Medical Ethics PHIL 148 @ Binghamton University, Sum 11

Examples

Contents

Marginalia
Case Study Day
News Day
Debate Day
General Discussion

Note: All examples earned a 3 or 4 in previous versions of the course.

Marginalia

Below is an example of an Initial Comment on one paragraph of a text.  The student picks out the main idea of the paragraph and discusses its importance.  Note that there are two main parts to any Initial Comment on the text: a brief summary and the student's analysis.  The best comments will accurately represent the claims of the text and analyze these claims in an interesting and informative way.

Here, McMahan argues that what is morally relevant about us is not that we are a biologically human organism, but a subject of experiences.  He claims that this shows that what makes us who we are is both our history of and ability to experience.  The clear consequence of this on abortion is that a fetus is not relevantly "human" because it does not have a history of experience (in other words, a memory).  So who a fetus is isn't persistent in the same way as humans who are already born.

Wouldn't this claim make infanticide okay?  I know this is a bit extreme, but babies probably don't have much memory either, so by McMahan's definition killing them wouldn't be killing a human/person.  Earlier, McMahan talked about a thought experiment where we think about a brain transplant and then ask where we think the person is, the body with their brain or the body the brain was removed from.  McMahan claims that we will answer where the brain is; thus, the fact that we are human organisms (have bodies) is unimportant.  But don't we identify each other by our bodies?  Aren't our bodies important parts of who we are?  Both this and the infanticide problem seem to point to a major issue with McMahan's position.  Maybe I'm missing something, though.  Does anyone have any thoughts on this?  Could McMahan's position work?

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Case Study Day(Group Leader)

Here is a Group Leader post on a case study about Eugenics.  The student starts by highlighting specific features of the case study , then explicitly states what she takes to be the essential moral questions in paragraph 3.  This creates a clear sense of what the student finds important and what she is aiming to answer.  The addition of extra facts is also a positive.  Note, however, that the student tries to touch on too many topics near the end of the post by bringing in the role of the doctor and also puts some, perhaps, very important info in an aside.  Always feel free to take discussion in an interesting direction by bringing in personal information, a new perspective, or information that may be slightly tangential.  At the same time, don't bring in new information just to bring in new information--always ask yourself "How is this related to my argument?"  Keep focused and have a clear argument.

Finally, note the student's grammar and spelling.  Even though this is a blog post, you are still presenting to an audience, so you need to make sure your writing is as clear and easy to read as possible.  Good grammar and spelling go a long way!

This case study actually hits really close to home. In my family my parents are both carriers of the sickle cell trait. Effectively, I am a carrier, my brother has sickle cell anemia, and my sister has neither the disease nor the trait. My brother and I were both born in Ghana, so I don't think my parents had access to genetic counseling to test if they had the trait or not; honestly I think they realized when my brother was born. But I can attest to the difficulty and pain that my brother feels because of his disease.

The way Mr. Johnson feels about the white man trying to control his fecundity, is a perspective that many blacks have taken. During the civil rights movement, members of the Black Panther movement were especially privy to this way of thinking (It's a complex issue to dive into, and I have a lot to say so email me if you want to discuss it some more). The main point raised by the case study is that the options available to the Johnson's were not all within their financial means. In fact the options that encompassed negative Eugenics were the ones that they could afford, and the ones that encompassed positive Eugenics were not affordable to them.

I think it is important then to consider to essential questions, is it ethically just that the positive options were not really options that could be explored by the Johnsons? And is the mandatory screening for carrier status moral?

Within Utilitarian ethics there are two parts to consider, the rule and the act. Within this case, the mandatory screening gives the parents information that prevents them from being limited; ignorance is not always bliss. From the perspective of the medical professionals it states that if the parents risk the 25% chance of having a child with the disease that they will live with "attendant anxiety." Utilitarianism seeks the absence of pain and suffering. On one hand by knowing the chances the parents have options, but as the Johnson's feel, the information will "produce anxiety and inhibit childbearing."

Since the mandatory screening can only test whether or not the child has s 25% of having the disease, and does not really aid in finding out if the child has the disease or even alleviating some symptoms, then according to Utilitarianism it doesn't help rid any pain or suffering, it is immoral. In fact the test brings anxiety to the parents as they are faced with 4 choices that will affect their lives forever.

