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Ethics Exam (Block I)

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Why was Griswold v. Connecticut an important decision?
This is the 1965 U.S. Supreme Court decision that first recognized a right to privacy by finding that state laws that banned physicians from giving contraceptives to married couples was unconstitutional. They said this violated the fundamental liberty to lead one’s personal life as one saw fit and that was assumed throughout the Constitution. This established a basis of using a right to privacy in allowing or denying medical treatments and was the basis of the Quinlan case.
What kind of court finally decided the Cruzan case? The Quinlan case?
Cruzan – U.S. Supreme Court (June 1990)

Quinlan – New Jersey Supreme Court
Who is Hugh Finn
Just as in the Schiavo case, there were two sides to the substituted judgment case where one side wanted to remove feeding tube and the other did not. Hugh’s wife wanted to remove the tube but his brother and parents did not want the tube removed after a nurse said that Hugh had said “Hi” to her. Also in this case, the governor stepped into a judicial matter and escalated a private family dispute that had already been ruled on by a court into a national debate.
What did Pope John Paul II do?
Said that feeding tubes were "ordinary care"
Wanglie and Gilgunn cases?
Examples of medical futility where the families disagreed with doctors.
What important requirement did HCFA pass in 1991?
The Health Care Financing Administration required all American hospitals to ask incoming patient if they had, or wanted to sign, an advance directive. This requirement increased the use of advance directives and has forced hospitals to specify their policies about honoring such directives.
What important facts did the SUPPORT study discover?
The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment found that most competent people change their minds when actually faced with a decision to decline treatment and die, despite having predicted the opposite about themselves many years before
How did Marcus Aurelius and other Stoics advocate the argument for the open door?
Marcus Aurelius and other Romans (yes, the same marcus from gladiator) celebrated suicide over living a long life of pain, the open door argument is “If the room is smoky, if only moderately I will stay; if too smoky, I will go” Keep a firm hand on it, the door is always open.
What does Alasdair MacIntyre call “paradox of Christian ethics”?
Alasdair MacIntyre calls a paradox of Christian ethics: It always tries to devise a code for society as a whole from pronouncements which were addressed to only a few individuals or small communities to separate themselves from society. For example, Jesus preached how to live until God inaugurated the Messianic kingdom and history was brought to a conclusion, not a set of ideals to live by for a continuing society.
Explain two arguments by Immanuel Kant why suicide by terminally ill patients is immoral or blasphemous.
1. Kant opposed suicide. First, he believes an act is right if it can be universalized: terminally ill patients are dying to escape pain and the motive there is self interest and cannot be universalized.

2. Second, people should be treated as ends in themselves and never as means. Destroying one’s life is destroying one’s will – man must not use his freedom to his own destruction. If a person killed themselves just to escape pain, their free will becomes relative to that pain and not absolute. (note, pence only asks for two but there are four arguments in the book:

3. Third, if a person accepts the general principle that life is sacred, they must respect the sacredness of their own life.

