Final Exam

Format

The final exam will consist of four essay questions, of which you will have to select and answer three. Each question will be of the form:

"Summarize and critically evaluate [author's] views in [article]."

You will have roughly 2 hours to complete the exam (from 7:45pm to 9:45pm, April 29th). I encourage you to budget your time carefully; plan to spend at least 20-25 minutes on each question, as the completeness of your summaries will be measured relative to those of other students. I will supply scratch paper and as many blue books as you need.


Grading

• 20% of your grade for each question will depend on the overall legibility, clarity, and organization of your answer. I encourage you to outline your answers before you begin writing them.

• 40% of your grade for each question will depend on how accurately and completely you summarize the author's view. The best essays will demonstrate a thorough understanding of the author's arguments and conclusions.

• 40% of your grade for each question will depend on the quality of your critical evaluation of the author's argument. The best essays will indicate potential problems for, or objections to the author's argument, and ways the author might respond to those problems and objections.

Material

Below, I've listed all the articles I considered fair game for exam questions. I've struck four of them, and I will allow the class to strike another three from the list. Struck articles will not appear on the exam.

1. Alan Goldman, “The Refutation of Medical Paternalism”
2. Terrence Ackerman, “Why Doctors Should Intervene”
3. Emanuel and Emanuel, “Four Models of the Physician-Patient Relationship”
4. Katz, “Informed Consent--Must it Remain a Fairy Tale?”
5. Daniels, “Equal Opportunity and Health Care”
6. Marchland, Wikler, Landesman, “Class, Health, and Justice”
7. Buchanan, “The Right to a Decent Minimum of Health Care”
8. Engelhardt, “Freedom and Moral Diversity”
9. Daniels, “Justice, Health, and Healthcare”
10. Sreenivasan, “Opportunity is Not the Key”
11. Pogge, “Responsibilities for Poverty-Based Illnesses”
12. Risse, “Do We Owe the Global Poor Assistance or Rectification?”
13. Brock, “Cloning Human Beings: An Assessment of the Ethical Issues”
14. Steinbock, “Respect for Human Embryos”
15. Ryan, “Creating Embryos for Research”
16. Marquis, “Why Abortion is Immoral”
17. Thompson, “A Defense of Abortion”
18. Arras, “Physician-Assisted Suicide: A Tragic View”
19. Dworkin et al, “The Philosophers Brief”

The youth in asia.....

I find myself able to argue both sides of this argument.

Good Life/Good Death
I know I would want PAS to be an option for me. I would hope if I felt encased in my body and my will to be here was gone, never to return, that someone would help me move on. I want to leave this place on my terms. I don’t want to leave my family unable to grieve my death or celebrate my life. How unfair it is for me to make them choose because I was too lazy or fearful to choose while I still could.
I am also very aware from my experience in the hospital setting euthanasia is practiced fairly commonly only under terms that make it seem less alarming like hospice or “comfort measures only”. Patients are given different painkillers when they express their desire to end chronic suffering. The patient is given the new meds and is told to be careful because more than 1or2 would certainly be lethal. With a handshake and a smile they get the message. Hearts slow to a stop and breathing becomes shallow, autopsies are performed only at the families request after a certain age (unless circumstances indicate a reason otherwise). Then there are friends and family that insist their loved one be sent home to die in more peaceful surroundings than the overcrowded floors of the hospital. It just doesn’t make headlines but these practices are practices of euthanasia. The fear behind it becoming a slippery slope seems to loose ground if it hasn’t “slipped” thus far. I know people who don’t want to be organ donors because they think medical staff will be less likely to use resuscitative measures. Maybe the idea people will be euthanized against their will is just as hollow. Lastly, as obvious as it sounds we do seem to condone euthanizing animals. There are many differences between animals and humans but at its core it is the same principal.

Hope for the Hopeless?
On the other hand, I too have trouble ignoring the fuzzy line between one’s right to die and one’s obligation to die. Sick people are vulnerable and need advocacy. After this reading and countless “you tube” videos I still wonder whose suffering people really want to relieve. Is it always the patient’s? I learned that within a year of a paralyzing spinal injury more than 90% of patients wanted to end their life but after 5years only 10% said they would. I can’t help but feel like we have an obligation to those people to make them stick around. I don’t trust the government to regulate euthanasia simply because of a poor track record otherwise. There are far too many ideas of what “quality of life” consists of. When it is up to others to decide what another person’s quality of life is some degree of misinterpretation is bound to occur.
The debate is far from dated. As context changes people are faced with new aspects to consider. Unless we plan for ourselves plans will be made for us, period.

The Forgotten - Those That Need Fighting For

Arras made a good point about the uninsured and poor, stating that, “Minorities and the poor already suffer from the effects of discrimination in our health care system, it is reasonable to expect that any system of PAS and euthanasia will exhibit similar effects, such as failure to access adequate primary care, pain management, and psychiatric diagnosis and treatment. Unlike Dr. Kevorkian’s “patients”, these victims will not get their pictures in the papers, but they all will have faces and they will all be cheated of good months or perhaps even years.” More focus should be on the minorities and poor, since they do not have stable financial means, or even any financial means, to help get counseling, pain relief, etc., and yes, they are then robbed of the life they deserve of fulfillment. Arras’ point about the uninsured, poor and minority, brought to my attention things that I did not even think about, which made me wonder why Dworkin and the other authors of the Philosopher’s Brief did not take this into consideration. The author’s of The Philosopher’s Brief are ‘united on their conviction that respect for fundamental principles of liberty and justice, as well as for American constitutional tradition, requires that the decisions of the Courts of Appeals be affirmed.’ But what surprised me is that when talking about liberty and justice, no where did they mention about the uninsured and poor.

The author’s discussed points about how individuals in a free society must be allowed to make life decisions for themselves, based on faith, conscience, and convictions, protected by the courts. Also, the author’s discuss the case of how Cruzan support the liberty interest, which states if a competent patient has a constitutional right to refuse life-sustaining treatment, then the court implied the state could not override that right. Cruzan also supports that a state may not burden a terminally ill patient’s liberty interest in determining the time and manner of his death by prohibiting doctors from terminating life support. Also, given were examples of different situations where people had certain diseases that were not curable and what their decisions were with regards to ending their lives without suffering….If these authors feel so strongly about respect for fundamental principles of liberty and justice, why did they leave out such an important group of people, which includes minorities and the poor? The article was worded to point towards a certain group of people that have the means to make the decisions they wish, but not to the less fortunate.

Suppose a poor person that lives on the streets, scrounging for food and a place to sleep at night, has cancer, chronic pain, or some other disease and cannot go into a clinic for help because they have no money. Do we disregard them and let them suffer and die as a human being that deserves respect and help, just like anyone else? Where is the liberty and justice there, which the author’s are so united about?

To Presence and anyone else interested....

Just wantedto put the info out about the writing center here on campus. Here is the description:

"The Writing Center is a free service for all students (both graduate and undergraduate) currently enrolled at Washington University, as well as for faculty members. We will work with students on essays, senior theses, personal statements, oral presentations, and more.
Our tutors are writers who help writers through the process of revision. Students come in at all different stages of the writing process, from brainstorming all the way to the later drafts. We listen to student concerns, read written drafts, and then discuss larger issues of the work first, such as thesis, organization, development, and clarity of the ideas. By talking with the tutors, students strengthen and clarify their ideas throughout the writing process. Tutors will not edit or proofread student papers. Instead, we will identify patterns of error in grammar, usage, spelling, and punctuation and help students become editors of their own work."

Gotta have an appointment- here is their info
Eads Hall, Room 111
(314) 935-4981
writing@artsci.wustl.edu

Mary Anne Warren's thought experiment

This is included in the Warren reading that is no longer on the syllabus.  It might be of interest to some, as it has a bearing on Marquis' "valuable-future" view. 

From "On the Moral and Legal Status of Abortion". Mary Anne Warren:

Suppose that our space explorer falls into the hands of an alien culture, whose scientists decide to create a few hundred thousand or more human beings, by breaking his body into its component cells, and using these to create fully developed human beings, with, of course, his genetic code. We may imagine that each of these newly created men will have all of the original man's abilities, skills, knowledge, and so on, and also have an individual self-concept, in short that each of them will be a bona fide (though hardly unique) person. Imagine that the whole project will take only seconds, and that its chances of success are extremely high, and that our explorer knows all of this, and also knows that these people will be treated fairly. I maintain that in such a situation he would have every right to escape if he could, and thus to deprive all of these potential people of their potential lives; for his right to life outweighs all of theirs together, in spite of the fact that they are all genetically human, all innocent, and all have a very high probability of becoming people very soon, if only he refrains from acting.

