Bioethics (PHI2396) - Quiz 3 PDF

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Chapter 7: Beyond Principlism: Alternative Perspectives: Aristotle:  Son of a doctor and father to son (Nicomachus)  Professionally trained as a biologist: o Devised a taxonomy of hundreds of species.  Species = a group of organisms that can breed amongst themselves but not with others. o Distinction of the human animal:  They demonstrate reason (logos) – logic like no other – humans as the most rational being.  The “rational animal” is a complex combination of both abstract reason (rational) and concrete embodiment.  Form+matter – mind related to the body. o Observations of the Natural World:  Animals/plants/ecosystems (systems of life) – characteristic of a healthy organism is balance, a state of homeostasis where all systems are working in tandem.  Illness is seen as an imbalance in the body (eg: cancer -uncontrolled growth  Balance  Stability  Consistency  Moderation Virtue Theory: - Moderation: acting in the mean was accomplishing the right action at the right time in the right way, to the right degree in the right relationship for the right duration. o Usually the moderate decision is the best decision, avoid the extremes of deficiency and excess and achieve the Golden Mean. o You need moderation in policy, best to look towards the average (ethos). - Inspiration from biology/medicine: o Health is the homeostatic condition. - Happiness, the mental equivalent of physical balance, is premised on mind/body balance and temperate behaviour. o By practicing the Golden Mean, human beings could achieve their natural purpose: eudaimonia (happiness, total well-being, flourishing) - Virtue theorists deny the need for a decision procedure or mechanical rule for determining the morally correct action. Examples: Virtue Theory

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The virtue of courage was the mean between cowardice and recklessness. Generosity is the mean between stinginess and prodigality. Virtue is difficult: o It is possible to fail in many ways. Aiming at the mean was not easy. o “For instance, both fear and confidence and appetite and anger and pity and in general pleasure and pain may be felt both too much and too little, and in both cases not well; but to feel them at the right times, with reference to the right objects, towards the right people, with the right motive, and in the right way, is what is both intermediate and best, and this is characteristic of virtue. Similarly with regard to actions also there is excess, defect, and the intermediate. Now virtue is concerned with passions and actions, in which excess is a form of failure, and so is defect, while the intermediate is praised and is a form of success; and being praised and being successful are both characteristics of virtue. Therefore virtue is a kind of mean, since, as we have seen, it aims at what is intermediate.” o Ability to examine all sides of a matter and place them in due perspective – phronic wisdom o It is hard to find the right balance but we don’t need to be extreme about moderation. o Assess the situation, most of the time it will call for conventional normal social rules rather than something extreme BUT there are some situation where you need to be immoderate.  Eg: someone who is chasing you and trying to attack you.

Virtue Theory (cont). - Character is the cornerstone of the virtuous person: o “[S]tates of character arise out of like activities” o Relates to character. = What ought to be? Rather than “What I ought to do? o Practice and repetition influences and formats mental capacity and tolerance. Mental endurance then encourages further physical/behavioural discipline. Allows one to develop a strong character. o We all have weak wills, make mistakes and are prone to failure. o Establishing a strong ethos – making moderation a habit – fix it in your character (cognitive psychology – changing your behaviour by changing the way you think).  Becoming a better student.  Quitting smoking.

o Reliance on personal integrity is necessary for following through in making the right (long-term decision)  Rules and formulae along are insufficient for bringing the right action to actuality.  Insurance against weakness of the will. Feminist Ethics of Care: - HISTORICAL ASSOCIATIONS - Men: o Rational, spiritual, right (handed!) – often portrayed on the right side, objective, universal, public, detached, justice (satisfying all parties) – basis of declarations and policy. - Women: o Emotional, bodily – connected to the body, left (over!), paintings, subjective, situational, private, attached – dependent on men, caring (not really included in policy). Male Morality: - The ethic of justice involves the formulation and impartial application of universal moral principles following the objective application of decision criteria, such as the categorical imperative or utility. - Prescribes principled conduct, regardless of relationships to others even close ones such as family. - The right action is performed by the cool, rational, disinterested agent. - Triumph of autonomy – self-made, the consummate individual. - Often takes the form of “I” (you) have the right to ..” , regardless of consequences.

