Up@dawn 2.0

Tuesday, January 31, 2017

Alternative Quiz #4

1. George Bernard Shaw described the medical relationship in his play, The Doctors's Dilemma, as a "conspiracy against the larity'. What does this mean? (p.80)

2. (T/F) Deciding what is in the best interest of the patient is ALWAYS straightforward? (p. 81)

3. What are the three key features of valid consent? (p.83)

4.  (T/F) No matter what, a doctor or health care professional is not allowed to disclose patient information. (p.87)

5. What is the medical terminology for the termination of pregnancy? (p. 88)

6. What is "in vitro" fertilization?  (p.92)

7. What is a designer baby? (p.96)

8. What does SCNT stand for? (p. 99)

9. What are cadavers and why are they relevant? (p. 109)

10. Name one of the books Campbell recomended for further reading and resources for this chapter.


1. How do you feel about the concept behind designer babies?

A Clip from House for Discussion

House as a series is pretty great at showcasing all kinds of moral and ethical dilemmas that can come up in the medical field, and one that I think should be mentioned here is when one of the doctors in the show (Chase) has a patient who happens to be a dictator of an African country. This dictator has been charged with crimes against humanity, and is a pretty stereotypical evil character. While this man is in the hospital, Chase has an opportunity to murder him and make it appear like an accident. The ethical question here is: Do you kill the dictator? Or do you let him live so he can "fly back to his country and murder thousands of people?" (quote from the show).

This raises a few interesting questions. One of them is not restricted to the medical field, and it can be stated as "If you know someone is going to kill numerous innocent people, and the only way you can stop this person is by killing them, should you do it?" The other one, which is specifically medically related, "Do doctors have an obligation to treat their patients to the best of their ability, even if they believe their patient is despicable human (in their opinion)?"

Alternative Quiz Questions: Ch. 4 Clinical Ethics

1. Campbell states that the "first consideration of a health professional must always be the best interests and welfare of the patient -". Why is this seemingly obvious statement even stressed? (80)

2. What is the overall result of long-term care of severely mentally or physically compromised patients who cannot care for themselves and make their own treatment decisions? (86)

3. What is considered the strongest reason for stressing the importance of confidentiality? (87)

4. An individual who HIV positive refuses to inform a sexual partner of their diagnosis. This is an example of a breach to what principle? (88)

5. What are some of the numerous conceptual difficulties mentioned by Campbell under the mentality that the entity created at conception is a person due to genetic uniqueness? (89)

6. Name at least one of the ethical concerns raised by the possibilities of creating a child mentioned by Campbell. (93- 94)

7. What is the relation between the term "natural" and the term "person" and how does this perhaps  contradict the teachings of the catholic church? (94-95)

8. What is the therapeutic potential of of Somatic Cell Nuclear Transfer? (99)

9. What are the two concerns related to ethical issues revolving around individuals with mental illness? (101)

10. After accepting death as a _______________, and not merely as a __________________, the question of whether to withhold or withdraw treatment immediately arises. (105)

Optional Alternate Quiz for Chapter 4

1.      In the play by George Bernard Shaw, the medical relationship is seen as a ‘conspiracy against the laity’. What does he mean by this?(80)

2.      What are the 3 key  features of valid consent?(83)

3.      What is ‘tort’? How can a health care professional be guilty of it?(85)

4.      Which court case resulted in the general principle that confidentiality could be breached if there was a clear threat to an individual?(87-88)

5.      The Roman Catholic Church led some groups to describe abortion as… (89)

6.      The ___________ view is one that sees the fetus as the beginnings of a nascent human life, but still far short of individual human existence as a person. As it develops it has increasing significance. (90)

7.      What is a weak justification for wanting to get an abortion? (91)

8.      Through assisted reproduction, theoretically how many parents could a baby have? (93)

9.      What are considered the ‘building blocks’ of all organic tissues in regenerative medicine?(99)

10.  What is a traditional approach in delivering a ‘bad prognosis’? (103)

Sunday, January 29, 2017

Should a person with mental disabilities be denied an organ transplant?

