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Health Care Ethics - Philo 133

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Philo 133I Final Examination

Case 1

The Role of Science in Environmental Ethics

http://www.scu.edu/ethics/practicing/focusareas/environmental_ethics

Science is a powerful way of knowing that has transformed the relationship between human society and the natural world. Drawn from the Latin word for knowledge, in the broadest sense, science means a systematic way of gathering information and drawing conclusions. In a more restricted sense, science refers to information gathered using the scientific method, a systematic approach to gathering empirical (observable and measurable) data and determining facts about nature or society. A scientific approach to studying the natural or social world asks clear, specific questions, makes predictions (proposes hypotheses), tests the accuracy of those predictions, and draws conclusions based on measurable evidence. The natural sciences use the scientific method to investigate the natural world, and social scientists use it to research social issues, in other words, in human society. When conducting experiments with natural phenomena, scientists using this method can determine cause and effect relationships. The scientific method attempts to determine knowledge by eliminating, so far as possible, the potential for our own interests and desires to influence the results. This has increased the sophistication of our understanding of how the plants, animals, nutrients and energy are related in the environment.

Science, technology and engineering have brought terrific benefits to society, and have made astounding wealth and material comfort possible. Yet upon closer analysis, many people have observed that these forces have had ambivalent effects. Tremendous benefits made possible by scientists and the scientific method have not been without negative impacts on the Earth, and in some cases, for the poor. The automobile has brought us convenience in transport, yet we have paved over much fertile farmland to make roads. Fossil fuels, such as oil and gas, have made possible all manner of industry and devices, yet the carbon dioxide emissions from their burning play a significant role in disrupting our atmosphere and climate. Nuclear technologies can promote health, for example, through radiation treatments for cancer. Yet these same when used for war could bring about indescribably horrific suffering. Nuclear energy produces no greenhouse gasses, which is good, but its waste products are radioactive (acutely dangerous) for 10,000 years or more. The wealthy nations of the world have generated great economic benefits through technology, but at times these technologies have extracted goods from poorer countries, and further frustrated their economic growth.

Science and the scientific method do not, by themselves, indicate what humans should do. By working to minimize bias, scientists are better able to determine knowledge of the natural world. But the "exclusion" of human values from the scientific method - which might bias the results - also means that its products are considered by most people to be amoral, in other words, neither ethical nor unethical. This has resulted in the widespread perception that scientific and technological developments should continue without considering the ethical implications of their products. The scientific method attempts to be free of bias, but the technological products of science have tremendous implications for social and environmental ethics.

Case 1 Questions:

1. Imagine you were asked to make an argument for protecting the environment, but at the cost of restricting economic development. How would you justify it using the following ethical theories? (10 pts each)

a. Principle of Utility

b. Categorical Imperative

Case 2

Case: Video scandal grips Cebu hospital

Man’s surgery posted on YouTube

By Carine M. Asutilla

Cebu Daily News

First Posted 14:07:00 04/15/2008

CEBU CITY, Philippines – A Cebuano male florist in his 30s was teary-eyed when he saw the video of his surgery for the first time. The emergency operation last January was already traumatic. Having a spray can removed from his rectum after a night of sex with a stranger was something he regretted.

Danilo (not his real name) was horrified to see images of the surgery three months later circulating on the popular video-sharing website YouTube. Danilo said he felt violated and would file charges against medical personnel at the government-owned Vicente Sotto Medical Memorial Center (VSMMC).He said his rights to privacy and confidentiality were violated. He was also offended when he saw in the video how medical interns and workers jeered and laughed when the metal can of Black Suede body spray was pulled out of his rectum. The can was inserted by a man he had casual sex with last New Year's Eve. Danilo said he was asleep when it happened.

“Mao nay confidential nga nikatag na man diay (This is what they called confidentiality when they spread it around),” lamented Danilo. “Mura man sila'g di mga graduhan oi. Sakto diay na? Gioperahan na gani ka, gisakitan ka, unya igo ra ka pistahan (They act as if they are not educated. Is this right? They operated on you, you were in pain then they feasted on you).” Danilo said he had heard about the Black Suede Internet scandal but he never realized it was about him until Basak Pardo barangay (village) Captain Dave Tumulak showed him the video.