Indeed, I think he would have a right to escape even if it were not his life which the alien scientists planned to take, but only a year of his freedom, or, indeed, only a day. Nor would he be obligated to stay if he had gotten captured (thus bringing all these people-potentials into existence) because of his own carelessness, or even if he had done so deliberately, knowing the consequences. Regardless of how he got captured, he is not morally obligated to remain in captivity for any period of time for the sake of permitting any number of potential people to come into actuality, so great is the margin by which one actual person's right to liberty outweighs whatever right to life even a hundred thousand potential people have. And it seems reasonable to conclude that the rights of a woman will outweigh by a similar margin whatever right to life a fetus may have by virtue of its potential personhood.

Thus, neither a fetus's resemblance to a person, nor its potential for becoming a person provides any basis whatever for the claim that it has any significant right to life. Consequently, a woman's right to protect her health, happiness, freedom, and even her life,' by terminating an unwanted pregnancy, will always override whatever right to life it may be appropriate to ascribe to a fetus, even a fully developed one. And thus, in the absence of any overwhelming social need for every possible child, the laws which restrict the right to obtain an abortion, or limit the period of pregnancy during which an abortion may be performed, are a wholly unjustified violation of a woman's most basic moral and constitutional rights .

How can it be resolved in abortion issues?

Don Marquis says that anything with human genetic code is human. Human fetus have a human genetic code. Therefore fetuses are human. Marquis is not arguing for againt abortion with human genetic code. Marquis belives that against abortion's biggerst point is "The view that what makes killing wrong is the loss to the victim of the value of the victem's future(p:550)".

Marquis is counter arguing based on his theory all the way to the end on his essay with "the loss of one's future of one's future is the wrong making feature of one's being killed dose not entail as santity-of-human-life theories do, that active euthanasia is worng(P:550)".

Marquis did not dealing with any option other than save fetus life. It brings some question on us that what we should do in case of someone got raped and unwanted pregnancy or if mother's health is jeopadized in her life by her pregnacy.

In contrast, A defense of abortion by Judith Jarvis Thomson, Her argument was that "Every person has a right to life. So the fetus has a right to life. No doubt the mother has a right to decide what shall happen in and to her body(p567)". Thomson belives that fetus is a person from the moment of conception.

Thomson does not belive that abortion shoud not performed unless mother has a serious diseases that would be affect her life by carrying full term of pregnacy as cardiac disease. Thomson says" directltly killing innocent people is a murder and murder is always and absolutely impermissible, abortion may not be performed(p:568)".

If only options are save a baby and letting mother die or save mother's life and letting baby die. What would you do in this case? Mother decided to perform abortion by third person( physician)to save her life then this is her right to save her life. Everyone has a right to own life. Is it child's life is more weightier than mother's life? No one can say that she was wrong to save her life.

If someone has a unwanted pregnacy by result of rape, then she is right to refuse carry a baby because she did not consented.

Thomson is giving a some room to protect individual right and autonomy in her essay, however, she is almost close to prolife that she does not belive to perform any abortion except few cases as described in above.

Battle Royale: Marquis vs. Thomson

Coming into this article I have to say I had a very liberal view towards abortion. I never really thought about the rights of the unborn child, but rather the rights of the mother. Don Marquis presents the “right to life” argument in a convincing way and gave me some hesitance about my opinion of abortion. However, while not a direct rebuttal to Marquis’s article, Judith Jarvis Thomson helps restore my opinion by arguing for the permissibility of abortion in certain situations.

The view that what makes killing wrong is the loss to the victim of the value of the victim’s future makes sense to me. And this is what really strengthens the case against abortion. Nothing has more of a future than an unborn child. Therefore, by killing a fetus, theoretically we are losing more of a future than by killing an adult. However, I believe that a conscious human being’s life is worth more than a fetus even though there is less future left. The impact of those close to this individual would be greater, and the mere fact that this person has an interest to be alive makes his life of greater importance than a fetus with no interests. But this begins to get complicated if we are talking about certain lives being worth more than others.

What I think matters the most is the interest of the mother. As Thomson illustrates in a number of examples, including the violinist one, a mother does not have a duty to carry an unborn baby whose existence is due to rape. The mother has the right to decide what to do with her body. I would go farther and say that the mother has this right even in pregnancies that were not due to rape.

One thing that neither author really touched on was the life prospects of the child after birth. It’s just assumed that the child will have a good life. Do unborn fetuses have a right to a life of being abused by their parents? Or not receiving the kind of nurturing, upbringing, or attention we’ve come to expect in raising a child. Obviously, the child can be put up for adoption if it is clear that the child will not have a home, or parents that will take care of him. But, as we all know, there are many stories of abusive households. If the case were clear the baby would be going into an abusive household, why not allow abortion? And even further, if the mother simply does not want to go through pregnancy, why not allow abortion?

Are there limits to the ways in which embryos may be treated?

Bonnie Steinbock who is a professor of philosophy at Albany and specialist in bioethics, she seems to understand well in embryonic stem cell research in pro and cons. on her esssay "Respect for Human Embryo", she was debating embryos in moral valuve and we have to carefully evaluated for sientific stem cell research technology for only for reasonably benefit for the human life in necessity.

There are people who has heavey weight in moral values in embryos as much as " deserves special respect" and "serious moral consideratiopn as a developing form of human life(p:668). the controversy as Jhon Robertson describes "If the embryo has no rights or interest , how can it be owed special respect? on other hand, if embryo is owed special respect, is it not then a holder of rights, including the right not to be the subject of research? What does 'special respect' mean(p:668&669)." It is hard to make a line how much moral value in embryos even though it can be pre implatation inform of human life.

Steinbock argues that embryo do not have interests or welfare of their own and it is impossible to show them serious moral consideration. There are many left over tens of thousand of embryos in infertility clinic's freezer in the United States that can not be useing for the Invitro fertilization(IVF) for the infertility women due to infertility clinic has to use freshly saved embryos for the fertility purpose.

We have to answer the questions that is it moral ethically right or wrong that these left over embryos keep in freezer forever or distroy them or sientists can use them as their reseach project for the cure for the serious diseases as a parkinsons diseas, spinal cord injuries, severely burned patients, bone marrow transplant or any other serioues diseases. so far stemcell research technology knows some of knowldges that blastcytes(few cells differentiated from embryo in befoer 5 days)can be injected to ill site of human body with minimal rejection or none rejection from human body to regerate new fresh cells.

I will be add little more later soon.











.

Addressing the Potential for Human Life

I would like to know, was the Ryan article a direct response to Steinbock’s? It was obviously a response to a Steinbock article, but was it the article we read? If it was, I believe that the editor of this collection did us a disservice. Ryan directly addresses a point raised by Steinbock that was not in the Steinbock article. A point I believed was missing and weakened Steinbock’s argument.

Steinbock wrote, “Just as disrespect for dead bodies can strike at our respect for living human persons, so, too, I want to suggest, an inappropriate treatment or use of embryos. Embryos, as much as dead bodies, are a ‘potent symbol of human life’ and for that reason have moral value and deserve respect, even though they lack interests, rights, and (therefore) moral status.”

I took issue with Steinbock’s casual dismissal of embryos as mere symbols of human life, “as much as dead bodies.” Her use of the example is, understandably, to answer the paradox of embryos deserving special respect, yet holding no rights, and it provides a reasonable example of an instance where a thing may not have any moral status, yet still have moral value. It deserves respect, however has no rights.

And, yes, that is a wonderful example to illustrate her point that it is, indeed, possible to give special respect to a thing while (contradictorily) that same thing has no rights. However, Steinbock does not address an embryo’s potential for life.

While it is a useful example to prove that such conditions exist, her point only addresses the possibility of such conditions existing. While the conditions exist, do embryos fall into that category? She continues on to describe what giving respect to human embryos consists of and addresses concerns raised regarding the question of what should be done with embryos no longer needed or wanted for IVF, but assumes that it is a given that embryos have no rights, yet are due special respect without addressing an embryo's potential for life.