The New England Journal of Medicine recently reported that U.S. Congress legislators made a petition to the Department of Health and Human services regarding whether a person with disabilities should receive an organ transplant or even be put on the list. With over a hundred thousand people on the waiting list for an organ, it’s safe to say the supply is limited. Some healthcare providers are afraid to give a person with intellectual/mental disabilities an organ because of the fear it may be “wasted.” The theory is that the person receiving the organ may not have the mental capacity to take care of themselves post-op and, thus, the organ may be rejected. If that is the case, someone who could have taken better care died while on the waiting list. However, research has shown that children with intellectual disabilities have the same odds of having a successful transplant as the children without disabilities. This study did not include adults, however, and children do have parents, guardians, or caregivers to ensure the best quality of care. Still, healthcare providers are wary to give children the transplant if they have a disability. One story became viral of a three-year-old girl named Amelia Rivera when she was denied a kidney transplant. The reasoning? She suffered from Wolf-Hirschhorn syndrome that causes severe intellectual impairment. The internet created a campaign with over fifty thousand people supporting her and she received the transplant. Other man in his twenties was denied a heart transplant because he was diagnosed with autism. Medical professionals are now calling for a review board that can make the decision if the case is debatable. Personally, I think they should not be excluded on the waiting list or denied an organ transplant.

Source: http://www.philly.com/philly/health/topics/HealthDay719036_20170125_Should_a_Mental_Disability_Keep_Patients_Off_Organ_Transplant_Lists_.html

Friday, January 27, 2017

Quizzes Jan31 & Feb 2

Quiz Jan 31, BB 4 - Clinical Ethics

1. (T/F) Dignity, respect, and confidentiality are among the aspects of the clinical relationship which emphasize the importance of trust. 

2. What (according to most recognized oaths and conventions) must always be the deciding factor guiding professional decisions? 

3. The idea that the doctor always knows best is called what? 

4. Is a diagnosis of mental illness grounds for establishing a patient's lack of capacity to render competent consent to treatment? 

5. What general principle allows breach of confidentiality? 

6. What term expresses the central ethical concern about "designer babies"? What poet implicitly expressed it?

7. Why have organizations like the WHO opposed any form of organ trading?

8. Besides the Kantian objection, what other major ethical issue currently affects regenerative medicine?

9. What does palliative medicine help recover?

10. What would most of us consider an unwelcome consequence of not retaining the acts/omissions distinction with respect to our response to famine (for example)?


  • How do you generally go about establishing trust in a new relationship? Do such general considerations apply equally to the clinical relationship? How does "professionalism" relate to trust?
  • Considering the "demented professor" (81) and other instances of patients whose expressed "best interests" may conflict with a clinician's therapeutic impulses: how important is the patient's present happiness, in influencing your clinical evaluation?
  • What's wrong, if in fact the doctor does possess more accurate information and more relevant experience, with treating the patient after the analogy of parent and child?
  • What would Dr. House do about patients who make (in his opinion) foolish decisions regarding their care? Would you hire him to work in your hospital?
  • Under what circumstances would you NOT violate confidentiality and inform a patient's partner that they were HIV positive?
  • What concept is more relevant in evaluating the ethical status of abortion: viability, humanity, personhood, maternal rights, or... ?
  • What do you think of Thomson's violinist analogy (91-2)?
  • Can a baby really have five parents (as opposed to five co-progenitors)? How do you define parenthood?
  • Should surrogacy, organ trafficking, and transplant tourism be regulated? How, and by whom? 
  • Do you think our society has a healthy attitude towards mental illness? Is it possible to declare a politically and ideologically neutral standard of sanity?
  • How would you counsel patients who insist they no longer value their "quality of life" and refuse potentially effective treatment and medication?  
  • Can the medical profession ever fully embrace the concept of ars moriendi, the art of dying?
  • Can you imagine ever facilitating a suicide, professionaly or personally?
  • Is there anything wrong with displaying cadavers in a museum exhibit (as in "Bodies: The Exhibition")? What guidelines should be followed?

Also of interest:

Drug Shortages Forcing Hard Decisions on Rationing Treatments...In a survey of cancer doctors conducted in 2012 and 2013, 83 percent of respondents who regularly prescribed cancer drugs reported having been unable to provide the preferred chemotherapy agent at least once during the previous six months. More than a third of them said they had to delay treatment “and make difficult choices about which patients to exclude,” according to a letter published in The New England Journal of Medicine.

