1. Name the three main standards of surrogate decision-making:
pure autonomy standard
substituted judgement standard
best interest standard
2. A person acts ______________ if he or she wills the actions without being under the control of another's influence.
3. Utilitarian Mill gives little weight to respect for autonomy in his moral theory of weighing happiness/value and unhappiness/lack of value produced by an action. (T/F)
4. The principle of respect for autonomy can be stated as either a negative obligation or as a _______________ obligation.
5. In the study cited by BC6 Korean Americans and Mexican Americans tended to believe that the family should make decisions about the use of life support. (T/F)
6. Autonomous choice is a duty of patients. (T/F)
7. Technically, health care workers assess capacity and not competence. (T/F)
8. The substituted judgment standard of surrogate decision-making determines whether or not the life lived and to be lived by the patient has adequate quality. (T/F)
9. The single core meaning of "competence" applicable in all contexts:
ability to preform a task
10. Competence is a threshold concept. (T/F)
11. The competence to decide is always relative to the particular ____________ to be made.
12. The main standard of disclosure to use in determining material facts to be disclosed to a patient is the professional practice standard. (T/F)
13. Two specific moral rules specified under the principle of autonomy:
tell the truth, protect confidential information
14. Name the three types of cases that provide legal exceptions to informed consent:
15. Persuasion is a form of coercion. (T/F)
16. A ___________ is a substance or intervention that the clinician believes to be pharmacologically or biomedically inert for the conditions being treated.
17. Subjects in research sometimes commit the ______________________, whereby the fail to distinguish the aims of clinical care from those of research.
18. Patients in mental institutions who cannot care for themselves and have been declared legally incompetent cannot make any autonomous choices. (T/F)
19. The principle of beneficence can be used to justify the rule of "respect the privacy of others." (T/F)
20. Consent should refer to presumptions about the choices the individual would or should make, not merely an individual's actual choices. (T/F)
21. BC6 cite several recent reviews of instruments to measure competence and they find that these instruments produce variable results. (T/F)
22. Many policies use pragmatic criteria of efficiency, feasibility, and social acceptability to determine whether a person is competent to make decisions about medical care. (T/F)
23. The level of evidence for determining competence should vary according to _____________.
24. Informed consents, when legally effective authorizations, are autonomous acts. (T/F)
25. Legal, regulatory, philosophical, medical, and psychological literatures tend to favor the following 5 elements of informed consent:
26. Name the two competing standards of disclosure:
27. Subjects in research sometimes commit the ______________________, whereby the fail to distinguish the aims of clinical care from those of research
28. Data indicate that patients generally make their decisions prior to and independent of the process of receiving information. (T/F)
29. Therapeutic privilege states that a physician may legitimately withhold information, based on a sound medical judgment that divulging the information would potentially harm a depressed or unstable patient. (T/F)
1. It is usually appropriate to recognize waivers of rights because we enjoy discretion over whether to exercise our rights. (T/F)
61. _________________________ is the name of the principle BC6 use to describe all forms of action intended to benefit other persons.
62. Some forms of beneficence are morally obligatory. (T/F)
63. Principles of beneficence are broad enough to justify all other principles. (T/F)
64. The New Testament parable of the Good Samaritan suggests positive beneficence is a moral obligation. (T/F)
65. We are morally required to benefit persons on all occasions. (T/F)
66. One rule specified under the principle of beneficence:
protect and defend the rights of others
67. Rules of nonmaleficence need not always be followed impartially. (T/F)
68. Rules of beneficence are negative prohibitions of action. (T/F)
69. Rules of nonmaleficence provide moral reasons for legal prohibitions of certain conduct. (T/F)
70. Failing to act beneficently toward a party is prima facie immoral. (T/F)
71. Failing to act nonmaleficently toward a party is prima facie immoral. (T/F)
72. The more widely we generalize obligations of beneficence, the less likely we will be to meet our primary responsibilities. (T/F)
73. Peter Singer argues even if it is in our power to prevent something bad from happening without thereby sacrificing anything of comparable moral importance, we have no moral obligation to do so. (T/F)
74. Health care worker X has an obligation of beneficence toward patient Y if five conditions are met. Name them:
y is at risk of significant loss or damage to life or health of another major interest
x's action is necessary to prevent this loss or damage
x's action has a very high probabiliity of preventing it
x's action would not present very significant risk cost or burdens to x
the benefit that y can be expected to gain outweighs any harms cost or burden x is likely to occur
75. Ethical theory and practical deliberation sets precise, determinate conditions of obligations of beneficence. (T/F)
76. There is an implicit assumption of beneficence in all medical and health care professions. (T/F)
77. ___________________ is the act or practice of making an appropriate and often proportional return.
