The individuals in Sicko have limitations and gaps in their insurance coverage which is considered to be 'under insurance'.
An updated story about the under insured occurred this morning on WBUR. Please see/listen to the story at WBUR's page.
Carol
Monday, September 28, 2009
Friday, September 25, 2009
Issues in Reproductive Ethics
Please read: "Fertility Clinic to Couple: You Got the Wrong Embryos" -- available at CNN.com.
Should the couple be required to give up the baby upon its birth? What is the ethical solution for this problem? Who do you consider to be the "real parents" in this situation-the couple who went through the pregnancy or the couple who's embryos were used? Lastly, what is your take on in-vitro fertilization?
(Submitted by Michael Keenan)
Should the couple be required to give up the baby upon its birth? What is the ethical solution for this problem? Who do you consider to be the "real parents" in this situation-the couple who went through the pregnancy or the couple who's embryos were used? Lastly, what is your take on in-vitro fertilization?
(Submitted by Michael Keenan)
Ethical Relativism: Good to Know
Many of you have expressed an interest in moral and cultural relativism. Thank you for interest in this subject; I think it's a rewarding debate. This post is designed to explain some of the basic issues of moral relativism and provide you with some resources for further reading, if you desire.
Before I begin, I'd like to point you to some resources that may be helpful as you seek clarification for your ideas. I would begin researching the issue by reading the entry on Moral Relativism in the Stanford Encyclopedia of Philosophy (hereafter SEP). This text relies on this entry. As you may know, the SEP is a very useful guide for understanding common philosophical terms, and is written by prominent philosophers in their respective fields. Here is a link to the SEP: Stanford Encyclopedia of Philosophy. For in-depth discussions of contemporary research in moral relativism and medical ethics, Professor Barash recommends works by Macklin ("Against relativism: Cultural diversity and the search for universals in medicine" is one she particularly mentioned).
There are, broadly speaking, two different versions of moral relativism. The first is Empirical Moral Relativism, which states that there are many, intractable, empirical differences between moral systems across societies. The second is Metaethical Moral Relativism, which argues that the truth and/or justification for different moral systems are relative to a particular culture, society, or time period. Both versions are hotly debated.
Empirical Moral Relativism seeks to establish both that there are widespread disagreements across cultures, and that these differences are unresolvable. Defenders of this position point to a number of anthropological, sociological, historical, and psychological studies documenting differences in moral systems across cultures. Opponent of this position argue in several different ways against this position. One strategy is to argue that the position is not established or true on a priori grounds. That is, they say that the position cannot be supported because any moral conflict is resolved by abstracting from the principle to general rules which are shared across cultures. Another strategy is to argue on a posteriori grounds that the position cannot be supported. Such arguments might take the form of disputing the data cited by defenders of the position, or by pointing to data that demonstrates sufficiently significant moral agreements across cultures. For example, Beauchamp argues in this vein by claiming that there are 10 universal moral principles. His claim is descriptive -- he is claiming that there are 10 universal moral principles, not that there should be universal moral principles. It might also be argued that individual cultures are not disparate units, but instead flow into each other, creating a blurred division between where one culture starts and another ends; such non-simplistic categories create problems for Empirical Moral Relativists because they are arguing that moral principles are relative to a particular, and definitive, culture.
Empirical Moral Relativism is often used as a premise in arguing for Metaethical Moral Relativism. Defenders of Metaethical Moral Relativism must argue both against moral skeptics and against moral objectivists, meaning that they must establish both that we can know universal moral principles AND that there are no universal moral principles. It's a difficult case to make. To begin with, Metaethical Moral Relativists must avoid self-refuting arguments. They cannot, for example, argue that we must be tolerant, since universal toleration of other moral systems would be a universal moral truth. More importantly, Metaethical Moral Relativists must defend the idea of relative justification for a moral truth, that is, that X is true relative to S. Relative justification is a complex epistemological issue. Opponents of Metaethical Moral Relativism might argue that if moral truths are relative to a particular population, then there could be said to be no moral conflict (each society is morally justified, and maybe even obligated, to disparage divergent moral practices); yet, why was there a presumption of conflict at all? This argument is a variation of Donaldson's argument that relativism presupposes an objective morality.