The threat of future shortages in children’s treatments is serious enough that Dr. Peter Adamson, who leads the Children’s Oncology Group, the largest international group of children’s cancer researchers, assigned his organization to set priorities. “We’ve been forced into what we think is a highly unethical corner,” he said in an interview...
Scientists create a part-human, part-pig embryo — raising the possibility of interspecies organ transplants

Human stem cells could be implanted in an early pig embryo, making a chimera with human organs suitable for transplant.

The president has greatly expanded a policy restricting federal aid to health organizations abroad that talk to women about abortion.

Quiz Feb 2, BB 5 - Research.  Happy Groundhog Day! (It still casts a shadow...)

Today in Bioethics we'll talk "research." Things like clinical trials and research involving animals and their rights, and genetics, and epidemiology. We'll look at the funding gap between what we need to cure and where our research dollars are actually going, and at the moral imperative of genuine and informed consent. We'll look at disturbing instances of fraudulent and dishonest research. And we'll consider Peter Singer's claims about "speciesism."

The future of research is a daunting source of apprehension and speculation. Michael Sandel and Bill McKibben have aired serious concerns about genetic and other "enhancement" research as potentially catastrophic for our capacity to achieve or even recognize "meaningful" lives. Enhanced may not mean improved.

1. Name one of the basic requirements agreed upon by all codes devised to protect individuals from malicious research.

2. What decree states that consent must be gained in all experimentation with human beings?

3. Name one of four areas of research discussed in the book.

4. Which famous contemporary philosopher coined the term speciesism?

5. Name one of four R's used in international legislation pertaining to animal rights in research?

6. Dilemmas in epidemiological research illiustrate what general point?

7. What did Hwang Woo-suk do?

8. What is the term for altering the numbers in a calculation to make the hypothesis more convincing, with no justification form the research findings for such members?

9. What categories of human enhancement does Campbell enumerate, and what does he identify as its "extreme end"?

10. What is the "10/90 Gap"?


  • Can there really ever be "fully informed" voluntary consent, given the many unknown variables and unpredicted consequences involved in most research?
  • Discuss: "Trials of pharmaceuticals may be driven as much by commercial considerations as by the likelihood of real therapeutic gain." 122
  • What concerns do you have about the use of animals in medical research? Is speciesism one of them? 10 medical breakthroughs due to animal testing... PETA... Touring an animal research facility
  • What limits, if any, would you like to see imposed on genetic research and the uses to which it may be put?
  • Were ethical improprieties committed in the case of Henrietta Lacks, whose cells (HELA cells) were harvested without her consent? (Rebecca Skloot... BBC...CBS...)
  • If "dreams of perfect health by the better-off will determine the research agenda" in the future, resulting in soaring health care costs and greater health "enhancement" opportunities for the wealthy, what should be done to insure adequate attention to "the health problems of most of the world's population"? 129
  • Should we be worried about a "Prozac revolution" and a "brave new world" of somatically-induced apathetic bliss? 130
  • Would you give special priority to any of Campbell's five enhancement categories (130)? Is "Transcendence"-style enhancement beyond the realm of reasonable concern (given the considerable monied interest of people like Larry Page)? 
  • Comment: "Why would we want such a 'posthuman' future? Are our lives better if we become physically stronger or more agile, or have an increased intelligence, or live for centuries?" 131
  • Is the outsourcing of clinical drug trials to developing countries ethically defensible? 132
  • How would you propose making research priorities "aligned to the needs of the majority"? 133
  • Is it likely that biobanks and other communitarian initiatives will in the future "prioritize health research according to need rather than profit," particularly in the U.S.? Would you support such a reprioritizing? How?
  • Have you seen Sicko? Care to share a review? Or of Michael Moore's latest doc'y?
Also of note:

To enhance our SuperBowl experience-
The New York Times (@nytimes)
N.F.L. Great Ken Stabler Had Brain Disease C.T.E. nyti.ms/1R1vYYw
It's the birthday of the first woman to graduate from medical school, Elizabeth Blackwell, born on this day in Bristol, England, in 1821. She wanted to become a doctor because she knew that many women would rather discuss their health problems with another woman. She read medical texts and studied with doctors, but she was rejected by all the big medical schools. Finally the Geneva Medical College (which became Hobart College) in upstate New York accepted her. The faculty wasn't sure what to do with such a qualified candidate, and so they turned the decision over to the students. The male students voted unanimously to accept her. Her classmates and even professors considered many medical subjects too delicate for a woman, and didn't think she should be allowed to attend lectures on the reproductive system. But she graduated, became a doctor, and opened the New York Infirmary for Women and Children. WA Feb3
IACUC - Institutional Animal Care and Use Committee

The Institutional Animal Care and Use Committee (IACUC) is a regulatory body comprising MTSU faculty who are appointed by the University's President through the recommendations from the Institution's Faculty Senate. The IACUC is responsible for reviewing the activities that involve the use of animals to enforce humane & ethical practices to be adopted by the University employees. MTSU adopts the following minimum requirement for the Committee's constitution thereby complying with the requirements of both USDA and PHS...
Neil Gorsuch wrote the book on assisted suicide. Here’s what he said.

