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Bioethics
Wayne State University Law School
Gable, Lance

INTRO TO ETHICAL THEORIES
ETHICAL THEORIES 
Ÿ Bentham’s classical utilitarianism – teleological theory, rightness in terms of external goal
1.) consequentialism – rightness of act determined by outcome, right in tendency to promote most happiness for greatest #; modern idea cost-benefit analysis
2.) Mill – utilitarianism doesn’t always create just outcome, short-term decisions create harm to meet end goal, appropriate outcomes make sacrifices to get greater happiness for whole –
a.) act utilitarianism – apply rule to 1 act, decision based on individuals impacted by it
b.) rule utilitarianism – test rule for greater number of people, justice for whole group not just directly affected, test rules to decide rightness of particular act against whole (laws)
c.) hedonism – wholly driven by happiness, define happiness as pleasure & assign values to diff pleasures to decide what good, benign benevolent spectator decide what happiness
Ÿ Kantianism (deontology) – duty, each person inherently rational, autonomous will governs duty, rational nature tells us what right, follow duty to act rationally; moral law determined by reason
1.) categorical imperative – act only if rule done will still work if apply universally, if this is universal rule will it still meet end of act considered. 
2.) treat people as ends not just means – everyone has inherent rationality must honor
3.) duties always observe are perfect duties (keep promises, tell truth, no suicide). Imperfect duties generally observe but give way to perfect duty (develop talents, contribute to happiness)
Ÿ Rawls combined both, highly influential in bioethics – add justice, modern approach
1.) 2 principles of justice –
a.) each person has equal right to most extensive liberty compatible w/ like liberty for all
b.) inequalities must be arbitrary unless reasonable to expect inequality will work to everyone’s advantage
2.) principles of justice by person in original position acting under ‘veil of ignorance,’ standard helps worst off, if rule works for all groups is just 
3.) central task of gov’t to preserve & promote liberty, principles of justice guide lawmaking
Ÿ Natural Law – 3rd main influence, humans evolve through life, fulfill duties w/ goal of promoting each person in fulfillment of life, fulfillment of human beings requires following law of reason
1.) reason inclines us toward good & helps us discover moral principles – ultimate source of natural law is divine wisdom not duty
2.) principle of double effect – act performed only if intent to bring about good effect & bad effect unintended/indirect consequence
3.) principle of bodily integrity – body special part of person in nature, need to protect it
Principles of Ethics
Ÿ Nonmaleficence – avoid causing harm to others (duty of care)
Ÿ Beneficence – provide benefits & balance benefits against risks, promote welfare of others, make reasonable sacrifice to help others
Ÿ Respect for autonomy – person has inherent worth, ends in themselves – important in informed consent & privacy laws
Ÿ Justice – application of rules, distribution of benefits & burdens, similar cases should be treated in similar manner      
Informed Consent
Ÿ Schloendorff – every adult of sound mind has right to decide what done w/ body
Ÿ Canterbury v. Spence – what patient reasonably needs to give informed consent
Ÿ Effective consent– show competency of patient, disclose all info & patient must comprehend it, minimize potentially influencing factors on patient, patient makes decision
Ÿ Competence gatekeeper, not competent no consent – adults presumed competent until show otherwise 
Ÿ Incompetent – children, mentally ill (presume competent, prove too ill), adults previously competent, adults never competent
HUMAN REPRODUCTION & BIRTH
Limiting Reproduction
Contraception
Ÿ Griswo

n’t work    
Ÿ Test for state law to see if violates fundamental right under 14th – state limit right only if compelling state interest & narrowly tailored to meet compelling state interest.
1.) 2 compelling state interests -protect health of mother & potential human life of fetus
2.) trimester system(thrown out in Planned Parenthood) –
a.) 1st trimester mom decide on own for getting abortion state has no say at all
b.) 2nd trimester state can regulate abortions to protect interest of health of mother
c.) 3rd trimester fetus viable interest in potential life starts so state can prohibit abortions if wish except to protect health of mother
Ÿ Fetus person – no, SC said didn’t have to decide when life begins, use viability as pt when state interest starts, don’t say life starts at viability if did no right to abortion, if fetus is person gets rights
Ÿ Why viability kicks in state interest – could exist independent of mother create separate interest, 24 week fetus couldn’t live outside mother or if did needs supreme intervention 
1.) right to not have child, SC sidesteps by focusing on medical issues, concept of viability has limited shelf life, won’t work when need to address right to not have children
Ÿ Planned Parenthood v. Casey – upholds ‘essential holding’ of Roe –
1.) right of woman to get abortion before viability w/out undue state interference; not really reaffirm Roe – included undue interference, Roe excluded everything, state here from day 1 can do something, only limitation undue interference