SPECIFICATIONS: 3;.i4 pages (750-1000 words, minimum); writing ,a longer paper n is OK, no penalty. I prefer a typed, double-spaced paper, dark ink, no very light dot-matrix printing. 1\ u u .INSTRUCTIONS: Pick only one of the attached cases. Attached are generic II Instruc-t”ions for writing a good philosophy paper in this course. The most I~ Important things to keep in mind are these: (1)You must provide a reasoned Ii justification for your position, a series of well-reasoned arguments, derived to’ a large extent from the readings and class discussion and your own reflection on I: those materials; (2)You must articulate at least one strong objection to the view IT you defend, and then respond effectively to that objection; (3)At the beginning. of the paper state clearly the moral issues that are the focus of your paper, and your position with regard to those issues; (4)There are usually specific questions attached to a case: be sure you have answered them.
On this first paper there is a large model. of moral debate that has shaped discussion in medical ethics over the past twenty years: this is the conflict between a traditional beneficence-based approach to medical ethics and an autonomy-based approach. It Is simplistic to think that one or the other of these approaches ,Would have absolute moral priority over the other. Most often, it is a matter of working out a reasoned balance of these competing moral considerations an’d the demands they make on health care professionals. Hence, I want to see in your papers evidence that you thought about these competing moral perspectives and the bearing they have on the case you choose to address. ” . ‘ ,
Making moral comparisons among cases is a good way to refine your moral judgments. How is the case’ you choose to discuss like or unlike the Dax case? Or some other case that might have been introduced in ,class or in the readings? ‘ If the~re Ar~ important facts of a case thatate’ nc>f entirely’clear, then feel free to make them clear “by hypothesizes.” Feel free to alter what you take to be edtical facts of the case that would result in a very different ma’tal jUdgment. That kind of hypothetical case variation is a good tool for moral analysis; you willse’e me do that frequently in class. ,, Don’t waste hundreds of words summarizing the c~se itself in your paper. I know the case. refer only to case facts needed to establish, the context for’· your moral analysis.
GENERAL SUGGESTIONS FOR WRITING ESSAYS
GENERAL AIM: Your genera.1 aim Is to develop a morally defensible position that Is best all things considered. This does not mean that you have to come up with a view that Is correct In the sense that no one would disagree with you. Nor does It mean any old view will do. Your goal Is to show that the weight of evidence Is on your side.
THINGS TO INCLUDE: (1)State your position clearly. (2)Support your position with well-reasoned arguments, mostly from the assigned readings and class discussion. Your objective, In part, Is to show that you have done the assigned readings, and you have done the readings thoughtfully and critically. (3)Anticipate and respond to objections, strong objections. Your objective here Is to show Intellectual honesty, that you are mindful of what others would argue who disagree with you, but you have good counter-arguments to respond to their criticisms.
STYLE: Your essay should “hang together,’· It should b~ well-organized, logically coherent. It should not be a set of distinct thoughts that are not logically related to one another, or to the task of making an Informed moral Judgment with respect to the moral Issues raised by the case you are discussing.
REFERENCES:’ If you use “outside” references, give a standard listing of them at the back of your paper. If you use only material from the course, then In the text. Itself In parentheses give the author’s last name and a page number. NOTE: Always refer to the author of the precise article you are dis cl:lsslng; never refer to the editors of the text (Arras and Steinbeck), unless what you are citing Is the Introductory material they provide at the beginning of each chapter.
HEALTH CARE ETHICS: PAPER #1 (some additional thoughts)
Leonard M. Fleck, Ph.D.
DUE DATE:
Here are some additional generic questions for the attached cases, as well as some strategic things to keep in mind. Go back to the Dax case. Think of the large questions there: (I)Were the physicians in that case morally obligated to do what they judged to be in Dax’s best interest? Could they have been justifiably criticized if they simply allowed him to die when they knew that they had the capacity to save his life? (2) Was Dax capable of making autonomous choices regarding his own medical care that his physicians would then be morally obligated to respect? How do you know whether or not Dax was “autonomous enough”? To answer that question you would have to apply Miller’s four senses of autonomy and examine carefully the evidence for or against each of those four senses. Pay attention to how Miller uses those four cases at the beginning of the article to frame and orient his discussion and analysis. Remember that in two of those cases Miller says, in effect, that medical paternalism was justified, that the physicians did the right thing in ignoring the vocalizations by patients saying that they wanted to die. So what precisely are the considerations that sometimes warrant medical paternalism? Think about all these general questions as you discuss your case.
Be sure to make case comparisons to show me how your judgment shifts in response to changing circumstances/ case facts. You can use the Miller cases for that purpose. You can use cases in the readings (Case of BB introduced in class or Bouvia). Pay special attention to the Bouvia case because this is the sort of case that is of great concern to advocates for the rights of persons with disabilities. They are concerned that “we” [persons presently without disabilities] are too quick to grant persons with disabilities the right to end their lives, especially when we think that their future quality of life is too compromised. You might also make comparisons with other cases in the assignment itself.
Some Special Notes
Some more specific comments. Each of the attached cases has “a little wrinkle” that makes it a little more difficult to just make a clear, straightforward moral judgment. In withdrawing life-sustaining care, think about the question of how morally important it is that a person is or is not imminently dying. Be careful about ‘ageism.’ It might be a little too easy to embrace “ageism,” a stereotype about old people that suggests they are really worn out and ready to die. And what moral meaning should be attached to the ambiguity that might be communicated by a patient’s family?
In the case of Mr. B the family is quite supportive of his wish to be allowed to die. Are you entirely comfortable with that support? Should that be given moral weight in deciding whether or not it is morally permissible to agree to the expressed wishes of Mr. B?
MORE TOPICS:
INFORMED CONSENT/ TRUTH-TELLING: In class I will have introduced a transplant case from Worcester Massachusetts. The patient needed a heart transplant; he was very near to death. He might have had 2-3 weeks to live. He was not an ideal transplant candidate, so it was very unlikely that he would receive a heart transplant from the usual transplant list. Too many other patients would be seen as being better candidates. So the physician found an organ that was otherwise rejected for transplant purposes because the patient from whom the organ was taken had metastatic cancer. This patient desperately wanted to live. The organ was otherwise a good match. But the physician did not inform the patient that the organ was SUb-par (quality-wise) because it came from someone with an advanced cancer. The physician was afraid the patient would refuse the organ without realizing this was his only realistic chance for a transplant. YOUR TASK: Write a paper in which you argue that the physician did the right thing by withholding this information from the patient. OR write a paper in which you argue that this physician’s behavior was open to justified moral criticism. Was this a case of justified paternalism? Why or why not? You know “the end of the story.” But you must write this paper from the perspective of someone who does not know “the end of the story.”
ETHICS AND MEDICAL EXPERIMENTATION: Go to page 211 of your text, case #3, which is about stopping a clinical trial. Write an essay in which you defend the view that it was morally permissible to stop the trial when they did, OR write an essay in which you argue it was morally obligatory to continue the trial. Be sure to explain carefully your arguments, showing me that you understand what is distinctive about the moral issues that are characteristic of experimental medicine.
ETHICS, CONFIDENTIALITY, and HIV: Imagine that you are a primary care physician caring for an 18-year old high school student whom you have just tested and found to be positive for HIV. He is actually a classmate of your daughter. You have heard your daughter talk about how handsome he is and how delighted she would be to have a date with him. Write a paper in which you defend the view that it would be morally permissible for this physician to inform his daughter that this young man is HIV+ OR Write a paper in which you argue that it would be morally wrong for this physician to inform his daughter.
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