History Behind This… - Males usually worked outside of the home (merchants, fishing boats, in the fields) while women usually stayed home. - Outside of the home, you deal with people you don’t know – treat them impartially (objectively) not subjectively wanted to develop a reputation of being trusted. Female Morality: Ethic of Care: - Home as a point of departure: ethic of care. o Experiences of caring, fostering those with which you have personal relationships.

Child rearing involves trust and tight bonds to establish healthy, moral adults – not contracts. o Happy household is a space of trust, unspoken consent, situational rules, recognition of differences, age appropriateness. 

“Female” Morality: - Premised on relationships, trust, caring, responsibility to the group. - Some of our relationships have powerful emotional charges and the involved parties must relate to each other needs – leads to partiality and involvement. - Often takes the form of “How can I resolve this issue and maintain or strengthen relationships/connections?”. - Self is understood as connected to other, not isolated or atomic. o Autonomy is only one value among many. o Sympathy, empathy and compassion are also important values. Summary: - For women, morality is a matter of caring and being responsible for others with whom they are involved in personal relationships. - For man, it is the impartial application of rules and principles, and an emphases on autonomy and rights, all characteristic of ethic of justice and patriarchy. - Keep an abstract and distant gaze is not appropriate in personal relationships. - Traditonal ethics tends to be more masculine oriented than feminine oriented. `

Existential and Spiritual Dimensions of Illness: - According to Bioethics in Canada (CPSI, 2014), studies have found that in hospital setting this group treated others the least respectfully. o A) Doctors o B) Orderlies o C) Nurses o D) Cleaning staff o E) None of the Above.

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Shildrick: The broken body of sickness can affect our self-perception – the sense of who we are, feeling of isolation, thinking life has no meaning. o Existential crisis Modern medical science has been criticized for being too clinical – for offering knowledge when what we seek is meaning. o Scientific training removes the ability to relate in a human way. Failure to address the existential aspect of illness.

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This is derivative of the implications of mechanistic science of the Enlightenment, which sought to explain health problems as mechanical malfunctions, rather than as spiritual or whole-body illness.

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The Death of Ivan Illich: Exploration of the consciousness of death. Only has a short time to live, nobody wants to address his need for understanding and human connection, undergoing and existential and spiritual crisis due to his fatal illness, needed a compassionate response. Family and friends didn’t care and physicians focused on the medicalization of body.

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Illness is not a mechanical problem but a whole-body disease. Gap between what he needed and what he got; demonstrates a gap in the physician’s primarily scientific training. Disease vs. Illness: o Disease is a synthesis and condensation of signs and symptoms, test finding and a web of sorting categories. o Illness on the other hand, is the experience of disease and this is a composite of all those elements that conspire to incapacitate a person.

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Conclusions: - Enlightenment ideal of science as objective conflicts with the subjective nature of human needs. - Psychological health is a balance of subjective forces such as relationships, personal narrative, associations, desires etc. But physical health is the product of objective neutral causal process, which can be examined clinically. - Belmont gave patients a much-needed voice but did not address the relationship aspects of the clinical setting. Chapter 8: Conceptual Matters in Abortion and Reproductive Technology:

A Divisive Question - Whether abortion is the taking of a human life depends on what is meant by human life. - The status of life is a question of ontology. o Onto-, from the Greek, ie; “being’ that which is” o The study of being or existence; because the ontological status of an unborn is not settled. The question of abortion cannot be put to rest. - Two sides to the debate: o 1) The unborn is a human being and therefore has rights including it’s right to life. o 2) Human beings have rights because they are sufficiently developed mentally, if not they are not a human being. History: Henry Morgentaler, MD: - 1967: Abortion is decriminalized in Canada. o Dr. Morgentaler testified before in the House of Commons.  Case based on harm resulting from botched illegal abortions and self-induced abortions.  MUST BE APPROVED BY HOSPITAL COMMITTEE. - 1969: Opens a private abortion clinic in blatant violation of the law. o Acquitted. - 1973: tried again, admits to performing over 5000 abortions. o Ultimately acquitted. - 1980s: Opened clinics in Winnipeg and Toronto: o Once again inaugurating protracted legal battles. -

