Ethics: Concept Checklist

Concepts covered across the module lectures, grouped by lecture. Tick each once you can explain it from memory.

L1 Brain Death and EOL (4 Mar) L1 Ethics Brain Death and EOL

• Why pronouncing death matters, and historical views on determining death
• Brain death: three cardinal findings (coma, apnoea, absent brainstem reflexes) and the ANZICS process
• Brain death as a medical determination not requiring family consent, and avoiding the term “brain dead”
• Personhood and personal identity as philosophical problems in end-of-life care
• Persistent/permanent vegetative state vs minimally conscious state: definitions and time criteria
• Landmark cases: Quinlan, Schiavo, Bland, Gard, and what each illustrates
• Enduring Power of Attorney: legal basis and limits of authority
• Advance directives under Right 7(5): definition, value and challenges; advance care planning
• Quality of life vs sanctity of life, and risk of unacceptable badness with life-saving but non-restorative treatment
• Glasgow Outcome Scale and extended GOS
• Locked-in syndrome: definition and causes
• Clinical approach to end-of-life decisions: goals of treatment, trial of treatment, working with families, reflection and support

L2 History of medicine, explanation and the biopsychosocial model (16 Mar) L2 Ethics History of medicine, explanation and the biopsychosocial model

• Engel’s critique of the biomedical model and the biopsychosocial alternative
• Snow and the London cholera outbreaks as refutation of miasma theory
• Semmelweis and puerperal fever: hypotheses refuted, predictive testing, and the Semmelweis effect
• Deductive-nomological model of explanation: laws, facts, explanans and explanandum; explanatory relevance and testability
• The ME/CFS controversy: Harvey and Wessely’s causal pathway, the PACE trial and objections to psychosocial explanation
• Levels of explanation and Dennett’s physical, design and intentional stances
• Definition of pseudoscience and how it differs from ordinary scientific error
• Anti-scientific rhetoric: fluoridation example and Gish galloping
• Disease mongering, illustrated by female sexual dysfunction and flibanserin

L3 Ethics of Resource Allocation (12 Jun) L3 Ethics Ethics of Resource Allocation

• Inevitability of rationing, and criteria proposed for rationing decisions
• Role of PHARMAC, and QALYs as a tool for maximising benefit (cost per QALY rankings of interventions)
• Objections to QALYs: ex ante vs ex post utilities, ageism, double jeopardy
• Rule of rescue: definition, pull on decisions, and the Child B case
• Retributive vs distributive justice
• He Korowai Oranga: rangatiratanga, equity as different approaches for different advantage
• Ethnicity in surgical prioritisation, and NZ ethnic disparities in cancer screening and mortality
• Rawls’ theory of justice and the original position
• Triage under scarcity: the ICU bed transfer case and justice-based guidelines
• Race-conscious rationing: SOFA-based ventilator allocation, how it can encode racial disadvantage, and proposed responses

L4 Euthanasia and physician assisted suicide (20 Jul) L4 Ethics Euthanasia and physician assisted suicide

• Distinguish withdrawing or withholding treatment, assisted dying, voluntary euthanasia and non-voluntary euthanasia
• Palliative care goals, palliative sedation therapy, and the doctrine of double effect
• Contested terminology around assisted dying, and the Act’s own definition
• International variation in legal assisted dying and eligibility conditions
• Legislative history of the End of Life Choice Act: Seales case, select committee, referendum, commencement
• Eligibility criteria under the Act, and conditions that alone do not confer eligibility
• Process under the Act: practitioner cannot initiate, roles of AMP, IMP, psychiatrist and Registrar, methods of administration
• Conscientious objection under the Act and the duty to inform about SCENZ
• NZ assisted dying service data: trends and applicant demographics
• Assessing arguments by truth and validity
• Arguments from compassion and autonomy, the joint view, and objections to each
• The assist-prevent continuum and the ambiguous role of the assessing doctor
• Evidence on attitudes: public polls, citizens’ jury, doctors and medical students
• Reasons people request assisted dying
• Unresolved concerns: rising numbers overseas, expanding criteria, pressure on providers, vulnerable persons and erosion of palliative and social support

L5 AI Ethics (14 Aug) L5 Ethics AI Ethics

• Definition of AI; symbolic AI vs neural networks and the black box; machine learning as statistical pattern recognition; large language models
• Five categories of opportunity for AI in healthcare, with examples
• Landscape of clinical-ethical challenges raised by AI
• Hype vs evidence: marketing and political claims for AI scribes compared with rigorous study findings
• Tensions between bioethical values and AI innovation pressures
• Explainability and the black box problem as a value trade-off
• Data and algorithmic bias, and AI as a possible tool to correct bias
• Hallucinations and automation bias, and the impact of AI scribes on clinical reasoning and recall
• Benefits vs risks of AI scribes in general practice
• Main ethical considerations: privacy, liability, Māori data sovereignty, hidden work, lack of evidence
• Slow innovation and critical-constructive assessment of AI tools

L6 Assisted reproduction (17 Aug) L6 Ethics Assisted reproduction

• Historical context of reproductive ethics: contraception, sterilisation and abortion
• Distinguish reproductive autonomy, procreative liberty and reproductive justice, and their historical development
• Human Rights Act 1993 anti-discrimination grounds relevant to fertility care
• Purposes of the HART Act 2004, including prohibitions and the information-keeping regime
• Prevalence of infertility in NZ and the publicly funded treatment pathway (FSA, CPAC score threshold)
• Referral eligibility criteria for publicly funded fertility assessment
• HART Act tiers: established procedures, regulated activities and prohibited activities, with examples
• ACART criteria for family gamete donation and surrogacy, and the close-relative prohibition
• Surrogacy: regulation, prohibition of commercial surrogacy, the 2013 Thailand case, NZ law reform
• Emerging technologies: PGD, genome editing, commercial embryo and newborn genetic testing

L7 Ethical issues of pregnancy _ birth (19 Aug) L7 Ethics Ethical issues of pregnancy _ birth

• Scope of reproductive ethics and the five-stage evolution of reproductive rights concepts
• The intention-behaviour gap in pregnancy lifestyle change
• Food safety in pregnancy: foods to avoid, listeriosis and toxoplasmosis risks; caffeine limit
• Smoking, vaping and alcohol in pregnancy: risks, support services, and social gradient in continued smoking
• Maternal requests against medical advice and how often they occur
• Container, dual patient, relational and parthood models of pregnancy
• Fetal personhood, court-ordered caesareans and criminalisation of pregnancy outcomes
• Rights 5, 6 and 7 of the Code applied to pregnancy and birth, including the right to refuse