Not since 2006 has the Supreme Court taken up a case involving “death with dignity” legislation — the handful of state laws that allow people to end their lives with the help of a physician. That year, the court handed a victory to death with dignity advocates, ruling that the attorney general could not bar doctors in Oregon — the first state to pass such a law — from giving terminally ill patients drugs to facilitate suicide.

It was only the third time the court had heard a case challenging such statutes, and the six-member majority tread lightly, recognizing the sensitivity of the issue.

“Americans are engaged in an earnest and profound debate,” the majority wrote, quoting from a previous opinion, “about the morality, legality, and practicality of physician-assisted suicide.”

That debate is far from resolved today — and it’s one Neil Gorsuch, President Trump’s nominee to the high court, will surely be eager to weigh in on, should he win confirmation.

Gorsuch, a 49-year-old federal appeals court judge from Colorado, was tapped by Trump on Tuesday to replace Justice Antonin Scalia, who died last year after three decades on the Supreme Court. Aside from his bona fides as a lawyer and a jurist — which may all but guarantee a favorable vote in the Senate — Gorsuch has cultivated something of an expertise in assisted suicide and euthanasia in his legal career.

[Trump picks Colo. appeals court judge Neil Gorsuch for Supreme Court]

In 2006, the year he was nominated to the federal bench, he released a heavily researched book on the subject titled “The Future of Assisted Suicide and Euthanasia.” The front cover looks almost like a Tom Clancy novel, with purple all-caps block text set against a black background. But the book itself is a deep, highly cerebral overview of the ethical and legal debate surrounding the practices... (continues)

Thursday, January 26, 2017

Website: Bioethics.

This website is a good one to us here in Bioethics. It has a numerous number of topics about bioethics' topics. 

Culture and Religion on Bioethics.

The field of bioethics continues to struggle with the problem of cultural diversity, cultural relativism and ethical relativism: can universal principles guide ethical decision making, regardless of the culture in which those decisions take place? Or should bioethical principles be derived from the moral traditions of local cultures? These questions are inevitable when diverse cultures and moral traditions share a common world, but they are barely considered and poorly addressed when Western bioethics travels abroad. We all agree with the influence of culture and religion on ethics. Each culture has such a unique form of society. Indeed, each culture has its unique ethical principles. We challenge the premises of moral universal-ism, showing how this approach imports and imposes moral notions of Western society and leads to harm in non-western cultures. Therefore, we cannot use universal principles guide ethical decision making regardless of the culture in which those decisions take place. As what Campbell asked "Should we suppose that each of us is trapped in our own culture and belief system, so that there is no possibility of a shared human morality? This case is called ethical relativism. I think this is one of the main theory that relates to the bioethics. Even if there are some serious problems with it. I also agree with Campbell about cultural influences seems better to talk about, but not to accept that they are so utterly determinative of it that there is no point in seeking universal human values. Last point I would like to share with you is about "moral absolutism". Moral Absolutism is the ethical belief that there are absolute standards against which moral questions can be judged, and that certain actions are right or wrong, regardless of the context of the act. I think moral absolutism doesn't even exist. 


Midterm choice

I'm  interested in the Case against Perfection as a choice for the midterm project . . . If anyone else is interested in this too, please let me know. :)

Stem Cell Research and Ethical Theories

This will probably overshoot 250 words, but I just wanted to run the stem cell debate past some of the ethical theories we talked about in chapter 2.

Utilitarian Consequentialism

The expectation of stem cell research is that the use of such research will rapidly expand our knowledge and production of certain types of intelligence regarding human tissues and organs. It's not hard to see how this research could be incredibly beneficial to humanity and reduce a large amount of pain and suffering; therefore, I would say that the utilitarian would be on board with stem cell research.

