Phil 3305: Medical Ethics
Instructor: Fareed Awan
Fall 2015 Anderson Hall 250 M 6:00-9:00pm
Email:
[email protected] Office: 858 Heller Hall Office Hours: T 10am-12pm
Grader: Jason Steffen (
[email protected]) Course Description: This is an introductory course in medical ethics. We will use critical philosophical methodology to examine contemporary problems related to current medical practice, research, and healthcare systems. The course begins with foundational problems within clinical and research practice, including: Is paternalism on the part of medical experts justified? To what degree should patients control their care? Should medical professionals always tell the truth? We will critically examine how these questions have been answered by patients, physicians, courts, and philosophers. The course will also examine contemporary philosophical debates on abortion, end-of-life decision-making, and the use of reproductive technologies, such as cloning. We will question what justice means in three different senses: 1) What is a just distribution of scarce resources, such as transplantable organs? 2) What is a just distribution of healthcare resources across a system? And 3) how should we conceptualize healthcare as a global health concern? In the final portion of the course, we will examine at individual roles and responsibilities within medicine, such as should conscientious objection be allowed? We will consider the cases of pharmacists and prescription contraception, as well as cases from medical education and research ethics. This course will familiarize students with philosophical methodology, especially written critical analysis, and cover a wide range of questions in the field of medical ethics. In this course, the complexities of reality will confront philosophical inquiry into what is good, right, and just. Textbook: Ethical Issues in Modern Medicine, 8th Edition. Eds. Steinbock, London, and Arras. New York: McGraw-Hill, 2013. Moodle: The paper, skills assignments, and short reading responses will all be submitted to the course Moodle site, accessible through moodle.umn.edu Readings not in the textbook and audio/visual course materials will be distributed via the Moodle site. There will also be a discussion board as a forum for class discussion, questions, and interaction with your peers. Course Expectations: Our task in this class will be to delve into timely and often controversial material together through discussion. Doing good philosophy requires patience and effort. Understanding
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these texts requires multiple readings, copious annotation, and thought. Students should expect to contribute the following to this course: 1. Preparation – In order to make a useful contribution to the discussion, you must complete the assigned reading prior to class, reread the material if it is not clear, and think through critical examples. 2. Participation – Philosophy is challenging. The best way to learn is to ask questions and engage critically with the variety of arguments presented. You will be expected to contribute to class discussion and engage with the material. 3. Respect – Given the course material and the nature of ethical theory, disagreement is both expected and encouraged. However, you are expected maintain a scholarly and respectful tone. This means that you should address the points presented in your peers’ arguments fairly and not attack that person’s character. Comments reflecting judgment about the character of the person presenting the argument are not acceptable. Evaluation: The course is graded out of 500 points: Short Reading Responses (RR) (12 – lowest 2 dropped, 10 points each) Skills Assignments (5 – Assignments distributed, 50 points each) Micro-responses (In class: 12 – lowest 2 dropped, 5 points each) Final Exam (Cumulative, 100 points)
100 Points 250 Points 50 Points 100 Points
Every assignment, besides the micro-responses should be submitted through the Moodle course page. The final course grade, i.e. the letter grade, will be based on the total points earned; you will not receive a letter grade until after the final exam. Grades will be formally assigned on the following basis: A/AB+/B/BC+/C/C-
Student performance was exceptional relative to what is required. Student performance was significantly above what is required. Student performance fulfilled all course requirements. Student performance is worthy of credit, even though course requirements D+/D/Dhave not been fulfilled fully. Student performance is insufficient to earn course credit, even if some F requirements are fulfilled. Students taking the course on a S/N basis must earn a C- in order to receive a grade of Satisfactory. Incompletes (I) will not be given except in extreme circumstances.
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Assignment Guide: Reading Responses (RR): You will be expected to submit 12 reading responses during the semester. Eight of twelve readings are marked as having a required reading response on the syllabus. •
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The RR should do two things: (1) summarize the main argument of an article and (2) offer either additional support or development of an argument/premise or one critical objection, in the form of a counter-example, pointed question, or difficult case that serves to critically engage with the article. Maximum length is about 250 words, i.e. around 1 page. The eight required RRs are marked on the assignment section of the syllabus below. They will be due the Friday before they are discussed in class. You may only submit ONE reading response per week. The additional four “open” RRs should be submitted before we cover that reading in lecture. For example, a reading response for the material covered in lecture 7 on 10/26 is due on Friday 10/23, and you may write about any of the article listed for L7. The same requirements apply to required and open reading responses. RRs submitted after the weekly deadline will not be accepted. Graded on the basis of +(excellent), P (acceptable), - (marginally acceptable), and X (No credit/no submission) Of your 12 reading responses, the lowest 2 scores will be dropped.