Then, while reading the Ryan article, Ryan provides Steinbock’s line of reasoning regarding an embryo’s potential for life. “Human embryos have the potential to develop into ‘the kind of being that will have interests,’ but, lacking conscious awareness, embryos and even presentient fetuses lack interests of their own; that is, they exist – at this stage – as the sort of being ‘to whom nothing at all can possibly matter . . .’” The argument continues to conclude that sentience is the necessary condition for moral standing.

Ryan’s direct and impressive criticism of this logic verbalized the issues I took with Steinbock’s dismissal of the potential of life (and many more than I briefly considered). But does Steinbock address the argument that potential persons are more than just symbols? Was it simply not quoted, and, if so, is there more to that argument than that briefly quoted by Ryan?

As one last aside, Ryan exhaustively addressed her moral argument differentiating between embryos created for scientific research and those for reproductive intentions, but I think she asks a basic question that I believe deserves more consideration from a different angle. “What are we doing when we fertilize in vitro . . .”? Which made me wonder, do all people have a right to reproduce? Is it a right?

That question has more to do with reproductive freedom we addressed last week. I guess I’m still debating whether or not it is a right, and if it is, why? Why does every human have a right to reproduce?

My two Cents...

Sorry guys.... This started out as a response to a posting but since it got a little long I am psting it alone.

I am still wondering how the argument in favor of cloning is so easily passed. Who exactly is in the position to declare that they should be cloned? Who decides "I am of such great talent and genius there should be two of me!" Those in positions of great power and wealth right? Now then, what are the characteristics of those in such powerful positions? Overall as you look at the power players in the world's arena, are they compassionate, sincere humanitarians? Or are they business minded self-serving people who gain their status on the backs of others.
On the other hand, say we leave it up to the public to decide who should be cloned. Well how long before a minority "genius" is cloned? Hell it took 40+ years to get a biracial president.
It is up to the population to decide where their priorities lie. Does diversity and uniqueness tip the scale to one side more than scientific advancement and our own selfish need to hold on to something that is gone. For me it does. I wouldn't consider risking the vast pool of differences in cultures, ideas and the beauty found in the many people that make up the world for anything... even granting a infertile couple a child. Just not worth it.
Consider this, about 6 years ago farmers were given a new type of corn. This type of corn needed very little pesticide and yielded almost double the crop. Transgenic maize or biotech corn was sold by Monsanto whose corporate office is right here in St. Louis. Today this corn is found everywhere cereal, chips, corn syrup, taco shells etc. the list goes on and on. Its long term effects are unclear but ah well. Hopefully we won’t become allergic to it as doctors predict.
Then you have the farmers who choose to grow organic crops. No pesticides or growth enhancing chemicals are used for their corn. As long as the farmers have a choice on what to grow and the consumer has a choice in what they buy its all good right?
No, that has not been the case. Since corn is easily pollinated by the wind the spores are traveling… fast! Farmers once certified as organic who sold their harvest for $2.75 a lb are being stripped of their organic seal. There FDA comes around and tests to see if you are using biotech products. Organic farmers who never used those products are testing positive. The price of their corn drops to less than $1. Did you know there is a place in Mexico where every species of corn is kept? It is like the world’s insurance. If there is a flood or outbreak of some kind that kills your corn crop you go there to replenish it. Recently, they found the BT corn had infiltrated the crops. Changing the corn slowly but surely to all be the same. There is nothing anyone could do to stop it. Scientist made the choice. Are you making the connection here? Seriously.
Furthermore since the product is patented by Monsanto they know who it is sold to and when. You sign a contract stating you will not replant the seed next year. You must only buy from them and there is a termination gene that can be introduced that wipes out the entire crop for those who violate the contract.
If this sounds at all worrisome to you, you may want to think about human cloning a little more critically. It’s not science fiction people it’s science.

Virtue Ethics Quiz

First: There are four excellent posts below on Dan Brock's "Cloning Human Beings" article, so if you haven't yet, you should read them and join the discussion.

Second: Since some of you couldn't make it to class last Wednesday, it's only fair to warn everyone that the quiz on virtue ethics has been postponed to this week. Study hard!

The Expectation with which a Cloned Child is Born

Dan Brock outlines and discusses the relevant moral considerations of human cloning.  Some of the considerations support human cloning; others do not. 

One of the relevant issues that Brock does not adequately cover is the circumstances under which parents might choose to produce a clone of their child and the possibility of unjustness that this might introduce.

Suppose the parents of a deceased child decided to produce a clone of that child.  The original child is dead; hence, the parents would not be treating the cloned twin as a mere means in any straightforward manner (they are not producing a clone to get bone marrow from the later twin, for instance).  Yet, it would seem that the parents have decided to produce a clone of the original child in order to assuage and compensate for their own feeling of loss.  The later twin is borne not out of the parent’s wish to have a child per se, but of the wish to have a twin that resembles the dead child hoping that this will allay their deep sense of loss.  Giving birth to child, in this case, is not an act strictly of procreation but of compensation.  The motive is different; and when the motive of an action is different, the moral worth of the action likely differs.

Furthermore, genetic determinism—roughly, the view that two persons with identical genetic make-up will grow up to be largely identical in appearance and demeanor—is false.  Human development is not only a matter of “nature”, but of “nurture.”  There is great likelihood that the cloned twin will develop in vastly different ways from the original, now dead, child that the parents so loved and wished to replicate.  In the case of the cloned twin, a part of the parents caring attitude toward the cloned child seem to have its roots in the parent’s expectation that the clone will grow up to replicate the characteristics of the original child.  Yet, given the falsehood of genetic determinism, it is highly unlikely that the cloned child will ever replicate all the characteristics of the original child that the parents favored.  The failure to do so will result in a disappointment for the parents.  It is questionable whether the parents will be able to continue to love the cloned child in the same way, if it turned out that due to environmental factors, the cloned child turned out to be very different from the original child they wished to preserve.

This possibility further suggests that the cloned twin will forever have to live in the shadows of his original, dead, sibling. 

Every cloned child is born with a massive burden of expectation on his shoulders that a non-cloned child does not have.  This is because in producing a clone, the producer is always motivated by a motive that is not just the longing for a child.  Perhaps the genetic clone of Einstein is born with the weight of an expectation to be intellectually brilliant; but what is clear is that the cloned twin of a dead child is born with the hopes of his parents to grow up to be like the dead sibling. 

The cloned child may be a genetically identical to the original child; but the cloned child is born with a much greater weight on his shoulders than the original child.  

Huxley Realized

Sadly, Dan Brock focused “principally with cloning by nuclear transfer, which permits cloning of an adult, not cloning by embryo splitting.” Based on recent current events, a little foresight would have allowed his article to directly relate to 2009. However, as he admits, “some of the issues apply to both” so copying a few of his points regarding nuclear transfer and applying them to embryo splitting will allow a discussion regarding Barack Obama’s March 9th Executive Order “Removing Barriers to Responsible Scientific Research Involving Human Stem Cells.”

(I’ve attached links at the bottom of this post for both the Executive Order as well as the Presidential Memorandum).

In the Presidential Memorandum, President Obama states, “we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.” The obvious issue is that the executive office only shut the door on cloning used for “human reproduction,” not all “human cloning.”

What exactly defines “cloning for human reproduction?” Reconsidering my original dismay at Brock having focused solely on nuclear transfer, following guidelines set forth by the new administration, is it not conceivable to legal clone an adult human as long as it is not for the purpose of human reproduction, that being, the implantation and gestation of the second twin embryo?

I am by no means any sort of expert regarding this order nor the science behind it, however it seems as though the legal door is open for a wide variety of ethical issues to come into play, specifically, the use of human clones as replacement body parts. Brook addressed human cloning in order to obtain “organs or tissues for transplantation” and refuted the morally reprehensibility of it because the cloned twin would be both a means to save a previous child’s life and an ends by “being loved and valued for its own sake” (page 635).

However, based on the order passed by President Obama, the cloned twin could only be legally cloned as a means, not as an ends in and of itself, since cloning is only illegal when done so for “human reproduction.” Is the term "cloning for human reproduction" so easily subverted?

The administration has not yet written the necessary additional regulations defining the executive order regarding stem cell research and the passing line regarding cloning; however, to the casual observer it appears as though there is quite a hole by specifically addressing cloning in regards to solely human reproduction.


Presidential Memorandum

Executive Order

Is Human Cloning Still a Current Issue?