In addition, Metaethical Moral Relativism cannot account for common sense intuitions of condemnation for horrific practices (i.e. the Holocaust). While defenders of Metaethical Moral Relativism might recognize this as a benefit to the theory, or at least accept it as a logical casualty of the theory, this seemingly obvious condemnation expresses two arguments about moral objectivism. The first deals with issues of burden of proof; common sense intuitions like this might highlight that we have more (universal) justification for believing in objective moral standards than we do in relative ones (either justifications or standards), requiring a higher standard of evidence of Metaethical Moral Relativists. The other argument is that a defender of Metaethical Moral Relativism needs an account of relative truths. To say that X is true relative to S must "mean more than that the people in S accept X" (SEP). (This is a particularly important idea for Metaethical Moral Relativists who argue for individual moral relativism, and not cultural moral relativism.) We accept the idea that epistemological truths can be revised, and that epistemologists are subject to error in formulating and justifying truths. Yet, how can a Metaethical Moral Relativist account for why and how some truths can function as authoritative for a particular culture, given that epistemological truths are subject to error and discovery? In other words, what is morally true relative to S is what is prescribed by some set of authoritative standards, some of which might be unknown or misunderstood to a population at a given time. It is not immediately clear why and how there could be a set of authoritative standards on a such a relative account. The SEP illustrates how this might be a problem by pointing the to idea of dissent: if an individual in S disagrees with a moral standard in S, how can such a disagreement be resolved? In cases such as this, some relativists have turned to arguments for complete individual moral relativism (Foucault argues for this in his work -- though in his later years he accepts a version of the Golden Rule as an objective moral standard). I am not sure, however, if this actually solves the problem or if it just pushes the level of analysis farther back.
Another avenue defenders of Metaethical Moral Relativism might pursue is to argue that moral premises are simply expressions of subjective opinions of either preference or emotion. This is an interesting idea, but before it can do any work in an extended argument about morality, it needs to be argued for as a premise. A sound argument cannot be constructed from this premise by assuming it as an axiom. Without such an argument, the argument for either type of moral relativism is weakened. There are several traditions that might be of use in arguing for this position because they espouse similar ideas. The idea that moral premises are expressions of preference is also often attributed to simple subjectivists. In simple subjectivism, moral statements are regarded as mere expressions of an individual's likes/dislikes. Also, Hume and Adam Smith discuss morality as expressions of emotion. One might turn to their work for information on this strand of argumentation.
As is the case with all issues about which people feel passionately, please be wary of the Appeal to Belief fallacy (it is described in the Jecker article). Truth must be justified on the basis of facts, and not from belief. It is not sound to use your belief in something as a premise for a conclusion about the truth of (or the existence of), say, a moral principle. Truth can be derived from facts, but it would be a fallacious move to deduce truth from beliefs. The content of belief premises are not true, nor are they false; they ascribe a belief to a person, but do not justify the truth of the belief.
I hope this information has been helpful. Please contact me (jjwmcd@bu.edu) with any questions.
(Submitted by Josh McDonald)
Before I begin, I'd like to point you to some resources that may be helpful as you seek clarification for your ideas. I would begin researching the issue by reading the entry on Moral Relativism in the Stanford Encyclopedia of Philosophy (hereafter SEP). This text relies on this entry. As you may know, the SEP is a very useful guide for understanding common philosophical terms, and is written by prominent philosophers in their respective fields. Here is a link to the SEP: Stanford Encyclopedia of Philosophy. For in-depth discussions of contemporary research in moral relativism and medical ethics, Professor Barash recommends works by Macklin ("Against relativism: Cultural diversity and the search for universals in medicine" is one she particularly mentioned).
There are, broadly speaking, two different versions of moral relativism. The first is Empirical Moral Relativism, which states that there are many, intractable, empirical differences between moral systems across societies. The second is Metaethical Moral Relativism, which argues that the truth and/or justification for different moral systems are relative to a particular culture, society, or time period. Both versions are hotly debated.