4. Fourth, Kant felt our lives are not in our own possession, but in God’s.)
Explain two arguments by David Hume why suicide by terminally ill patients is NOT immoral or blasphemous.
Hume believes the opposite that its not blasphemous or immoral. Voluntary death is not a sin – it’s the result of natural laws created by God. Any suicide is insignificant to the workings of the universe – basically we’re not as important as we think we are – and to think otherwise would be blasphemous.
Who is Geetruida Postma
1st Physician assisted suicide in Holland in 1971. Now totally legal.
Who is Janet Adkins
Killed by Dr. K. Adopted a ‘wait and see’ attitude toward her demise. She valued her mind very much, quality of life was everything for her. She had Alzheimer’s disease, and if she waited she could eventually get to the point where she could not request to die since she would be incompetent. It does not speak about the requirements for physician-assisted suicide but it does state Kevorkian interviewed and noted that Janet was not depressed or ambivalent about her decision to die, if Janet had waited to later stage of her Alzheimer’s, Dr. K may not have done the procedure.
Who is Dr. Quill
Assisted death with a patient, but diff. from Dr. K. cause he knew the patient for a long time
Who are Elizabeth Kubler-Ross and Cicely Saunders
Helped start palliative care. Started Hospice.
What does James Rachels argue
that, in certain cases, letting die does not differ morally from killing
Who is Michael Swango? What kind of slippery slope?
Dr. , Diary revealed he killed for pleasure, not mercy. Empirical slope.
What was the view of Thomas Aquinas on abortion?
St. Thomas Aquinas believed in the concept of ensoulment stating that God ensouled male embryos at 40 days of gestation and females at 90 days. He said even though abortion was sinful at any time, it was worse once it had been formed or “ensouled.” This was easily disproved when microscopes revealed life at many staged.
What is the principle of Double Effect in medical ethics as applied to abortion or terminal sedation of patients?
Double effect was the Catholic Doctrine saying that an action having two effects- one good and one evil, was morally permissible under certain conditions, mainly if your real intension is the good part.
How was the 1962 case of Sheri Finkbine a pivotal case in making Americans rethink the illegality of all abortions?
Sherri was taking an anti-nausea drug at the time she got pregnant with her fifth child, not realized that the drug was a known teratogen and was a “monster former.” Instead of delivering a known deformed fetus she wanted an abortion. The district attorney threatened to prosecute if she had an abortion so she flew to Sweden where abortions had been legal since 1940 where she did abort a severely deformed fetus. This was a case where it was a medical issue causing abortion and not the fact that she had an unplanned pregnancy.
What was Human Vitae? Reaffirmed by whom?
no birth control

Pope John Paul II
Thompson feelings on abortion?
you can kill / abort for self-defense. If someone is dependent upon you for life you are not obligated to help.
Nancy Klein?
1989, Nancy went into a coma during early pregnancy and doctors wanted to abort it to increase blood volume in her body. In the end, they did abort and she woke up 11 months later.
1993 Pennsylvania decision?
The Pennsylvania decision upheld R vs. W and basically said, this is where we stand on the issue and we will hear no more cases on it. Since then they have denied such cases challenging it.
Louise Brown?
1st IVF baby. Doctors were Steptoe and Edward
What is the Paradox of harm
The paradox of harm is the self contradictory statement that a baby can be harmed just by bringing it into this world
J Marion Sims and Robert Latou Dickinson?
Early artificial insemenators. Sims, 1850. Dickinson, 1890's
What do Merit feminists believe?
Merit feminists believe that women should be held accountable for signed contracts involving surrogacy. They define justice as equal opportunity for men and women.
What do Social feminists believe?
Social feminists believe that women are superior nurturers to men. They define justice as equal recognition of the unique natural abilities, talents, and values of women and men.
Who is Baby Jaycee?
Baby with 5 parents.
Maria and Elsa Rios?
Rios died and left IVF embryos frozen in an Australian clinic. Questions arose about the fate of the embryos (could they be destroyed, could the implanted in surrogates, could the children born from the embryos sue the estate for an inheritance, could the sperm donor have input). An ad hoc committee was formed by the Australian gov’t ruled that the embryos must be preserved until adopted, however years of freezing caused the embryos to deteriorate and the issue became moot.
What did the Dickey-Warner Amendment ban?
Dickey-Warner banned “research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death greater than allowed for research on fetuses in utero.
What percentage of Americans are covered by employment-based plans?
54%
What is cost-shifting?
where hospitals charge more for services to insured patients to make up cost of covering uninsured
When was Medicare created? What are its two parts?
Created 1960, passed in 1965
1. covers ALL people over 65
2. covers the disabled under 65
What is Medicaid? When was it created? How is it different from Medicare?
1965; for low income, state sponsored and federally matched; covers long-term care and includes nursing home coverage (Medicare does NOT)
What is sCHIP?
-State Children Health Insurance Program
-covers the families of working poor that don’t qualify for Medicaid
-sCHIP can work with Medicaid
-Children of parents with low-paying jobs can obtain free regular check-ups, prescriptions, dental and eye care, as well as hospital and physician services
Who is covered by CHAMPUS/Tricare
covers active duty military families; must go to military facilities/hospitals for care.
Covers medical necessities only
What is EMTALA?
Emergency Medical Treatment and Active Labor Act. Created in 1986, ER cannot turn away anyone that is unstable. medical safety net for uninsured and illegal.
What law did Canada’s Supreme Court strike down in 2005 ?
Struck down law that outlawed buying or providing private insurance. Opened up private care for cash for surgery instead of waiting a long time for it to be “covered”
Name three states that do or will cover all citizens medical care.
1. Oregon
2. Massechusetts.
3. Vermont
4. (and San Fransisco) according to
Overhead costs of Medicare? Private insurance?
1. 2.5%
2. 2-12%
What financial dangers loom ahead for Medicare, even without expansion
Medicare will go bankrupt in 2018 without higher taxes
What did Gov. Lamm (Colorado) say about medical finance?
Americans need to realize what the nation can afford as far as coverage and find a way to balance ridiculous costs with maximizing coverage.

