1. PHIL242: MEDICAL ETHICS SUM2014, M-F, 9:40-10:40, SAV 156
INSTRUCTOR: BENJAMIN HOLE
OFFICE HOURS: M-F, 10:40-11 

2. Agenda Clicker Quiz Finish Kant Introduce Access to Healthcare
Humanity formulation
Introduce Access to Healthcare
Where we are, what we’re doing
Textbook, Chapter 11
Start Singer
Administrative Note
Feel free to ask questions using the comment function on Canvas.

3. Clicker Quiz Please set your Turning Technology Clicker to channel 41
Press “Ch”, then “41”, then “Ch”

4. In Kant’s terminology, a maxim is:
a principle on which one acts.
a moral duty.
an action that brings about more good than any other available action.
a bit of folk wisdom.
all of the above.
none of the above.

5. Kant claims that the dictates of morality are:
always mere means to ends in themselves.
hypothetical imperatives.
categorical imperatives.
heteronomous imperatives.
rules of thumb.
all of the above.
none of the above.

6. A “right to health care” is usually considered a positive right.
Yes, that’s true
No, that’s false

7. Finish Kant
Humanity Formulation of the Categorical Imperative

8. Humanity Formulation Negative Aspect: Positive Aspect:
“Act so that you treat humanity, whether in your own person or in that of another, always as an end and never as a means only.”
Negative Aspect:
“never as a mere means”
Positive Aspect:
“always as an ends”

9. Problems The Basic Problem
The notion of treating someone as an end is vague, and so the principle is difficult to apply.
The principle fails to give us good advice about how to determine what people deserve.

10. The Moral Standing Objection
Is the scope of Kant’s account of personhood too small?

11. Humanity applies to all rational beings …

12. But not to non-rational beings …

13. The Moral Standing Objection
The principle cannot explain why those who lack rationality are deserving of respect.
If the principle of humanity is true, then animals have no rights.
If animals have no rights, then it is morally acceptable to torture them.
Therefore, if the principle of humanity is true, then it is morally acceptable to torture animals.
It isn’t morally acceptable to torture animals!
Therefore, the principle of humanity is false.

14. Access to Healthcare Where we are, what we’re doing
Textbook, Chapter 11

16. Chapter 11, Dividing Up Health Care Resources, Lewis Vaughn

17. Access to Healthcare Facts
Nearly 90 million Americans were without health coverage for part of 2006 or 2007.
Over 80 percent of the uninsured are members of working families.
In 2006, there were 8.7 million uninsured children—nearly 12 percent of all children.
In 2006, 46.5 million Americans had no health insurance—18 percent of people under age 65.
In 1997, of a global total of 52.2 million deaths, million were due to infectious and parasitic diseases; 15.3 million were due to circulatory diseases; 6.2 million were due to cancer; million were due to respiratory diseases, mainly chronic obstructive pulmonary disease; and million were due to perinatal conditions.
Today's population is made up of 613 million children under 5; 1.7 billion children and adolescents aged 5-19; 3.1 billion adults aged ; and 390 million over 65.
At least two million a year of the under-five deaths could be prevented by existing vaccines. Most of the rest are preventable by other means.
Source:
Sources: The Kaiser Commission on Medicaid and the Uninsured, “The Uninsured: A Primer,” The Kaiser Family Foundation, October 2007, (21 March 2008); The National Coalition on Health Care, “Health Insurance Coverage,” The National Coalition on Health Care, 2008, (21 March 2008); Organization for Economic Cooperation and Development, OECD Health Data 2007, July 2007, (27 March 2008); E.A. McGlynn et al., “The Quality of Health Care Delivered in the United States,” The New England Journal of Medicine, 2003: 348(26): ; S. Asch et al., “Who Is at Greatest Risk for Receiving Poor-Quality Health Care?” The New England Journal of Medicine, 2006: 354(11):

18. The Affordable Care Act
Most individuals required to have health insurance beginning in 2014.
Individuals who do not have access to affordable employer coverage will be able to purchase coverage through a Health Insurance Exchange.
New regulations will prevent health insurers from denying coverage to people and from charging higher premiums based on health status and gender.
Medicaid will be expanded to 133% of the federal poverty level ($14,404 for an individual and $29,327 for a family of four in 2009) for all individuals under age 65.

19. Justice – “people getting what is fair or what is their due”
Distributive justice—Justice regarding the fair distribution of society’s advantages and disadvantages.
Theories of Just Distribution
Egalitarian theories—Doctrines affirming that important benefits and burdens of society should be distributed equally.
Libertarian theories—Doctrines holding that the benefits and burdens of society should be distributed through the fair workings of a free market and the exercise of liberty rights of noninterference.
Utilitarian theories—Doctrines asserting that a just distribution of benefits and burdens is one that maximizes the net good (utility) for society.

20. A Right to Health Care?
Negative rights—imposes a duty not to interfere with a person’s obtaining something.
Positive rights—imposes a duty to help someone in her efforts to get something.
A “right to health care” usually refers to a positive right that someone has an obligation to help provide access to healthcare.

21. Rationing Rationing cannot be avoided.
Dilemmas arise among individual patients and providers who must contend with scarce life-saving resources.
Dilemmas arise among healthcare policies and vulnerable populations who must contend with scarce life-saving resources.
Transplants: What criteria should be used to decide which patients get transplants, and who should make the decisions?

22. Cases for Evaluation Life, Death, and Money
Black Market Organ Transplants
Is it okay to buy/sell organs between consenting adults?
Expensive Health Care for Killers
Is society required to fund expensive health care for convicted felons?
Life, Death, and Money
Is it ever morally permissible to withhold critical care from someone for lack of payment?
Famine, Affluence, and Morality
Are people living in affluent nations required to provide health to people in less affluent nations?

23. Pond & Envelope Thought Experiment
Peter Singer

24. Pond & Envelope Thought Experiment

25. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree
You are morally required to jump in the pond to save the drowning child.
Strongly Agree
Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree
Strongly Disagree

26. Proximity makes a moral difference
Strongly Agree
Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree
Strongly Disagree

27. The existence of other people in a position to help makes a moral difference
Strongly Agree
Agree
Somewhat Agree
Neutral
Somewhat Disagree
Disagree
Strongly Disagree