Empirical Moral Relativism seeks to establish both that there are widespread disagreements across cultures, and that these differences are unresolvable. Defenders of this position point to a number of anthropological, sociological, historical, and psychological studies documenting differences in moral systems across cultures. Opponent of this position argue in several different ways against this position. One strategy is to argue that the position is not established or true on a priori grounds. That is, they say that the position cannot be supported because any moral conflict is resolved by abstracting from the principle to general rules which are shared across cultures. Another strategy is to argue on a posteriori grounds that the position cannot be supported. Such arguments might take the form of disputing the data cited by defenders of the position, or by pointing to data that demonstrates sufficiently significant moral agreements across cultures. For example, Beauchamp argues in this vein by claiming that there are 10 universal moral principles. His claim is descriptive -- he is claiming that there are 10 universal moral principles, not that there should be universal moral principles. It might also be argued that individual cultures are not disparate units, but instead flow into each other, creating a blurred division between where one culture starts and another ends; such non-simplistic categories create problems for Empirical Moral Relativists because they are arguing that moral principles are relative to a particular, and definitive, culture.
Empirical Moral Relativism is often used as a premise in arguing for Metaethical Moral Relativism. Defenders of Metaethical Moral Relativism must argue both against moral skeptics and against moral objectivists, meaning that they must establish both that we can know universal moral principles AND that there are no universal moral principles. It's a difficult case to make. To begin with, Metaethical Moral Relativists must avoid self-refuting arguments. They cannot, for example, argue that we must be tolerant, since universal toleration of other moral systems would be a universal moral truth. More importantly, Metaethical Moral Relativists must defend the idea of relative justification for a moral truth, that is, that X is true relative to S. Relative justification is a complex epistemological issue. Opponents of Metaethical Moral Relativism might argue that if moral truths are relative to a particular population, then there could be said to be no moral conflict (each society is morally justified, and maybe even obligated, to disparage divergent moral practices); yet, why was there a presumption of conflict at all? This argument is a variation of Donaldson's argument that relativism presupposes an objective morality.
In addition, Metaethical Moral Relativism cannot account for common sense intuitions of condemnation for horrific practices (i.e. the Holocaust). While defenders of Metaethical Moral Relativism might recognize this as a benefit to the theory, or at least accept it as a logical casualty of the theory, this seemingly obvious condemnation expresses two arguments about moral objectivism. The first deals with issues of burden of proof; common sense intuitions like this might highlight that we have more (universal) justification for believing in objective moral standards than we do in relative ones (either justifications or standards), requiring a higher standard of evidence of Metaethical Moral Relativists. The other argument is that a defender of Metaethical Moral Relativism needs an account of relative truths. To say that X is true relative to S must "mean more than that the people in S accept X" (SEP). (This is a particularly important idea for Metaethical Moral Relativists who argue for individual moral relativism, and not cultural moral relativism.) We accept the idea that epistemological truths can be revised, and that epistemologists are subject to error in formulating and justifying truths. Yet, how can a Metaethical Moral Relativist account for why and how some truths can function as authoritative for a particular culture, given that epistemological truths are subject to error and discovery? In other words, what is morally true relative to S is what is prescribed by some set of authoritative standards, some of which might be unknown or misunderstood to a population at a given time. It is not immediately clear why and how there could be a set of authoritative standards on a such a relative account. The SEP illustrates how this might be a problem by pointing the to idea of dissent: if an individual in S disagrees with a moral standard in S, how can such a disagreement be resolved? In cases such as this, some relativists have turned to arguments for complete individual moral relativism (Foucault argues for this in his work -- though in his later years he accepts a version of the Golden Rule as an objective moral standard). I am not sure, however, if this actually solves the problem or if it just pushes the level of analysis farther back.
Another avenue defenders of Metaethical Moral Relativism might pursue is to argue that moral premises are simply expressions of subjective opinions of either preference or emotion. This is an interesting idea, but before it can do any work in an extended argument about morality, it needs to be argued for as a premise. A sound argument cannot be constructed from this premise by assuming it as an axiom. Without such an argument, the argument for either type of moral relativism is weakened. There are several traditions that might be of use in arguing for this position because they espouse similar ideas. The idea that moral premises are expressions of preference is also often attributed to simple subjectivists. In simple subjectivism, moral statements are regarded as mere expressions of an individual's likes/dislikes. Also, Hume and Adam Smith discuss morality as expressions of emotion. One might turn to their work for information on this strand of argumentation.