If parents choose to do the test before they ever consider having children, then it can be considered moral. The anxiety of choosing the fate of a family out of 4 options is lessened because the life of the child is not in immediate uncertainty.

The doctor is fulfilling his beneficent duty, according to the oath he took. I think that care ethics is really the only theory that could find this testing completely moral.

Treatment for sickle cell patients have greatly improved and it is a disease that can be coped with. Each family is different, the Johnson's are justly paranoid about this test (email me if you want to know why), but another family might choose to know and based on financial means make their decision. It’s all personal and dependent upon the family's circumstance.

See here a brief example of discussion started by this post.

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News Day(Group Leader)

Here is a Group Leader Post on Abortion.  The student first posts a link to the news article and then begins an analysis of the moral issues involved in the policy discussed in the article (please note that news day articles can be about events and specific situations, not just law and the like).  She sets up the larger context and then focuses in on a specific issue, but notice that her contextual setup already points to the specific issues she is concerned with by focusing on the widespread idea of birth as something "joyful" and abortion being justified when that isn't the case.  The setup could be pared down and the extra space used to discuss the ethical issues more in depth, but this is not too heavy on the summary.  Be careful that you don't spend too much time summarizing the news article.  You've provided the link; the other students should read it for themselves!  Notice also that the student ties the news article directly to one of the texts for class and tries to figure out what the author of that text would have to say about the policy.  Finally, she asks some questions to the class--always a good discussion starter!

http://edition.cnn.com/2010/WORLD/europe/06/03/italy.abortions/?hpt=T2

Abortion has been a controversial topic since the infamous ruling of Roe v Wade in 1973, which allowed women the right to abortion before viability of the fetus. The debates have continued since 1973, constantly asking, "when exactly is the fetus viable?" Can the fetus feel pain before the viable stage is reached? Does that turn over the Supreme Court decision? Some religious groups such as the Catholic Church believe that life begins at conception, and aborting or preventing conception is therefore immoral. There are numerous debates when it comes to the morality of abortion, but to understand them it is important to examine some reasons why women turn to abortion.

Society views abortion as a negative end to what should be a joyful situation. We have become familiar through advertisements by Pro-Life and Pro-Choice advocates that the decisions leading women to seek abortion are generally irresponsibility with birth control methods, or being the victim of a rape. In both of these scenarios an abortion is sought with the woman's best interests in mind. Oftentimes the situation when an abortion is sought for the child's best interest is overlooked.

Italy has recently passed a program for women in poor financial situations, which can make them seek abortions for reasons the new scenario described above. The country plans to disburse $5,500 per abortion-seeking female to help those who do not have the economic means to raise a child. They plan on notifying the women of this opportunity when they present themselves at an abortion clinic. The funds can be used towards the mother's healthcare while she carries the child, and/or products to care for the child once it is born, such as diapers and food. The country hopes that this grant will provide more women the chance to keep their child and decrease the number of abortions in Italy.

From the reading we learned about perspectives of personhood, and how Marquis focuses on defining personhood by the ability of having a valuable future. From that opinion we could conclude Marquis would be in favor of Italy's plan because it is providing the opportunity of a future to these women and children. By taking away an economic obstacle the Italian government is improving quality of life for anyone who takes part in this plan. It seems to be a great way to eliminate the moral dilemma of abortion for those who are forced to terminate their pregnancy for financial reasons out of their control.

Do you think a program like the one in Italy could work in the USA? Do you think it has the potential to be abused? Using the provided link (http://moneycentral.msn.com/articles/family/kids/tlkidscost.asp) do you feel that the $5,500 is only a short term fix? What effect would this have in the long term development of the child?

Is it moral to pay women to keep their child? Does the morality change if the women accept the money because they want a child vs. because they want the money?

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Debate Day(Group Leader)

Below is, first, a Group Leader Position Post, then a different Group Leader's Response Post to this Position.

