EDF4603 Ethics

The exam will consist of three essay questions, each of which is worth 10 points. You will have two hours to take the exam, and your final submission should be no longer than three typed, single-spaced pages. Your exam may be shorter, and that is okay as long as you cover the material, but I don't want you to go beyond three pages. The object of each essay is to get directly to the point(s) which address the question(s) asked. I do not want a lot of background information or a poetic introduction like you might have for a literature paper. On the other hand, you do need to include all the parts required if you are asked to make an argument using one of the five theories we studied. Remember to start any argument that uses a theory with the standard or standards of that theory, and then show how that standard or standards applies to the situation at hand (use Handout #3, just like you did for assignments #3 & #4). Finally, be sure to answer each part of each question - some questions have several parts, and I assign a point value to each part when I am grading.

There will be no surprises on the exam. Of the 6 questions below, three will appear on the exam. You may do as much work ahead of time to prepare your answers to these questions as you like. However, you will only have two hours to take the actual exam. Also, once you start the exam you cannot stop or return to it. If you stop typing for very long, it will time you out, and then you cannot reopen it. So, be sure you are ready to take the exam (cell phone off, kids in bed, bathroom needs attended to) before you start. I also have had students who have had trouble attaching files to the exam (if they are navigating between screens, they sometimes have gotten locked out), so you will probably be better off typing your answers right into the exam text boxes. You can take the exam anytime between July 23rd and July 30th - the exam is due at 9:00 AM on the 30th - don't try to type beyond that time, or the computer will cut you off because it is an exam. . . so if you are someone who does things at the last minute, be sure to leave yourself enough time. If you have questions as you are studying, please feel free to contact me.

 

1. Of the five theories we have studied (Mill, Kant, Aquinas, Aristotle & Gilligan), which TWO theories do YOU think are the best in terms of their ability to help in moral decision making when faced with ethical dilemmas in medicine? Why? Now, choose one of the two and give an example of what it would say should be done in the medical dilemma of your choosing. Be sure to explain the dilemma clearly and describe what the theory you chose would say was the right thing to do.

2. Of the five principles of biomedical ethics (autonomy, nonmaleficence, beneficence, utility and justice), which do YOU think is the most important for medical decision making? Why? Which of the five do YOU think is the least important in medical decision making? Why? Finally, give an example of a medical dilemma (this dilemma can be from the book, the news, real life or one you make up) and show why the principle you chose as least effective was not helpful.

3. Read the case below. Then, write an essay which says whether or not YOU believe that Maria should take the hormone treatments. Support your view by using one of the five theories we studied (Mill, Kant, Aquinas, Aristotle or Gilligan) AND one of the five principles of bioethics (autonomy, nonmaleficence, beneficence, utility or justice).

Case: Dr. Marshall Marino talks to couples every day at the fertility clinic where he works. All of his patients are there because they have infertility problems, which are usually due to one of three things: not enough sperm, not enough eggs, or problems holding the embryo in the uterus. Both partners are tested for infertility problems. Today, Dr. Marino is speaking to the Hernandezes. They have been trying to get pregnant for four years, but are still young, in their thirties. The doctor explains that Maria's ovaries are not producing eggs on a regular schedule. He suggests they begin hormone treatments as soon as possible. The hormones will stimulate the ovaries to make eggs. Mark and Maria Hernandez have done their homework, though. They read about the McCaughey septuplets born in Iowa and wonder if that might happen to them. Dr. Marino wants to be honest with all of his patients, so he explains the side effects of taking the hormone treatments. Often the ovary responds to the hormone by giving off a number of eggs at one time. If these eggs are all fertilized, the result is a multiple birth. Years ago, doctors thought they could control the dosage of the hormone and, therefore, keep the ovulation under control. This has proven not to be true. There is a chance of what are called "supertwins," that is, triplets and more. Maria thinks a multiple birth would be good. With their problems, who knows if she will ever get pregnant again? But Mark has read that the more embryos in the uterus, the more danger there is of premature birth, brain damage, and possibly death. This frightens him.