1988 Supreme Court hears appeals to the legal contests from the Doctor’s clinics and strikes down Canada’s abortion law. o Law violated the Charter of Rights and Freedoms:  Profound interference with a woman’s body and this a violation of the security of the person.  The right to liberty… guarantees a degree of personal autonomy over important decisions intimately affecting his or her private life… The decision whether or not to terminate a pregnancy is essentially a moral decision and in a free and democratic society, the conscience of the individual must be paramount to that of the state. o Abortion seen as a moral decision rather than one of medical nature, and morality tends to be of an individual nature.

History (cont) - The high court asked Parliament to fashion a new law that would meet the standards of the Charter.

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1990 legislation passed in the House of Commons (MDs would be “gatekeepers of the procedure) but was defeated in the Senate is they argued this was essentially the equivalent of hospital committees. o MDs in conflict the notion that abortion is a moral issue. o No law was ever accomplished.

Access Problems: - Access is regulated by the provinces (healthcare), regulation through access. - Nunavut: o No clinic or hospital providing abortion services - Québec, Nova Scotia: o Partial funding for private clinics. - PEI o No more than 12 weeks pregnant for an abortion. - New Brunswick: o No funding for private clinics:  However, New Brunswick women get Mifegymiso (Morning After Pill) free of charge. Developmental Sequence of Human Life: - Terms: o Induced Abortion: the purposeful termination of a pregnancy. o Therapeutic abortion – abortion for the protection of the mother’s health (mental or physical) o Elective abortion – abortion for the personal choice, sometimes called abortion on demand.  Constitutes 95%-98% of abortion in the US. o Zygote - single celled being with chromosomes, complete set or conceptus, differentiated cells at days 1-3. o Blastocyte – 2 day through second week – further evolution o Foetus – week 9 to birth, also used colloquially for any stage of the unborn. o Trimester – three month divisions of a pregnancy  Vast majority of pregnancies are terminated in the 1st term.  Less than 1 in 1000 are terminated in the third term, where babies are developed most human like (US numbers) - First Trimester: o Cell differentiation, week 1 o Zygote implantation in uterine wall, week 2-3 o Heartbeat detected by ultrasound, wk.5 o Primitive nervous system observed, wk 6.

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o 90% of abortions occur during this trimester. Second Trimester – viability (survive outside the womb) possible at week 24, has become recognized point for ontological status (personhood) o Quickening (fetus is kicking/movement) or mothers perception of movement, wk. 16 Third Trimester – self/other perceptions develop? o Higher brain (cerebral cortex) “wired” wk. 24 – consciousness. o Cell structure of brain appears nearly the same as a newborn, wk. 32 o 1000/1.3 million abortions occur in this trimester.

Ontological Status of the Unborn: The Meaning of Human Life: - The genetic sense suggests that DNA markers are established at conception. - Is an unborn person a person? Should we include pregnant women in a census as two people? o But an entirely dependent being is not usually considered an individual, an individuated being. Yet someone on life support would be counted as a member of the population, while a viable fetus at week 32 would not. Is this right? Or is it a holdover of what we used to think as human being? - According to the Western religious view, it is divine likeness that makes life human. “Biological Human Life”. The willful destruction of even the earliest stage is wrong. - For many philosophers and religious liberals the human part of life has something to do with demonstration of sapience (of the Homo sapiens) o So it is the termination of a psychological life that is morally problematic. o “Psychological human life” – ability to use symbols, to think and imagine are distinct human properties. o The intentional termination of a psychological life is what is considered morally problematic.

The Meaning of Personhood: - Roman Catholicism makes no distinction between a human being and a person since both are defined by a God-given an immortal soul. DNA defines both a human being and a person – at fertilization there is the creation of a of unique strand of human DNA. o Discredit: prembryo, pre-person, pre-human beings.