Skills Assignments: Skills assignments will develop three areas of philosophical writing as well as additional skills particular to applied ethics: (1) Evaluating arguments and making a decision, (2) justifying premise, (3) formulating objections, (4) applying empirical evidence, and (5) answering applied cases. These will be 2-3 pages (double-spaced). Micro-responses: Throughout the semester, you will be asked to provide 12 short responses questions in class based on the readings. These will be unannounced and at the instructor’s discretion. The micro-responses will be 5 points each and will consist of multiple choice, free response or true/false questions. The lowest two scores will be dropped. Final: The final exam will be held in person during the assigned exam period. It will be cumulative, and will be based on the micro-response multiple choice and true/false questions. The final will also include a few short answer questions.
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Academic Honesty: Proper citation of all sources within your written work is required. The University policy on plagiarism is available online (http://oscai.umn.edu/content/plagiarism), as are additional resources on citations and how-to guides for formal citation practices, (http://www3.crk.umn.edu/services/academicassist/writingcenter/resources/citation.htm). If you are unsure about what constitutes plagiarism, you should attend office hours to ask questions. Understanding this policy is your responsibility. Any assignment that violates the University policy will receive a grade of zero. Plagiarism is taken very seriously and will result in disciplinary action by the University. General Course Policies: Class Etiquette: Don’t do anything to disrupt other students’ attention, such as having side conversations, texting in class, etc. Email Communication: Emails will be responded to within two (business) days. You may be asked to attend office hours to discuss questions posed via email. Office Hours: No appointment is needed for weekly office hours. Simply drop by. If you cannot make the regularly scheduled office hours, send me an email at least 48 hours ahead of time suggesting several times that you are available to schedule an appointment. Additional Service: If you have a disability that requires special accommodations or other classroom modifications, please notify both Disability Services and the instructor as soon as possible. To notify Disability Services, call 612-626-1333 (on campus; x6-1333), email
[email protected], or access their website at: http://ds.umn.edu/index.html . Absences: Making up in-class work following any unexcused absence will not be possible. Extenuating circumstances such as illness, University sanctioned travel, etc. that result in missed work will require official documentation of the circumstance. Notify me, in writing, prior to missing class. In cases of emergency where you cannot provide prior notice, notify me, in writing, and provide documentation as soon as possible. Late Policy: Extenuating circumstances that may result in a missed assignment deadline may qualify for an extension, depending upon the circumstances. You must notify me 48 hours in advance of a deadline if you would like to discuss an extension or as soon as possible following the unexpected/unplanned incident that necessitated the request (hospitalization, etc). Only under extraordinary circumstances (such as hospitalization) will extensions be given.
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Reading and Assignments Date
Topic or Assignment
Author(s)
Title
Source
9/14 L1
Part I: Ethics and Medicine
London, Steinbock, and Arras (Eds)
Moral Reasoning in the Medical Context
1-41
9/18
Required RR for L2
Emanuel and Emanuel
Four Models of the PhysicianPatient Relationship
76-84
9/21 L2
Clinical Ethics
Hippocrates
The Hippocratic Oath
59
Alan Goldman
The Refutation of Medical Paternalism
60-68
Eds
Case Study: Beneficence Today, or Autonomy (Maybe) Tomorrow?
68-69
Bernice Elger
Commentary
69-70
Jean-Claude Chevrolet
Commentary
70-71
Terrence Ackerman Why Doctors Should Intervene 9/28
Skills Assignment #1
9/28 L3
Autonomy and its Limits
71-75
Paternalism and Autonomy
Moodle
John Arras
Case Study
85-86
Françoise Baylis
Errors in Medicine: Nurturing Truthfulness
87-90
Blackhall et al.
Bioethics in a Different Tongue: The Case of Truth-Telling
91-99
Dax Cowart
“Dax’s Case”
Moodle
Keith Burton
A Chronicle: Dax’s Case as it Happened
343-347
Cowart and Burt
Confronting Death: Who Chooses, Who Controls?
