Category Archives: Medical Ethics

Ethical Theory…

First, a definition — ethical theory is kind of like a formula for ethical behavior or to make ethical decisions… when you APPLY it to a problem.

There are more or less four kinds of ethical theory — theories that look at consequences, theories that look at motivations,  holistic theories that ask ‘what are the elements of being a good person’, and contractual theories.

Consequences: — (or consequentialism) — look at the outcomes of the theory, is the result of the action going to make something “better”.  Better can mean either improving a situation by increasing “good” — OR, decreasing “bad”.  The most commonly discussed consequentialist theory is utilitarianism.  It defines “good” as more or less pleasurable.. so, an action is good if it overall increases pleasure or decreases pain.

To make a decision based on utilitarianism, you simply need to look at all the possible pain and pleasure coming from the action, then do the thing that provides the greatest net increase in good/ decrease in pain.  Note, this MAY be different from the ‘greatest good for the greatest number of people’… because, an action may be very good for a small number of people…

What this theory does well is to help a person choose between existing options to do the thing that will do the largest possible net good… so, it tells you which particular action is the best.

Motives — (deontology, Kant.. for the most part) — asks, is the person’s motive or reason for action good.  Kant’s reasoning works like this — The only absolutely reliably good thing is a good will — or good motive.  He then developed the Categorical Imperative as a test to see if a person’s motive for action (or will.. ) is a good one.

To make a decision based on motives, Kant’s Categorical Imperative requires that, if others knew your motives, they would agree to the action — and, it asks if you would want to live in a world in which others acted as you want to act?  This is generally speaking the “universal” formulation of the Categorical Imperative.

Kant continues to give other examples of his Categorical Imperative — one of the really important ones is the means/ ends formulation — which directs you to always treat others as an ends, and never as ONLY a means.  Translated, you should not use people to get what you want — you should not withhold information that would make them disagree with the “plan” (i.e. lie to them) — because, what you’re doing is ignoring the fact that they’re an autonomous person (one who has the ability to make decisions about their own life).

You can see how this is a version of the universal formulation — if the action you wanted to take were “universal” — including knowledge of your motives, would that be acceptable?

What Kant’s theory does well is to eliminate possible actions  — the problem is that it does not suggest one course of action as the “best”possible thing to do.  To narrow down the one course of action among all the permissible ones (the ones that pass the Categorical Imperative), you may use any criteria you’d like.

Holistic theories — The general idea here is to ask what a “good” person does?  So — for example, a virtue theory would ask what a good person would do in a particular circumstance?  The answer, is that they would be virtuous, and a list of virtuous characteristics would follow.  Feminist ethics of care are similar, in that they ask what a good person would do, and the answer centers around making good choices for their family and those in their immediate circle of care.

Contractual — These are theories that are more or less ‘good is what we agree is good’ — kinds of theories.  One major kind of contractual theory is the Social Contract theory — in which, whatever the society deems to be ‘good’ IS good.  Nothing is good objectively, in that there is nothing about the action itself that can determine what is or isn’t ‘right’.

Another version of the contractual theory are the multitude of professional codes of conduct.  So, for example, legal ethics centers on what it means to be a “good” lawyer.  That may include NOT breaking a client’s confidentiality if they tell you they’re guilty etc.

Both holistic and contractual theories are often said to be ‘incomplete’, in that they depend on another theory about what is or isn’t right to come to a final decision about the permissibility of an action.  On the other hand, they tend to capture how we, as human beings actually DO decide what’s right.

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Privilege, what it is and what it isn’t..

The word “privilege” gets a lot of use these days… most of it helpful, but sometimes not… Personally, I find the term “check your privilege” to be unhelpful and antagonistic, in that it doesn’t really mean anything and the effect is to shut down someone instead of actually helping them to see how their privilege is relevant to the situation at hand.

So — the question is, what IS ‘privilege’?

