The objective of this exercise is to be able to identify the moral form of thoughtfulness the primary person in the case is using to resolve his/her moral dilemma.
The objective of this exercise is to be able to identify the moral form of thoughtfulness the primary person in the case is using to resolve his/her moral dilemma. While multiple forms could be used and might be considered, what is the form the person uses ultimately to decide what to do? All you have to do is identify the form (you don’t need to say why it is the case). Remember, don’t identify the moral form you would use, but the one the person in the case is using. Be sure to read the “Moral Forms of Thoughtfulness” article. For some, this can be a challenging exercise. Try to relax and know that as you go through the course, this will become easier.
D = Deontology/obligation
UA = Consequentialism/act utilitarianism
UR = Rule utilitarianism
V = virtue
JU = justice utilitarian
JL = justice libertarian
JE = justice egalitarian
1. Marie is a nurse on an acute trauma ward. A patient asks her about the diagnosis she just received from her physician. “Is he telling me the truth – or is it really worse than this?” Marie knows the diagnosis is actually worse that what the woman was told. She ponders what she should do or say. She decides that it is her obligation to the patient to tell the truth, regardless of the consequences. So, she explains to the woman what is really going on.
2. In the same scenario as number 1, Marie decides instead that the woman’s current state of health is very precarious. She believes bad news will make her situation only worse. She decides it is better to be slightly dishonest about the diagnosis in order to help her in her current recovery. She rationalizes that it will be easier for her to take the truth later. So, the good outcome justifies the means (being slightly dishonest).
3. In the same scenario as number 1, Marie decides that although it might be best not to tell the woman all of the truth, Marie doesn’t like the idea of being dishonest. She is concerned about how frequent decisions to be dishonest might impact her character and long-term ability to be honest. So, she tells the truth.
4. Jane’s father Juan, 85, has had a stroke. He is not expected to recover the ability to talk, walk or eat. He will need a feeding tube inserted – and will require 24-hour care for his mobility. Juan had always told his daughter that if he could not eat or be independently mobile, he didn’t want a feeding tube or other life-preserving therapies. Although Jane would prefer to have a feeding tube inserted, she believes she has a duty to act as her father would have wanted (respecting his autonomy). So, she honors her father’s wishes and informs the physician that nothing is to be done for her father except to keep him comfortable.
5. Robert’s father (John) is in terminal stages of cancer. He has a very remote chance of getting through the current acute respiratory crisis. The medical staff says that if Robert wants to prolong his father’s life, they will have to put him on a respirator. Robert compares the benefits of the respirator versus the prolonged suffering he will undoubtedly endure. He decides against the use of the respirator since the benefits do not outweigh the prolonged suffering.
6. Frank is the physician in care of a patient (Robert) who has just had an operation to remove a small tumor. Robert’s recovery has been good. The hospital is facing a shortage of beds due to an unusual outbreak of a severe flu. The hospital has asked physicians to identify patients they think could go home early (freeing up their beds). Frank thinks Robert is such a candidate. He believes it is fair or just for Robert who is in good health to give up his bed for those in worse shape.
7. In the same scenario as number 6, Frank doesn’t believe it’s fair to deprive Robert of the care he would have gotten had there been no shortage of beds. Frank believes there’s an implicit contract between him and Robert for Robert’s care – and even if others might benefit, Frank is under contract with Robert.
8. In the same case as number 6, the hospital administrator orders several patients home early. He realizes there are risks with sending them home, but he believes those risks are less imminent than the good that could come about by admitting the more severely ill.
9. Martha’s father expressed wishes that when he was older and faced long-term illness, he did not want to be kept alive using artificial hydration or nutrition (feeding tubes). Jane believes she has a duty to preserve life more than a duty to honor someone’s advance directives about health care. Since her father can be kept alive rather easily with a feeding tube, she has one inserted.
10. Martha’s sister, Fran, disagrees with Martha’s decision. She believes we have an obligation to honor someone’s advance directives or wishes. She also believes we have an obligation to minimize suffering. She suggests that the medical team not only not insert a feeding tube but also give her father increased doses of morphine as a way of speeding up his death.
11. In the above scenario, the physician agrees that something needs to be done for Martha’s and Fran’s father’s potential suffering. He also agrees that it is not good to increase or prolong his suffering through use of artificial hydration and nutrition. However, he believes it is important to distinguish between use of morphine to speed death and use of morphine to ease pain. He believes this distinction is important for preserving the right attitudes towards the dying.
12. Francine is a physician at a university-sponsored hospital. She is in charge of a research protocol involving a new treatment for a particularly type of cancer. Several of her patients are receiving the new treatment. She suspects that the treatment is not better than existing ones – but she only feels that intuitively. As a researcher she knows the experiment needs to be carried on further. As the physician of her patients, she is concerned about their well being. She weighs the benefits of continuing the treatment (for her and for others) vs. the harm it is causing her patients – and decides against further experimentation.
13. In the same scenario, Francine’s colleague, Jennifer, believes that her patients are her number one obligation and decides at the moment she feels concern about them – to stop the experiment.
14. Another research physician on their team (case from #12) voices his concern. Since he believes that these patients are going to die anyway – and there is still some doubt about whether the new treatment is better or not – it wouldn’t be fair to others who could be helped or harmed by the treatment to stop the experiment. He believes the good that will come about from the research justifies the means.
15. Milton, a nurse caring for the patients (in case #12), is concerned that the patients being treated (and part of the research protocol) are poor and that a decision to exploit them for research purposes is unfair. He believes if they were richer, he would have less of a problem but, since they are poor, we should in fairness give them the best treatment.
16. Jeremy is the physician in a clinic that serves a large gay population. He happens to be the primary care physician of two guys who begin dating. Jeremy knows that one of the guys, Jim, is HIV+ – and that Jeff is not. When he’s visiting with Jeff – Jeff expresses how excited he is about dating Jim. When Jeremy asks are you practicing safe sex (which he asks any patient who tells him they are sexually active) – Jeff says – “well, not always.” Jeremy ponders whether he should tell Jeff that Jim is HIV+. He believes his primary obligation is to preserve confidentiality, and decides only to encourage Jeff to practice safe sex.
17. In a similar scenario (as #16), Jeremy’s colleague, Juan, decides that he should tell Mike (another patient) about Dan’s (another patient) HIV+ status. He believes it’s his obligation to prevent harm/death.
18. Pat works at a women’s clinic. She believes abortion is immoral, but part of her job is to inform women of various options available to them during pregnancy. She believes it is her professional obligation to inform women of their options.
19. Pat’s friend, Jan, believes that even though it is her work obligation to inform women of options, she believes her moral obligation is to prevent or discourage abortion. Since she is concerned about her character/virtue, she decides she can’t work in the clinic anymore.
20. Mike is in charge of drafting a sexuality education program for a local school district. He is in charge of health education. Although he believes sex outside of marriage is immoral, he also believes that in order to prevent unwanted pregnancy and sexually transmitted disease, he should provide adequate information about use of contraceptives and safe sex. The risk that such information could lead to more sexual activity (which normally it doesn’t anyway) is outweighed by the importance of preventing more serious risks.
21. Mike’s colleague, David, believes that he can’t, in conscience, teach safe sex since this would lead him to affirm its value – when he doesn’t believe it has value. He is concerned about how repeatedly teaching this might impact his characater and values.
A statute in a state legislature is moved to the floor to require health care plans to cover contraceptives for women. It is argued that it is unfair that health care plans pay for men’s Viagra pills – but not women’s birth control pills. Men and women should be treated equally.
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