Re: Medical Ethics

From: Immortalist (Reanimater_2000_at_yahoo.com)
Date: 10/24/04 

Date: Sun, 24 Oct 2004 11:30:24 -0700

"Immortalist" <Reanimater_2000@yahoo.com> wrote
> "Edgar Svendsen" <solon013@earthlink.net> wrote
http://groups.google.com/groups?selm=DQved.6450%24ta5.5453%40newsread3.news.atl.earthlink.net

> > A recent newsitem about a kidney transplant and a private website that
> > promotes finding donors and donees outside the "official" organ transplant
> > waiting list spawned a spate of aticles about the ethics of private
> > acquisition of body organs. Some, even most, medical ethicists seem to feel
> > that private acquisition is wrong in that it denies equal access to needed
> > transplant by the poor. This raises a larger issue; again many, if not most,
> > medical ethicists, believe that ethics demands access for all to medical
> > care in general.
> >

Consider the problem of a hospital's ethics committee faced with the task of
deciding which of two terminally ill patients receives the one organ available
for transplant. According to the rules of the hospital, which have been accepted
by the staff, cases that raise tough ethical issues are sent to the committee,
whose decision is binding. In this case, each patient will die without a
transplant, but not enough compatible organs are available to save both.

The first patient, A, must have the transplant almost immediately because his
situation is very unstable. However, A would not have needed the transplant so
quickly had he followed his physician's instructions about diet, medication, and
exercise. Because of his own negligence, he needs treatment right now. The second
patient, B, has been highly responsible and has postponed the need for treatment
through good health habits. Furthermore, because B can be relied on to follow
instructions, he could wait at least a short time in the hope that another organ
will become available. While the odds are against another compatible organ
becoming available, there is some chance that one will be found. Should the
doctors give the organ to A, who will die imminently without a transplant, and
hope that another organ will be found in time to save B, or should they save B on
the grounds that A's predicament is his own fault, for which B should not suffer?

Suppose the committee decides that B should get the transplant because its
members find A's behavior irresponsible, and further suppose that the physician
who will perform the transplant believes that he cannot just stand by and let A
die, especially when there is some chance that another organ will become
available in time to save B.

One issue raised by this case concerns the justification of the decision by the
ethics committee. Was its decision warranted? A second issue concerns what the
physician should do. Should he follow the directive of the committee and operate
on B, or should he follow his own conscience and reject the committee's
directive? It might not be easy to decide what the best resolution is to either
issue.

The Individual & the Poliical Order
An Introduction to Social & Political Philosophy
-Norman E. Bowie & Robert L. Simon
http://www.amazon.com/exec/obidos/tg/detail/-/0847687805/