Cebu Daily News checked the video on YouTube, but the website said it had been pulled out.

Doctor Gerardo Aquino, VSMMC medical center chief, formed a committee last month to look into the violation of confidentiality after he heard about the video and without waiting for a complaint, said Dr. Emanuel Gines, the hospital's committee chairman on media.

“We believe that there was a break in the flow of procedure during the operation,” said Gines.

The investigation would determine who posted the video on the Internet and who should be held liable for the breach of operation procedure and confidentiality, said Gines. He said results would be known this week. He said the probe also aims to review hospital policy, especially since it was the first time that such an incident happened in the VSMMC.

Since there were nursing interns inside the operating room at that time, their schools had been informed about the investigation.

“I heard they were also conducting their own investigation,” said Gines. Normally, only eight medical workers are allowed inside the operating room. But based on the video, there were more than eight inside the operating room. The hospital does not take a video of all operations but only select cases for academic purposes, Gines said. He stressed that this is done only when there is consent from the patient and that the record is treated with utmost confidentiality and with respect for the rights of the patient.

According to Danilo, his trauma started on December 31 last year when he met a man in the streets who offered to have sex with him for P100. Danilo, who said he was drunk, brought the man home and had sexual intercourse with him. But he recalled bruising the man's ego by criticizing the size of his sex organ. Apparently challenged, the man told Danilo to have sex with him again, but this time using the canned body spray he found inside Danilo's room.

“Ingon ko di ko, unya nakabati na lang ko nga sakit (I said no, but later I felt something painful),” he said.

Danilo said he then fell asleep. The man was gone when he woke up. Danilo said he felt something painful inside his body. It was even more painful when he tried to urinate. He said he started to get scared when he remembered what the man last told him and when he could no longer find his body spray. Danilo, however, decided not to inform his family so as not to ruin the New Year's celebration. He only came clean on January 2. His family then brought him to the hospital for a check-up.

When doctors discovered there was a foreign object in his body, Danilo said he noticed that the doctors and nurses kept asking him how it felt and why they had done it. He was scheduled for operation the following day. Danilo complained that there were too many people inside the operating room before he dozed off due to the anesthesia.

“Gayaw-yaw ko, oi. Naingon man ni’g Carbon, kadaghan ba sa tawo (I kept on complaining. I said it looked like Carbon market in there because there were so many people),” he said.

Danilo was discharged from the hospital January 5. He thought his trauma would end there but on January 18, he went back to the hospital to get his medical records. A doctor then informed him that they had videotaped the operation and kept the body spray. “Nangutana pa man gani to siya nako kung mangayo ba kuno ko'g copy, ingon ko dili (He asked me if I would ask for a copy and I said no),” said Danilo.

He said the doctor promised him the video and other records would be treated with confidentiality. About two months later, Danilo said he was surprised that barangay captain Tumulak sought him out and showed him the video. In the video, as the canister was being pulled out of his body, people inside the operating room were heard laughing while someone shouted “baby out, baby out...” When the can was fully extracted, the same person screamed: “body spray” followed by laughter and jeers. The cap was opened, then returned. Then the can was held up like a trophy before it was wrapped in surgical gauze.

Barangay captain Tumulak said he was willing to help Danilo press charges. He said he recognized the operating room in the video because he had been in VSMMC before. That was when he started tracing the identity of the patient and was surprised to find the patient was a resident of his barangay. On Monday, Tumulak wrote to Dr. Aquino, asking to change some hospital procedures to prevent a similar incident from happening again. He said the posting of the video in the Internet violated several provisions of the Patients Bill of Rights, including the right to be free from unwarranted publicity and to good quality health care and professional standards.

While Danilo’s face was not seen on the video, Tumulak said his right to privacy was violated because many of his colleagues knew it was him. Because of the video, Danilo stopped mingling with his friends, he said.

Case 2 Question:

2. Identify five (5) Bioethical Principles that were either used or violated in the case presented above. Why?(10pts each)

2nd Quarter Grades in Health Care Ethics

2nd quarter grades for the first semester of SY 09-10 is now available. It also includes the names of those who are exempted from taking the final exams. Check links...

