Biomedical Ethics
Midterm Study Guide
Spring 2020
Short Commentaries. You will be asked to discuss several of the following items on the midterm exam. You will have some choice (e.g., 5 out of 7). Some of the items may be reworded for
clarity, or to indicate the desired level of detail in your answer.
Introduction to Bioethics
1.
Ethical theories: utilitarianism, deontology, and virtue ethics
2.
Beauchamp & Childress’s principles method
3.
Specification and balancing
4.
Absolute, prima facie, and relative principles or rules
Health Care Professionals and Patients
1.
Differences between the original Hippocratic Oath and contemporary versions (Markel).
2.
What are the three core elements of professionalism? How do these elements work
together? (Wynia, et al)
3.
Relationship between professional ethics and a) law, b) personal morality, and c) personal
values (Kipnis)
4.
Two dimensions of professional values and three “additional elements…required to
establish a professional obligation.” (Kipnis)
5.
Patient responsibility and its relation to autonomy (AMA)
6.
The Confucian view of truth-telling in medicine (Fan & Li).
7.
What is the patient’s work? How does the concept differ in the paternalism, autonomy,
and mutuality models? What is the physician’s moral function in each model?
(Groopman, Miller, & Fins)
8.
Kelley’s distinction between prospective and retrospective responsibility, and why she
supports the prospective view in the medical context.
9.
According to Miller, Brody, and Chung, what is the internal morality of medicine and
why is cosmetic surgery incompatible with it?
At the End of Life
1.
Cardiac, whole brain, higher brain, and brain stem standards of death and Bernat’s
support for the whole brain standard over the other possibilities.
2.
Veatch’s “conscience clause.”
3.
According to Kass, why is finitude good for us?
4.
Quantitative, qualitative, and physiological futility (Gampel).
5.
Gampel’s three differences between futility cases and other cases where professional
standards define appropriate care.
6.
Types of paternalism; active & passive, weak & strong (lecture).
7.
Two conditions essential for autonomy and the distinction between respect for autonomy
as a negative obligation and as a positive obligation (Beauchamp & Childress)
8.
The distinction between subjective and objective theories of wellbeing and their relation
to patient refusal of treatment (Varelius).
9.
Substituted judgment, pure autonomy, and best interests standards as bases for surrogate
decision-making (Beauchamp & Childress)
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Arras’s use of the concept “person” in relation to treatment decisions
Arras on whom should decide “gray area” cases and why.
Ordinary (obligatory) and extraordinary (optional) forms of care.
According to Robertson, when should doctors seek to override parents’ wishes regarding
life-sustaining treatment for newborns?
Insights from Dostoevsky regarding NICU treatment decisions (Paris, et al).
Three points that physicians should present concerning ANH (Casarett, Kapo, & Caplan)
Methodological shift in Catholic medical ethics (Shannon and Walters).
Rule (or principle) of double effect (lecture)
Active and passive euthanasia (lecture)
The “devil’s choice” metaphor and why Magnusson prefers it to the principle of double
effect.
Singer’s utilitarian reasons for when killing is and is not wrong.
According to Keown, why do Buddhists reject the view that life must be preserved at all
costs?
Catholic rejection of euthanasia (Sacred Congregation)
Wolf’s three problems regarding a rights framework for analyzing PAS and euthanasia.
Autonomy and “big decisions” (Gill)
Why it is not intrinsically wrong for a physician to participate in PAS (Gill)
Klagsbrun’s four conditions for justifying physician-assisted suicide (lecture).
At the Beginnings of Life
1.
Catholic view of abortion, and exceptions to the Catholic argument (lecture).
2.
Catholic obligations in relation to abortion (Sacred Congregation)
3.
Jewish view of abortion (lecture)
4.
Buddhist view of abortion (lecture)
5.
Why Marquis favors the “future of value” view over the “standard view” regarding the
wrongness of killing.
6.
Thomson’s distinctions between a Minimally Decent Samaritan, a Good Samaritan, and a
Splendid Samaritan.
7.
Moazam’s feminist argument supporting restrictions on prenatal gender screening and
abortion
8.
Kaczor on why artificial wombs could end the abortion debate
9.
The three possible solutions to pharmacist refusal to fill emergency contraception
prescriptions, and Cantor and Baum’s reasons for either rejecting or supporting them.
10.
Definition of infertility (lecture).
11.
Murray’s support for a focus on “human flourishing” over procreative liberty.
12.
The Catholic and feminist opposition to reproductive technologies, including the
similarities and differences (Lauritzen).
13.
Raymond’s rejection of altruistic surrogacy.
14.
Wertheimer’s different types of exploitation and whether surrogacy is harmful
exploitation of women.
Essay. The second part of the exam will consist of an essay question, and most likely be in the
form of a case. If so, the case will be short and will resemble cases used in class discussion.
Regardless, you will be provided parameters for discussion. See the old exam for a sample
question. Knowledge of the above items will be important when writing the essay.
Abortion and
Procreative Autonomy
At the Beginnings of Life
(part 1)
Scott Roeder
Paul Hill
John Salvi
The Abortion Debate:
Absolutes v. Dialogue
Judgments about acts
❚ No moral issue; fetus as mere tissue
❚ Abortion is homicide or murder
❙ Also language of holocaust; genocide
❙ Michael & Jayne Bray; ArmyOfGod.com
❚ Abortion as a moral problem
❙ requires justification; justifiable tragedy
❙ Some pro-life people here
❙ Disagree regarding when and how justified
Laws and access to funding
❚ Negative rights and
positive rights
❚ Consistent about laws
and acts.
❚ Personal ethics v. public
policy
❙ Mario Cuomo
❚ Practical emphasis
❙ Public support for
prospective mothers
Personhood and the beginning of
human life – who counts morally?