 

4. Read the case study below. Then, write an essay which answers the following: Would Mill say that CPR should be performed again if necessary? Why or why not? Would Kant say that it should be performed? Why or why not? Would Gilligan say it should be performed? Why or why not?

Case: Ms. Sonja Pines, an 83-year-old who suffers from liver cancer and kidney failure, is no longer able to communicate medical decisions. Her 60-year-old daughter, Sarah, is recognized as her proxy. The health-care tem believes that CPR is inappropriate for Ms. Pines and that kidney dialysis should be discontinued. In a few days, or perhaps a few weeks, she will almost certainly die. She is quite frail, so CPR would probably produce significant damage and is unlikely to be successful. If she survived CPR she would probably be brain damaged. A resident, Dr. Alice Patik, has talked with Sarah, who adamantly insists that “everything” be done for her mother. Sarah’s other family members live mostly out of town and rarely visit. They have been contacted by phone and all agree, Sarah says. Ms. Pines codes and CPR is performed. The procedure causes two broken ribs; although Ms. Pines is unable to communicate, it appears that she suffered as a result of CPR. She is placed on a ventilator. Dr. Patik thinks that the results of the CPR confirm the view of the health-care team about the harmfulness of the procedure. With good reason, Sarah believes that her mother would have died without the CPR, and this confirms her view about its importance.

5. Read the case study below. Then write an essay which says whether YOU think that the physician should report the mother to child services or not. Support your view by using TWO of the five theories we studied (Mill, Kant, Aquinas, Aristotle or Gilligan).

Case : You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.

6. Compare and contrast the theories developed by Mill, Kant and Aristotle. Tell me ways in which they are similar and different, and remember that each is trying to say what it means to be moral, so the fact that they are all ethical theories doesn't count as a similarity. Think of the standard of each and the way each one works, and that should inform your answer.

Answer:

1. Tow Appropriate Ethical Theory in Making Moral Decision.

For this question, the two theories that are appropriate and the best when an individual is making the right decisions in a medical predicament are Aquinas’ Natural Law and Aristotle’s ethical theory. Aristotle’s virtue theory argues that virtuous people will always find themselves doing the right thing (Butts, & Rich, 2015).

Case Study

An example of a medical predicament is the issue of euthanasia which is intentionally ending a person’s life to relieve suffering and pain. Bradly is one of the medical doctors in a large infirmary. Bradly is the physician in charge of a patient on a life support machine. Bradly and the staff find themselves in a contradicting situation because they feel that the patient is going through a lot. They want to remove the patient from the life support machine and allow nature to take its sequence but on the other hand, the family members feel like it is the responsibility of the doctor to care of their patient. Bradly is applying Aristotle’s virtue theory as he is disturbed that the patient is going through a lot of pain. Bradly feels that he is morally right because the patient is going through a lot and the only thing he can do is to remove the patient from the machine and allow nature to take its course. However, Bradly might be morally wrong as the family members want Bradly and the team to do everything to keep their loved one alive notwithstanding what Bradly and the groupthink.

2. Principles of Biomedical Ethics

In medical decision making the principle of beneficence is the most important because it is based on the value that the physician must be of benefits to their patients (Ten Have, 2015). On the other hand, the principle that is least significant is the value of utility. This principle is least important because it only focuses on the most significant advantage and pleasure and in medicine, the goal is to balance possible benefits against risks of action.                     

Case study

An example of a predicament is that Nick as a physician and is supposed to amputate a leg because of a condition which if the process is not done soon the person might die. Nick applied the principle of beneficence in making the decision. A physician must balance possible benefits counter to a risk of an act. The principle of utility is least important because it only focuses on the pleasure and most benefits of an action and for the case of an amputation it calls for a tough decision to make.

