Moral Hazard, Epistemic Injustice, Precedent Autonomy and Ethics of Biotechnology


This week’s readings discuss two issues in public health (the opioid epidemic and HIV) in which some people favor harm reduction strategies (like PrEP and naloxone), while others worry that use of those strategies present moral hazard that could make things worse.

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Using a specific example, describe a different public health issue (other than the opioid epidemic or HIV) in which a harm reduction strategy could present moral hazard. Do you think the possibility of moral hazard is reason enough not to employ that harm reduction strategy? Appealing to specific moral principles, defend your view with an argument.

Epistemic Injustice

Many patients report experiences of epistemic injustice in health care, with their reports of pain or descriptions of symptoms being denied or dismissed. To combat this problem, clinical bioethicists emphasize the important of the physician-patient relationship, arguing that a focus on respect, clear communication, and shared decision-making are ways to promote epistemic justice for patients.

Describe an encounter between a patient and a health care provider in which you believe epistemic injustice occurred. Many of you probably have a story of your own, or from someone you know, but there are plenty of cases that made the news, as well. Identify what aspects of the encounter were epistemically unjust. Be as clear and detailed in your moral reasoning as you can.

Precedent Autonomy

This week’s readings center on particular moral concerns that arise regarding patients with dementia who had previously expressed preferences regarding their care which now conflict with their current preferences. Although this is a very common occurrence regarding patients who have dementia, patients actually change their minds all the time. The best laid birth plans are often revised on the fly when the reality of labor hits. People who were very sure they “wouldn’t want to live like that” suddenly change their minds when the alterative to “living like that” is death.

Some argue that the frequency with which patients revise their preferences when actually confronted with the experience of illness suggests that the concept of precedent autonomy – and the practice of creating advanced directive that allow our former (presumably autonomous) selves to speak on behalf of our current (incompetent) selves, is flawed.

Do you think that you can know now what medical interventions you will want (or not want) in the future? If so, explain what moral values you hold that lead you to believe your mind will not change on these matters? If not, identify the moral values that you hold which lead you to believe your views on this matter are changeable.

Ethics of Biotechnology

For this discussion, I’d like each of you to do a little research and find an example of current biotechnological research (not the ones from the course readings) with potentially morally questionable implications. Briefly describe the research and/or provide a link.

After describing the example of biotech research you have found, offer the strongest argument you can in support of your position regarding the moral permissibility of that research. Be clear and specific, taking care to identify the relevant moral principles that are involved.

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