Philosophy 242 MEDICAL ETHICS SUM2014, M-F, 9:40-10:40, SAV 156 INSTRUCTOR: BENJAMIN HOLE OFFICE HOURS: M-F, 10:40-11  EMAIL: BVHOLE@UW.EDU

Agenda Clicker Quiz Bioethical Context: Chapter 3 – “Paternalism and Patient Autonomy” Discuss case studies Please set your Turning Technology Clicker to channel 41 Press “Ch”, then “41”, then “Ch”

Dax Cowart was determined to be competent by mental health professionals suffered severe and disabling burns over most of his body wanted to commit suicide all of the above A & B B & C

Generally, Kantian ethics rejects Autonomy Paternalism The right to refuse treatment Self-determination All of the above None of the above

Justifiable censorship The patriot act According to the textbook, paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished is known as: Autonomy Strong paternalism Antipaternalism Weak paternalism Justifiable censorship The patriot act

Autonomy Autonomy—A person’s rational capacity for self-governance or self-determination Autonomy principle—Autonomous persons should be allowed to exercise their capacity for self-determination

Refusing Treatment The courts have established the “right to refuse treatment” principle that a competent patient has a right to reject recommended treatments, even life-saving ones. Does this expression of autonomy conflict with beneficence or utility? Beneficence: “we should do good to others and avoid doing them harm” Utility: “we should produce the most favorable balance of good over bad (or benefit over harm) for all concerned”

Paternalism Paternalism—The overriding of a person’s actions or decision-making for his or her own good. Weak paternalism—Paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished. Strong paternalism—The overriding of a person’s actions or choices although he or she is substantially autonomous.

Refusing Treatment The courts have established the principle that a competent patient has a right to reject recommended treatments, even life-saving ones. The right to refuse treatment is problematic when the patients are “mature minors” parents reject medical treatment for their minor children the patient has “diminished autonomy”

Paternalism & Ethical Theories Utilitarianism allows for the possibility of paternalism. An act is right if and only if it produces the best net benefit for all those affected. In general, Kantian ethics rejects paternalism. An act is right if and only if It can be consistently conceived and willed as a universal law. It can treats persons as ends and never merely as means. Natural law theory is more paternalistic than Kantian ethics An act is right if and only if it does not violate: life, procreation, knowledge, or sociability. Conflicts in violating those values adjudicated by the doctrine of double effect.

Favorite theory, with respect to bioethical issues of paternalism and autonomy. Utilitarianism Kantian Ethics Natural Law Theory

“Paternalism and Patient Autonomy” Case Studies “Paternalism and Patient Autonomy”

Case Study: Dax Cowart Should the state force people to undergo life-saving medical treatment against their will?

The state should force people to undergo life-saving medical treatment against their will Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Discussion Question Suppose that you are the physician and found Dax to be fully competent, and suppose that he requests your help as a physician in hastening his death, either by giving him a lethal drug he could take himself (physician-assisted suicide) or by injecting a deadly drug (voluntary active euthanasia).  Would you agree to this request?  What considerations besides respect for patient autonomy would be relevant to your answer?

Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree If you were Dax’s physician and found him to be fully competent to refuse treatment, you would respect his request and hasten his dying process. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

injecting a deadly drug (voluntary active euthanasia) You would respect Dax’s refusal of treatment and hasten his dying process by: giving him a lethal drug he could take himself (physician-assisted suicide) injecting a deadly drug (voluntary active euthanasia) it doesn’t matter (whether you choose A or B) neither (wouldn’t do it)

Case Study: Prayer, Medicine, and Death 1990: “David and Ginger Twitchell, a Christian Science couple … who relied on prayer rather than on doctors as their young son lay dying from an obstructed bowel, were convicted of involuntary manslaughter …” 1993: “The Supreme Court of Massachusetts … reversed the manslaughter conviction …” “Do you think that parents should have the right to reject medical treatment for their children on the basis of religious beliefs? What moral principle would support your judgment? Should religious liberty be construed to allow parents to do anything with their children as long as the actions are based on religious considerations? If not, what sorts of actions should and should not be allowed?” (pg. 80)

Parents should have the right to reject medical treatment for their children on the basis of religious beliefs Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Case Study: State Paternalism and Pregnant Women “Should the state force pregnant women to behave in certain ways while carrying a fetus? If pregnant women can be legally punished for “fetal abuse,” how should it be defined? Is a pregnant woman guilty of fetal abuse if she refuses to eat properly? Drinks any amount of alcohol? Forgoes prenatal care? Whose interests should be given greater weight – the woman’s or the fetus’?” (pg, 82)

The state should force pregnant women to behave in certain ways while carrying a fetus Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree