Philosophy 2803-056

Health Care Ethics

Midterm Solutions

Short Answer Questions

1. Five criticisms discussed in class:

“Too grand

Vague (“well-being”)

Seems to medicalize too many things (including happiness)

Overestimates the importance of doctors

Doesn’t leave enough room for individual responsibility (“it’s not my fault, I’m sick”)”

2. a. Paternalism

b. Weaknesses discussed in class:

How can we know all the consequences of an action?

How can we compare utility from person to person?

Do we include all generations?  All species?

Will utilitarianism lead us to ‘repugnant conclusions’?

3. No. The N.C. insists on the consent of the research subject (“The voluntary consent of the human subject is absolutely essential.”) Very young children can’t consent, so the N.C. wouldn’t allow the research.

4. a. The most important point is that the “Court rules that the appropriate standard of disclosure is what a reasonable person in the patient’s position would want to know.” You needed to mention this in order to get full value. As some of you mentioned, the Reibl v. Hughes decision also requires that:

“in obtaining consent … a surgeon, generally, should answer any specific questions posed by the patient as to the risks involved and should, without being questioned, disclose to him the nature of the proposed operation, its gravity, any material risks and any special or unusual risks attendant upon the performance of the operation.” (p. 158)

“even if a certain risk is a mere possibility…, yet if its occurrence carries serious consequences, as for example, paralysis or even death, it should be regarded as … requiring disclosure.” (p. 158)

b. As the notes point out, this is a mixed approach. In other words, it’s a “compromise between [an] objective and subjective view.”

5. a. “The amount of paternalistic intervention justified or required, is inversely proportional to the amount of autonomy present”

b. This is the ‘engineer-client’ model. The doctor/nurse presents options without taking a position on which options are best. The patient makes the decision based on these options. This model involves maximum autonomy for the patient, minimum for the doctor/nurse.

6. This “case established [the] Canadian standard” for research ethics. The “duty owed by researchers is ‘at least as great as, if not greater than, the duty owed by the ordinary physician or surgeon’ (p. 260).” Many of you focused only on consent. To get full value you had to note that the case was significant for research ethics in general (i.e., it applied to more than just consent).