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Utilitarian Bioethics
Things to thinks about: The main goal and direction of the article.

Content

 * Definition: traditional and current definitions?
 * Figures: More history on the prominent figures of utilitarian ethics and their work
 * More talk about the applications of utilitarian bioethics and content on Groningen protocol and ADA in Texas.
 * Viewpoints of utilitarian bioethics on controversial topics in modern bioethics.

Tone
The way the content is portrayed in the article seems to suggest some bias for opposing utilitarian bioethics. Giving the only example of a nurse caring for a terminally ill patient or a patient in a vegetative state is a nurse that could have cared for a sick baby or a child gunshot victim seems to show utilitarian bioethics as a cold ethical practice. Using phrasing like "one less nurse" hints to the reader that the writer has a particular stance on the subject. At least this is how I perceive the tone of the article. I would probably delete the example and add some viewpoints of utilitarian bioethicists on controversial topics in modern bioethics.

Sourcing
The citations to the referenced sources do not have links that would direct the reader to the site of information. The sources seem to be old and not have any on-line accessibility besides the Washington post, and it is only a click-able link to another citation of the same source and not the original Washington post article. Although the sources may be accurate, it would be more helpful to the reader to fact check them with some means of on-line access to the referenced material. Citation seem to come from not so reliable of sources and stronger sources could definitely be used. Also sources are needed for much of the article to be in compliance with Wikipedia policy when using any quotations and challenging information as the article does: Citing sources/ Verifiability/ Reliable sources Identifying reliable sources (medicine)

Talk Page
The talk page seems to be very critical of the writer and the way the content is conveyed in the article. There is talk about the bias of the writer and how the tone is leaning toward opposition of Utilitarian Bioethics. This article is rated as a Start-class and is apart of the WikiProject for Philosophy. We have only briefly discussed Utiliotarian ethics in class and therefore have not really discussed it in regards to bioethics.

Morality

 * In Ethics out of Economics, Broome writes "The ‘Principle of Utility’ is the principle that actions are to be judged by their usefulness in this sense: their tendency to produce benefit, advantage, pleasure, good, or happiness." He writes that the meaning has been shifted to mean, especially in economics, that Utility is "that which represents a person's preferences."


 * "Complicity and Stem Cell Research." (2008) Sullivan and Costerisan argue against the utilitarian argument for using human embryonic stem cells (hES) and they find it immoral, and any participants of using hES are complicit in its immorality.
 * “The Limited Utility of Utilitarian Analysis” (2006), Strong argues Utilitarianism is not a moral theory and utilitarian decision analysis fails to concede to common morality, the idea of autonomy, and that utility and autonomy are incommensurable.
 * "Bioethics: Utilitarianism" (2012) Utilitarianism permits the offense of one over the benefit of many. Given that the good in the utilitarian perspective is the maximization of total well-being, we should use a utilitarian approach in genetic and medical practice, even though the offense to an embryo or defected fetus may result.

QALY, Cost-Effective Analysis, and Resource Allocation

 * “Qalys.” In Ethics out of Economics, Broome argues that QALY is a beneficial tool in medical decision making when weighing alternative choices, and that it does not, and should not, account for fairness. He stsates fairness should be a different issue.
 * "Rationing Of Medical Care: Rules Of Rescue, Cost-Effectiveness, And The Oregon Plan: Presidential Address" Lamb argues for cost-effective analysis that incorporates diplomatic values, and the superiority of Utilitarian methods of distributive justice through cost-effective analysis leads to a plausible single-payer system in the U.S.
 * "Diplomacy and Health: The End of the Utilitarian Era" Kevany and Matthews argue that the Kevany Riposte can be a better alternative to the old cost-effective analysis (CEA) in that it accounts for not only economic value, but also diplomatic value which has the advantage of improving cost-effectiveness, a perk that CEA seems to lack.
 * “The Ethics of Resource Allocation” (1983), Boyd asserts medical culture and society have competing values when it comes to resource allocation for those who are the most vulnerable, i.e. the rare conditions/diseases and/or complex trauma, and those in the norm of medical treatment. In any decision on resource allocation when considering these groups, it is inevitability that there will be an ethical offense. For context on Walker Hospital story

The Texas Advance Directive Law and Futile Care

 * “Futile-Care Theory in Practice: A Look at the Law in Texas” Capone and Grimstad argue that Futile-care theory and the Texas Advance Directives Act demeans human value and dignity and also provide examples of the misjudgments of medical experts "futile-care" decisions


 * "The Texas Advanced Directive Law: Unfinished Business" (2015), Kapottos and Youngner argue that the Texas Advance Directive Act (TADA) is incomplete in regard to its application because it lends itself to performative inconsistencies, i.e. what may be futile-care in one case may not be in another as judged by the provider or facility.
 * "Futility and Fairness: A Defense of the Texas Advance Directive Law" (2015), Jecker argues against Kapottos and Younger's critique and reasons that their premesis of TADA's inherent asymmetry, giving of unilateral authority, and incompleteness are invalid.