In his article, “Cloning Human Beings: an Assessment of the Ethical Issues Pro and Con”, written shortly after the infamous cloned sheep, Dolly, was “produced” in 1997, Dan Brock delves into the moral issues involved in human cloning. When the news of the first successful cloning came out, many people quickly condemned it as a violation of moral rights and “ethically unacceptable”. Brock begins his article with analyzing this particular response, stating that many of the individuals condemning cloning were doing so from an emotional, or relativistic, standpoint and although it is incorrect to base moral reasoning from such a position, he states that the reason why the issue of cloning elicits such a response must be clarified and understood in order to come to a conclusion on whether Human cloning is morally justifiable in today’s society.

First, Brock investigates the argument for human cloning. He suggests that the right to clone oneself successfully falls under an individual’s moral right of reproductive freedom, especially if this is the only way this individual can successfully reproduce. After identifying what moral right is at stake with the right to clone oneself, Brock outlines the possible benefits to individuals and society:

1. It would allow a new means in a way to relieve infertility, especially if other infertility technologies were not an option.
2. It would enable couples who may have a genetically transferrable disease the ability to have a biological related child from at least from one of the partners.
3. The cloning of a “later twin” would allow an individual the ability to obtain needed organs or tissues for transplantation.
4. It would allow an individual to clone another of significant meaning to them, such as a lost loved one.
5. It would enable duplication of individuals with great talent and genius.
6. It would allow for important advances in scientific research.

Brock ends his argument for Human Cloning by stating that although there is no great benefit to human cloning, a case can be made for cloning through the premise of protecting the moral right to reproductive freedom.


Brock continues his article by turning his attention to the argument against human cloning using the same format. He first identifies what moral rights are at stake if human cloning was legal in society, focusing on “the right to an open future”, meaning the moral right of a “later twin” to decide their own fate. Brock emphasizes that this “right to an open future” is not based in the reality of the situation but in the later twin’s perception of their future. If the later twin perceives their fate to be decided due to the earlier twin’s past life decisions then their moral right to decide their own future is compromised and is therefore morally wrong.

Specific harms due to Human Cloning in society are then outlines as follows:

1. The psychological stress to the later twin. Again this is dealing with the perceived loss of control of the later twin rather than the reality of the situation.
2. Risks to the cloned individual, such as trial and error, failed attempts at cloning and premature death of cloned individual.
3. Cloning would lessen the intrinsic worth of a human being and diminish respect for life.
4. Cloning would divert resources from other important societal and medical needs.
5. Cloning might be used for commercial interest for financial gain.
6. Clones could be used by government or others for immoral and exploitative purposes.
7. Widespread use of Cloning would drastically reduce genetic diversity and our ability to adapt to our environment.

Through disproving most of the forementioned benefits and harms in his article, Brock concludes that the pros and cons of human cloning are “sufficiently balanced”; cloning is not a central component to reproductive rights therefore not necessarily morally justified. Conversely, cloning does not seem to violate any particular moral right. Futhermore, even though cloning is capable of causing significant harm to individuals and society, these harms are speculative and does not warrant prohibition of human cloning.

As I was reading through the article, I could not help from feeling that although Brock made some very good points on both sides of the cloning issue that the topic is extremely out of date in the science/medical field. Since 1997, major advances in stem cell research have been made, making it more highly more likely that organs will be grown in labs than in human clones and the need to grow a whole genetic copy of an individual is no longer necessary. Although there may be a small percentage of clones made for privately funded research or, of course, unless all of a sudden we need a clone army, I really believe the scientific community has surpassed and dismissed this technology. But does this fact make the topic any less morally important? No, I think the benefits and harms outlined by Brock in this article could be tailored to such issues as stem cell and embryo splitting and could make a strong point for either side of this issue. I just found myself not as concerned with the topic as perhaps I might have been 10 years ago when it was first presented. Does it seem as outdated a topic to you?

I was also wondering while reading the article why the moral issue of equality was not brought up by Brock. Cloning yourself would be so expensive that it would only be available to a few wealthy individuals, which according to some moral theories is morally unjust as it limits equal opportunity, so therefore would it matter if the practice is unjust, isn’t it is unjust first and foremost in its unequal distribution?

In any case, I think the overall problem Brock faced in this article and we, as a society, face with any of these growing scientific technologies is the vast uncertainty of their effects of individual and societal moral rights. We will not know until they are put to the test and by then would it too late or could we fix it?

Is Human Cloning really THAT bad??

Seeing as how I will not have internet access during the upcoming week, I decided to blog on this article even though I am not an assigned blog leader. I had to do it for two reasons: one, an increase in my comment grade (!) and two because of how excited I got while reading this article . I have taken many classes in genetics and human heredity where I was previously able to formulate my own decision regarding human cloning. To be honest, I pretty much only saw negatives in moving forward with the use of humans in cloning. Somatic cell nuclear transfer is a highly controversial technology, with reason, and it is terrifying to think of how things could be if this technology was not severely restricted.


I believe that Dan Brock did an excellent job highlighting the pros and cons of cloning. His arguments for cloning were so convincing that it was difficult for me to see the pros and cons as being equal as he had believed. The view of seeing human cloning as just an extension of a reproductive right was quite clever. In denying individuals a potentially available service for cloning, it is almost as if we are condemning infertile individuals by not allowing them to maintain a biological connection with their child. Sure other alternatives are available, but if cloning
were the only option, then it seems wrong for us to deny them that right.


I think that the strongest argument made by Brock for cloning was his point that it is not illegal for parents to carry children to term that are known to have a serious genetic defect, yet it is illegal to clone (or select for genetically competent children to be carried to term). Though the parents of the child with the genetic defect are aware of what they will be subjecting their child to, they are able to make that decision for their child and negligently inflict a life of pain and suffering. And for what? How can we permit this to happen?? It almost seems as though we are giving more of a right to the parents than to the child. I will argue that we can’t accurately speculate the wishes of the unborn child, but I am pretty sure that no one chooses to have a serious disease.


I can feel myself ranting, so I should stop. Though Brock brings up amazing pros and cons with cloning, I still believe that cloning is wrong mostly because of the psychological and social distress that it may cause the later twin, or “clone”. It is difficult for me to see that the clone could ever be valued as a whole person, independent of his or her carbon copy, with his or her rights to ignorance and to an open future. To be honest, my disapproval of human cloning is entirely concerned with the rights of the alter twin and not so much of the individual cloned.

Who Is Responsibility Is It?

After reading Pogge and Risse articles several times I was left feeling a little confused due to my lack of understanding from some of the language that was used.(perhaps if they could find a way to dumb it down a little) So I was advised to go to (my new best friend) Wikipedia and find the meaning of some words that I did not understand like the use of "Benchmarks" and "Social institutions" to see if I could clear some of my misunderstandings. (It helped but not enough though) Here are some of the things that I agreed/disagreed with Pogge on:

1. As a person you have a much stronger moral reason to makes sure that you do not harm someone else out of your own negligence than you have to make sure that they are not harmed by causes outside of your control.

I agree with this because you can only control what actions that you have taken and you can only (well should be) held accountable for your own consequences not the actions and consequences of others. For example if someone is hungry and they need food I would with out a doubt supply the food because that is within my control. But, if you choose not to eat the food that is supplied before you I can do nothing because your own negligence is out of my control.

2. ..."One's moral reason to help prevent and mitigate others' medical conditions is stronger when these others are compatriots than when they are foreigners. I reject this belief in regard to medical conditions in whose incidence one is materially involved. "

I disagreed with this point because I would be inclined to help someone regardless of the fact of me having some type of commonality with the person that is in need whether I was materially involved or not. That is like say that I am only going to combat the spread of AIDS/HIV only in Americans because I am American and to boot any patient that is not of American decent with AIDS/HIV. Or I am only going to help a child that got hit by a car only because I was the driver.

As far as the economic institutions ( in regards to both Risse and Pogge) I would have to agree that it does play a major role in the level of poverty that one faces. However, it is not the only contributing factors: like ignorance, apathy, dishonesty, and dependency. And we have come a long way in terms of economic stand point but we need to take it a little bit fether than we have. I feel that if anyone are going to try and combat poverty and the components of poverty then you are going to have to attack it at many different angles in order to get the job done rather than just one angle. Meaning you just can not throw money at the problem and that the answer you have to supply other resources like education, a vital workforce, and healthcare in order to have given a solution.

So are we responsible for combating poverty and poverty based illness outside of our country?

Pogge vs. Risse-- who is right?