The Position Post is extremely clear and precise.  The student's very first sentence state's her position and she follows this up with her reasons for taking that position.  The student supports then gives several specific examples to provide concrete material to discuss the debate topic.  Concrete examples are often convincing because they give the reader something to hold onto.  However, you need to be careful that your example (1) truly applies and (2) is not overly complicated.  Note also that this student tends to appeal to "moral responsibility" and an "immoral system."  This is problematic.  Keep in mind that this is exactly what you are arguing for, so be careful in simply applying moral valuation from the get go.  Some relevant questions to answer explicitly would have been: "What makes this immoral?" and "Why should severity of injury impact morality?"  Overall, however, a clear Position Post that does a good job tying in a specific ethical position and some of the ethical concepts of the course.

It is immoral for the government or individual hospitals to provide limited resources on a first come, first serve basis. Hospitals should provide medical treatment to patients based on the severity of the patient’s condition, not if they got to the hospital first. It is immoral to treat a patient who came in for flu treatment first over a patient who just had a heart attack. Even though the flu patient was there first, the patient who had the heart attack is in greater need of treatment because his problem is more life threatening. By applying the first come, first serve method, you are blatantly deferring any moral responsibility. Doctors are stripped of the ability to use their medical training to assess the situation properly. The first come first serve method revokes the freedom of the doctors to come to a medical decision as to who deserves treatment first. A doctor who truly cares for the well being of a patient would never choose to treat a flu patient over a heart attack patient.

By providing medical care to people on a first come first serve basis the healthcare professionals are not considering the morality of treating those in higher need, all they are doing is following an immoral system to get a job done. This would completely go against the oath of a doctor, their job is to actually care for a patient and provide treatment, not just care for a patient because they have to or just to make good money. Doctors are trained to make decisions about the patient’s condition and how each and every patient should be treated. By implementing a first come first serve method we are removing the doctors ability to make this decision for their patients. For instance if there was a fight and many people were injured (stab and gunshot wounds) and bought to the hospital. For argument's sake let’s say that people with stab wounds arrived 5 minutes before the people with gunshot wounds; on a first come first serve basis doctors would take care of all the stab wound victims before caring for the gun shot wounded victims. What if doctors used the majority of medical supplies to treat the stab wound patients and had little resources left for the gunshot wound patients. This could mean the gun shot patients could go into shock and need to be transported taking crucial time away from their treatment, or worse they could die if not treated in time. Of course we could argue that a patient was stabbed close to their heart and a person was shot in the leg then it would be okay to go with the first come first serve basis, but only if the stab wounded people arrived first (which in my scenario they did). If doctors treated on severity the gunshot wound patients would not be in this situation, nor would the victim who was stabbed close to the heart. Doctors would choose to treat the patients with the most life threatening wounds first therefore hopefully saving their lives. Immediate life threatening situations need to be treated before those that aren't life threatening.

Care ethics would say that the first come, first serve basis is clearly immoral and patients should be treated based on severity. First come, first serve creates a form of detachment of the doctor in regards to the patient they are treating. If the doctor is treating a patient for a stab wound knowing that there is a patient in the waiting room who is about to die there is no attachment between the doctor and the patient he is currently treating. In care ethics relationships are of great importance but when we care for people according to first come first serve we are completely negating any form of relationship.

This method of treatment also goes against egalitarianism because "the main position of egalitarianism is that individuals should be guaranteed a basic minimum"[need citation], the first come first serve method of treatment is basically guaranteeing care to the first patient and nothing to the last regardless of severity. There are way too many variables when it comes to treatment of patients to leave the arrangements up to a robotic and simplistic system.

This Group Leader Response uses factual information to put pressure on the other Group Leader's Position.  However, be careful about doing this.  In this case, it is not clear that the initial two paragraphs are really focusing on a morally important point.  It may be true that the First Group Leader's example is not a very good one, but the point of the Position Post is still clear.  Focusing too much on tiny details in an example can derail the conversation.

At the same time, details can be useful.  In the third paragraph, this student objects to the idea that Care Ethics would approve of treating patients by severity.  Note that her strategy is to reject the idea that Care Ethics can hold in the circumstances of the ER--she rejects the basic assumption of the first Group Leader's point.  Doing this can be a powerful argument, but make sure that you include a justification.  Always give your reasons for thinking something!