The Groningen Protocol

 * "Euthanasia of Newborns and the Groningen Protocol" (2014), The Groningen Protocol is the first of its kind to address euthanasia in newborns. Euthanasia is illegal in all countries of the world except Netherlans, Belgium, and Luxemberg. The Protocol calls for strict criteria in order to justify the process of active euthanasia of newborns with severe diseases and conditions. The critics of the protocol take issue with the determination of "quality of life" value and distorted views of unmistakable diagnosis and prognosis, among others. Worthy to note is that although euthanasia of newborns in the Netherlands isn't legal, however it is tolerated; it happens yearly with no one being sent to trial.
 * "Neonatal euthanasia: The Groningen Protocol" (2014). The Groningen Protocol is not ethically permissible, given the dubious nature of the protocol's criteria. Providers are given licenses under the principle of "do no harm first" which is inherent in the modern concepts of beneficence and non-malfeasance. One cannot accurately determine suffering or quality of life, especially in neonates. Regardless of inability to cure or return the patient back to health, providers must lean towards caring for and not killing the patient.
 * “Dutch Protocols for Deliberately Ending the Life of Newborns: A Defence” All parties relevant are involved in assuring the best good for the newborn and are in unanimous agreement that the killing of the newborn in severe cases is a good and not a bad. The standard of autonomy and suffering cannot be reasonably applied to newborns as done with adults. The killing of a newborn is morally permissible in extreme cases, and the deeply held belief against any killing of a newborn ever may be grounded in evolutionary development and not in a rational basis.

Triage

 * “Nursing Ethics and Disaster Triage: Applying Utilitarian Ethical Theory” Disastrous situations calls us to change our medical ethics when medical resources are scarce. Our priorities change on who to treat first and in disaster situations we tend to seek the greatest amount of good for the greatest number of people, a utilitarian principle. An understanding of utilitarian ethics will help the disaster triage nurse face the moral distress faced during disaster situations. Utilitarian ethics are used in disaster situations and to a lesser degree in regular medicine and therefore should be viewed positively.


 * Triage most used is ESI-5-tier system in U.S.


 * Among international triage systems, ESI, CTAS, MTS, ATS, RTS; RTS was shown to have the most reliability while ESI was shown to have the most validity.

Other

 * "AGAINST HOMEOPATHY – A UTILITARIAN PERSPECTIVE", Kevin Smith argues on the disutility of Homeopathy and the ethical problems associated with it. He also suggests ethical duties on the part of individuals and society and recommends actions that should be taken on the part of health-care professionals.
 * "Living Organ Procurement From The Mentally Incompetent: The Need For More Appropriate Guidelines".*The author discusses ethical problems with organ procurement from mentally incompetent and also why is would be problematic to categorically prohibit organ donation from this group, even though there is diminished autonomy associated with it. One view is that is may be morally acceptable to procure the organs if there is imminent danger to ones life and the donation would save them. In this case, there is only benefit to the recipient. The writers have guidelines to follow for such an ordeal 1) the recipients conditions renders the procedure necessary 2) the incompetent donor is the last resort, there is no medical alternative, no donor or live-competent donor 3) likely that procedure will be successful and organ will be accepted 4) risk and complications possible are seen to be acceptable for the donor 5) significant psychological benefits for donor are expected 6) donor and recipient are in close relationship 7) donor is included in the decision making process and does not actively dissent 8) guardians give legal free informed consent 9) final decision is taken by multi-discipline independent body. A quote from the article "A duty to fully protect vulnerable people may conflict with a duty to help people in need."

Opening paragraph [edit]
Utilitarian bioethics is a branch of utilitarian ethics and bioethics that recommends directing medical resources where they will have most long-term effect for good. [Definition: ]

It is implicitly used in some healthcare planning decisions, such as the use of quality-adjusted life years (QALYs) and the concept of triage, but is controversial in many other cases.