>
> Create a lottery in the application process for the "privately owned" organ
> transplant Corp. The person who got the money draws a ticket and a poor guy
with
> a government payment voucher draws a ticket, the winer gets the organ and the
> private business booms.
>
> Then this happens: Plot: Canadian Mountie Louis Burke apprehends serial killer
> Christian Naylor, nicknamed ‘The Sandman’. He is given an assignment - to go
> undercover into a US maximum security prison posing as a prisoner in order to
> investigate the deaths of several inmates. But there he discovers a secret
scheme
> being run to harvest prisoners for their organs. Once they discover who he is,
> the prison authorities retaliate by placing him up against The Sandman. Movie:
> "Death Warrent" Rent this awesome movie today. (a black market organ-legging
> operation) Prisoner organ abuse!
>
> > It seems to me that such a position goes directly counter to America's
> > so-called free enterprise system. Nobody is arguing that everyone have equal
> > access to other things, for example, property in Beverly Hills. Here, access
> > is limited by wealth acquired within the free enterprise system and, since
> > not everyone acquires the same amount of wealth, not everyone gets equal
> > access to Beverly Hills property. Many see this as just and proper. Work
> > hard and succeed and you can afford things that those who don't work hard
> > can't afford, that's the general gist. So if you work hard and bank your
> > money you can afford health care when you want it. Doesn't that seem like
> > the American way?
> >
>
> Should transplants be sold to the highest bidder or given out by a fair
lottery?
> If sold, what reasons could be given for showing that some people are more
> valuable than others?
>
> You have been impaled upon the Horns of a Dilemma, meaning you can grab a horn,
> go between the horns, pull down both horns or create a Counterdilemma With the
> Opposite Conclusion.
> http://groups.google.com/groups?selm=v8jl8bb6c67e2b%40corp.supernews.com
>
> ----------------------------------------------
>
> Imagine that you coulds step behind a veil. Imagine that you are ignorant of
> yourself, your natural abilities and social position. Knowledge of personal
> racial, sex, national or other interests and commitments cannot then influence
> your judgement. You become . a rational, free, and morally equal being. If you
> could vote on vrious ways society could be, how would you decide about the
> distribution of wealth, racial equality, and other conflicting issues etc?
>
> Bam; everything was so perfect with this method, the viel of ignorance, then
the
> ship begins to sink, there are only so many lifeboats but more people than they
> can hold, who gets to stay alive in them and who dies, choose quickly the ship
is
> sinking.
>
> http://www.uwyo.edu/moffett/courses/phil1000/lecture6.html
>
http://www.garretthardinsociety.org/articles/art_lifeboat_ethics_case_against_helping_poor.html
>
> -----------------------------------------------
>
> What are the sources of organs used in transplantation? How can we make the
> procurement system more efficient? Should we pay for organs? Should someone who
> has already received one transplant be allowed a second? Should alcoholics be
> given liver transplants? Are transplants really worth the tremendous costs?
>
> Lying at the heart of most of these ethical debates are the twin questions of
> procurement and distribution. How do we get organs, and how do we decide who
will
> receive the implants? There are always fewer donors than there are potential
> recipients, and that's why some 5,000 people die every year while waiting for
new
> organs.
>
> As far as distribution goes, everyone has to be able to pay in order to receive
a
> transplant - and that is why many poor people never undergo the process.
Overall,
> transplants are a procedure for people with lots of money or lots of insurance.
> But should the choice of who gets new organs also depend upon social worth?
That
> is to say, should a doctor get a new organ but a prisoner be refused? What
about
> alcoholics - should they be denied new livers because they "deserve" what has
> happened to them?
>
> This article leaves about where your article does.
> http://atheism.about.com/library/weekly/aa052302a.htm
>
> ------------------------------------------------
>
> Discussion of th Viel Of Ignorance Theory.
>
> What principles of justice would we come up with if we were placed behind a
veil
> of ignorance with all other rational agents and instructed to devise a set of
> principles of organizing society so that justice in the society would be
> achieved? The key to understanding how the principles of justice are to be
> selected is the veil of ignorance, or ignorance principle.
>
> The ignorance principle states that the contract makers are to act as if they
did
> not know their place in society. Such ignorance guarantees impartiality and
> prevents us from arguing on selfish rather than general grounds. This veil of
> ignorance would exclude knowledge of one's class position or social status,
one's
> fortune in the distribution of natural assets and abilities, one's
intelligence,
> one's physical strength, the nature of one's society, and one's individual
> conception of the good.
>
> Operating in this way, none of the contract makers would have any special
> interests to defend nor would they have any reasons to form alliances to adopt
> principles that work to the disadvantage of a minority of other contract
makers.
>
> In effect, as Rawls applies it, the ignorance principle tells us to act as if