While reading the commentary by Pogge, "Responsibilities for Poverty-Related Illnesses", I found myself agreeing with a couple of points that Pogge was making. I believe that he had a point in saying that there is greater moral weight in helping others in instances where we have some kind of material involvement. I agreed with this point only when he mentioned it in the context of helping someone who was hurt directly as a result of our actions. I, however, also felt that he took it too far by saying that persons involved with upholding the economic institutions [those that govern ownership, production, use and exchange of natural resources, goods and services]are materially involved and are thus permitting the medical injustices between rich and poor to continue.


Though it is a known fact that poverty is correlated with overall health, I do believe that is unfair to place the blame entirely on our economic institutions. Pogge did have a point in saying that we as citizens are somewhat responsible for this because we elect the very politicians that shape our economic institutions. Perhaps if we were not selfish and cared more about taking care of less advantaged individuals in our society, we would elect those that would work to eliminate poverty and health deficits. Though there were some good points, I do believe that Pogge's arguments seemed somewhat scattered and as though he was trying to blame anyone and everyone for current health care injustices.


I personally agreed more with the commentary by Risse, "Do we owe the Global Poor Assistance or Rectification" which basically credited economic institutions and the global order with considerable improvements over the last 200 years. Pogge seemed to focus more on his negative perceptions of the global order, while Risse focused on all the good that it has done for most, if not all, societies.

Over the last 200 years, there have been vast improvements in medical advancements, life expectancy, literacy rates, per capita income and infant mortality rates. I believe that this is a fact that should not be ignored when questioning whether or not our health care system is "unfair". Though our current health care system is far from perfect, I believe that it is unfair to blame the global order for this problem. I agree with Pogge in that we should feel some moral weight in trying to resolve this problem, but I also agree with Risse in that we need to realize that progress is being made.

An Economist’s Critique of Pogge

I am writing this objection to Pogge’s argument without yet having read Risse’s article, because I saw in Risse’s first paragraph that he too is advancing an objection and I wanted to try to come up with my own ideas.

Pogge’s essential argument combines two theses:

First, Pogge says that our moral reason to prevent particular medical diseases is not only based on “distributional factors,” but also on how we are related to the medical conditions. That is, we have a stronger moral responsibility to mitigate a disease that we are the cause of than one that is outside of our control.

Second, Pogge argues that the responsibility to mitigate a disease that we are the cause of is not sensitive to whether the medical conditions at stake are suffered by foreigners or by compatriots.

And combining the two we have: “Foreigners’ medical conditions, if social institutions we are materially involved in upholding substantially contribute to the incidence, have greater moral weight for us than compatriots’ medical conditions in whose causation we are not materially involved.”

As an economist, I certainly accept the first thesis, but I don’t necessarily buy the second and the combined. Since when is a country responsible for the well-being of all other countries? We live in a democratic, capitalist nation that rewards hard work, innovation, and production. And the factor that creates this reward is competition. Enterprises compete against each other for greater market share; people compete against each other for better jobs, and countries compete against each other for greater prosperity.

The leap that Pogge takes in concluding that developed countries’ economic institutions are the cause of world poverty baffles me. Because a country’s policies are focused on the interests of that country does not mean that they are causing harm to other countries (unless of course those policies are war and violence on other countries).

Is Pogge really saying that the countries that lose (the countries that employ less successful economic and political systems) are entitled to aid from wealthy countries because the wealthy countries are the cause of their poverty? It seems to me that Pogge is almost in favor of a socialist world.

While I’m in favor of a prosperous and developed world, and while I’m still torn on the healthcare and distributive justice issue in general, I think Pogge is taking it too far. My argument may seem a little cold-hearted, but, like I said, this is coming from an econ major. I’m open to attacks.

File Insurance claims or "claims of justice"

Fundamental human rights, Life Liberty and the pursuit of happiness. One can define them however they wish. Some interpret this to say if something requires action on the part of others it can’t be right. Both Daniels and Sreenivasan are not proponents of radical libertarianism because both hold an allotment of tax money should be devoted to healthcare. The collection of tax money itself is an infringement on one’s liberty to choose how he spends his money. So there difference is in how that money is spent.
A recent news story involving Nataline Sarkisyan is one to ponder. At 17 she suffered from Leukemia and after a bone marrow transplant was unsuccessful she was in need of a liver. The trouble was not that there were no livers available or they didn’t have insurance the problem was that the insurance company, Cigna, refused to cover the transplant calling it experimental and investigational. Although liver transplants are one of the most common transplants in the United States she died waiting. So, how would she have been helped by living in a land of equal educational and workforce opportunity? Those points are of no value to her if she wont get to experience them or have children that will. I know by making healthcare universal there are increased wait times to see a doctor but do they outnumber the deaths from insurance denials or conditions treatable with preventative medicine combined? To do anything except provide universal healthcare is as Daniels said “the ambulance that waits at the bottom of the cliff”. Privately owned and administered healthcare is driven by profit not fundamental human anything! So the illusion that one is more liberal in their right to choose a healthcare company is just that, an illusion. Insurance companies are not required nor do they desire to work for your best interest the goal is profit. Like the Sarkisyan family you may find yourself less autonomous than ever allowable under a well run universal healthcare system.
Why should healthcare be so different from emergency medical services and fire protection? We unquestionably invest in those institutions which preserve our health. From behind the veil of ignorance Daniels points out we would choose to provide healthcare for everyone even if it limits our ability to spend our money the way we choose. From behind the veil of ignorance one would also be a supporter of reducing society’s economical gap. So the choice lies in which is more concrete, which is doable in the context of modern times. To devote money to equalizing the distribution of income, education and jobs it a bit more complex and I would say just as bit as expensive to accomplish correctly. For instance, to bring public education to the level offered by private schools, how much money would that cost? And are we then all going to support affirmative action because we want workplace balanced. Seems to me making healthcare available to everyone is the first step in improving our country’s overall wellbeing. Then, if this is indeed the greatest country on earth, the other social problems should be addressed. As other countries have made little progress in closing the gap in health by providing universal healthcare perhaps if the US finds an effective and durable way to implement it we can become their model.
Although Sreenivasan's article is titled "opportunity is not the key" both authors suggest a fair share to opportunity only in different ways. It's just that Daniels has a solution that has the potential to make the most immediate difference.

Health is not Healthcare

In regards to healthcare inequalities, Daniels writes, in his article “Justice, Health, and Healthcare”, that a society’s health is strongly affected by its social inequalities, such as unequal distribution of income; therefore, we, as a society, must bridge the gap between these social inequalities thereby eliminating health inequalities. He uses empirical evidence to support this argument, quoting studies that show the more unequal a society is in economic terms, the more unequal health is in that particular society. One strong suggestion he makes is that income inequality leads to educational inequality which leads to health inequality. Not only do these inequalities lead to poorer health but he states that it also “erodes social cohesion” within the society. Utilizing Rawl’s Theory of Justice, a supporter of Kantian Contractariansim, Daniels argues that since it is morally just to protect opportunity and distribution of goods, these social inequalities are unjust. Furthermore, since health inequalities are a result of these social inequalities and further limit opportunity, they too are unjust. Therefore, Universal Healthcare is necessary to promote equality.

Sreenivasan, criticizes Daniels argument in his article, “Opportunity is not the Key”, stating that Daniels has missed an important factor by assuming that health and healthcare are essentially the same thing. He argues that health is indeed special in terms of equality but “access to healthcare” is not the same moral right and therefore, is not unjust. Using Daniels own empirical evidence, he states that since health inequalities are a result of socioeconomic inequalities and the fact the universal healthcare has been shown not to work in terms of equalizing health, such as in the UK, then a just society has a duty not to provide universal healthcare access. Instead, it should utilize all its resources to equalize socioeconomic inequalities.

Although I have in the past been a strong proponent for Universal Healthcare, our discussions in class on the sheer complexity of what would be necessary to provide minimum healthcare to all and what exactly the definition of “ decent healthcare” would entail, I find myself agreeing with Seerivasan that the socioeconomic inequalities are the true culprit in an unequal society and that we must work on closing the gap between these inequalities first and foremost. Thinking of these inequalities, I found myself stuck on Daniels suggestion that income inequality leads to education inequalities which leads to health inequality. Is this the correct cause and effect order or do they blend together? I do see how income can lead to education inequalities through unequal distribution of state resources. However, I believe income inequalities ultimately stem from generations of individuals being lost in a poor education system. As a result, they do not have the same resources as others and cannot find a job with equal income. Both inequalities are so strongly tied together that how does a just society chose which inequality needs to be fixed first? Furthermore, I think it would take generations to fix these inequalities in any society. For example, fixing the education system now will not show economic results until those children enter the workforce. So, in the meantime, what do we, as a society, do while we wait for the inequalities to diminish. Can we stand by and let the current generation suffer so that in the long run future generations have greater opportunity?

