PHL 223 1st Edition Exam 1 Study Guide Lectures 1 11 Lecture 1 August 22 Introduction to Medical Ethics When did the field of medical ethics begin What are the two main reasons that helped boost the interest in medical ethics What is the difference between active and passive euthanasia Field of Medical Ethics began in 1970 o Why not before 1 Trends in Philosophy Dominated by the analysis of language Then o A Theory of Justice John Rawls o Delayed impact of the 1960s 1 There was a draft 2 Drug movement 3 Sexual revolution 4 Women s movement o Common Sense difference between right and wrong 2 Changes in Technology Created new ethical problems Life sustaining technologies feeding tubes ventilators When is dying bad End of Life Issues Vocab Passive Euthanasia letting die taking off of a ventilator Legal in all 50 states Most deaths tend to happen this way Active Euthanasia mercy killing shorten life Considered murder in all 50 states NO EXCEPTION Lecture 2 August 25 Who is Karin Quinlin What was her standpoint case What was the final outcome Who was Nancy Cruzan What was her diagnosis What was the final outcome of her case What are advance directives Why are they important Karin Quinlin Case 1975 21 years old healthy Took drugs at a party which caused anoxia lack of oxygen to the brain because she stopped breathing She survived but was in a coma Permanent vegetative state or PVS o Now 35 000 patients are in PVS o 280 000 patients are in a minimally conscious state Quinlin would open her eyes vomit and moan She was placed on a ventilator Her condition became wretched and her family wanted her removed from the ventilator The catholic hospital refused to kill Quinlin Quinlin s lawyer argued for the family s defense and right to remove their daughter from the ventilator The NJ supreme court withheld that the right to privacy includes the right of a family to let a patient die by withdrawing life support o letting die under the law After being removed Quinlin remained alive for 10 more years Nancy Cruzan Case 1983 Missouri 24 years old Lost control of her car and was thrown into the air 35 feet into a ditch She was not wearing a seat belt Anoxia led to PVS She was kept alive for 7 years Cost 910 000 about 2 million in today s money Parents sought to remove her feeding tube The Missouri court said there must be clear and convincing evidence of the patient s wishes for the support to be withdrawn Vocab Advance directives o Living will values inventories o Durable power of attorney someone who acts for you The court could not remove her feeding tube U S Supreme Court agreed with Missouri s ruling The Supreme Court also held in 1990 that competent patients may decline medical treatment even if it leads to their death Cruzan was actually divorced When her story became public people who knew her told the court that Nancy had said that she did not want to live PVS In 1990 her tube was legally removed Lecture 3 August 27 What are the positives of death What are the statistics for hope of recovery Defining Death What s at stake o Provides closure for the family o End of emotional drain o Expense of Treatment Tx o Saving lives through organ transplants o Hope of recovery statistics o 1 year in PVS 1 5 chance in waking up 3 200 o After 3 years in PVS 1 1000 o After 4 years Never happened Lecture 4 August 29 What is the whole body standard Brain death What are the criteria for the Harvard Criteria Describe the Uniform Brain Death Act of 1978 and the two standards irreversibility and cognitive What is more important biological or biographical life Who is James Rachels What is his point of view on active and passive euthanasia How does Gay Williams object Rachels point Definitions o Legally the definition of death varies by state o Whole Body Standard older standard everything would go at once stop breathing no O2 to heart heart stops etc o Brain Death When your brain completely stops working Harvard Criteria loss of all brain activity and 2 flat EEG s Uniform Brain Death Act Standard of 1978 o Irreversible loss of all brain function o Irreversibility standard when you will never be aware of anything ever again o Cognitive criteria loss of core mental properties o Memory reason self awareness BIOGRAPHICAL LIFE MATTERS NOT BIOLOGICAL LIFE James Rachels on Active and Passive Euthanasia o The legal distinction between active and passive euthanasia is unjustified o Active can sometimes be more humane than passive o Throat cancer example o Compassion well being mercy o The value of autonomy can also favor active euthanasia o If a competent adult wants to die this is a reason to kill him o But isn t killing worse than just letting one die o Rachels Consider 2 cases just the same except for one is killing and one is letting die o If John deliberately plans and drowns his little brother himself is it just as bad as if John sees his little brother drowning and doesn t make any effort to save him Main Argument Passive and active are in themselves equivalent Passive is less humane than active If passive euthanasia is okay morally and legally then active euthanasia should be ok too o Paradigm Case 1st thing you think of Gay Williams Objections I Euthanasia goes against our natural instincts a Often we should go against nature b Male aggression natural The possibility of being cured a Na ve hope b How to deal with dying optimism without losing touch of reality Slippery slope a A scare tactic b No known abuses of active euthanasia in the Netherlands or of PAS in Oregon II III What causes death Active someone other than the patient Passive the disease or some natural process Permanent sedation the disease kills them most common Lecture 5 September 3 What is the Netherlands view on Active Euthanasia Who is Elizabeth Bouvia What was the final ruling in her case The Netherlands Active Euthanasia is legal if o Voluntary request by a competent patient o Intolerable suffering o All analgesics pain killers have been tried o Patient is fully informed o 2nd opinion agrees another doctor 90 of Dutch citizens support the law o PVS patients can t be killed since they re incompetent o Patient doesn t have to be dying o Almost all are terminally ill The Case of Elizabeth Bouvia Disabled person wants her feeding tube removed She has cerebral palsy It costs 150 000 year to keep her alive She is severely depressed Often considers suicide Thinks of herself as a burden to society In September 1983 Elizabeth was 25 and paralyzed from