-We spend 5-8x’s more than any other nation and we still achieve the same outcome ($240,000 to pay for one 76 yr old woman for a liver transplant)

-By not spending as much on dialysis and transplant surgery we can help many more Americans in preventative and less expensive procedures
Is universal coverage necessarily socialized medicine?
Doctors still have freedom of practice. Pence wants us to answer NO to this question
What was the case of Coby Howard ?
it falsified the Rule of Rescue

Oregon resident that ended up dieing of leukemia because the Oregon Health Plan would not pay for his transplant. This was a failure of the rule of rescue.
Who coined the term ‘Rule of Rescue’? When?
Jonsen, 1986
Leon Kass?
Strong proponent of emotivism
Aleta St. James
was a 57 year old woman who, through in vitro fertilization (IFV) using eggs from a younger woman and sperm from a former boyfriend, gave birth to twins in 2004.
Rosee Swain
was a 57 year old woman from Fort Payne, Alabama who gave to twins after already having two grown children in their 30s, six grandchildren and two great-grandchildren.
Adriana Iliescu
66 year old Romanian woman who gave birth to a daughter in 2005.
Bobbi McCaughey
gave birth to septuplets in 1997 through the aid Pergonal (a purified preparation of hormonal gonadotropins) to help her superovulate.
Leon Kass
professor at U. Chicago who champions the wisdom of listening to feelings about natural conceptions. Strong proponent of emotivism.
Define Baseline harm.
Requires a time and baseline component. Happens when a change occurs that makes someone worse off.
Define Abnormal harm
compares a present deficiency to what normally would have been. Results when someone is injured by being brough into existence with some defect that could have been avoided by taking reasonable precautions.
Define Total harm
Results in a life of total pain and injury, such that no hope exists of relief. (Ie. Pigs confined in small spaces until slaughtered) Some consider human cloning to constitute total harm.
Which kind of harm is a wrongful birth?
Abnormal harm. ALSO: that physician’s actions or omissions caused the relevant defect.
Example of wrong without harm?
Mother has a healthy baby to try to trap man into marrying her.
What kind of harm is a wrongful life?
Total Harm
David Benatar?
thinks there should be a higher standard for ending a newborn's life than for not starting a newborn's life
In 2005 average cost of a cycle of IVF?
12,500
Why is Mary Beth Whitehead famous?
Hired for $10K to bear child in 1986 for Bill and Elizabeth Stern. Upon delivery, Whitehead refused to give up the child and then fled to Flordia. Sterns sought legal counsel and in 1987, courts ruled that legal contract must be upheld, that the Sterns would receive the child and Mrs. Whitehead was not to see the child again. 1998 court overturned decision and gave Mrs. Whitehead full visiting rights and invalidated surrogacy contracts.
Who was the baby with 5 parents
Jaycee Buzzanca: Parents hired surrogate and was conceived from egg/sperm from other than from the parents who hired the surrogatge.
Who are William Mayfield and Dr. William Hammesfahr
testified that Terri Shiavo would respond well to hyperbaric oxygenation therapy (HPOT).
What does Alan Shewman think of the proposed category of minimally consious state?
“an inaccurate name for an invalid concept.” Shewmon argues that there is no scientific or philosophical way to distinguish between minimal consciousness and full consciousness, implying that conciousness is something one either has or does not have, like saying you can’t be a little bit pregnant.
Define Structural Discrimination
?” As defined by Fred L. Pincus, “Structural discrimination refers to the policies of dominant race/ethnic/gender institutions and the behavior of the individuals who implement these policies and control these institutions, which are race/ethnic/gender neutral in intent but which have a differential and/or harmful effect on minority race/ethnic/gender groups.”
How long between Shiavo's collapse and her death?
15 years
What was “Terri’s law?”
In the fall of 2003, the Florida legislature passed a special bill, Terri’s Law, that allowed the governor to issue a one-time stay of a judge’s order to remove a feeding tube in certain cases where a patient is in PVS. After its passage, Governor Bush immediately issued such a stay.