Revised Schedule March 25 - May 5

Here is the revised schedule for March 25th through May 5th. I’ve written in the bloggers assigned to particular days, but Lebenswelt, mighty skunk, Wasabi, and my_silent_orchestra will each have to pick a new set of readings to blog about.

Mar 25 (Wallace)
Brock, “Cloning Human Beings: An Assessment of the Ethical Issues,” 6th Ed., 631-643

Apr 1 (Wallace)
Steinbock, “Respect for Human Embryos,” 6th Ed., pp. 668-671
Ryan, “Creating Embryos for Research,” 6th Ed., pp. 672-683
Theory: Religious Ethics, pp. 20-23

Apr 8 (Lebenswelt)
Marquis, “Why Abortion is Immoral,” pp. 547-555
Thompson, “A Defense of Abortion,” pp. 567-576

Apr 15 (ILoveLucy)
Arras, “Physician-Assisted Suicide: A Tragic View,” pp. 484-487
Dworkin et al, “The Philosophers Brief,” pp. 488-495
Theory: Nonmoral Considerations, Modes of Moral Reasoning, pp. 35-41

Apr 22 Review Day

Apr 29 Final Exam

May 5 Papers Due (Tuesday, 5pm)

Why equalitarian proposal is morally wrong in Health Care System?

It is ideal to have a health care to every body's benefit; however, there are limitation resources knowledge and also disagreement what is right or wrong in peopl's mind because of limitation and disagreement. so we need accept the policy that has both moral diversity and inequality.

We have to recognize that people who want to have better quality of basic health care benefit through private resources by their own freedom of choice that is a way to purchase their health benefit; however, if people who can't afford to purchase their own private insurance, then, there should have a state system for funds, for those people, for their basic health care benefit. People should agree and accept that our health care system would not be equalized same as moral diversity and disagreement in our social setting.

In equalization in health care system would have limits people who like to purchase private insurance by their own ability. Our disagreement about equalization in health care system is similar to those people who disagree about abortion right, artificial insemination, assist suicidal euthanasia that not resolvable in general moral secular terms and lot of disagreement in public norms for fairness.

Is There a Right to a Decent Minimum of Health Care?

Author Allen E. Buchanan for this essay is professor of philosophy in public policy at Duke University since 2002 and written 6 books in biomedical ethic, social justice, international justice including international law. he served staff philosopher for president's commission on Medical Ethic 1983, and 1996 to 2000. I am giving you author's back ground information that it help us understand better his article.

Definitely, Buchanan is favor of having Universal health care that "our government to guarantee a decent minimum health care for every body(p:525)." not only certain people but for every body to all person with backing up coercive power and policy by state or federal to succeed for this application.

we have already has had special rights for health care for man and women who served country that sacrificed for the good society and social welfare for the country, and people can argue for other group that injustice argues for American African and Native American. There are many clinics already for indigent groups through all of the United States with enforced principles requiring toward familiar public good by rotating physician to participate for runing clinic smoothly beside their own practice.
If our societyin health care change to all one category of Universal health care then poeple who want go freedom of choice to pick their own health care for better treatment, there will be very unhappiness among the lot of people who diminishing their freedom by that. Also where all these cost of Universal health care will be coming from even if it would be working in the future?

Health Care Irrespective of Socioeconomic Status?

In the commentary "Class, Health and Justice"many different possible solutions to the inequalities in health care distribution are listed. It is a known fact that in most societies, there is a definite difference in the health care distribution which is the direct result of a difference in socioeconomic status. Simply put, money rules everything. It governs not only the opportunities available to us (with regards to things such as education) but also the treatments that we are able to receive (for example, health care).

Four possible solutions to resolving this inequality were listed:
1. Maximizing the total sum of health of a society
2. Equalizing levels of health between classes
3. Maximizing the health of the lowest socioeconomic class
4. Give priority to eliminating and treating the sickest individuals

Before reading this commentary, I will admit that I was 100% for universal health care. I didn't see any issues with equalizing the health care provided to all socioeconomic statuses until the point was brought up of how underlying egalitarianism would have to extend far beyond just issues of health. This would only result in a socialist society, which in theory seems morally just, but we know it just does not work.

After completing the commentary, my position had changed to my believing that the fourth solution would be the best. I however must mention that I could not ignore the consideration listed towards the end of the commentary: "any attempt to locate the source of injustice in class inequalities in health is the notion that people bear some responsibility for their own morbidity and mortality."I strongly agree with the statement that each individual is somewhat responsible for their health. I know there are definite exceptions, especially when considering genetic predispositions, but why should health care be equalized when we don't know for sure that everyone has the same goals and life plans? Many individuals may not care about their health and may engage in activities that deteriorate their health, so I do not believe that they should receive equal treatment as someone who chooses not to engage in such behaviors.

Even in agreeing with this statement, I think that the fourth option is still the best as it gives advantages to those who really need it. Not only this, but in attempting to help those that are the "worst-off", we are also eventually helping ourselves by directing our resources towards diseases that desperately need cures.

The Haves Get Sick Too

There is no denying that there are vast differences in the longevity, healthfulness and availability of adequate health care between those in high income brackets as opposed to those in low ones. Political pundits offered their opinions on this subject for months during the recent race for our nation's newest President. This disparity is no longer considered the big pink elephant in the room, but rather one that has bore it's way to the forefront of our attention as our nation's jobless rate climbs, insurance rates sky-rocket and diseases like heart disease and cancer loom over our aged thoughts. In the article Class, Health And Justice, authors Marchand, Wikler and Landesman weigh in on this topic and offer four main points of justice/equality and health.

Point 1 - Equity as Maximization (moral assumption: everyone is treated the same as a matter of justice regardless of how this might effect other social programs)

Point 2 - Equity as Equality (moral assumption: everyone deserves to live a long, healthy life, therefore "improvements for those who are better-off financially are not as valuable as improvements in health for those who are worse-off")

Point 3 - Equity as Maximin (moral assumption: the poorest amongst us should have the best health possible without regard to "equality")

Point 4 - Equality as Priority to the Sickest (moral assumption: socioeconomic differences are not taken into account at all - whomever is suffering the most should be treated with the best available resources)

The authors also skimmed the idea of the causation of and individual responsibility for illness and how diversity of culture can play a role in both, but left that discussion in a rather neutral position.

I agree with the fourth point because who doesn't value being healthy particularly when we are sick? I appreciate how the authors redirected the attention not on the obvious disparities that class causes in health care, but on the actual needs of the sickest and how their needs could best be met. Ultimately even if one favors the idea of creating equality by providing a leveled field for the "Have-Nots", given the evidence, often it is the Have-Nots who suffer from the worst health and live the shortest lives so their needs would be best met with point 4 as would anyone who was seriously suffering from illness. Equality in health care to me is the opportunity to help those who need it the most, regardless of race, creed, religion or economic status or lack and I think point 4 brings that idea home. What do you say?

Equal Opportunity in Health Care Can = Individuals' Successes or Failures

Daniels argues that equal opportunity in health care is relative to how one views "justice" in health care and the question of justice in health care poses other questions like - should health care be viewed as a commodity like owning a TV or automobile, or should it be categorized separately and viewed as "special"?

For me, the author's most interesting argument was the one most developed, the normal opportunity range as a consideration for health care differences. Daniels asks us to take into account people's life plans and how their health might contribute to their success or lack. This is ultimately (according to Daniels) is how health care should be judged, if it is fair or equal really depends on whether or not it allows individuals the opportunity to reach their life plans without being hampered by illness.

Vaccination and Autism

Since the subject came up in class, I thought some of you might be interested in this article from US News & World Report: Court Says Vaccine Not the Cause of Autism.

Death or Impotence -- Tell the Truth

I favor the full Kantian Categorical Imperative approach against paternalism, there should be 100% informed consent with Mr. Williams. Dr. Kramer should tell the truth and have a serious discussion with Mr. Williams about the small risk of temporary impotance from taking the antihypertensive medicine. The good doctor is showing respect to Mr. Williams by telling him the truth!