78. Paternalism typically involves a conflict between two moral principles. Name them:
beneficence and autonomy
79. The analogy between professional paternalism and paternalism of a father for a child presupposes two features of the paternal role. Name them:
father acts beneficently
he makes all or at least some decisions relating to childrens welfare rather than letting them make those decisions
80. The complete definition of paternalism used by BC6:
intentional overriding of one persons preferences or actions by another person where the person who overrides justifies this action by the appeal to the goal of benefiting or preventing or mitigating harm to the person whose preferences or actions are overriden
81. The main difference between soft paternalism and hard paternalism is the existence of what in hard that is absent from soft?
in hard persons actions are voluntary where soft prevents nonvoluntary actions
82. Refraining from soft paternalism is an example of respect for autonomy. (T/F)
83. Refraining from hard paternalism is an example of respect for autonomy. (T/F)
84. Soft paternalistic actions are morally complicated because of what specific determination?
whether a person acts are substantially nonautonomous and determining appropriate means of action
85. "Sin taxes" are an example of a hard paternalist policy. (T/F)
86. What an informed and competent person actually chooses to do is the best evidence we have of what his or her values are. (T/F)
87. BC6 warn against routinely using soft paternalism for three reasons. Name them:
susceptible to abuse if lack public scrutiny
stigmatize behavior and create psychosocial cost
runs risk of preparing the way for hard pateralist interventions
88. Three general positions dominate the literature on the justification of paternalism. Name them:
paternalism justified by consent
paternalism justified by prospective benefits
89. BC6 argue the main justification for paternalistic interventions is respect for autonomy. (T/F)
90. BC6 argue that beneficence alone justifies paternalistic actions. (T/F)
91. As the benefits for a person increase and that person's autonomy decreases, the justification for paternalistic action becomes less plausible. (T/F)
92. In general, as the risk to a patient's welfare increases or the likelihood of an irreversible harm increases, the likelihood of a justified paternalist intervention correspondingly increases. (T/F)
93. In general, as the risk to a patient's welfare decreases or the likelihood of an irreversible harm decreases, the likelihood of a justified paternalist intervention correspondingly increases. (T/F)
94. There exist cases of justified hard paternalism. (T/F)
95. The antipaternalistic stance resisting suicide intervention is vulnerable to criticism on two grounds. Name them:
a. Lack of communal concern
b. not acting autunomously
96. A suicide attempt, irrespective of motive, almost universally provides a legal basis for public officers to intervene but not grounds for involuntary hospitalization. (T/F)
97. _________________ include the resources required to bring about a benefit, as well as the negative effects of pursuing and realizing that benefit.
98. IRB stands for ____________________________________.
Institutional Review board
99. An IRB proposal should, most basically, demonstrate what about the research being proposed?
Why the probable benefits outweigh the risk
100. CEAs are typically put in monetary terms. (T/F)
101. CEA and CBA are appear precise and helpful because they _________________________.
Present trade- offs in quantified terms
102. _____________ refers to a possible future harm.
103. Benefit is a probabilistic term. (T/F)
104. __________________________ is the set of individual, institutional, or policy responses to the analysis and assessment of risk, including decisions to reduce or control risks.
105. Societal perceptions of clinical research shifted significantly in the 1970s and early 1980s, from increasing access to clinical trials to protecting individuals from risks and burdens associated with research. (T/F)
106. BC6 draw two general conclusions from their consideration of the RBA of silicone-gel breast implants. Name them:
a. Should not be interpreted as an argument against indispensable role
b. RBA's not value free
107. Measures commonly associated with the _______________________ principle include transparency, involvement of the public, and consultation with experts about possible responses to threats marked by uncertainty or ignorance about probabilities and magnitudes.