Philo 133H

Philo 133F

Philo 133B

Philo 133I

Final Exam in Philo 100B

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Philo 133I - Environmental Ethics

Who, When, Where and How:The Distinctiveness of Environmental Ethics
By Keith Douglass Warner OFM, with David DeCosse
http://www.scu.edu/ethics/practicing/focusareas/environmental_ethics/lesson2.html

This lesson introduces the distinctive features of environmental ethics by inviting you to see how environmental ethics are related to personal or social ethics. Whether you consider yourself a very ethical person or not, the fact is that you no doubt already think in many ethical ways. You think about right and wrong, about what it means to be treated fairly, about having justice done. This lesson plan aims to extend such common thinking about personal ethics to the field of environmental ethics. We will do this by invoking the classic question words - "who," "when," "where," "how," and "what" - as bridges by which both to see the connection between personal and environmental ethics and to see the distinctiveness of environmental ethics itself. At the end of each step in this lesson, there is a question or questions to guide reflection and prompt discussion. We invite you first to respond to these questions from what you already know. If you have more time, we also invite you briefly to consider each question in light of related information that can be found on some of the Web sites provided on the list at the end of this short course. You should take notes as you proceed through the questions. There is no more extended writing assignment for this lesson plan.

The "Who" of Environmental Ethics
We are used to thinking of ethics in personal or interpersonal terms. Ethics is the field of study that pertains to how we ought to act - toward ourselves and others. But the field of environmental ethics has invited us to think more broadly about who in fact are the subjects of ethics. Specifically, environmental ethics invites us to consider:

1. That ethics is not only about the personal. Rather, it may be about how groups treat their members, or and how nations treat each other.
2. That ethics pertains as well to how we act - not only toward ourselves and others - but also toward the natural world itself.

In the past, the natural world was often the unseen participant in many situations of ethical significance. Humans treated it as a passive backdrop, when in fact nature played an active role in shaping human society. For instance, it was not uncommon that a blind eye could be turned to the environmentally damaging effects on a community of manufacturing or waste disposal. Now, however, community well-being is assessed not only in terms of such things as the quality of jobs or the provision of health care. Rather, such well-being is also assessed in terms of the environmental safety and health of the community. Or, for instance, it may have historically been the case that excessive tree cutting in forests was permitted as a way to provide for economic livelihood. But it may not have been the case that connections were made to the beauty and value of the trees in themselves or to how trees in a forest affect many other living things.

All Stakeholders have some moral status
In any ethical decision, we must always ask who are all the stakeholders? Who are all of the persons who have an interest in the outcome of the ethical decision? Environmental ethics has required us to consider far more carefully the actual extent of the range of stakeholders in any ethical decision. These may include, of course, the immediate people involved. But the stakeholders may also include the people of future generations who may be affected by changes in the environment brought about by decisions made today. The stakeholders may also include people who live far away who may be affected via air and water by the environmental decisions made near at hand. And stakeholders may include the natural world itself. This concept invites us to consider the "moral status" or the intrinsic value of each stakeholder - whether the stakeholder is a human being or are the animals, plants, and ecosystems of the natural world itself. The concept of "the moral status of nature" is a key feature that distinguishes environmental ethics from social ethics.

The common good includes the goods of the earth
It is always helpful to think of a decision involving environmental ethics in terms both of the concepts of the "common good" and of "social ethics." The common good is an ethical concept that means that the good of each person is inseparable from the good of all persons. To the degree that environmental issues almost always involve actions that may have an effect on a wide variety of persons, such issues almost always require an assessment of our good in light of the common good. Because of this requirement to address the common good of many persons, environmental ethics are known as a branch of what is called "social ethics" (which we can distinguish from the less-peopled notion of "personal ethics"). Moreover, it is also important when engaging in environmental ethics to consider all of the different goods that figure in the common good. Of course, the goods of many different men and women figure in the common good. But environmental ethics and the concept of moral status invite us to look beyond only human goods. Rather, they invite us to consider that the common good includes human and non-human goods: That the common good includes not only those environmental conditions that enhance the fulfillment of men's and women's lives but that the common good also includes the well-being of the natural world for its own sake.
Question: Who are all of the stakeholders in the case of an endangered species threatened with extinction?