In the case of the flu patient arriving before the heart attack patient, you are not comparing apples to apples. A flu patient does not require the same supplies and care as a heart attack patient. There would not be an issue of rationing of limited supplies because they require different care. Even if doctors and nurses are considered a limited resource, it is incredibly unlikely that a hospital will not have enough of both to take care of both patients simultaneously.

It is immoral to withhold supplies from the stab wound patients just in case gunshot wound patients came in. The doctors had the stab patients right in front of them; they cannot deny them care because they think that more patients may be coming in. Doctors have the duty to stabilize all patients, and they might not do that if they withhold supplies because they assume that more people will be coming in. Kantian ethics require the medical personnel to treat the stab patients that are in the hospital NOW, not to hold on to some supplies because they think more will come in later. Hospital staff should not let a severely injured person who comes in later cut in front of people who are moderately injured, but have been waiting longer. Say that there are 4 people with moderately life-threatening injuries, such as stab wounds to the stomach or lung and they’ve been waiting in the hospital for care. It is estimated that it will take 30 minutes to stabilize each of them, and only one doctor is available for that situation. Then, a patient with a stab wound to the chest comes in. It will take two hours to stabilize that one patient. The utilitarian school of thought would support saving the moderately injured people first because they have the greater chance of survival, and more lives can be saved. Utility would decrease if all of them were to die because the severely injured patient was allowed to cut the line. Utilitarian philosophy would justify treating the moderately injured people who had been waiting longer because that would allow for more utility than letting them die because the medical team was treating the one chest wound patient instead.

I disagree that care ethics deems first come, first served immoral. Very few, if any, patients have their own personal ER doctor. Therefore, many patients and doctors meet for the first time when emergency care is given. They all have the same relationship because they are all meeting for the first time. The doctor-patient relationship requires that doctors do what is best for their patient, even if it’s one they just met. They are not giving the best care possible to the patient at hand if they are busy thinking about some other patient in the waiting room.

The egalitarianism argument does not completely disregard severity. Different degrees of severity merit different types of care, which obviously merit different supplies required for treatment. We need to make sure we are comparing apples to apples in situations regarding rationing. An egalitarian approach would allow different levels of basic minimum care to all heart attack patients AND all flu patients.

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General Discussion

Below, find several examples of normal discussion comments on different types of activity days (Reading, Case Study, News, and Debate). Note how each student picks up on something another student said and builds on it.

Lecture

I believe that it is not moral for parents to select traits for their child. I think the "designer baby" concept is ridiculous. I joke with friends and my boyfriend saying that I hope he has a blue eye gene so I can have blue-eyed babies, but if I were ever to be able to "pick" blue eyes for my child I know I would not be able to go through with it. I think that designing a baby is going against a natural law and will come back to negatively affect the child. I think it would also change who that child may/could have been.

On the other hand, if this designer baby technology could be used to remove genetic abnormalities, such as obesity (if an exact gene is found) or diabetes, I think it should be used to improve the baby's life. I think when it comes to genetic disease the possibility to alter the genotype for the benefit of a better life would be moral. Altering genotype for no health related benefit (ex. blue eyes instead of brown) would have a risk that should not be taken.

If the designer baby technology were not around and the only option for a terrible genetic disease, such as Tay Sach's, I think that it is moral to abort. It is an unfortunate decision to make, but the baby would live a terribly short live and in pain with the disease. From a care ethics perspective aborting the baby would be what is best for him/her even though it may be hard for the parents to do. It is putting the babies needs ahead of their own.

A problem with this is where do we draw the line? What disease deserves an abortion and what doesn't? Some can argue that severe mental retardation could be a reason to abort, but then what IQ point would be the cut off? Would we be able to test just how functional the baby would be while it is in the mother?

Case Study Day

You stated that care ethics could find this testing completely moral. However, if you look at my post, you'll see that it really depends on the kind of relationship that a doctor is supposed to have with his patient. In my view, a doctor should not only look out for his patient's health, but also for his happiness. It's very similar to the argument we spoke about earlier over whether a doctor should be treating a disease or an illness. If the doctor mandates that Mr. Johnson be tested for carrier status, he will not be looking out for his happiness and therefore, he will be immoral, even according to care ethics.