Contents

 * 1History
 * 2Economic argument
 * 3See also
 * 4References

[maybe restructure or take out some parts of the contents like further reading].

[end of opening section]

History[edit]
Although utilitarian philosophy traces itself back to the nineteenth century British thinkers John Stuart Mill and Jeremy Bentham, [Possible stoppage and creation of new sentence at the comma?] the application of these principles to contemporary bioethics originated in the work of Peter Singer in the 1970s and 1980s. A second generation of utilitarian bioethicists, including Julian Savulescu, Jacob M. Appel and Thaddeus Mason Pope, advanced these arguments '''[delete these arguments. replace with either principles or philosophy]''' further in the 1990s and 2000s. Among [delete among and put in a few] applications of the utilitarian bioethic in policy are the Groningen Protocol in the Netherlands and the Advance Directives Act in the American state of Texas.

In the 1990s [delete in 1990s possibly?],[previously took out "a"] backlash against utilitarian bioethics emerged, led by such figures as Wesley J. Smith and novelist Dean Koontz [delete dean koontz] Bernard Williams.

[end of history section]

Morality
Those against utilitarian principles in research, health care, or bio-medical fields suggest that the means to achieve an overall benefit for society is not justified and becomes immoral, and anyone who is part of the act or who is involved in it being allowed is complicit in its immorality. They argue that utilitarianism fails to join itself with common morality, and thus the cannot be accepted as a moral, and any application of utilitarian principles are unethical.

Those in favor of utilitarian principles in research, health-care, or bio-medical fields seek advancements in these areas for the benefit of all people and the collective happiness as a species. They view, what those who are against utilitarian ethics would suggest as immoral acts, as good and necessary practices as a means to maximize total well being,and the arguably controversial research and medical practices are good and beneficial to all people. Many who argue for the morality of utilitarian principles in research and medical areas point to our already accepted model of disaster triage, inherently utilitarian, which seeks to do the greatest amount of good for the greatest number of people by foregoing treatment of those in critical conditions for those who have a higher chance to recover and those that can be quickly cared for to then help in the care effort.

Resource Allocation
Utilitarian bioethics is based on the premise that the distribution of resources is a zero-sum game, and therefore medical decisions should logically be made on the basis of each person's total future productive value and happiness, their chance of survival from the present, and the resources required for treatment. One way to grasp an effective way to distribute resources is by cost-effective analysis. Utilitarian bioethicists argue that cost-effective analysis is the most effective tool in distributing and utilizing resources so to maximize the best possible outcome with the idea that the outcome would lead to a benefit or increased happiness for society One example of cost-effective analysis in regard to health care is the concept of quality-adjusted life years or QALY. QALY is a measure of benefit from treating or allocating resources to individuals based on the comparison of each individuals alternative outcome. Although there is controversy in regard to the equality of persons in this concept, equality should be regarded as a separate issue, because if one uses an standard of measurement that produces the same amount of qaly for each individual, as proposed by G.W. Torrance one of the economist credited to the creation of the concept, then there is unfairness when we consider different age groups, with the elderly getting a lower amount of qalys.

Some this method of resource allocation as mechanical and devoid of human emotion, and argue for an augmented form of cost-effective analysis which seeks to correct this, called the Kevany Riposte. The Kevany Riposte is similar to the traditional cost-effective analysis method in that it compares alternative choices and their cost-effective ratio, but adds and additional element to the equation which is called the diplomatic value. This added element to resource allocation takes into account the future diplomatic and political effects of a decision, which shows how choices can have a future improvement and be more advantageous in the long run, though less cost-effective in the outset.

For many resource allocation decisions, those involving the most rare and severe cases, medical culture and society are at odds and the choice of where to distribute resources will inevitably cause some ethical offense.

TADA and Futile Care
In 1999, with the passing of the Advance Directives Act, Texas became the first state to have a law on the books that deals directly with futile medical care. Section 166.046, Subsection (e) of the law states physicians have the right to refuse any intervention they deem as inappropriate. Utilitarian ethics would allow for such a decision given that if there is no benefit from the intervention, than resources as being used ineffectively and therefore effecting others in society, decreasing overall happiness. Some argue that the law is inherently flawed, in that what some physicians find futile-care, others might not agree. And even more, some argue that the very law itself demeans the value and dignity of human life. There have also been cases where the physicians who determined that treatment being done was futile-care were actually not so, which lead to possibly avoidable death. Given its criticisms, many applaud TADA for its groundbreaking development into medical policy and see it as a step forward to better health care.