As is the case with all issues about which people feel passionately, please be wary of the Appeal to Belief fallacy (it is described in the Jecker article). Truth must be justified on the basis of facts, and not from belief. It is not sound to use your belief in something as a premise for a conclusion about the truth of (or the existence of), say, a moral principle. Truth can be derived from facts, but it would be a fallacious move to deduce truth from beliefs. The content of belief premises are not true, nor are they false; they ascribe a belief to a person, but do not justify the truth of the belief.
I hope this information has been helpful. Please contact me (jjwmcd@bu.edu) with any questions.
(Submitted by Josh McDonald)
Moral/Ethical Relativism
The question is Moral or Ethical Relativism. Does an objective morality really exist? Whenever we argue for or against certain moral positions, do we simply presuppose that objective morality exists and neglect the possibility that it may not?
Take for example the question of abortion, which I know we have not discussed in-depth. We can make a sound argument for it, and a sound argument against it. Regardless of how well we argue, in the end we seem to reach a stalemate. Although we may feel strongly one way and may delineate all of our premises and conclusions, we never seem to reach an objective conclusion, only a conclusion that abides by our original premise or presupposition.
Applying different ethical theories in different situations only strengthens the argument. If you use a consequential argument in one case, and a deontological argument in another case, then you switch the premise, meaning that no one "truth" persists.
In the end, Americans may disagree with the ethics of another culture, but can there ever be a strictly logical argument, devoid of sentiment, that attains an objective morality?
(Submitted by Brendan Berger)
Take for example the question of abortion, which I know we have not discussed in-depth. We can make a sound argument for it, and a sound argument against it. Regardless of how well we argue, in the end we seem to reach a stalemate. Although we may feel strongly one way and may delineate all of our premises and conclusions, we never seem to reach an objective conclusion, only a conclusion that abides by our original premise or presupposition.
Applying different ethical theories in different situations only strengthens the argument. If you use a consequential argument in one case, and a deontological argument in another case, then you switch the premise, meaning that no one "truth" persists.
In the end, Americans may disagree with the ethics of another culture, but can there ever be a strictly logical argument, devoid of sentiment, that attains an objective morality?
(Submitted by Brendan Berger)
Thursday, September 24, 2009
Issues in Health Care
Please look at these 3 articles and respond to the issues raised therein about health care.
1. What Does Quality Really Mean?
(Students Note: The commentators are respected experts in the field.)
2. New York Times: Physician-assisted Suicide
3. WBUR report
1. What Does Quality Really Mean?
(Students Note: The commentators are respected experts in the field.)
2. New York Times: Physician-assisted Suicide
3. WBUR report
Tuesday, September 22, 2009
Medical Ethics and Other Cultures
Please read these two articles and respond to the issues raised therein in the context of the issues discussed in class today, especially the issues raised by the intersection of Non-Western cultural practices with Western medical practices. Please consider if/how cultural and moral relativism is relevant.
Article 1: "A Doctor for Disease, a Shaman for the Soul" here.
Article 2: "To Explain Longevity Gap, Look Past Health System" here.
Article 1: "A Doctor for Disease, a Shaman for the Soul" here.
Article 2: "To Explain Longevity Gap, Look Past Health System" here.
Sunday, September 20, 2009
Responses to Paul Farmer's Article "New Malaise: Bioethics and Human Rights in the Global Era"
[This prompt is in response to Paul Farmer's article "New Malaise: Bioethics and Human Rights in the Global Era" (p. 293 - 304).]
The term bioethics or medical ethics tends to cause people to think about issues such as genetic testing, doctor-patient relationships, end-of-life care, life-prolonging technologies etc. which are at the forefront of modern ethical dilemmas in medicine in many industrialized nations like the US. However, Paul Farmer's article from the Journal of Law, Medicine and Ethics, "New Malaise: Bioethics and Human Rights in the Global Era," asserts that medical ethics must take on a broader scope to consider the ethical implications of the millions of people who live in poverty without access to healthcare at all. Modern medical ethics discussion tends to focus on technologies and services that are available only to those who can pay for them and who live in places where these services are accessible. But what about everyone else?
Farmer suggests that the ethical considerations of distributing healthcare globally should be the forefront of bioethics, rather than focusing on the ethical implications surrounding advanced medical technologies which only pertain to a select group of people who have the resources to obtain them.
