Kindle Notes & Highlights
not wanting her life to end in years of dependence and passivity,
This nuanced approach to ADs, incorporating both their moral weight and the pull of any conflicting current interest, may not be the right one (we leave that to the reader). It is an example, however, of how a more complex view can emerge from wrestling with both sides of a difficult dilemma.
What communication challenges limit the use of advance directives?
failure to appoint a proxy, or appointing one who cannot support what is in the directive, or failure to communicate well with the agent can result in a directive not being followed.
Without adequate communication from and with providers, directives easily become irrelevant.
Concluding thoughts
What principles for ethical research emerged in the Nuremberg Code?
What notable experiments influenced the development of medical research ethics?
Jewish Chronic Disease Hospital cancer cell injection studies
The Willowbrook State School hepatitis studies
The Tuskegee Syphilis Study
Are randomized clinical trials ethically questionable?
than
Since a clinician’s foremost obligation is to her patients, then if a relatively effective therapy already exists, how can the clinician fulfill her obligation by inviting patients into a trial with a new treatment whose effectiveness is unknown?
Within a Kantian ethic of respect for persons (see Chapter 1), randomization will then be unethical: though an imperative of good scientific medicine, it amounts to sacrificing current patients for the benefit of future ones. Obtaining participants’ fully informed consent may still provide ethical justification, but that consent will have to be extremely well informed.
utilitarian argument: for the maximum long-term good of everyone affected, scientifically sound RCTs are needed.
“equipoise,”
ideal: with the trial not completed, we gain less certain knowledge about the effectiveness of the new treatment. Benjamin Freedman has argued that, for this reason, clinicians can ethically continue a trial because they are still effectively in equipoise—they still do not really know that the new therapy is more effective.
"[T]hey don't really know" (really, despite a 50% decrease in mortality?!) -- could this be disingenuous rationalization to keep trials going?
When honest, professional disagreement still exists among clinicians about what is most effective, a trial can still continue.
When do placebo-control trials violate basic principles of medical ethics?
How do international contexts affect the ethics of trials?
When are “challenge” trials for new vaccines acceptable?
We'll "go light" on this section...
When do exclusions and priorities unjustly affect disadvantaged groups?
Concluding thoughts
Bernat4
Any point that is chosen as the definitive moment of brain death is bound to be arbitrary. Therefore, we should give up the quest for a criterion of death and instead address on their own merits practical questions about when life support may be withdrawn and organs may be harvested,
Are we essentially organisms, as DeGrazia maintains? If so, then our death should be no different than the deaths of other animals, or at least higher invertebrates.
Is Physician-Assisted Dying an Ethical Choice?
What is euthanasia?
although death ordinarily is regarded as a great harm to the person who is killed, causing someone’s death can be merciful, as implied by the term “mercy-killing.”
What is the difference between voluntary and nonvoluntary euthanasia?
voluntary euthanasia,
nonvoluntary euthanasia
involuntary euthanasia.
unlikely. In real-life cases, as opposed to philosophical thought experiments, killing people who want to go on living is not euthanasia, but murder.
What was the Nazi “euthanasia” program?
the so-called euthanasia program is often characterized as a ‘trial run’ or ‘dress rehearsal’ for the Holocaust.”
However, the fact that the Nazis used the term “euthanasia” as a euphemism for mass murder is not an argument against genuine euthanasia.
What is self-administered physician-assisted dying?
euthanasia
we use the term “self-administered PAD” for this kind of hastened death, although we recognize that “PAD” is also used to cover both self-administered PAD and voluntary euthanasia in jurisdictions where both are allowed.
euthanasia,
Are there good reasons to prohibit voluntary euthanasia while allowing self-administered PAD?
Here, S&M argue that if PAD, then euthanasia
view, there is no intrinsic moral difference between them.
They are right and wrong for the same reasons
intentionally to bring about the patient’s death out of compassion for the patient who requests it.
1
There could be a pragmatic reason for banning euthanasia while permitting self-administered PAD:
2
self-administered PAD may seem safer than euthanasia. It may also give more room for a change of mind.
However, patients who request euthanasia can also change their minds.
Belgian woman,
“Even after the needle goes in,