Ensoulment
Conception
Implantation
Unity and uniqueness
Brain life
Appearance
Quickening
Viability
Birth
Survivability
Acceptance to med school
Personhood & moral standing
❚ Potential person
❙ Strict limits on abortion?
❙ Some moral standing?
❚ Personhood ≠ problem
solved
❚ Non-trivial reasons needed,
even for non-persons
❚ Justifiable reasons possible,
even with moral
personhood
The unconscious violinist
❚ To unplug, or not to
unplug?
❚ Duration
❚ Other examples
❙ Brothers and chocolates
❙ Burglars
❙ “People seeds”
❚ Mothers or 3rd parties
❚ 3 types of Samaritans
❙ Duty v. supererogatory
The future of value
❚ “The standard view”
❙ Marquis’s objections
❚ Bible not helpful
❚ “Future of value”
❙ Is his view better?
❙ Would it help abortion
opponents?
❚ Reject and permit
The Legal Landscape
❚ Common law tradition
❚ 19th century shift
❙ increase in scientific
knowledge
❙ physician control
❙ protect women’s health
❙ anti-feminist slant
❙ increased moral and
religious interest
The Legal Landscape (cont’d)
❚ Roe v. Wade (1973)



Compromise
Trimester framework
Celebration & resentment


Fetal viability?
Undue interference?

Rejects trimesters

Contrasts, partial-birth
❚ Webster (1989)
❚ Casey (1992)
❚ Stenberg (2000) & Carhart
(2007)
State abortion laws
❚ Physician & hospital
requirements
❚ Gestational limits
❚ Partial-birth
❚ Public funding
❚ Private insurance
❚ Refusal
❚ Mandated counseling
❚ Waiting periods
❚ Parental involvement
❚ Genetic abnormality
❚ Personhood
Roman Catholic pro-life views
❚ Historical evolution
❚ Early Church – virginity
and chastity
❙ Augustine (late 300s)
❙ Didache
❚ Medieval Church &
ensoulment
❙ 40 days M / 90 days F
❚ Doctrine of the
Immaculate Conception
Church’s moral reasoning
❚ Theological premise
❙ God is sovereign lord of life
❚ Moral premise
❙ murder is wrong
❚ Factual premise
❙ Life begins at conception
❚ Conclusion
❙ abortion is morally wrong
Avoiding the conclusion
❚ Factual premise
❙ fetus not a person
❚ Moral premise
❙ fetus not innocent
❙ metaphor of aggressor
❚ Indirect means
❚ Rule of double effect
❚ Contrasts
Probabilism
❚ If the evil is doubtful,
then the action is
permitted
❙ some versions more
lenient; as long as evil is
not certain, then action is
permitted
❚ If conception is doubtful,
then contraception
permitted after rape
Protestant Perspectives
❚ Wide range of views
❙ Pro-life
❘ Christian Coalition
❘ Southern Baptists
❘ Mennonites
❙ Pro-choice (justifiable
tragedy)
❘ Methodists
❘ Presbyterians
❚ No general mode of
reasoning in common
Jewish view of abortion

Fetus not a person





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