The "When" of Environmental Ethics
When we discussed above the stakeholders in a decision about environmental ethics, we noted the importance of considering the stakeholders of the future. To be sure, the future is a category especially pertinent to environmental ethics. In many ethical decisions, the effects of our actions are immediate and apparent. In many environmental ethics decisions, however, the effects of our actions may be cumulative, long-lasting and, at least in the near term, hidden. The classic case of this is nuclear waste, the devastating effects of which may be invisible. But the consideration of the future in environmental ethics applies far more broadly than to the potency of nuclear waste. For instance, the pollution from a new residential subdivision might flow into a nearby river. At first, the damaging effects may be slight. But, over time, these effects may accumulate until the character of the river is fundamentally and destructively altered.

Think to the Seventh Generation
In many environmental ethics decisions, we always need to ask: What is the role of the future generations in this decision? How can we assess the cumulative effects over time on the environment of whatever action is under consideration? How can we assess the cumulative effects of a decision we are likely to make? The contemporary Seventh Generation environmental movement is founded on this concern for the future. The movement draws its name from a declaration of the Native American Iroquois Confederacy: "In our every deliberation we must consider the impact of our decisions on the next seven generations."
Question: Do you think future human generations have moral status in the debate over climate disruption?

The "Where" of Environmental Ethics
Environmental ethics invites us, then, to look far ahead in time. It also invites us to look far afield on land and water and air. We tend to understand our ethical encounters as strictly interpersonal and as occurring in the home or office. But environmental ethics invites us to consider a far broader field as the scene of every ethical decision.

Natural World Not Taken For Granted
Asking the "where" question of environmental ethics invites us to consider the interconnectedness of the natural world as a factor in all of our decisions. This requires us to leave the comfort of our homes or offices or shopping malls to perceive and consider the effects of actions on a natural world that we often take for granted or that we use without thinking too much about.
Environmental ethics invites us to consider places far from us. Whatever action we take may have an effect near-at-hand: The plastic bottle we throw out the window remains sitting for months by the side of the road. But our actions may also have effects that occur, literally, at a remove from what we specifically do: The used engine oil we pour down the roadside drain runs through miles of waterways and pipes all the way down to the faraway bay. The burning of coal in China results in soot and ash falling on the Western U.S. The greenhouse gasses burned in Europe and North America are chiefly responsible for raising average global temperatures, and the impacts of those temperatures will be affecting virtually every person and ecosystem.

Emphasis on 'Wholes'
The third way that environmental ethics invites us to think differently in terms of place is in its emphasis on "wholes." That is, environmental ethics invites us to consider decisions in light of such living realities as the biosphere and ecosystems. Not only, then, can an action we take have an effect emerge far from where the action took place. But also, our isolated action may well occur within an existing biological system in which a small effect in one place may ripple out widely through an interconnected and interdependent web of life. Thus, when we trace the possible effects of a particular action, we must pay close attention to how the initial effects near at hand may well create a chain reaction of critical effects.
Question: Do you know where your household's waste ends up, whether via sewage pipes or waste disposal system?

Step Four: The "How" of Environmental Ethics
When we begin the process of thinking through a decision of environmental ethics, we should keep in mind several key factors that inform how such reasoning is done. These factors are the difference between the empirical and the ethical; the role of risk, uncertainty, probability, and prediction; and the meaning of absolute, intrinsic, and instrumental value. Ethical reasoning on many topics may involve such aspects. But in environmental ethics these factors have an unusually significant role.