Groningen Protocol and Euthanasia in the Netherlands
Euthanasia in the Netherlands has been legal for sometime, albeit not for infants. However, neonatal euthanasia still occurs in the Netherlands with a general tolerance by society and no physicians or associated parties going to trial. The Groningen Protocol sought to provide an ethical framework to allow for euthanasia of infants with severe medical diagnosis and prognosis. Many believe that the protocol cannot be followed because the criteria of the protocol cannot be met by neonates, namely the quality-of-life and pain and suffering criteria. Those against the protocol believe in the value of principilism, that of beneficence and non-maleficence, and that the physician should care for the infant with the best of their ability. Proponents of the protocol argue that if there is unanimous agreement for the euthanizing of the neonate among those who are in the best position to make that decision, the parents and physicians, then euthanizing is in severe cases is a good and not immoral.

See also[edit]

 * Baby K
 * Ezekiel Emanuel
 * Medical ethics
 * Peter Singer
 * Socialized medicine

References[edit]

 * 1) ^ Fetal Tissue and Fine Lines; New Technologies Test the Power of Utilitarian Principles, The Washington Post, Sept. 20, 1988 [this reference has nothing to do with the origins and contemporary application of utilitarianism. it is also cited incorrectly. *delete* the online article can be found here
 * 2) ^ Harris, Kathy. One Door Away From Heaven', Fort Worth Star-Telegram, Feb 14, 2002
 * 3) ^ Colon, Alicia. "When Killing An Ill Infant 'Is Not Wrong, The New York Sun, December 3, 2004

[None of the references can be found online]

Further reading[edit]
[Delete section, re-title, or add readings]

In favor of forms [Delete the words "of forms"] of Utilitarian Bioethics:


 * Peter Singer, Practical Ethics, Cambridge Univ. Press (Pap Txt); ISBN 0-521-43971-X; 2nd edition (February 1993) [maybe delete the reference and put this work in a citation]
 * Udo Schüklenk, 2001 [2001? what is this? delete?]

Against:


 * Deshawn A.Baptiste [delete. page does not exist]
 * Wesley J. Smith [just a wiki page. no reference to any work]
 * [ maybe Add Bernard Williams and a citation to his work]



Evaluation
Although the writer did mention the Definitions of abortion page and gave a brief explanation of the difficulty in defining abortion, I would address this difficulty in th opening paragraph, maybe giving a single sentence to it before explaining its' more general definition and its' relation to miscarriage. Maybe another source on the distinction of miscarriage and abortion could be taken from here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841747/

There seems to be little said about the issue with feticide in abortion which seems to be a huge issue in society today, with the proponents for anti-abortion calling any type of abortion feticide. I would talk more about the issue and give more context to the distinction of abortion and feticide and also multiple views of what constitutes feticide.

Talk Page
There is some talk in the definition but seems that this editor's reasoning differs from my own. I would like to see some distinction, if any, about the definitions of abortion and miscarriage. The talk page goes into how the abortion article is just a summary of the general topic of abortion and connect the article with different subtopics of abortion for further reading on the topic.

Evaluation
The second paragraph of the opening seems like an unfounded judgment, and looking at the source given which is just the Merriam-Webster dictionary definition of the word solidarity, it seems that this is just an assumption on behalf of the writer. I would take this part out or give more context and better citation to it. The last sentence of the opening sentence seems like it should have a comma after "Union" or end the sentence there and start off the next clause as a new sentence.

Also I would give some more context as to who the Émile Durkheim as the writer did with Peter Kropotkin, and also introduce other major figures relevant in the concept of solidarity and the early figures formed its ideology. I would add a history section to the article. I would also put all the important figures under one section to compile the information and make it more organized. The section on its use in philosophy seems too small for the article since the term itself is an ideological concept. I would add some various subsets of solidarity. I would also add more content to solidarity in various disciplines such as bioethics and sociology and provide examples.

Talk Page
There is a lot of talk of article development about this article. The article is rated as start-class. There is discussion about other social theorists and their use of solidarity but not enough about the historical figures. Also I agree don't agree with the last comment about highlighting leftist connotation but I do think there should be equal representation of political views on the concept of solidarity, if any.