thanks for hearing me out guys, and good luck with the rest of the summer session.

1Jun/116

Introduction

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My name is Erika King. I am an integrated nueroscience major. I plan on going to medical school after Binghamton. This past January, I had an internship in public health in Cusco, Peru. This country has a very bad economy and yet it still manages to provide health care for anyone in need, many do not accept it. I found this the most interesting, considering America cannot do the same. I think this issue will be prevelant in this class and that is why I am most interested in participating.

[Erika is traveling right now and only has intermittent internet access.  Please leave your comments anyway and she'll respond as soon as she can. - Brandon]

1Jun/116

HELLO

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Hi everyone my name is Rameisha Allen and I will be a Sophmore in the fall. I am from Queens, NY and my majors are PPL and Spanish with an intended minor in Sociology. After my undergraduate at Binghamton University I will be attending Law School, hopefully Columbia University/ the University of Chicago. I decided to take Medical Ethics because it's required for my major and I heard that it is a fun and interesting class. I have never taken a course online and the main reason why I have chosen to do this is because Medical Ethics isn't available in the Fall.

1Jun/117

Good Afternoon!

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Greetings all!

My name is Albert Thomas. Below is a short biography of myself. I hope that it gives you an idea of the type of person I am. Since we're all taking this class online, perhaps we can all find things that we can relate to in others' biographies, which will help us to become familiar with each other. Happy reading!

I'm a junior at St. John's University, majoring in Criminal Justice with a minor in Legal Studies. I decided to take a couple of summer courses here at BU so that I can focus on courses intensive to my major at St. John's. When I graduate, I plan on attending Brooklyn law to obtain my J.D. My goal is to become a successful attorney, and my dream is to find work on Capitol Hill in Washington, D.C. In my free time, I like to read, play basketball, and watch movies. I'm very laid back, and enjoy having quiet time and personal space. As a matter of a fact, my biggest complaint about schooling in NYC is that everyone wants to party, thus making dorm life a little rowdy and very loud. I have a wild imagination, and at times may say things that curve from general perceptions. I'm not very religious, but I do follow a personal moral code that I feel keeps me out of trouble and on the road to success.

1Jun/116

Greeting

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Hi All,
My Names is Sam Ahmed and i will just finished my 3rd year at BU. I am a recently declared PPL major hoping to continue on to Law School.  I am very interested in Bio Ethics as both my parents and older brother are currently employed by Health Professions.  Until recently i thought would share the same destiny but much to their dismay i have chosen to go for a different path of life. I am orginally from Syracuse but Im staying in Binghamton for the summer with our house's new puppy. I also play rugby for the BURFC.   This is my first online class but im looking forward to a different but interesting learning method.