The Difference Between the Empirical and the Ethical
The first factor is the difference between the empirical and the ethical. Often, these two kinds of thinking are mistakenly thought to be the same thing. But the first kind of thinking - the empirical - is about how in fact we do live. The second kind of thinking - the ethical - is about how we ought to live. Thus, for instance, it is an empirical claim to say that the United States pollutes the world's greatest source of climate disrupting greenhouse gasses as a result of fossil fuel burning. This claim is a fact, which may or not may not be true. But it is not yet an ethical claim - that is, that the Federal government should take action to address this. In environmental disputes, many people make claims based on ideology, or a system of ideas that people believe to be true whether or not evidence supports it. An ideology often reflects the position: "I have made my mind up so don't bother me with the facts." In a free society, everyone is permitted to have their own opinion, but that does not mean one is allowed to have their own facts. Lesson 7 describes in greater detail therole of science in environmental ethics.
To make an ethical argument, establishing scientific data and determining scientific conclusions are vital, but several more steps are necessary. In particular, we need to supply a step in the argument that says clearly why such an action to reduce greenhouse gas pollution ought to be taken. For instance, we would have to say: greenhouse gasses are disrupting our climate. Actions should be taken to reduce greenhouse gas emissions because disrupting our climate will have terrible environmental consequences for people and the Earth. People and the Earth have great moral worth, and merit our protection. With these reasons in hand, we now can make the ethical claim that actions should be taken to reduce greenhouse gas emissions. More on this inlesson 9 on climate ethics.

Risk, Harm, and Prediction
Another key factor in reasoning about environmental ethics is the role played by risk, uncertainty, probability, and prediction. Often cases of environmental ethics involve looking at the cumulative harms of actions stretching far ahead into the future. But how accurate are such prediction of impacts? The Earth's ecosystems behave in very complicated ways, and these defy human understanding and accurate prediction. How probable is it that the predicted harmful or beneficial effects on the environment of some action will in fact happen? As a quick test, it is usually the case that the more probable it is that a damaging effect will occur, the more powerful is the ethical responsibility for managing or mitigating the effects of that action. But it is always important in assessing a case in environmental ethics to ask about the quality of the evidence used in assessing risk and in making predictions. More on this in the lesson on the responsibility principle.
Question: How well can you tell the difference between an opinion, an ideology, and scientific evidence? How would you go about distinguishing between an empirical and an ethical claim?

Absolute, Intrinsic, and Instrumental Value
A third key factor to keep in mind in thinking through a decision in environmental ethics is to note the difference among absolute, intrinsic and instrumental value. Something that has absolute value cannot in any way be harmed. Many people think, for instance, that innocent human life itself has absolute value and, thus, that there can be no justification for harming innocent human life. Not as many people today think that the natural world itself has a similar, absolute value. But many people have increasingly said that the natural world has intrinsic value or, in other words, counts for its own sake (we referred to this idea earlier when we spoke of "moral status").

In environmental ethics, there may be a number of reasons for why we attribute intrinsic value to things. For instance, some people may grant intrinsic value to animals because these people believe that animals are created by God. Other people may grant intrinsic value to animals because these people think that animals have feelings of pain and pleasure that must be taken into account in our assessment of actions taken that may possibly harm animals. When we grant such intrinsic value to things, we do not regard them as readily as things that can be used. Rather, such things become protected or preserved or enhanced. Even so, however, it is important to note that something can have intrinsic but not absolute value: In other words, something can be precious but not so precious that under no circumstances will we permit it to be harmed. For instance, many people who support hunting may think along these lines. They value animals for their own sake but nevertheless justify hunting for reasons like wildlife management.

Last, we should also keep in mind the role of instrumental value in environmental ethics. We are reasoning by instrumental value when we say, for instance, that the natural world has value insofar as it benefits human life. At one level, this claim is not controversial. Almost everyone would say - when pressed - that we do value the natural world in great measure because of the way it shapes human life. But the key concern here is the degree of instrumentality that we grant to the natural world. For instance, it would be highly controversial in environmental ethics to use a notion of instrumental value that says the natural world only has value insofar as it benefits human life.

Question: Do you think animals have absolute, intrinsic, or instrumental value? Does the distinction between farm and wild animals make a difference in your opinion?

Final Exam in Philo 133

Final Exam in already posted. Click here...

Bioethical Principles Part II

The part II of the summary of bioethical principles is now available. Check link...

Summary of Bioethical Principles - Part 1

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No Class from Sept. 8-11, 2009

This comes to each and everyone of you late.... I am absent from September 08-11, 2009. I am attending a conference here in Manila. I was not able to inform you about my absence...for this, i apologize.

In my absence, please make the necessary paper requirement... check link for your respective subject.