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Secular view; John Locke (1869) – Focus mainly on activities or attributes that they believe indicate personhood. o “A person is a thinking intelligent being has reason and reflection, and can consider itself, the same thinking thing, in different times and places. o Most philosophers today tend to think of person hood as a cluster of mature traits like autonomy, rationality, self-awareness, language competency, etc.

When Ontological Status is Attained: - When is it attained in human development? ( when does someone become a person) o At conception vs. at some point after it’s conception, -

Hominization and Ensoulment: o Hominization – The point in gestation that the unborn attains full human status. Derived from latin Hominem – meaning “man”.  Pope Pius IX (1869) endorsed “immediate hominization” (personhood at conception) and so abortion at any stage is homicide.  Currently, the adopted position of fundamentalist Christians and a point of solidarity against Jewish, Muslims (and Buddhist) traditions.  Delayed hominization – the unborn does not attain full human status until a certain point in the process of development.  Used to be the main theological view. o Ensoulment – Refers to the creation of the soul within a human being or other creature (when a soul is created). Soul is what differentiates humans from other beings.  Aristotle (The Scientist) guessed that this happens 40 days after conception also had the hierarchy of souls – humans – rational soul. Former model of the Western Church.  St. Thomas agreed, arguing the early fetus was more plant than animal and certainly more animal than human and ultimately rational. Though abortion at any point to save the life of the mother was permissible.  Piggybacks on the 19th century science of embryology.  Conservative Christians now believe in immediate ensoulment which forms the basis against Christian’s moral objection to various reproductive procedures.

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Eg: Stem Cell research – unborn from conception is a human life. Frozen eggs are entitled to the same protection as an infant.

Other Beliefs in Monotheism: -

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Judaism: o According to rabbinical law “A baby becomes a full-fledged human being when the head emerges from the womb. Before then the fetus is considered a partial life”. o “Israel’s abortion law now among the world’s most liberal” – 2014 Islam o The creator makes the human being in “stages” o Ruh (spirit) is breathed into the fetus at 120 days – the point in which it becomes a human being. o Saudi Arabia (conservative political leanings)  An abortion is only legal id the abortion will save the woman’s life or if the pregnancy gravely endangers the woman’s physical or mental health.

Summary: Moral Status of the Unborn: - Religious Views (mainly Catholic) o Used to believe in Aristotle’s doctrine of delayed ensoulment. o Pius IX changed the belief to that of immediate ensoulment, asserting that the full moral status of the unborn and reject abortion as there is no distinction between a person and a human being which is created at conception. - Secular Views; o Shaped by the understanding of the unborn’s ontological status. o Moral agency or the ability to make to make responsible decisions is the mark of personhood. Scientific Views About When Life Begins: -

The Genetic View: o A full individual is created at conception/fertilization, when the genes from the parents combine to form an individual with unique properties. o DNA and epigenetic factors oriented towards the development of a brain and central nervous system.

Here religious conservatives legitimize their views with the generally Godless method of science. They favour genetic view. The Embryological View: o An objection to the genetic view; identical twinning can occur up to day 12, producing two individuals with different personalities and souls (theology)  Would permit “morning after pills and other terminations up to two weeks. The Neurological View: o With analogy to whole brain death-loss of cerebral function (the official designation of death in Canada), whole-brain wiring, xc. Wk. 27 would be the moment of “life”. o Some scientists think that the acquisition of the human EEG (wk.27) should be defined as when human life begins. o Could allow abortion into the third trimester. 

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Additional Views: o Ecological/Technological: human life begins when it can exist separately from its maternal biological environment. o Viability wk 24 approximately o Immunological View – human life begins when the organism recognizes the distinction between self and non-self. Occurs @ time of birth. o Integrated physiological view: independent of the mother and has its own circulatory/alimentary/respiratory systems. Traditional birthday. o Metabolic view – there is no one point when life begins, life begins at conception but the human element is gradual and progressive. Buddhism: o Appears to have a utilitarian approach to abortion in as much as the end of suffering is the goal of life. Given this, abortion may be a reasonable option if the suffering incurred by having a child is greater than the suffering of the termination of...