3. Case Study the Hernandez’s

 In the case of this scenario, I think Maria should take the hormonal treatment because it is the law of nature to procreate according to Aquinas’ Natural Law. According to this theory when an individual fulfills the natural need, he/she will be contented. Therefore, the action is morally right (Monteverde, 2015). The principle of autonomy will apply the decision of the patient should be respected regardless of the consequences. However, there is a probability that the child will be born with the disability, but that does not mean that the child has been harmed by being brought into existence.

4. Case of Ms. Sonja Pines

Mill would have been against a performance of CPR on Ms. Pines. The act will be based on the ethical theory of Utilitarianism which holds that the best act or an action is the one that maximizes the well-being of a person and not one that results to the suffering of anyone involved in the action. Although CPR will be beneficial to Ms. Pines Kant would say that CPR is performed on Ms. Pines. The ideology is rooted in the ethical theory which incorporates the Categorical Imperative, where, one has to consider a setting in which individuals did CPR or not. If logically, it was not possible to imagine a context that CPR could be performed, the doctor should not do it. But, if it were possible to imagine such a setting, then it would be better for the concerned parties to ask themselves if the patient would want to live in that setting and if this question is answered as yes, then the CPR should be done. Putting in mind Kant’s formula of Kingdom ends – which holds that we should never treat others as means but ends – it would be logical and somewhat ethical to perform CPR on MS Pines.  Gilligan would say CPR be performed to Ms. Pines. The notion is rooted in her Ethics of Care theory which emphasized the importance of the response to the individual. In this case, the doctor should not weigh, at any given point, possibilities of the procedure or the patient’s survival. Instead, she should uphold care as a primary objective and perform CPR for Ms. Pines.

5. The physician should report the matter to Child Services. According to Mill, actions are right if the consequence tends to promote happiness (Monteverde, 2015).  In this case, the caregiver of the child did a wrong thing to perform coining to the child as the consequence of this action did not bring happiness to a child.  Therefore, she should be reported to the Child Services. Using Kant’s theory highlights, the caregiver should be reported to the Child Services because she used the child as a means to an end.

6. Comparison and Contrast of Aristotle’s, Kant’s and Mill’s Theories

Similarities:

Both Aristotle’s and Kant’s theories avow the role of an individual over the result of their actions. The reasoning and character of an individual determine the moral stand. Both Aristotle and Kant concur that there are actions that are not accepted and therefore such actions should be avoided by a person. Moreover, both Aristotle’s and Mill’s theories base their proposition on an individual’s quest for happiness (Cohen-Almagor, 2017). Lastly, both Kant and Mill advocate for the individual’s freedom regarding the pursuit of morality, that one should be able to consider whether or not, their actions are moral or immoral.

Differences:

Despite, their similarities, these theories hold different ideas to heart.  Their philosophical approaches differ. Aristotle and Mill put forward practical and understandable constructs for their moral philosophy and the expectations of the humans and the societies while Kant appears to be strict in his ideas of the people and the society if his approach on moral philosophy would be followed. Aristotle’s and Mill’s moral philosophies are considered teleological while Kant’s moral philosophy is considered deontological (Monteverde, 2015). Lastly, Aristotle also evades fixing god in his idea and advocates for the conscious course of action of the individual in understanding morality.

References

Butts, J., & Rich, K. (2015). Foundations of ethical nursing practice. Role development in professional nursing practice, 117.

Cohen-Almagor, R. (2017). On the philosophical foundations of medical ethics: Aristotle, Kant, JS Mill and Rawls. Ethics, Medicine and Public Health, 3(4), 436-444.

Monteverde, S. (2015). Undergraduate healthcare ethics education, moral resilience, and the role of ethical theories. Nursing ethics, 21(4), 385-401.

Ten Have, H. (2015). Respect for human vulnerability: the emergence of a new principle in bioethics. Journal of bioethical inquiry, 12(3), 395-408.