The quick answer is that having privilege means  your life is easier in some ways than it is for folks without that kind of privilege.  It does NOT mean that you directly get extra stuff because of your privilege, but rather earning the things you DO have is easier for you than it is for someone else — because of the way both of you were born / raised ( generally..).

So, I’ll take myself as an example…  I have white privilege and ‘cishet’ privilege.  FYI– “cishet” is short-hand for cisgender, heterosexual — so, I was born female and my gender is also female (i.e. I’m not transgender)… and I’m heterosexual, so my main romantic interest is in men.

Being cishet makes things easier for me in a variety of ways… it’s never been my experience that, because of the way I’m born, I would question as to whether or not I would be able to marry the person I love (and, of course, the person who loves me…)… that’s the “het” privilege part.  Much of that changed when same-sex marriage became legal in the US — but, it still remains that I’m not likely to be fired or denied housing because I’m a woman and my spouse is a man.

I’ve also never had the experience of society presuming I’m a woman when I feel, inside, that I’m not a woman.  For the most part, people read me as female and treat me as such.  I’ve never had to “come out” as female, I’ve never had to decide if I want to alter my body to match my gender (sex is more or less biological, gender is what you feel inside).

I will say that, because of my gender expression (the way I choose to present myself) — I have had to ‘come out’ as heterosexual… but, that coming out wasn’t something I worried about.  I didn’t have to have a challenging conversation with my friends and family, I’ve never faced social isolation because the person I love isn’t what my friends expected etc.

As a white person, I see other white people in the media, classroom, government etc.. on a regular basis.  It isn’t some kind of unusual achievement for a white person to, for example, be President of the United States.  I’ve never had someone say “you’re pretty, for a white girl” — and think it’s a compliment.  When I — or another white person — does something horrifically bad, I don’t have to worry that strangers will assume I’m about to do something similar because of my race.

My privilege gives me a lot of wiggle room to make mistakes and recover.  I know that, statistically speaking, a white person with a partial college degree and a relatively minor criminal record will still earn more than a black person with a degree and no record.  I know that young white girls in school are much less likely to be suspended from class for breaking a rule than a young black girl would be for breaking the same rule.  I know that my white step-son is much safer hanging around in public — goofing around with his white pals than a similarly behaving black boy with his pals.

There are a variety of ways I don’t have privilege as well.  For one, I’m a woman — I live in a culture that has shown me that women are in danger of sexual assault and other kinds of violence.  I belong to an academic discipline in which it is significantly less likely that a woman will earn a PhD and get a full-time academic job.

I’m also fat — so I’ve certainly experienced people giving me the ‘look’, young kids telling their moms that I’m pregnant, and don’t even get me started on buying clothes.  On a regular basis, the media tells me that my body isn’t socially acceptable BUT — if I’ll only participate in ___________ new weight loss fad, I’ll meet their expectations.

‘Intersectionality’ is an important concept that goes with the concept of privilege.  The idea of intersectionality is a means of indicting that privilege isn’t an all or nothing concept.  So — people can have privilege in more than one way, but lack it in another.  So — a black man has male privilege, but lacks white privilege.  A black woman lacks both gender privilege and white privilege, or a poor white woman lacks economic and gender privilege, but has racial privilege.

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Reading theory….

Thinking Cat (1)

No matter which course you’re taking, you’ll have to read articles about “theory” — in ethics, it’s ethical theory — in Intro to Philosophy it also includes theories about mind-body, free will, God etc..

The thing about these articles that is similar is that the philosopher has an idea, and they’re trying to put that idea down on paper — sometimes it works well, other times it’s a bit more difficult to understand what they’re thinking or trying to say..

So — some hints and tips..

  • Read all parts of the assignment, the introductions and conclusions — the foonotes etc.. because you’ll often find clues there.
  • Google the word, idea, or concept that seems central for another point of view on it…
  • Skim the assignment first trying to get the general idea.  Figure out how the parts of the article and argument go together.
  • Go back and read carefully — taking notes as you go… write down each major move in your own words, and why the philosopher thinks that’s a good move.  As you’re going, write down objections and questions you have — since those will be useful later.
  • When you’re done reading and taking notes, look at your notes — do they make sense?  If you had to use them to teach someone else what you just read, could you do it?  If not, go back and check to make sure your notes reflect what you read…
  • Then, think about ways that theory connects to the world around you — put it in context for you… (this is a good way to start a mid-term and final paper assignment… ).