Philo 133

Philo 100

Philo 211

Summary of John Rawl's Theory of Justice

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Midterm Grades

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Midterm Exam in Philo 211

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Midterm Examination, First Semester, SY 09-10

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Summary of Kant and Mill's Ethical Theory

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Reaction Paper for Philo 133

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Time for Health Care Renewal (Part 1)

Demons and Doctors

Activity # 4 – Case Study 1

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Case Study Format

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Thesis Statements in Philo 211

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Thesis Statements in Philo 100

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Thesis Statements in Philo 133

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Activity 3 in Philo 133

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Introduction to Philosophy (Philo100)

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Health Care Ethics (Philo 133)

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Grades in Philo104A-Summer 2009

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Thesis Statements in Philo 104 Summer

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Philo 104 Summer 09 Class

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Final Grades in Modern Philosophy

Final Grades in Philo 213A

	Philo 213A
	ID#	1QTR	2QTR	FINAL EXAM	FINAL GRADE
1	'057068	70	85	75	77
2	'060865	86	88	67	80
3	'060868	89	90	88	89
4	'060866	76	85	90	84
5	'056945	85	75	64	75

Philosophy of Man Final Grades

Attention!!!

Final Grades in Philosophy of Man (Philo 102) is now available. Click here.

FYI: You may get your papers tomorrow April 3, 2009 at 9am-12nn, LRC 307. I will be submitting the final grades to e-class tomorrow afternoon, hence if there are any questions or clarifications, please see to it that you see me tomorrow morning.

The Phenomenological Papers

Click here to view some of the Phenomenological Papers in Philosophy of Man.

Class Standing for 2nd Quarter

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Professions for the Final Paper in Philo 102

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Final Grades in Philosophy

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2nd Quarter Grades and Exemptions for the Final Exams in Philo 104

Exemptions in Philosophy of Religion, Philo104. Click here.

Philosophy 104 Thesis Statement

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Grade of Student with ID #057110, Philo 104B

1st QTR	2nd QTR	Final Exam	Final Grade
80	79	78	79

Philosophy of Man Website

The guidelines for the phenomenological paper are already posted. Click link to visit the website.

Consultation Schedule

If you have any questions about your grades, feel free to see me this afternoon(Jan30) at 3pm at LRC 307 and tomorrow morning at 10am, same room.

Philo 104 K

	Philo 104 K
	ID#	Q/20	QP	P1	ave	*60%		D1	*10%		GW1	GW2	ave	*30%		CS	*2/3		MS	MP	*1/3		MG
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2	'056280	20	100	88	94	56		90	9		85	83	84	25		91	60		100	100	33		94
3	'056020	20	100	88	94	56		90	9		75	85	80	24		89	60		80	87	29		89
4	'041843																						WF
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6	'041044	12	75	85	80	48		60	6		75	80	78	23		77	52		23	66	22		74
7	'030237	3	63	88	76	45		88	9		75	80	78	23		77	52		33	68	23		74
8	'056790	20	100	84	92	55		90	9		85	83	84	25		89	60		90	93	31		91
9	'056433	18	94	60	77	46		60	6		60	60	60	18		70	47
10	'057129	20	100	87	94	56		87	9		75	85	80	24		89	59		87	91	30		90
11	'041143	13	79	90	85	51		88	9		85	78	82	24		84	56		77	85	28		84
12	'056466	18	94	95	95	57		90	9		95	87	91	27		93	62		92	94	31		93
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16	'041177
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18	'056789	10	72	87	80	48		88	9		85	60	73	22		78	52		77	85	28		81
19	'056563	20	100	85	93	56		90	9		85	83	84	25		90	60		85	90	30		90
20	'041842	5	65	84	75	45		88	9		60	78	69	21		74	49		22	66	22		71
21	'041255	13	79	60	70	42		87	9		75	80	78	23		74	49
22	'070940	10	72	87	80	48		60	6		85	60	73	22		75	50		76	71	24		74
23	'056211	20	100	95	98	59		95	10		95	87	91	27		95	64		95	96	32		96
24	'056219	18	94	95	95	57		90	9		95	87	91	27		93	62		90	93	31		93
25	'990777																						WF