Kantians Can't?!

In medicine both Kantian and utilitarian ethics need to be employed to reach solutions to complex and difficult problems. In the ideal world, Kantian ethics would be morally superior to utilitarianism an consequentialism -- the right act is not always the one with the best consequences; Kant argued that this can never make an action right or wrong.

Kant's formulas: (1) act as to treat people always as ends in themselves, never as mere means -- people deserve respect -- the ends do not justify the means; (2) act only on that maxim whereby you can at the same time will that it would be a universal law -- refrain from making exceptions of ourselves -- universalization. Kant argues that all persons must be treated equally. In our reading regarding the 5 innocent people who need organ transplants (p. 14), the killing of one person for the distribution of organs to the others is morally wrong. This act would certainly be making an exception and treating a person as a mere means! I could not justify this act. However, I can see that Kantian ethics are much more challenging to implement in medicine, to decide what is morally right or wrong and to treat people as "ends" themselves not "means." People do not exist simply to fulfill our purposes...are ther not exceptions? What if he or she is not a rational being? All cases are not ruled out! Utilitarianism can use its belief as an excuse to do something morally wrong in saying it is in the best interest of the whole, like cloning body parts.

I see the Kantian test for universalization similar to the "Golden Rule"-- treat others as you would like others to treate you -- it is not a personal policy but a principle for everyone. I agree with Kant that consistency and universality are part of a concept of moralilty and duty. Thus patients and research subjects must give informed consent before they are treated, also that they are shown respect by telling them the truth...even when the knowledge might be painful. This allows the patient/subject to make their own moral choices. This is good, I agree because Kantianism does not provide a decision procedure for deciding which out of all morally permissive acts is right. Thus giving less guidance to the patient/subject and encouraging autonomy and self-determination.

Pain and anesthesia could be a concern involving Kantian ethically following doctors. Should a doctor allow a patient to sufferwith out pain medicine if he/she believes they deserve pain? Pain depends on whether it is deserved (according to Kantian ethics), and it is morally right that the wicked should suffer?! I stronglly disagree with Kant here; who is to decide who is truely morally right, wrong, or wicked in society? Should the woman have an epidural for her pain during labor or not? How did she get pregnant, maybe she should not according to Kant?

What type of Physician-Patient Relationship Do You Want?

According to Ezekiel and Linda Emanuel there is a struggle between patients and physicians regarding the amount of control that patients have in the decision making process when it comes to their medical care. This struggle arises because of the unbalanced nature of human rights of the patient verses the physicians duty to keep patients from harm even if its from themselves. So in order to give a solution to the problem they have outlined four types of physician-patient interactions that have occurred in clinical settings.

The first of the models is the Paternalistic model. This model only ensures that the patients receive the best interventions solely based on their health and well-being. The physician has no regard for the patients values or desires. The second model is the Informative model, where as the physician gives the patient all the vital information to make their own choice in the type of medical intervention that he or she wants and then the physician follows through with what the patient has chosen. The physician in this case only does what the patient wants(not bothering to ask the patient of his or her values and/or desires) and does not suggest his or her own thoughts as to what the patient should do. Thirdly, you have the Interpretive model where the physician tries to elucidate the patients values and desires of what he or she actually wants and then tries to help the patient select the best possible medical option that correlates to the patients values. In this case the physician seems to care about the values of the patient and tries to offer some advice as to what should be done.

Lastly, you have the Deliberative model where you have the patient and physician both collaborating with one another on the best medical care and the best course of action in order to make the patients values come to life( or give them a more realistic view of the situation) for overall optimum health. In each one of this case the patient can also be an issue in regards to their own health. Patients can range from not being able to voice their desires to being blatantly defiant with what the physician suggests, or waiting on the doctor to tell them what they should do and not questioning what other possible solutions there may be.

In my opinion the deliberative model is the best in terms of physician-patient relationships. I want a physician that is not only going to give me information, but listen to my desires and values and help me try to facilitate my views in a realistic sense.And I want to be able to grasp the knowledge that the physician as given in order to be able to satisfy my level of autonomy. But all to often I hear stories of physicians and patients being the latter. I have a best friend that is diagnosed with Ehlos-Danlos Syndrome and she has had doctor's that have represented each one of the models that have been named. Also, I have seen patients that refuse to act right when it comes to their own health and medical care that they have gotten from the doctor. Then in the same breath ask why do I have to feel like this or why me? And now are running to the doctor and asking what can they do "now " to make the issue that they have go away.(because they have made the problem worse.)

All in all, I believe that a physician would have to embody all of the models because it depends on the type of patient that he or she encounters. And be able to discern the type of patient that you have before you so that they will be able to give diagnosis, prognosis, and possible treatment solution in certain manners with regards to the patient that they are treating. With out this knowledge the patients autonomy could be in trouble.

So what should be the ideal Physician-Patient relationship for you? And where does you level of Autonomy fit in?

Autonomy Today, and Autonomy Tomorrow, next Wednesday, and for the Rest of Your Life

We'll continue to chip away at the concept of autonomy next week, but for those of you who walked away with unanswered questions, I recommend John Christman's article on autonomy in the Stanford Encyclopedia of Philosophy--an excellent online resource for all things philosophical.

Here are some of the passages I found especially relevant to our discussion:

Put most simply, to be autonomous is to be one's own person, to be directed by considerations, desires, conditions, and characteristics that are not simply imposed externally upon one, but are part of what can somehow be considered one's authentic self.

...autonomy can be used to refer both to the global condition (autonomous personhood) and as a more local notion (autonomous relative to a particular trait, range of acts, or aspect of one's life). Addicted smokers for example are autonomous persons in a general sense but (for some) helplessly unable to control their behavior regarding this one activity.

In addition, we must keep separate the idea of basic autonomy, the minimal status of being responsible, independent and able to speak for oneself, from ideal autonomy, an achievement that serves as a goal to which we might aspire and according to which a person is maximally authentic and free of manipulative, self-distorting influences.

Christman's notion of an "authentic self" plays a role similar to Ackerman's deliberate life plans, and to Goldman's preferences and value-orderings. Whichever terminology we choose, there seems to be some gray area between externally imposed choices on the one hand, and "authentic," internally motivated choices on the other. How we draw the line between external and internal sources of action is what's at issue between competing accounts of autonomy.

What does it mean for beliefs, desires, and values to be a part of one's "authentic self"? Can we simply choose, as if by fiat, what constitutes our authentic selves, say, by making a New Year's resolution to maintain a healthy diet? Or is who I really am at least partially determined by unreflectively adopted habits, like my habit of eating at McDonald's? Could my authentic self contain both of these at the same time? Does one of them 'outrank' the other?

I'm don't know. But I look forward to discussing the next article with you next week; Emanuel and Emanuel try to individuate four different models of the doctor/patient relationship by correlating them with four different conceptions of autonomy, so maybe they can help us out. Happy reading, and happy blogging.

UPDATE: You might also want to look at Sarah Buss's article on personal autonomy.

Two Kinds of Patient-hood

Pellegrino writes (quoted in Ackerman, pg.74): "The state of being ill is therefore a state of 'wounded humanity,' a person compromised in his fundamental capacity to deal with his vulnerability."

I suspect that there are two ways to understand the notion of "patient-hood" and its relation to patient autonomy. The first way is this: to regard a patient (=a person suffering illness of some serious degree) as being different from a healthy person in some fundamental way. According to this understanding of patient-hood, illness diminishes an essential quality that comprises a human being, namely, autonomy. The second way to understand the concept of patient-hood is to regard a patient as being different from a healthy person in some "merely" temporary aspect, and that a patient is no different from a healthy person except that a patient's life is inhibited by illness.

Example: We would not regard John (who is an average guy) in a drunk state is fundamentally different from John in his normal waking state. Once John becomes sober, he will return to his normal self--so drunkenness is only a temporary alteration, an inhibition that can be lifted. But if John lost a part of his mental capacity (say, to recognize people's faces), perhaps as a result of an accident, it is likely that we regard post-accident John as being somehow fundamentally different from pre-accident John.

Why does distinguishing the two ways to understand patient-hood matter?