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How to Talk to your professor…

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This is a brilliant site about how to “do” college…

It’s all pretty much common sense to us, the proffies — who have spent most or all of our adult lives in college in one way or the other.. but, you’ll probably find some helpful advice here…

Probably #1, It’s on the syllabus (Class Schedule 🙂 )…. I really do mean that.

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Refusing treatment… when you’re 17…

of scars, me..

Cassandra from Connecticut refusing chemo…

Read the article in the link — the basics are this — the patient has Hodgkin’s Lymphoma — she’s 17 and, with the support of her mother, is refusing chemo.  The doctors think this is a bad idea, so they got DCS involved, along with the courts, to make her get treatment… If Cassandra were 18, she’d be able to legally refuse the treatment.

I have kind of a lot to say about this — so I’ll start with the relevant background..

The reason you see my photo on the top of this post is that I had breast cancer in 2008 — I did chemo, had a mastectomy, and then participated in a photo project about breast cancer scars — called “Of Scars” — I’m reminded every day that I had cancer and that my body has changed as a result.  I’d also do chemo again without hesitation…

Being told you have cancer and need chemo is scary — it just is.  They tell you all kinds of horrible things about the side-effects, they tell you that even if you get sick from the chemo, it may not work etc… they tell you you run a risk of infertility, that your hair will fall out, you’ll have trouble with nausea, you’ll have mouth sores, fatigue, cognitive problems, numbness in your hands and feet — and a lot more that I don’t remember.

You see chemo patients on the TV all the time — looking pathetic, about to die with the bag hooked up etc.. you’ve probably already been to the cancer clinic and saw the folks in the waiting room — it really does look more or less like the Grim Reaper’s ‘to do’ list — and it’s scary, it’s just plain scary.  The first few treatments are probably the worst.  Sooner or later you learn new limits (eat bland stuff like chicken nuggets and corn dogs, take lots of naps, drink lots of water etc..) — and you figure out that the rest of your life continues even though you’re in chemo.

So — I get it — in  a very basic way, chemo is scary… but death is scarier — and cancer WILL kill you.  Hodgekins lymphoma means you’ll probably die of infections your body can’t fight, or a swelling tumor will choke you… it doesn’t go away on it’s own, with good food and prayer.  It just doesn’t.

I understand that Cassandra and her mom are scared.  They want to put poison into her body.  It’s likely to make her sick.  She’s going to feel crummy, then she’ll live — that’s the doctor’s position (as far as I know it).  Refusing this kind of treatment, with the high likelihood of success, is seen as child abuse by the court.

I also see the other side — for WHATEVER reason, a person ought to be able to make choices about what happens or doesn’t happen to their body.  If Cassandra’s treatment were happening less than 1 year later, she’d be legally able to refuse that treatment, and to force it on her would require a ruling of incompetence to make her own decisions — that’s a big thing… and a high bar — as well it should be.

I get it, Cassandra should be able to make a decision about her own body — whether it’s about getting a tatoo, gaining or losing weight, working out, having sex, not having sex etc… it’s about the most basic freedom we can have.  It’s the last thing that gets taken away from people when they’ve broken the social contract and it’s a sign that, as a society, we respect the autonomy of the individual.

Forcing Cassandra to have treatment MAY be for the greater overall good (Mill would like that, I think..), but it violates Cassandra’s inherent right to make choices that determine her future — i.e. something Kant thinks is at the root of the autonomy that makes us human.