Kantian Deontology

This one is a pretty slippery slope. Kant wants us to treat ever person as an end, not a means to an end; however, when we're talking about embryonic stem cells, the discussion becomes: when does one obtain "personhood." Depending on your opinion (which Kant would want you to be very honest about), it may be a hard pass- Kant would never want you to destroy a life for the potential benefit of another.

Virtue Ethics

Far and away the most enigmatic ethical theory, in my opinion, virtue ethics would have us ask "how should I be?" The implications of this are numerous and seem to naturally mingle with the same issues that Kantian Deontology brought forth. What is more conducive to building moral character- to strive to advance medical science? Would it necessitate the sacrifice of innocent lives and, if so, would it be worth it? I'm not approaching this for an answer. The vague nature of (my understanding of) virtue ethics lends itself to a cycle of perpetual reflection more so than the other theories we've covered, and for that, it may be my favorite.

Word count: 287

Alternative Quiz Questions: Ch. 3 Perspectives

1. A 2009 report published by the WHO showed that the biological and behavioral advantages of women in higher-income countries are outweighed by what? (49)

2.What are some common stereotypes of masculinity and femininity in regards to the way people handle moral issues? (52)

3. How does the philosophical idea of dualism view the mind in relation to the body? (52)

4.What are the subtle differences between ‘caring for’ and ‘caring about’ people? (56)

5. What is the philosophical paradox that Campbell uses to address the issue with ethical relativism? (57)

6. (T/F) Globalization of trade and the rapid spread of mass communication has had a significantly negative effect on Asian cultures and has been detrimental to their economies. (58)

7. Both of the dharmic traditions Campbell discusses see spiritual development and liberation rather than simply moral development, which results in what sort of behavior towards the world? (68)

8.  Which of the five religions discussed does Campbell consider to be the most “complex and diverse”? (72)

9. Arguably the most characteristic feature of Islamic bioethics is that it is ___________. (76)

10. How do the ideals of Islam view God’s will in terms of the Socratic question, “Is something good because God wills it, or does God will it because it is good?” (77)

Tuesday, January 24, 2017

Trump Reverses Abortion Policy for Aid to NGOs


Seems relevant to us here in bioethics.

"Between a Rock and Hard Place"

 Answering the discussion question of "What would you do as the Mayor in the situation", I believe that what I would want to do and what I would actually do are two completely different subjects. Solely because we don't know the outcome of our actions. If we could see the future and get a better idea on what was to come, our choices would be easy. But... since I am neither clairvoyant nor a time traveler, my answer is this:

1. What I would want to do
    I would want to take that "unloaded gun" and fight. Of course, I would realize that it is not loaded, but I would keep fighting. I think this is the most important idea in life. Fighting for what feels right to you, fighting for your moral ground, and fighting to show others that its okay to stand up to authority if it is against your moral ideals. I would fight because I would want to be this example to the hostages. Surrender is not always the answer, and more than likely judging the previous actions of the colonel with the mutilated bodies, he is not above killing the hostages regardless of you killing the two captives. So with this, I say fight with everything that you are.

2.What I would actually do
    As stated above I do not possess any mystical powers or abilities. Therefore, it can be said that in a situation of this amount of pressure, it would depend on what thoughts were racing through my mind during the few minutes given to make a decision. Personally,  I panic slightly under pressure. I would hope that  I made the decision above, but it such a state I  cannot imagine making such a choice.
I could never kill an innocent man,yet i'd be willing to sacrifice myself at the hope of  some chance of freedom for others whether that be the freedom physically from the tyrants or spiritually through death, freeing them from a life of enslavement. A quote from Star Wars( yes i'm a nerd):

Image result for hope quote star warsImage result for star wars

Alternative Quiz Questions: Ch. 2 Moral Theories

1. According to Bentham’s Greatest Happiness Principle, what is the “correct” moral choice that the mayor should make? (20)

2.The idea of universal law, which considers the idea that when doing a particular action, we must be willing to accept the same action being done to us, is more familiarly recognized as what rule? (26)

3. (T/F) Because our moral absolutes need to be more carefully formulated, it would be more beneficial to consider Kant’s alternative formulation of basic moral law which states that people should be treated as the means to an end. (29)

4. At the core of Kantian moral principle (deontological theory), is the requirement to respect the ___________ of others. (30)

5. According to Campbell, why is Kant’s approach of requiring logical reasoning for moral decisions seem to be “asking both too much of us and too little”? (31-32)

6. What is meant by a virtuous human being? (33)

7. According to English philosopher Thomas Hobbes, without society what becomes of our lives? (39)

8. ( T/F) In Isaiah Berlin’s revised version of liberal theory, more room is allowed for a richer account of moral agency as opposed to the highly individualistic version. (42)

9. What is a common misunderstanding of Beauchamp and Childress’s four principles addressed by Campbell? (43)

Saturday, January 21, 2017

The New World Order.