The first way of understanding patient-hood supports paternalism. If patient-hood implies a loss in the patient's capacity for autonomy, then it is unclear how the patient's autonomy can be respected in the first place. There is no overarching patient autonomy that physicians must respect; rather, the aim of medical treatment becomes eliminating the factors that inhibit patient's autonomy--that is, curing the illness becomes the overarching aim. Patenralism, thus, can be justified on instances where it would lead to better consequences for the patient.

The second way of understanding patient-hood supports patient autonomy. Since autonomy is something that must be respected in all occasions (perhaps there are exceptions; eg. when autonomy is voluntarily relinquished), and since the second concept of patient-hood regards patients as possessing the capacity of autonomy just as much as healthy people, it should follow that autonomy must be considered as something that is to be respected even if it means that a patient will be worse off in the long run.

Now, I am open to the possibility that in some cases, the nature of an illness is so that the first understanding of patient-hood is more plausible, while there may be cases where the second understanding is better suited. What such a possibility implies, I think, is clear.

Ackerman points out that "no longer is it permissible for a doctor to withhold information from a patient, even on the grounds that it may be harmful." Thus we have informed consent. Arguably, how can a doctor be sure that the patient is indeed informed, and that said patient is making a decision for about his or her health without having been coerced by family, or societal pressure? These are just some of the questions posed in the article "Why Doctors Should Intervene".

It is my belief that besides providing the best care for their patients possible according to AMA practices and standards, doctors must ensure that their position of "authority" is not abused. From my own experiences with family members, and as noted in class and in the article, there are certainly times when patients defer to their physicians to make decisions for them. If a patient chooses to do that and allow the doctor to direct his or her care without formal involvement is a choice that that patient made. At that point, and I believe the doctor has the patient's permission to intervene, but certainly the doctor should continue to inform the patient of his or her options and the course of care the doctor recommends.

Doctors should intervene when patients ask them to, (unless of course there is an emergency and a decision needs to be made quickly; or if the patient cannot speak for themselves for some reason other means should be found to ensure the patient's rights are not violated) it should not be automatically assumed that the doctor should intervene without the request being made by the patient.

Beneficence Today? Give me autonomy.

The central idea of the concept of "autonomy" according to the context of this article is that an able-minded, relatively rational thinking person makes an informed decision concerning his/her health. In the case of forty-nine year old Monica with a form of terminal cancer, the author seems to ask if the medical team should truly allow Monica autonomy in what appears to be a no win situation for her, or if in their definition of compassionate care, the team should step in to make the determination on how Monica would be best off. I agree with the commetary offered by Elger when she notes in her conclusion "in the abscene of written or oral directives, not waking Monica would be an unjustifiable form of hard paternalism."

How can a physician assume total responsibility for how a patient chooses to live (or die)? Is that the role of a physician? If the issue is strictly on providing care, then Monica's team of physicians have done their jobs to the extent that she is as stable as her condition will allow. Because it seems possible to "wake" Monica from her sedative state, even though she may be in pain by doing so, why shouldn't she at least be allowed to have her voice heard? If Monica had no chance of resusitation or the ability to regain conciousness then wouldn't the physicians be required to contact any known next of kin to see if they could speak on behalf of the patient's wishes? It certainly seems unethical and perhaps illegal for a physician to take a patient's life into his/her hands soley on the basis of what he/she believes is right when there is the opportunity to let the patient (or patient's family or friends) make such an important decision. Afterall, that doctor may have just met Monica for the first time when she was admitted into the hospital. Each person is an individual in that we don't all view life and death issues the same way. Why would the physicians even want the burden of assuming that for a complete stranger when the decision is probably twice as difficult when it's made for oneself?

Reserve Materials

Readings for the next few weeks are now on ERes. Just click on "Electronic Reserves & Reserves Pages," and search by course number, course name, department, or instructor. Here is the link:

http://eres.wustl.edu

As always, let me know if you run into any problems.

The Relativity of Values: Health and Life

While reading the first paragraph of the author Alan Goldman's article on Relativity of Values: Health and Life, the questions that came to mind is, how do we know a person is actually acting irrationally or inconsistently when it comes to their own long range preferences? At what point is it ok to have paternalistic interference be justified? Of course, the people who actually know the person really well, (family members and close friends), can tell if something is not in sync with the decisions this person decides to make. But what about this person changing their mind that seems logical to them about how they want their health handled? And what if even close family and friends think this is irrational thinking, when in fact, this is the way the patient wants it? What if this person made statements their whole lives mentioning that no matter what happens to them, they wish to be hooked up to a ventilator and have their life prolonged as much as possible, in hopes of a miracle, and then when the time comes when they are in the hospital, fully aware of what is going on, decide to not be attached to any medical equipment to prolong their life knowing their life is going downhill and the pain they are in, to be let go naturally and let nature run it's course? Would this decision be irrational, or would it be just the patient changing his mind while going through these hardships?

Autonomy, Paternalism, and Medical Models

In medicine and in life there are cases for and against paternalism. I agree with the author Alan Goldman. Nevertheless, adults should be allowed choices. In America, patients have "The Patient's Bill of Rights" that gives patients the rights like privacy and confidentiality, involvement in their treatment, right to refuse, continuity of care, etc. The best judge of a patient's interests can only be the patient themselves, if they are informed -- they know their values and beliefs.

The invoking of paternalism in the example of ignorance when Dick desires to board a New York train but almost boards a Boston train instead certainly warrants coercing in most cases since this is what the subject initially desired. However, did it not deny him the right to possible learn from a mistake? Jane, in contrast, not donning a motocycle helmet, does not warrant paternalism; She should have the right to wear or not to wear a helmet, as an adult -- whether it shortens her life or not, it is her choice. Maybe she wants to "live in the moment." The "minor nuisance" can make a big difference in the thrill and enjoyment of riding a motorcycle as well as visibility.

Is minimizing the risk to health and life the real reasons for paternalistic laws? What about peoples choices to smoke, or their choice whether or not to wear a seat belt while driving?

Recently, the actor, John Travolta had his son, Jett, die from hitting his head while experiencing seizures from Kawasaki disease. Mr. Travolta is a member of the Church of Scientology. It is believed that this church does not condone the use of medications which possibly could have prevented Jett from having seizures. Jett was 16 years old when he died. Should the doctors have intervened in this case?

Bioethics: Nature and Scope, Sources of Problems and Concern

Euthanasia:

I agree with the author that euthanasia is society's problem, and that it is against The Hippocratic Oath. However, why should the doctor in these modern times exercise paternalism when the patient is over 18 years old, considered an adult by society, of rational mind, and not coerced by wanting relatives to make the adult choice to live or to die -- is it not their life? Where are the patient's rights? Patients should have a choice as long as the patient has been thoroughly evaluated by experts and informed of alternative possibilities of how to live that their life may not truely be over just because they think it is; What about Stephen Hawking, the physicist genius, with Lou Gehrig's disease/ALS that is still making the best of his life although in the advanced stage(s) of ALS -- he considers himself "lucky" despite his disease and its slow progression which allowed him to make more influential discoveries.

The Hippocratic Oath

The Hippocratic Oath:
In the world, medicine is becoming more and more diverse. Information is being shared via computers and international broadcasts. There are different religions, cultures, values, and beliefs to consider. Likewise, there are also different thoughts on healing other than the ancient Greek concept of healing by the "Father of Western Medicine" -- Hippocrates. What about eastern, psychological, divine, natural and other types of healing? Modern science recently confirmed concepts of Eastern Medicine like acupuncture to be valid, and the many great advances in modern surgery, are these not to be considered. As commendable as this oath may be it was sworn in the presence (witnessed) of Greek gods and godesses that are refuted by most religions of the world. Can The Hippocratic Oath apply to todays modern world? Should this oath be the foundation for a more conclusive, multi-healing oath that can be used by the international community at large?

Inaugural Post

Hello, and welcome to Just Another Biomedical Ethics Blog, a weblog for my course on biomedical ethics. We will use this blog as a way to relay class information, and as a forum for writing and discussion.

Each week several students will be assigned to briefly summarize and comment on the readings. The rest of the class is assigned (among other things) to read and and comment on the chosen authors' posts. These are intended to be discussions of questions and problems raised by the author--not necessarily criticism of the author's post itself.

A portion of each student's participation grade will depend on his or her contribution to the blog. For several examples of academic blogging, see the following:

• Cosmic Variance
  
• Crooked Timber
  
• Philosophy, et cetera
• Balkinization

As always, if you have any questions, please feel free to contact me at the email address listed on the syllabus. Happy blogging!