What rates of detection do the tests: high-resolution fetal ultrasounds, combined with three measurements of maternal blood levels of alpha-fetoprotein, human chorionic gonatropin, and estriol have for Down syndrome and trisomy 18?
90 and 97 percent, respectively.
How does eugenics differ from Eugenics?
Eugenics (with a capital “E”) refers to the racist movement founded on state coercion that held false views of how to eradicate genetic disease. The second case, eugenics (with a lower-case “e”) refers to people who voluntarily choose to abort to prevent genetic disease, not based upon false information about their fetuses but upon reliable data.
Who coined “eugenics” and why? Where was the center of the movement in the first part of the 20th century?
Darwin’s cousin Francis Galton invented the term “eugenics” (literally, “good birth”) and championed maximal births by the most “fit” people and sterilization or voluntary abstinence of “unfit” people.
What was the Immigration Restriction Act of 1924 ?
It severely limited entry into the United States of people from “inferior” lands such as Asia, Africa, southern Europe, and Ireland, while simultaneously encouraging immigration from England, Germany, Switzerland, and Scandinavia.
Who was James Delahunty?
pro-life obstetrician. say discouraged them from pursuing amniocentesis when a sonogram showed a fetus with a thickened skin on the back of the neck (a sign in utero of possible Down syndrome). The jury awarded the couple nearly $2 million and found Dr. Delahunty guilty of “failing to recognize, appreciate, and failing to discuss the results of the tests, particularly ultrasound” with his patients
What was the Karen Coveler case about?
Karen Coveler requested “all the DNA tests she could to determine if she was at risk of passing on a genetic disease,” yet her physician did not offer her a test for a genetic cause of deafness, which her son had, leaving him deaf at birth. Physician don’t offer similar tests for breat cancer and mental retardation because they make a cost-benefit moral judgment that (1) the genetic condition was not too bad, (2) that the risk of this condition was low, and that (1) and (2) did not justify an abortion.
What was Ben Haygood’s case about? The result?
He was born in August 200 in Mississippi. Ben did fine for two years, then suddenly got sick and dies that night. He had a rare but treatable disease, MCADD (Medium-Chain Acyl-Co-A-Dehydrogenase Deficiency), that prevented metabolism of fats. Ben’s death may have been prevented by a slight modification of his diet and by discovery of MCADD which would have been revealed by a $25 test at birth.
Why do critics of newborn testing for genetic disease claim that the above program may easily kill or harm more kids than help?
History could repeat itself when all states mandated testing babies for phenylketouria (PKU).
Who developed the blood test for PKU and what did he then campaign for? Why did mandatory testing for PKU harm some babies?
In 1959, Robert Guthrie, a microbiologist at the University of Buffalo, developed a simple blood test for PKU in babies and campaigned passionately to test all babies. If tested positive, Guthrie argued, PKU babies could be raised on a special diet low on phenylalanine. Without testing, PKU would not be discovered in babies until they were brain-damaged. Two assumptions were made: that a positive result on the test meant that a baby really had PKU (no false positives), and that the special diet was safe for babies misdiagnosed with PKU. Both assumptions were false.
What happened in the Dryer case?
After learning the fetus they were carrying had Down syndrome, the Dryers decided to abort. They conceived again and had their new fetus tested at 12 weeks, and it also had Down syndrome. In this case, they decided to bring the fetus to term and have the baby. Nevertheless, the Dryers felt uncomfortable in their church and neighborhood. About a month after their child was born with Down syndrome, they accepted new jobs on the other side of the country and moved.
What percentage of the world’s medical resources are consumed by people in developing countries?
10%
Mark Warnock?
suggested elderly patients should consider suicide rather than being a financial burden on their families and on society
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