01 Oct A twenty-year-old diabetic patient, who usually managed her condition with insulin, has also caught a case of pneumonia.
A twenty-year-old diabetic patient, who usually managed her condition with insulin, has also caught a case of pneumonia. The two conditions together overwhelmed her, and she slipped into a coma. Since her diabetes was under control and she was otherwise healthy before catching pneumonia, she never felt the need to discuss such a situation with her family, appoint a surrogate with medical power of attorney, or leave an advance healthcare directive. She worked part-time at a nearby donation center, but she and her family live below the poverty line. Medicaid has paid for her ventilator and gastronomy tube for the entirety of the patient’s two-week-long coma, and it would continue to cover those expenses indefinitely (which may be decades). The patient has remained unresponsive, and her face is blank; however, her family is still clearly impassioned about their belief that God may pull her out of her comatose state. As acting physician, your own prognosis is that she is unlikely to regain consciousness; however, it is difficult to say how unlikely. Suppose that law and medical-oversight powers are unclear. State whether you would recommend keeping the patient on, or removing the patient from, life support. Elaborate the moral reasoning behind your decision, including the (ir)relevant moral principle(s) and how they apply to the specifics of the case. Specifically, state whether one or more of them is absolute and why. If they are all prima facie, then state why. If absolute or prima facie principles conflict with one another in this scenario, then state how we should decide which to privilege and why. Pay special attention to justice – who does and does not deserve what in healthcare and why. State the primary goal(s) of medical care (not the scope) and why. Explain why your decision is consistent with that/those goal(s).
2) A seventeen-year-old patient has Huntington’s disease; though there were no questions of their medical competence until recently, their behavior and medical-imaging results both now raise questions, but not definitive answers, to whether they are now in early stages of dementia. Unexpectedly, medical-imaging results also show a malignant, yet still localized, brain tumor. While cancer has not yet spread to nearby lymph nodes, your opinion as lead physician is to perform a surgery soon – before it does spread. The surgical staff has a good track record with this kind of brain surgery, but it is risky. When told of the news, the patient demonstrates a level of understanding that raises questions, but not definitive answers, for a seventeen-year-old. The patient insists on eschewing surgery in favor of chemotherapy alone, which you believe would be much less likely to be successful than surgery; however, her parents agree that surgery is the best option. The patient has unfortunately neither appointed a surrogate with medical power of attorney nor left an advance healthcare directive from when they were surely autonomous. Their private health insurance will cover both, and the patient’s parents can afford to pay what insurance will not. Suppose that law and medical-oversight powers are unclear. State whether you would recommend performing surgery against the patient’s wishes, but with the wishes of the parents, or not. Elaborate the moral reasoning behind your decision, including the (ir)relevant moral principle(s) and how they apply to the specifics of the case. Specifically, state whether one or more of them is absolute and why. If they are all prima facie, then state why. If absolute or prima facie principles conflict with one another in this scenario, then state how we should decide which to privilege and why. Pay special attention to autonomy – what it is, who does and does not have it, when paternalism (weak or strong) occurs, if/when it is justified, and why. State the primary goal(s) of medical care (not the scope) and why. Explain why your decision is consistent with that/those goal(s).
3) You are a capable cosmetic surgeon running your own private practice. A famous footballer has scheduled an appointment with you. After years of soul-searching, they have come to realize that they are transabled – they identify as disabled despite being traditionally abled; specifically, they believe that they should be legless. While their legs are uninsured, they are emotionally valued by the patient’s many fans, the league that employs the patient, and the patient’s friends and family members. Those who know of the patient’s identity and belief overwhelmingly find them troublesome; thus, the overwhelming majority of fans, friends and family, and employers all stand to be emotionally and psychologically harmed by the patient’s desire being satisfied – that desire being to respect what they believe to be a right to bodily autonomy. The patient is well-informed about the potential complications and adverse side effects which, given your technical proficiency, should be as limited and unlikely as possible. You gather from interacting with them that they are very serious and emotionally invested in the amputations. Due to their football success, they can afford to pay out of pocket, since insurance will not cover the amputations. Suppose that law and medical-oversight powers are unclear. State whether you would perform the amputations or not. Elaborate the moral reasoning behind your decision, including the (ir)relevant moral principle(s) and how they apply to the specifics of the case. Specifically, state whether one or more of them is absolute and why. If they are all prima facie, then state why. If absolute or prima facie principles conflict with one another in this scenario, then state how we should decide which to privilege and why. Pay special attention to autonomy – what it is, what it is not, when paternalism (weak or strong) occurs, if/when it is ever justified, and why. State the primary goal(s) of medical care (not the scope) and why. Explain why your decision is consistent with that/those goal(s).
In your essay, you should use at least two sources that we have read. You may consult outside academic sources if you wish; however, they should be serious academic sources, i.e., more serious than IEP, SEP, and Britannica entries. Consult with me if you have even an inkling of doubt about whether a source is sufficiently academic or not. In addition to being roughly five pages long, your essay should be double-spaced with 12-point, Times New Roman font and 1” margins. You have your choice of citation style (e.g. MLA, APA, Chicago) as long as it is consistent throughout. Unofficially, I encourage you to use that preferred by your major. I will grade only secondarily according to formatting, grammar/spelling/punctuation, and citation. Work found to be academically dishonest and work not submitted through Turnitin will receive a zero. I will not grade according to any bioethical beliefs I may have myself. I will be grading primarily according to the following:
Do you take clear positions for yourself? By design, each prompt includes many plausibly relevant facts to render decision-making complicated and difficult. Drawing attention to how complicated, difficult it is accomplishes nothing.
How effectively do you utilize sources (i.e., how plausibly accurate are your characterizations of them? Are you citing relevant information? Are you citing enough information, and elaborating it well enough, to justify your argument? Are you addressing positions different from yours that we have seen? For example, if you argue that life-prolongation is the primary purpose of healthcare, which is fine, then you should address Goldman’s argument and why it is wrong).
Have you addressed every part of the prompt, even if only to mention what is irrelevant (and why)?
How plausibly true are your premises?
How logically connected are your premises to the conclusions that they should support?
How free, or close to free, of assumptions is your essay?
How free, or close to free, of logical fallacies is your essay? (Any will cost you points, but ones listed in Chapter 1 especially will).
How free, or close to free, of contradictions is your essay? (I strongly recommend revisiting Chapter 1 regarding this and the preceding three points).
Essays are due at 11:59 PM on Wednesday, October 21st. I will accept no late essays without either a legitimate, documented excuse or prior approval. I will accept no .pages files. My grading presupposes acquaintance with PowerPoint slides, audio, and discussion-board posts so far; thus, I encourage you to (re-)visit the relevant ones over the next two weeks.