our
> enemy were to assign our place in society.
>
> For example, suppose the issue were the distribution of income. Since the veil
of
> ignorance prevents you from knowing how wealthy you are or will be and it
> prevents you from knowing your occupation and talents, what strategy would it
be
> rational to adopt? Surely, Rawls argues, you would want to protect the position
> of the least well-off.
>
> Similar thought experiments would assure that there would be no racist
principles
> for the organization of social institutions. After all, you cannot be sure that
> you would not be a member of the race that would be discriminated against.
Since
> the contract makers are like rational egoists operating from behind a veil of
> ignorance, they would adopt the general principle of seeking to minimize their
> losses.
>
> We can now see how unanimous agreement on the principles of justice is
possible.
> Since everyone agrees that it is rational to reduce one's losses and since no
one
> knows what position they hold in society, the following two principles would be
> adopted unanimously:
>
> (1) Each person is to have an equal right to the most extensive total system of
> equal basic liberties compatible with a similar system of liberty for all:
>
> (2) Social and economic inequalities are to be arranged so that they are both
>
> (a) to the greatest benefit of the least advantaged, and
>
> (b) attached to offices and positions open to all under conditions of fair
> equality of opportunity.
>
> These principles which are the result of the contract are just because the
> procedure which produced them is just. Rawls's hypothetical contract is an
> example of pure procedural justice.
>
> These are the principles that self-interested persons would choose when
> constrained by the ignorance condition. Since they do not know particular facts
> about themselves, they have no specific interests to protect. Rather, the
concern
> is with those goods Rawls calls primary goods-general goods that are necessary
to
> the attainment of any other individual goods persons may desire.
>
> One of the most important of these primary goods is liberty. Since no one will
> know his or her place, it is in one's interest to adopt principle one, which
> provides an equal system of liberty for all.
>
> To the question "What are the constituent liberties that comprise the system of
> liberty?", Rawls provides a list of basic liberties. This list includes:
>
> political liberty (the right to vote and to be eligible for public office)
> together with freedom of speech and assembly; liberty of conscience and freedom
> of thought; freedom of the person along with the right to hold (personal)
> property; and freedom from arbitrary arrest and seizure as defined by the
concept
> of the rule of law.
>
> The second principle is concerned with the primary goods of opportunities and
> power, income and wealth. What Rawls does is to consider his principle in
> contrast to several competing ones and then ask which principles would be
chosen
> by self-interested persons constrained by the ignorance principle. Rawls first
> considers a system of natural liberty. In such a system, positions are open to
> those able and willing to strive for them. The principle governing the
> distribution of wealth in such a system is called the principle of efficiency.
In
> terms of his theory Rawls defines the position as follows:
>
> Thus we can say that an arrangement of rights and duties in the basic structure
> is efficient if and only if it is impossible to change the rules, to redefine
the
> scheme of rights and duties so as to raise the expectations of any
representative
> man (at least one) without at the same time lowering the expectations of some
(at
> least one) other representative man.
>
> Rawls argues that this principle of efficiency within a system of natural
liberty
> would be rejected, however. If, after the initial distribution, someone has
> vastly more wealth than others, nothing could be done to correct the situation
> that would not run afoul of the efficiency principle. Moreover, the
distribution
> of wealth at any given time has been strongly influenced by the cumulative
effect
> of the natural and social contingencies of past distributions. Accident and
good
> fortune play an important role as to who is wealthy at any given time. Since
the
> veil of ignorance prevents us from knowing our own fortune and since, according
> to Rawls, it is rational to seek to minimize our losses, the principle of
> efficiency would not be accepted in the contract. Rational contractors would
seek
> to avoid the risk of turning out to be on the bottom in the efficient society.
>
> Rawls has more positive reactions to the principle of equal opportunity. This
> principle asserts that people with the same ability, talents, and expenditures
of
> effort should have roughly the same prospects of success in given fields of
> endeavor. One's family background, race, religion, sex, or social background
> should not act as impediments to success. To assure equality of opportunity,
> society imposes heavy inheritance taxes, offers a broad public education, and
> passes antidiscrimination legislation. To the extent that such societal
measures
> are successful, the distribution of goods and services depends upon ability,
> talent, and effort.
>
> In Rawls's view the principle of equal opportunity is still not sufficient.
Rawls
> argues that the distribution of talent, ability, and capacity for effort is
just
> as arbitrary from the moral point of view as the distribution of sex, family