As Farmer cites in his article, the international code of Medical Ethics (Geneva, 1949) states that medical professionals "will not permit considerations of religion, nationality, race, party politics or social standing to intervene between [their] duty and [their] patient." However, it is exactly these factors which in many cases deny thousands of people any care at all. If the international code of Medical Ethics establishes high standards of care and obligates doctors to act upon their duties to their patients, are we to say that only the people who have access to obtain care under a doctor deserve the high standard of care which this code calls for?
It makes sense that all humans have a right to healthcare, and the fact that economic and geographic factors deny many humans from these basic rights seems innately unjust and wrong. I would argue that denying treatments to people (whether life-saving or basic in nature) when we have the technology to treat those people is morally wrong, regardless of the socioeconomic status of that person. But how do we as a global healthcare system provide healthcare for everyone? Who is obligated to pay for it and provide it? Are we as a society held morally responsible creating a system in which not everyone has the equal opportunity to receive the same quality of healthcare or to receive care at all? And to the same extent, how do we not allow race, socioeconomic status, geography and nationality to determine who receives healthcare and who doesn't?
(Submitted by Michelle Kielty)
The term bioethics or medical ethics tends to cause people to think about issues such as genetic testing, doctor-patient relationships, end-of-life care, life-prolonging technologies etc. which are at the forefront of modern ethical dilemmas in medicine in many industrialized nations like the US. However, Paul Farmer's article from the Journal of Law, Medicine and Ethics, "New Malaise: Bioethics and Human Rights in the Global Era," asserts that medical ethics must take on a broader scope to consider the ethical implications of the millions of people who live in poverty without access to healthcare at all. Modern medical ethics discussion tends to focus on technologies and services that are available only to those who can pay for them and who live in places where these services are accessible. But what about everyone else?
Farmer suggests that the ethical considerations of distributing healthcare globally should be the forefront of bioethics, rather than focusing on the ethical implications surrounding advanced medical technologies which only pertain to a select group of people who have the resources to obtain them.
As Farmer cites in his article, the international code of Medical Ethics (Geneva, 1949) states that medical professionals "will not permit considerations of religion, nationality, race, party politics or social standing to intervene between [their] duty and [their] patient." However, it is exactly these factors which in many cases deny thousands of people any care at all. If the international code of Medical Ethics establishes high standards of care and obligates doctors to act upon their duties to their patients, are we to say that only the people who have access to obtain care under a doctor deserve the high standard of care which this code calls for?
It makes sense that all humans have a right to healthcare, and the fact that economic and geographic factors deny many humans from these basic rights seems innately unjust and wrong. I would argue that denying treatments to people (whether life-saving or basic in nature) when we have the technology to treat those people is morally wrong, regardless of the socioeconomic status of that person. But how do we as a global healthcare system provide healthcare for everyone? Who is obligated to pay for it and provide it? Are we as a society held morally responsible creating a system in which not everyone has the equal opportunity to receive the same quality of healthcare or to receive care at all? And to the same extent, how do we not allow race, socioeconomic status, geography and nationality to determine who receives healthcare and who doesn't?
(Submitted by Michelle Kielty)
Wednesday, September 16, 2009
Virtue Ethics
How important is character/virtue in doing the right thing? Please respond after reading this article about recent bad behaviors by public personas.
Veatch Case: Is Birth Control Bad for One's Health (CIB renaming of case: Who Know's Best? Who's Right Is Primary?)
"In 1970Dr. R. Browne was a kindly 63 yr old British general practitioner. He was the physician of a 16 yr. old woman since her birth. The young woman thought she should get contraceptive counseling. She realized that Dr. Browne might not look favorably upon this request, so she went elsewhere for advice- to the local birth control counseling clinic. She received the counseling, a physical examination, and a prescription for oral contraceptives. IT is standard medical practice to inform the primary physician if one writes a prescription for someone who normally sees another physician. The clinic's physician asked if he could notify Dr. Browne. Perhaps, without thinking, she gave her approval.
Dr. Browne received in the mail, unsolicited, a letter informing him that his patient was on the pill. Dr. Browne expressed 2 concerns. First he was concerned about her pharmacological well-being. In 1970 the pill had not been on the market very long. Nobody understood what the effects might be, especially in a 16 yr. old. But he was also worried about her total well-being; in particular, what he called her 'moral' health.