Yikes — what would I do… I think I’d have to sit with Cassandra and her mother (because, Mom is a huge factor in this) — and lay it on the line…. Chemo IS terrible, but dying an early and painful death that could have been prevented is worse…

Specifically to Mom — I’d have to probe her reasoning in support of not having Chemo — as parents we tell our kids all the time that they need to do things that aren’t pleasant, but are good for them (eat your oatmeal, wait to cross the street, do your homework, clean your room etc..).  This is just an extreme case of that.

I’d also ask her about what has been reported as her central concern, that Cassandra won’t be able to have kids later — ummm… WHAT?  Of all the things, this is the one that is most pressing?  You certainly can’t have kids if you’re DEAD.  There are many other ways to raise kids other than giving birth to them, and — really — are you saying you prefer a slightly higher chance of grandchildren to the life of your LIVING daughter?  Is being a grandma all that for you?  Are you prepared to raise those theoretical grand-babies, because their mom’s cancer killed her when they were toddlers?  Really?

For Cassandra — I’d ask her to really think about having a few unpleasant months, and a healthy life afterward.  Sure, the first few chemo sessions suck (and no two chemo regimes are similar, really) — and the prospect of not having kids, when you’re 17 seems pretty bleak — but, there are lots of other things that can go well in your life if you survive this cancer.  You’re likely to live another 60 years… another 4 times as long as you’ve already lived…

You should also think really carefully about this choice — and how much your mom is influencing you.  Are you comfortable with the information she’s using to push you to refuse?  Is she actually pushing you?  Are you sure that you agree that you shouldn’t have the treatment?  Is she freaking out because you have cancer, and her advice is driven by panic and psuedo-science rather than logic and medical information?

Also — there’s the issue of Cassandra’s age…

I don’t know if she’s a fully-informed and average 17 year-old — but, I’m going to assume she is.  If she’d been born less than a year earlier, she’d be legally allowed to make this decision.  1 year makes a HUGE difference if you’re talking about the first decade of a person’s life, and less if you’re talking about the second decade… the growth in people’s maturity level slows a lot once human beings become teenagers.

In many societies — past and present — 17 year-olds are treated like adults.  In Europe, they can drink, in many developing countries they work as adults, get married, have children, and ARE adults… In our country, they can drive, access the internet etc.. and are about to graduate from high school.  Some 17 year-olds ARE parents already, and some ARE college students already…

So, if I were the doctor making the final decision, I’d want to see what Cassandra has to say about it — I’d ask a lot of questions (because she IS still legally a minor) and if I were persuaded that she actually is making a fully-informed and independent decision, I’d support her choice not to have treatment.  Of course, I’d tell her all the reasons she should have treatment etc — I’d introduce her to patients who are getting the treatment now, i’d give her reading etc… but, in the end, if she wants to decline treatment, she should be able to do so.

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Writing and editing a philosophy paper… hints and tips

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Disclaimer — I’m a philosophy Ph.D, not a writing professor — it’s quite possible that you’ve had better advice about how to write papers elsewhere — and that advice is probably right, if it works for you.  Below is what has worked for me over philosophy courses between about 1088 and 2002 — and then in writing my dissertation from 2002-2010… your mileage may vary — but, if you adapt these ideas and write a good paper, it works — if your paper sucks, then find other ways… there are plenty of places on the internet that will help you write, go find one that works…

the BIG questions answered up top..

Page numbers in an assignment are guidelines, and assume you are double-spacing a paper at 12 point Times New Roman font.  

You can choose ANY citation format.  Philosophy officially doesn’t care.  Most students use MLA or APA, but we don’t care which you use.

No, you can’t have an extension — IF your class has a one late paper policy, you can use it.

