I have Biomedical Ethics 1180 01Module 6 Reading Questions

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Module 6 Reading Questions

Read the following selections from our text:
Truog and Miller “The Dead Donor Ruler and Organ Transplantation” (pp 338-340)
Council on Ethical and Judicial Affairs “Withholding and Withdrawing…” (pp 341-343)
Michel “Suicide by Persons with Disabilities…” (pp 348-354)
Mappes “Some Reflections on Advanced Directives” (pp 363-370)

News Articles (these are located in Module 6 in the submodule ‘Module 6 Reading Questions
Material’)
“Let’s Change the Rules for Organ Donation”
“Complexities of Choosing an End Game for Dementia”

Respond to the questions here and submit to the Module 6 Reading Questions Assignment
Dropbox.

Truog and Miller article questions:
1. Organ transplantation is guided by one “overarching ethical requirement.” What is that
requirement? (And make sure to state what it requires)
2. Why was the redefinition of death by the ad hoc committee at Harvard related to the
dead donor rule?
3. Truog and Miller say that the arguments about why brain dead patients should be
considered dead have not been entirely convincing. What are some of the reasons they
mention? What overall “uncomfortable” conclusion do they draw?
4. Truog and Miller say that the dead donor rule has again been challenged by a different
practice—what is that practice? And why do they say this practice (and the
accompanying conception of death that goes along with it) is problematic?
5. Why do Truog and Miller say that reliance on the dead donor rule and its need to rely on
a definition of death has undermined trust in the transplantation enterprise?
6. According to Truog and Miller, why has reliance on the dead donor rule compromised
the goals of transplantation?
7. How do Truog and Miller propose to characterize the ethical requirements for organ
transplantation? What reasons do they point to in support of their view?

Council on Ethical and Judicial Affairs questions:
1. Explain why “the withdrawing or withholding of life-sustaining treatment is not
inherently contrary to the principles of beneficence and nonmaleficence” (p 341). Use
your own words.
2. Explain the distinction between extraordinary vs ordinary treatment. Give an example
of a treatment that can be considered ordinary in one context but extraordinary in
another context. Be specific.You can make use of Handout: Ordinary vs Extraordinary
Treatment.
3. What does the Council say about the status of artificial nutrition and hydration—how
does the Council itself view ANH?

4. The Council claims that there is no ethical difference between withdrawing and
withholding life-sustaining treatment, and offers three reasons for this. Explain each
reason.
5. What are some areas of concern with allowing an expansive policy of respecting a
patient’s requests regarding life-sustaining treatments? (p 342)

Michel questions:
1. What are the three basic types of cases involving refusals of life-sustaining treatment?
Which type will Michel focus on?
2. The types of cases that Michel focuses on have been described by the courts as cases
involving patients refusing life-sustaining treatment. How does Michel propose we view
them instead?
3. Michel says that correctly describing the cases she wants to focus on is important (page
349). Why does she think it is important to correctly describe these cases? Explain in
your own words.
4. What general point does Michel draw from her discussion of the Larry McAfee case (p
351)?
5. What general conclusion is Michel arguing for?

Mappes article questions:
1. What, according to Mappes, are some benefits of a living will?
2. What is one common shortcoming to living wills? Explain.
3. Why might advanced directives be “hopelessly vague”?
4. Does Mappes think everyone should have an advanced directive? He discusses some
reasons that he says are good reasons for having a proxy designation. What are they?
And what are some good reasons for having a living will? (His discussion of all this is on
pages 366-368 in the section “The Relative Value of Advanced Directives”).
5. Does Mappes think it is sometimes justified to not honor a living will? In what sort of
cases? (there are three types of cases)
6. What is the “past wishes versus present interests problem”? Be thorough and explain in
your own words.
7. Mappes says that related to the past-wishes-versus-present interests problem is the
problem of personal identity? What is that problem?
8. Describe the case of Albert H and what moral issues it raises.
9. What is the problem of incompetent revocation? What moral questions does it raise?

Reflection Questions: After reading the article “Complexities of Choosing an End Game for
Dementia” (questions 1-3) and “Let’s Change the Rules for Organ Donation” (question 4) and
thinking about the ideas in the readings from the text, address the following questions:
1. (Background questions) What is VSED (refer to the news article )? What is the “new”
debate about it, according to the news article? What is the main “dizzying” moral and ethical

issue raised by the article?What does Jerome Medalie want? Why wouldn’t he qualify for
VSED?
2. If Medalie eventually becomes incapacitated by dementia, and using ideas from the
Council on Ethical and Judicial Affairs article from the text (in particular, questions 1,2, and 3
you answered for this reading), what would be important to think about regarding Medalie’s
request? Would it be morally acceptable or not?
3. From the Mappes article, review what the past wishes/present interests problem is
(question 6). If in the future Medalie becomes happily demented, how should health care
providers resolve the past wishes/present interests problem as it relates to Medalie? Would
they be justified in refusing to honor his living will? What do you think generally about
Medalie’s request (whether or not he becomes happily demented)—should his request be
honored? Why or why not?

4. Based on the piece “Let’s Change the Rules for Organ Donation,” what is the proposed
change to organ donation outlined in the piece? Would Truog and Miller agree with that
change? Why or why not? What do you think?

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