Dr. Browne consulted with colleagues, and came up with a plan. One day when the young woman's father was in the doctor's office, Dr. Browne told him the story.
The young woman was not pleased with this turn of events. The clinic physician was also not pleased. Dr. Browne was charged before the General Medical Council in Great Britain with the violation of patient confidentiality, 1971. Dr. Browne, in his defense introduced two documents: The Hippocratic Oath, and the British Medical Association code. The Oath says that the physician should not disclose "that which should not be spread abroad". That, in turn, has traditionally been interpreted as confirming the core Hippocratic principle, that his moral duty is to what he thinks will benefit the patient. Likewise, the BMA code explicitly permits disclosures when doing so is believed to be for the benefit of the patient. Dr. Browne, having struggled with his conscience and consulted with colleagues, claimed he did what he thought was best for his patient. He may have had a somewhat archaic view about what would benefit her, but he really believed that this was the most beneficial course."
Did Dr. Browne do the right thing?
What are some problems with what he did?
What are some good things about what he did?
Dr. Browne received in the mail, unsolicited, a letter informing him that his patient was on the pill. Dr. Browne expressed 2 concerns. First he was concerned about her pharmacological well-being. In 1970 the pill had not been on the market very long. Nobody understood what the effects might be, especially in a 16 yr. old. But he was also worried about her total well-being; in particular, what he called her 'moral' health.
Dr. Browne consulted with colleagues, and came up with a plan. One day when the young woman's father was in the doctor's office, Dr. Browne told him the story.
The young woman was not pleased with this turn of events. The clinic physician was also not pleased. Dr. Browne was charged before the General Medical Council in Great Britain with the violation of patient confidentiality, 1971. Dr. Browne, in his defense introduced two documents: The Hippocratic Oath, and the British Medical Association code. The Oath says that the physician should not disclose "that which should not be spread abroad". That, in turn, has traditionally been interpreted as confirming the core Hippocratic principle, that his moral duty is to what he thinks will benefit the patient. Likewise, the BMA code explicitly permits disclosures when doing so is believed to be for the benefit of the patient. Dr. Browne, having struggled with his conscience and consulted with colleagues, claimed he did what he thought was best for his patient. He may have had a somewhat archaic view about what would benefit her, but he really believed that this was the most beneficial course."
Did Dr. Browne do the right thing?
What are some problems with what he did?
What are some good things about what he did?
Friday, September 11, 2009
Evaluating Different Theories of Ethics
Do you believe that certain ethical theories are more applicable, or more justifiable in certain situations than others. Let us consider this question in light of the '6-year old child stealing food from the lunch room' example. Are the Theories of Justice more capable of handling this situation than Deontology or Consequentialism? If so, how do we decide which of these theories "outranks", holds greater weight, than the other theories?
(Submitted by Tully Cheng)
(Submitted by Tully Cheng)
Wednesday, September 9, 2009
Swine Flu and the Work Place
Please read Tuesday's (9/8) New York Times Science Section article: Preparing for a Stressful Flu Season, by Tara Parker-Pope.
True Story: The President and CEO of a medical device company located in Boston announced- privately- that is internally only- that all employees are required to get a swine flue shot and must bring full documentation of their inoculation to work in order to continue employment. Is this ethical and why?
True Story: The President and CEO of a medical device company located in Boston announced- privately- that is internally only- that all employees are required to get a swine flue shot and must bring full documentation of their inoculation to work in order to continue employment. Is this ethical and why?
Tuesday, September 1, 2009
Welcome to PH 251 (Fall 2009)
Welcome to PH 251! We meet on Tuesday and Thursdays, from 12:30p - 2p in room 101, College of Communication Building (640 Commonwealth Ave).
Feel free to drop by my office hours with questions on Thursdays from 2-3p (Room 504 in the Philosophy Department). Or, you can speak with my TF, Josh, during his office hours (Tuesdays and Fridays from 2-3p).
See you in class on September 3.
Feel free to drop by my office hours with questions on Thursdays from 2-3p (Room 504 in the Philosophy Department). Or, you can speak with my TF, Josh, during his office hours (Tuesdays and Fridays from 2-3p).
See you in class on September 3.
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