108. One method used to determine the value of a human life by policy makers is ___________________________.
Discounted future earnings
109. QALYs bring __________ of life and __________ of life into a single framework for evaluation.
Length and quality
110. One major problem with determining quality adjusted life years:
May not entrail efforts to reduce the number of individual victims in it's attempts to increase the number of life years. Only attaches utility to selected outcomes
111. A holder of a valid claim based in justice has a right, but it not necessarily due anything. (T/F)
112. Another name for distributive justice is retribution. (T/F)
113. A clear example of distributive justice appears in the history of research involving human subjects. (T/F)
114. The formal principle of justice:
Equals should be treated equally unequal unequally
115. A material principle of justice identifies relevant _________________ for distribution.
116. In Philosophy 221, the two maternal principles most used for grading:
Each person according to merit to each person according to effect or to each person according to contribution
117. If one were to accept only a principle of free-market distribution, then one would oppose a principle of need as a basis for public policy. (T/F)
118. In the Auto Workers v. Johnson Controls, Inc., the court found that the workplace policy involved was based on the irrelevant (unjust) property of ______________.
119. In order to specify and balance principles a general _________ of justice can provide assistance.
120. Utilitarians argue the standard of justice demands we seek to maximize social welfare. (T/F)
121. The US has almost exclusively accepted the free-market ideal that distributions of health care are best left to the marketplace. (T/F)
122. For the libertarian, health care is not a right and the ideal health care system is privatized. (T/F)
123. Libertarians generally support a health care system in which health care insurance is privately and voluntarily purchased. (T/F)
124. ____________________ theories of justice focus on principles that evolve through traditions and practices.
125. Zeke Emanuel proposes a health care system with thousands of what he calls "_______________________," each involving citizen-members.
126. The right to health care is on a weak foundation when based on overall utility. (T/F)
127. For egalitarians, each member of society would have equal access to an adequate level of health care. (T/F)
128. _____________theories of justice hold that health care is not a right, and the ideal health care system is privatized.
129. Rawls uses fair opportunity as a rule of __________.
130. John Rawls' theory of justice holds that each person is entitled to the maximum amount of ______________ compatible with a similar measure of liberty for others.
131. Rawls recognizes that the principle of fair opportunity can only be imperfectly carried out as long as the institution of the ____________ exists.
132. The theory of _________________ holds that there is a social obligation to reduce or eliminate barriers that prevent fair equality of opportunity.
133. The fair opportunity rule is specified under the principle of _________________.
134. The fair opportunity rule says that no person should receive social benefits on the basis of _________________. It also hold that no person should be denied social benefits on the basis of ___________________ .
undeserved advantageous properties and undeserved disadvantageous property
135. The genetic lottery refers to distribution of advantages and disadvantages of ticket numbers for a hypothetical health care insurance drawing. (T/F)
136. Many studies in the US indicate blacks and women have less access to various forms of health care in comparison to white men. (T/F)
137. Data indicate that somewhere between 10% and 20% of research subjects who are healthy volunteers self-report their primary motivation for volunteering is financial need. (T/F)
138. The notion of vulnerability refers to a person's susceptibility to inducement or coercion or to harm, loss, or ______________.
139. The right to volunteer as a research subject has been granted to prisoners in most nations, although denied in the US on the grounds of the potential for manipulation or coercion in penal institutions. (T/F)
140. A ______________________ situation is one where a person feels controlled by the situation, such as severe illness or lack of food and shelter.
141. The presence of an irresistibly attractive offer is a sufficient condition for making an inducement undue. (T/F)
142. Undue inducements are sometimes referred to as undue profits. (T/F)
143. Inducements are not undue unless they are both excessive in _______ and excessive in ________.
Risk and Payment
144. BC6 warn against stopping pharmaceutical company use of research studies in poor communities, as payments for studies are a vital source of needed funds for the economically disadvantaged and a way to provide jobs in these communities. (T/F)
145. Two main arguments support a moral right to government funded health care: an argument based on _____________________ and an argument from ______________________.
Collective social protection and Fair opportunity
146. On each of the nonlibertarian theories of justice, the argument from other comparable government services successfully generates a public obligation to provide some level of health care services. (T/F)
147. The decent minimum approach entails acceptance of a __________________ system.
148. The concept of decent minimum represents one place of agreement among different theories of justice. (T/F)
149. BC6 conclude it would be fair in many cases to require individuals to pay higher premiums or taxes if they accept well-documented risks that may result in costly medical attention. (T/F)
150. Public preferences should play a role in setting the decent minimum. (T/F)
151. Ethical and political theories that explicitly address questions of global justice are referred to as ______________________ theories.