Before Writing

  • You start with the question — if you’re given one (like in most of your short paper prompt) great — then, ask what it means… what every part of the prompt means, this isn’t a multiple-choice thing, you need to answer the whole paper prompt.
  • Have an on-paper brainstorming session — sit down with a pen and a blank piece of paper.  Write key words for each of the paper prompt on the paper and write down all of your thoughts about each one.
  • Turn your paper brainstorming into an outline — it will probably follow the path of the paper prompt, but maybe not.
  • Do main sections for each part of the paper prompt — maybe putting each of those sections on a separate piece of paper… now, put the stuff you wrote down into an outline that starts at the beginning of how you’d like to write the paper and working down.  
  • Ask yourself what’s missing — where do you need quotes of philosophers, where do you need more analysis, where should you insert stuff you read from your classmates etc.  
  • Fill what’s missing into the outline… it may help to do the outline on note cards, so you can easily rearrange the points.
  • Gather all the stuff you’re missing — use post-it notes as bookmarks if you want to use philosophers in your text.  If you’ve found online sources outside of the class, then gather them in a set of bookmarks on your computer.  If you’re using quotes from classmates, copy them into one document and make sure keep track of where you found it.
  • When you’re gathering sources from elsewhere, make sure you have enough information to make a citation… I usually do this by keeping track of the author’s name, where I found it, and when their information was published.

Writing

  • Write the introductory paragraph, outlining your paper –something like, “I’m going to prove that Macs are superior to PCs by explaining that Macs are easier to use, are less vulnerable to computer viruses, and their hardware is more durable.” — notice that I gave a conclusion “Macs are superior to PCs”, and three reasons (premises) for why that is the case.  At this point, you have three main sections to develop — and then a concluding paragraph to write.  
    • It’s important to note that the introductory paragraph may change as you write the paper, but if you’re working from a good outline, it may not change much..
  • Write the body of the paper — a few things that have helped me:
    • Use a color to denote places you’ve used the words of others — it may be one color for direct quotes and another for paraphrasing.  Pretty much, when you’re looking at another thing and typing, you need to use a color.
    • Insert placeholders for your citations.  If you like parenthetical references, use  something like (Insert ________ info here) — keeping track of what you’re looking at as you type.  Put these notes in RED — so  you’ll see them later.  If you prefer footnotes or endnotes, insert them as you write — they’ll follow the text if you move it — and put the shorthand of the citation in the blank area… The reason for doing it this way is that your brain is in a creative mode, it’s jarring to put citations in right away… besides, you’re going to edit anyway.
  • Keep writing until you think you’re done.  Then, go back and keep writing… you’re going to cut.  Don’t just STOP when you get into the page range… stop when you’re done saying what you need to say.  
  • Write the concluding paragraph, explaining briefly what you did and how you did it.
  • NOW — save it a couple of places, and if you can — print it.
  • This last step is important — walk away.  Physically get up from the computer and walk away — go do something else.  Let  your brain unwind, and give yourself time to think of stuff that should be in the paper — or stuff you need to cut.  I call that part “percolation” — and it’s important.  I tended to put longer stuff in percolation for longer periods etc.. 