You also said that this is immoral according to utilitarianism. I do agree with you, but just to play devil's advocate, I think you could look deeper into the argument. If the parents find out that they have a 25% chance of having a child with the disease, they might choose to adopt a child. While this is a blow to the parents, there will be a child from an adoption agency that gets a wonderful home and a much better life than he might have had. Because utilitarianism is the "maximization of pleasure," it really depends on what you believe is more important--the happiness of the child that is going to get a good home or the happiness of the parents.



This is a continuation of the discussion started by the Case Study example above.

Student #2:

[Student #1], I think your argument "No one should be waiting around and relying on someone else in order to be motivated to find out essential information about themselves" is not correct. Not everyone can afford such tests. If a more well off family member finds out he is likely to get diabetes or another disease, should he be morally obligated to let his siblings or other family members that they may be prone also? I think direct family should know about such findings. I understand if someone doesn't want to tell their 2nd cousins or other distant family as their genes are probably different, but people who might have similar genes should know.

Student #1:

Okay, I see where you’re coming from.  However, you said that people who have similar genes should know, but you don’t think that a second cousin or distant family member should. Couldn’t it be argued that second cousins and distant family members can have the same genetic tendencies? How far should someone therefore spread their personal medical information. What is the criterion that someone should use when it comes to deciding who to tell their medical information too. Wouldn’t it just be a lot simpler to keep private medical information private? What about the individual’s right to privacy?

News Day

Student #3:

This is a great example of eugenics. It is using genes to help people live better lives. Utilitarian ethics support this development because it helps people to increase their happiness. This is very interesting, but I don't understand what the moral issues you are raising have to do with it, unless you're asking if it is moral to terminate a fetus with this condition or one like it. In which case, I believe that it is still moral to have the choice to do so. This is a terrible condition that can lead to distress or death, like two of the patient's brothers. It is morally defensible to terminate in order to save the fetus from that fate. Also, this seems like a very consuming condition. One must worry about diet and medication, especially for young patients. If parents are not able to provide this care, it is moral to abort, as well.

Student #4:

[Student #3], there are several different genetic interventions that can be taken; the reading gave some examples. I was just raising the morality questions in order to explore the different consequences with the other interventions, apart from the one taken in the article. I totally agree with your point about the financial strains that a disabled or chronically ill child can have on a family. If this unbalance exists where some people can afford to keep their disabled fetuses, or even seek another form of intervention, while others due to financial strain cannot, can it be considered justice if the same rights to intervention are not allotted for everyone?

Debate Day

In a way, I do agree with you, [student's name]. However, it really depends on your definition of what is and is not detrimental to your health. While you believe that a genetic disease doesn't directly affect someone as much as an STD or HIV, I believe that they are very close.

For example, hemochromatosis is a disease that you may not show clear symptoms of until you are a well-developed adult. It is a genetic disease that alters the body's ability to regulate iron absorption. If left untreated, it could result in death. If you find out that you have this disease, is it moral not to tell your father or mother, who may be suffering from the same exact thing? There are very different kinds of genetic diseases than the ones that are mentioned in the textbook and some are far more dangerous than others and are actually treatable.


Student #5:

[Students’ names], I don't think I can agree with you. Honestly with situations such as child bearing and possible developmental diseases it is their responsibility to share information with their significant other. If them producing an offspring that has the disease and die this is unethical and can be considered immoral. Even though we do have rights to privacy, there are certain duties within morality concerning others that should be adhered to, as a decent human being. What if a mother is HIV positive and refuses to tell her fiancé and in turn he is infected, as well as the child that she bears? Would you say this was moral and just because she is able to have her right to privacy? An innocent life will suffer for their whole life because she decided to withhold that information. Especially in the event that she does not treat that child.

Student #6:

[Student #5], I completely agree with you! There are certain things that I feel we are obligated to tell our families especially if they are affected by it. It is morally wrong for a person who knows they are HIV positive to participate in sexual behaviors that will transmit their disease. They are obligated to tell their partner they have the disease so they can take the necessary precautions in order to eliminate transmission. The potential harm that is caused to the fiancé and baby is far greater than their right to medical privacy and risk of embarrassment. HIV is preventable if people would put aside selfish behaviors and take the necessary precautions. This also has to go along with getting tested for a disease like discussed in previous posts. If a person tests positive they are morally obligated to take precautions so they don’t transmit it to others.

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