152. Madison Powers and Ruth Faden posit that social justice is concerned with human well-being, not only health, and list six core dimensions of well-being. Name them:
Health, personal security, reasoning respect, Attachment self determination
153. Inequalities are not merely a matter of bad luck of personal failings. They are often distributed by social institutions the can be structured explicitly to reduce the inequalities. (T/F)
154. Approximately 20 million people in the developing world die each year from malnutrition and diseases that can be inexpensively prevented or treated by cheap and available means. (T/F)
155. The goal of the CUA is utilitarian, health benefits are quantified, and QALYs are used. (T/F)
156. Good evidence exists to show that public health expenditures targeted at poorer communities for ________________________ (such as prenatal care) save many times that amount in future care.
157. Both need and prospect of success are value-laden concepts. (T/F)
158. BC6 present several basic "target goals" for a new health care policy:
159. Some form of _____________________________.
160. Acceptable incentives for ___________________ and for __________________.
Physicians and Patients
161. A fair system of rationing that does not violate the ____________________.
Decent minimum standard
162. Put new system into effect ____________________.
163. ___________ is a French term meaning sorting, picking, or choosing.
164. The use of a lottery system for distributing scarce resources is never justified. (T/F)
31. The principle of nonmaleficence is the fundamental principle of the Hippocratic tradition of medical ethics. (T/F)
32. Obligations to help others are more stringent than obligations to not harm others. (T/F)
33. If one harms someone then one also violates someone's rights. (T/F)
34. BC6 define ________________ as "thwarting, defeating, or setting back some party's interests."
35. Acts of harm are prima facie wrong. (T/F)
36. "Do not cause offense" is a rule specified under the principle of ______________________.
37. Sometimes agents are causally responsible for a harm they did not intend or know about. (T/F)
38. ____________________ means the absence of due care.
39. Due care means ________________________________________.
taking sufficient and appropriate care to avoid causing harm as the circumstances demand of a reasonable and prudent person
40. Name the four essential elements in a professional model of due care:
duty to the affected party
breach of the duty
party experiences a harm
harm caused by the breach of duty
41. The distinction between withdrawing and withholding treatments is morally irrelevant. (T/F)
42. The distinction between ordinary and extraordinary means of treatment is unacceptably vague and morally misleading. (T/F)
43. Courts have increasingly maintained that medical nutrition and hydration are medical procedures subject to the same standards of evaluation as other medical procedures and thus sometimes unjustifiably burdensome. (T/F)
44. There is no reason to believe that medical nutrition and hydration is always an essential part of palliative care or that it necessarily constitutes a beneficial medical treatment. (T/F)
45. Evidence indicates that patients who are allowed to die without artificial hydration sometimes die more comfortably than patients who receive hydration. (T/F)
46. The term "________________" means a treatment provides no physiological benefit or is hopeless and becomes optional.
47. A judgment about whether to use life-prolonging treatment rests unavoidably on the anticipated quality of life of the patient, not merely on a standard of what is medically indicated. (T/F)
48. Give the main reason(s) why the two cases of therapeutic abortion are not justified when applying the rule of double effect
in the two cases of therapuetic abortion that are not justified when applying the rule of double effect, the problem was that the action of termoiiating fetal life is a means to save the pregnant womans life, and as such it requires intending the fetus's death. So criteria of the agents intention, distinction between means and effects and proportionalit between the good effect and the bad effect all are violated by the double effect
50. BC6 argue there is no relevant difference between obligatory and optional treatments. (T/F)
51. Name three types of situation in which conditions exist to override the prima facie obligation to treat:
treatment of the futile or pointless, inefective
burdens of treatment outweigh benefits
children with serious illness or disabilities
52. A physician is not morally required to provide a futile treatment but must inform the patient of the treatment. (T/F)
53. Even if a patient is not terminally ill, life-sustaining medical treatment is still not obligatory if its burdens outweigh its benefits to the patient. (T/F)
54. When determining a patient's best interests, mental retardation should be factored in. (T/F)
55. Criteria focused on the incompetent patient's best interests should be decisive for a proxy unless the patient's interests conflict with familial or societal interests in avoiding burdens or costs. (T/F)
Letting die" is (prima facie) acceptable in medicine under one of two conditions:
voluntary and competent refusal of treatment
57. BC6 argue that assisted suicide is never morally justified. (T/F)
58. Name the two types of advance directive used to govern future decision making:
durable power of attorney
59. Name two problems with advance directives:
fail to change directive after changing preferences
60. Give the four qualifications of a surrogate decision maker:
ability to make reasoned judgments
adequate knowledge and information
a commitment to the incompetents patients interest, free of conflicts and free of controlling influences by those who might not act in the patients best interest