Hey Guys,
I would like to share with you this part from Lemert's book "Social Theory". In his book, he talks, in general, about the new world order. What is meant by the new world order? What place will it allow for the old ways? what new demands will it put before human beings? Actually, questions like these nag at us, whatever our policies or ethics or situation in life. In this respect, the end of the twentieth century is a time much like the end of the nineteenth. We are asked what to make of the new world order. We are asked to think about the world in terms different from those used before.
As what I said and mentioned in my first post about the ethical relativism from one society to another. Also this part I just shared above from Lemert's book "Social Theory" talk about a new world order which means we have to use and think about the world in terms different from those used before. Indeed, we have to think differently about bioethics and its questions, laws, demands, etc. 

Friday, January 20, 2017

Informing Patients of Their (Sometimes Bleak) Diagnosis/Prognosis

The conversation in class yesterday was a pretty good barometer of the way in which many people in today's age view the idea of whether or not doctors and/or family members should inform patients of their terminal diagnoses. Many people share Nick's sentiment of "I wouldn't want anyone to keep it from me, so I certainly wouldn't keep it from anybody else." However, this has certainly not always been the case, and many people still do quite the opposite.

Sherwin Nuland talks rather extensively about this in How We Die. He informs us that many times doctors will not comprehensively inform the patient of their diagnosis. An example would be a doctor telling a patient that he/she has a serious form cancer, but the doctor would leave out the fact that the test results also indicated that the patient has a 5% chance of survival. The reason doctors and families alike do this, Nuland says, is that many doctors believe that, even with all of the leaps and bounds medical technology has made in the last few decades, hope is still the best medicine the human race has in its arsenal. If you take away a patient's (or even their family's) hope, you may have just removed the best chance the patient has of recovering. And this is a hard stance to contest, as most of us have heard of one case or another about somebody simply hanging on and fighting against all odds to overcome their prognosis, to prove their doctors wrong, and defeat the odds.

So why then, do the apparent majority of us believe that we should tell people their diagnosis, even if it is the worst imaginable, and even if it may actually lower their chance of survival in ways we don't yet quite understand? Because by not educating someone exhaustively on their diagnosis you are taking away their freedom to take control of their affliction in the only way they can: their freedom to choose how they spend their final days, as in Dr. Oliver's case with his father; their freedom to choose how they die, ideally with dignity; and their freedom to take control of their future, which is now much shorter than they could have imagined.

There is certainly a lot more that can be said on this, but I'll stop here as this is essentially Nuland's thesis on this idea, and I thought it seemed pretty relevant given the discussion yesterday. I would love to hear other people's ideas on this, so feel free to leave some comments, even if they disagree (or perhaps preferably if they disagree!)
                                                                  - T-Rex

What's Bioethics and Ethics itself?

As Campbell begins his book by asking many questions that show what the bioethics branch of study is concerning about. Bioethics deals with ethical questions surrounding clinical medical practice, with ethical issues entailed by biomedical research, and with more general ethical questions about the maintenance and improvement of the health and well-being of communities on both the local and global levels. Bioethics has a very long history concerns about how doctors treat their patients. The history also shows us some ethical codes like "Hippocratic Oath and the Charaka Samhita Oath". Also when we discuss a topic such bioethics, we cannot just move on without highlight the ethical relativism theory. Ethical relativism is the theory that holds that morality is relative to the norms of one's culture. That is, whether an action is right or wrong depends on the moral norms of the society in which it is practiced. The same action may be morally right in one society but be morally wrong in another. Indeed, the answers for the questions that Campbell asks in the beginning of his book will have different answers than what we had before. Basically, there is a wide variety of social norms in the world regarding what is good or evil. Many cultures have norms that differ so much from each other that they are virtually contradictory. And social norms of conduct have also varied through the ages, with some eras having very different norms than other eras.