Medical Ethics Lecture Summary Slides 14 17 Lecture 14 Reviewed arguments by Radcliffe Richards et al kidney sale and Harris on The Survival Lottery Radcliffe Richards Arguments against she argues these are bad Exploitation of the poor if really need money might feel more compelled to sell R R educate people about dangers so there is not an argument against poor selling R R do something about poverty if worried about limited options of poor removing option to selling kidney won t help poverty R R rich also engage in risky activities don t have to be poor an exploited to make risky decisions Unfair that rich exclusively should have benefits have exclusive benefits of a lot of things why is this an issue Payment permissible don t require altruism for other things why should it be required here Undermines confidence in medical profession doctors seen as being involved in transactions should separate from doctors Women and children might be coerced seen as objects in some places not humans and might be pressured forced to donate Selling kidney could lead to slippery slope may begin to sell other vital organs that shouldn t be sold Public outrage westerners tend to have issue with organ donation most others fine with it and there wouldn t be an outrage Harris If two people need organs only need to kill one healthy person to obtain organs and save two lives Problems Terror and distress knowing that at anytime doctor could come and harvest organs Harris lottery more efficient way to save more people Cannot ask doctors to do what is wrong kill healthy person Harris is it really not killing to let two people die whose life you could save Disrespects individuality of healthy person Harris why is individuality of one person more important than that of two Playing God Harris do that neither or either way Killing one person is intentional and disease of other two is not worse to kill one person than to let two people die Harris killing not intentional just removal of organs Discussed arguments on micro allocation of scarce resources by Menzel multiple organ transplants Count before you cut save greater number instead of multiple organ transplant Menzel against these arguments for permissibility should save greater number medical frontiers not important for their own sake just because something is more difficult does not make it more urgent our practive of organ transplantation shows that we care about saving greater number Consent based on overly romantic idea of process 2 Lecture 15 1 Briefly compared consequentialist and deontological reasoning Consequentialist whether an act is morally right depends on its consequences Weakness overdemanding no excuses to bringing about best consequences Underdemanding killin may be permissible Deontological whether an act is morally right depends on reasons other than consequences Weakness might produce overall worse results 2 Reviewed arguments by Rescher distribution of ELTs and Veach age on how to decide between patients Rescher two step process involving two sets of criteria 1 Who from everyone needing ELT comes into question constituency interest of science prospect of success best person to decided is doctor strictly medical 2 Who selected above should ultimately receive ELT deontological with exception of e only 1 and 2 are strictly medical prospect of success strictly medical life expectancy strictly medical family role potential contribution services rendered Should lay persons or only doctors be involved in committee to apply above criteria Lay persons should be because many of these are ethical not just medical If there are still more patients that can receive ELT after this selection process need to do random selection lottery selection Veach Should age count 1 Consequentialist grounds for age mattering need to insure greatest good for greatest number allocating resources to elderly is inefficient against age mattering world worse if allow this discrimination because horror anxiety of growing old look at individuals not groups 2 Non consequentialist justice based grounds look at individuals not groups some people age differently and seem older younger at specific biological age might create anxiety about aging for people and elder family members Veach says consequentialist reasons against age mattering are not convincing consequentialist in favor of age mattering Over lifetime allocation less extreme cases chronic condition that does not threated personal identity over lifetime Slice of life allocation extreme cases severe pain separating oneself from personal identity Lecture 16 1 2 3 Briefly reviewed Rescher s policy proposal for allocating scarce resources Reviewed arguments by Veach age on how to decide between patients and started discussing Lockwood welfarist account SEE 15 ladadeedadeeweliketopartydancingwillmollydoingwhateverwewantthisisourhousethisisourroofandwecantstop 4 Lecture 17 Discussed Lockwood welfarist account and Daniels Prudential Life span Account on the allocation of scarce resources Critically evaluates QALY quality adjusted life years is this a good way to address the allocation of scarce resources Idea of QALY balancing the quality and quantity of expected life years after treatment How is quality measured By looking at feeling and considered judgment of average representative patient Regain normal functionality after treatment Can return to old life in some comparable way May be subjective can change between individuals Which treatments have high quality or low quality QALY applied on macro level suggests to allocate scarce resources to hip replacement surgery instead of life saving renal dialysis Why applied to micro level QALY results in favoring younger patients over older patients may make more effective health care system Objection favors young patients discrimination is morally wrong Object ageist doesn t make it unjust no arbitrary line to describe age uses characteristic of treatment to decide who gets it compares different types of treatment discomfort vs death doesn t pay attention to urgency of someone s life at stake Objection why should we care justice requires to be responsive to need should respond to life and death situation first difference between age and race discrimination every reaches ages but people don t change races age is different category than sex and race will even out over lifetime because one who was once young will be less likely to get resources as old Objection someone who didn t