> wealth, and social class. Jones has no more of a right to more money because he
> is smarter than Smith than he has a right to more money because he is of a
> certain religion. Distribution is only fair in Rawls's view if human assets are
> treated as collective social goods. The distribution of goods and services is a
> cooperative effort on the part of all. Given the cooperative effort, the only
> fair principle is the one that accepts inequalities only if the inequalities
work
> to the advantage of the least well-off:
>
> It seems to be one of the fixed points of our considered judgments that no one
> deserves his place in the distribution of native endowments, any more that one
> deserves one's initial starting place in society. The assertion that a man
> deserves the superior character that enables him to make the effort to
cultivate
> his abilities is equally problematic; for his character depends in large part
> upon fortunate family and social circumstances for which he can claim no
credit.
> The notion of desert seems not to apply to these cases. Thus the more
advantaged
> representative man cannot say that he deserves and therefore has a right to a
> scheme of cooperation in which he is permitted to acquire benefits in ways that
> do not contribute to the welfare of others. There is no basis for his making
this
> claim. From the standpoint of common sense, then, the difference principle
> appears to be acceptable both to the more advantaged and to the less advantaged
> individual.
>
> Strictly speaking, such considerations do not influence Rawlsian contractors
> deliberating behind the veil of ignorance. Vicious circularity would be
involved
> if, on one hand, justice was defined in terms of the outcome of such
> deliberations and, on the other hand, parties to the deliberations voted on the
> basis of their views on justice. Rather, the people in the original position
> behind the veil would reject liberal equality of opportunity in order to insure
> themselves against the possibility of turning out to be a relatively untalented
> person in a liberal society.
>
> What the quoted passage does show, Rawls would maintain, is that his principles
> of justice conform to our own considered judgments about justice, those
judgments
> in which we place the most confidence. Perhaps what ultimately justifies the
> Rawlsian contract procedure is its ability to explain, support, systematize,
and
> provide grounds for reconsideration of our intuitive sentiments about social
> justice.
>
> When fully spelled out, then, the Rawlsian argument is that the two principles
of
> justice are justified because they and they alone would emerge from a fair
> procedure of rational choice. The procedure itself is warranted because of its
> coherence with our most firmly held considered judgments about justice and
> fairness. Finally, Rawls would maintain that were his principles actually
> applied, then, because of their emphasis on wealth as a product of cooperation,
a
> stable well-ordered society would result.
>
> For much of the remainder of his book, Rawls then applies his theory to the
task
> of creating social institutions in accordance with the two principles of
justice.
> The details of Rawls's analysis takes us beyond the scope of this study, but we
> should point out that liberty is secured in the writing of a constitution and
the
> implementation of the difference principle is accomplished through the
> legislature.
>
> To get a better idea of how a pure procedural theory of justice works, let us
> contrast a libertarian market analysis of economic justice with a more
> egalitarian view like that of Rawls. We will then evaluate each theory and
> provide the outline of a procedural theory of our own.
>
> The Individual & the Poliical Order
> An Introduction to Social & Political Philosophy
> -Norman E. Bowie & Robert L. Simon
> http://www.amazon.com/exec/obidos/tg/detail/-/0847687805/
>
>
> > If there are some things that ought to be independent of the financial
> > system, some things that people are entitled to regardless of their position
> > or contribution to the economic system, what are they and who should insure
> > that they get them? Food and shelter are two that some think everyone is
> > entitled to, at some minimum level, and the various governments, Federal and
> > local take the responsibility to assure that through various welfare
> > programs. It is as if there were a philosophical principle that says there
> > is a "floor", everyone has a right to a basic subsistance, but, above that
> > floor it's economic competition. Although the "floor" is never defined very
> > well, you can deduce approximately what it is by what the various welfare
> > agencies provide.
> >
> > Is there such a "floor" for medical care? If so, who should have the
> > responsibility to assure that everyone is provided for? In England and
> > Canada the government does make that assumption and does take responsibility
> > for the care at the 'floor' level. In America no organized group has
> > responsibility to assure "floor" level access to medical care. As a
> > philosophical principle, are they right and we wrong or are we right and
> > they wrong?
> >
> > One could argue that one system or the other is more efficient at delivering
> > health care, but that's a different argument altogether. That's about
> > implementation details of a fundamental principle, I'm trying to find out
> > what the fundamental principle is or ought to be. What is ethically right?
> >
> >
>
>

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