Editing the paper

  • Now that the paper is out of percolation, take one of the copies (and make sure you know where the other copies live, just in case disaster strikes at this point) and re-name it something like “Ethics ethical theory paper 1 Patty Courtney” — so, your class name first, the assignment second, your name last.  Putting the course name first will help you find ALL of your work for that course… trust me, you’ll want that system later when you’re looking for a writing sample, something to revise etc.
  • If you can, print out the paper — this really DOES help.. look at it away from the computer screen. 
  • Outline the paper — yep, sounds weird, but make marks in the margin as to which paragraphs go with which parts of your original outline.  Do you spend 6 paragraphs on a sub-point and only one on the main point?  Maybe that needs to change, or maybe you need to revise your opening paragraph to shift the focus of the paper… before you do that, is that shift going to satisfy the assignment?
  • Highlight, with a pen, the quotes — do you have lots of quotes right next to one another without your own analysis in between?  Are you asking your sources to do all of the explaining?  If I wanted that in a paper, I’d just go read your source…. I want to see what YOU think of  your source.  How does it interact with your argument (is it in support or opposition — if it’s opposition, why are they wrong and you right?).  
  • Circle all the places you put in placeholders for the citations.  
  • Find  your pile of references — bring it to the computer.  
  • Adjust the body of the paper so that it makes sense — cut paragraphs if needed, explain more where needed and generally adjust the writing so that it answers the question (remember, it’s all about the question, doncha know? ).
  • Now — look at the form of the paper — a few things to look for (among many):
    • spell-check underlines… and pay attention to what spell-check wants to insert, is it correct, use the dictionary to find out.
    • Missing punctuation — do your in-text quotes have TWO quotation marks?  Do your other uses of quotes fit the style you selected.
    • Informal language — no “lol” — if you’d text it to a buddy, that’s probably not ok language for a formal academic paper.  Also (and this is a biggie) when referring to a philosopher, use their LAST NAME (not their first name… you don’t know them, and there are lots of “Immanuel”s out there in the world, but I think there is only one Kant… use the last name, not the first name — and generally not the whole name.
    • Get the names right — and the names of their theories right… FYI, JS Mill is NOT “Mills”.  
    • It’s your (for things that belong to you) and you’re for (you are).  See other common mistakes all over the internet.
  • Now the body of the paper is how you want it, you’ve adjusted the proportions of the paper and generally you’re (notice that.. hmmm…) happy with the way the paper reads.  At this point, go back and put the citations in — carefully checking the text of the citations one more time.  Follow your style manual, doing your best if you can’t find a way to cite what you’re using — making sure to include basic information.
  • THIS IS IMPORTANT — make sure that EVERY time you use an idea from another person, in the body of your paper, you have something that indicates it’s a quote or paraphrase.  
  • IF you have incomplete citations in the body of the paper (Smith, 97) for example, you MUST make a “works cited” page that includes the full citation.  If you’ve used footnotes or endnotes, that’s not necessary.
  • Once you’ve done all of that — give it another read on your computer.  Fix small errors, adjust the phrasing and generally look carefully at every paragraph.
  • Now –put it in short percolation…
  • When you’re back — give it one more read –quickly this time… does it say what you want to say?  If so, go in and turn everything you’ve colored to black type, no highlighting etc.
  • Save it.
  • Save it someplace else.
  • Close it.
  • Submit it to the dropbox… 

There you go — a million little steps to a decent philosophy paper… 

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How did the course end up this way — or, what’s the bigger picture?

10 rules for teachers and students…

I just read this, and it’s very true — so, I love it — go read it… now…

Ok… now, you’re back and of course you’re wondering how all of this class stuff goes together… 

First of all, Logic is different — in terms of how / where I teach it, what we’re supposed to accomplish and all of that.  So — while the general principles apply to logic too, I’m going to talk about courses that aren’t logic for a bit here… 

  • I constructed the course with the idea that it takes at least 3 exposures to an idea for it to catch in your head.
  • I think that you’ll learn writing skills by writing — hmmm… no shock there.
  • I think that collaborating is a good idea, as is competition.  It’s also a good idea to see how other students think about things, to evaluate their arguments, and to respond to their positions.  Generally, I think an open discussion board is a terrible place to do this (because everyone posts at the last possible minute).  
  • I think that Philosophy is hard.
  • I think that online classes make you (the student) work harder to get the ideas, because you don’t have me to explain it in the traditional lecture setting — and, that you don’t NEED me to do this.  I do explain, in a more Socratic way.. and, as such I think that you’ll need to explore your own ways of gaining information to be successful in the course.  This is a good life skill.  
  • Finally, I think that when you write a formal paper, that you should have already demonstrated some knowledge about the topic and that you’ll have written about it informally before you write about it formally.

So — how does all of this wash out in the class —  you need to think about the activities in the class in this way, 

First you read — then you take a quiz / post  your reading notes… (reading notes lets you see how other folks interpreted the material) — then you write a short read and respond assignment that gets MY feedback (so you can see if you’re on the right track) — you also participate in a general discussion or a debate.  Especially in the debate, you do the collaboration part, the evaluation part, the respond part etc…  Finally, you write some papers and turn them in… 

And, along the way, I hope you learn some philosophy, some critical thinking skills, some writing skills and some research skills… so — go!

 

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