348-353
5
10/2
Required RR for L4
Dresser and Robertson
Quality of Life and NonTreatment Decisions for Incompetent Patients: A Critique of the Orthodox Approach
398-409
10/5 L4
Part II: Decisionmaking and end of life
Fagerling and Schneider
Enough: The Failure of the Living Will
355- 365
Advance Directives and Substituted Judgment
Norman Cantor
Testing the Limits of Prospective Autonomy: Five Scenarios
366-367
Jay Wolfson
Case Study: Erring on the Side of Theresa Schiavo: Reflections of the Special Guardian ad Litem
369-373
Eds
Case Study: In the Matter of Claire 373-383 C. Conroy
John Arras
The Severely Demented, Minimally Functional Patient: An Ethical Analysis
383-390
U.S. Bishops’ ProLife Committee
Nutrition and Hydration: Moral and Pastoral Reflections
391-397
10/9
Required RR for L5
John Hardwig
Is There a Duty to Die?
483-493
10/12 L5
Physician Assisted Suicide
Timothy Quill
Death and Dignity: A Case of Individualized Decision Making
437-441
John Arras
Physician Assisted Suicide: A Tragic View
455-461
Henri Wijsbek
‘To Thine Own Self Be True’: On the Loss of Integrity as a Kind of Suffering
462- 467
Margaret Battin
Euthanasia: The Way We Do It, The Way They Do It: End-of-Life Practices in the Developed World
467-483
Felicia Ackerman
“For Now Have I My Death”: The “Duty to Die” versus the Duty to Help the Ill Stay Alive
493-501
6
10/16
Required RR for L6
James Rachels
Active and Passive Euthanasia
Moodle
10/19 L6
Part III: Moral Status and Rights
Bonnie Steinbock
Intentional Termination of Life
Moodle
James Bernat
The Whole-Brain Concept of Death Remains Optimum Public Policy
517-524
Jeff McMahan
An Alternative to Brain Death
530-534
Wesley Smith
“Human Non-Person”: Terri Schiavo, Bioethics and Our Future
535-536
Formulating Objections
Moodle
Pope John Paul II
The Unspeakable Crime of Abortion
543-545
Mary Anne Warren
On the Moral and Legal Status of Abortion
545-555
Don Marquis
Why Abortion is Immoral
556-563
Judith Jarvis Thomson
A Defense of Abortion
564-574
Lee and George
The Wrong of Abortion
Moodle
Euthanasia
10/26
Skills Assignment #2
10/26 L7
Abortion
10/30
Required RR for L8
Bonnie Steinbock
Payment for Egg Donation
659-668
11/2 L8
Reproductive Technology and Cloning
Susan Haack
Case Study: Melissa Rowland
595-596
Minkoff and Paltrow
Melissa Rowland and the Rights of Pregnant Women
596-599
Buchanan et al.
Reproductive Freedom and Prevention of Genetically Transmitted Harmful Conditions
602-608
Jessica Cohen
Grade A: The Market for a Yale Woman’s Eggs
655-659
(continued) 7
11/9
Skills Assignment #3
11/9 L9
Part IV: Justice Justice in Allocation
Leon Kass
The Wisdom of Repugnance
Moodle
Bonnie Steinbok
Reproductive Cloning: Another Look
683-693
Choosing Deafness
Moodle
Shana Alexander
They Decide Who Lives Who Dies
Moodle
Alex London
Bone Marrow Transplants for Advance Breast Cancer
233-240
Ronald Dworkin
Justice and the High Cost of Health
240-246
Persad et al.
Principles for Allocation of Scarce Medical Interventions
265-275
Radcliffe-Richards, et al.
The Case for Allowing Kidney Sales
277-280
Erin and Harris
An Ethical Market in Human Organs
280-281
Joralemon and Cox
Body Values: The Case against Compensating for Transplant Organs
281-287
11/13
Required RR for L10
Ichiro Kawachi
Why the United States is Not Number One in Health
222-230
11/16 L10
Justice in Healthcare
Eds
The Young Invincibles
167-185
President’s Commission
An Ethical Framework for Access to Health Care
174-182
Norman Daniels
Equal Opportunity and Health Care
182-185
Sreenivasan
Opportunity is Not the Key
230-233
Thomas Pogge
Responsibilities for PovertyRelated Illness
289-293
11/20
Required RR for L11
8
11/23 L11
Health and International Justice
James Dwyer
What’s Wrong with the Global Migration of Health Care Professionals? Individual Rights and International Justice
294-301
Mathias Risse
Do We Owe Global Poor Assistance of Rectification?
301-306
Healthcare Systems
Moodle
11/30
Skills Assignment 4
11/30 L12
Part V: Research
Military Tribunal I
The Nuremberg Code
711-712
Research Ethics
John Arras
Case Study: The Jewish Chronic Disease Hospital Case
712-721
James Jones
Case Study: The Tuskegee Syphilis Experiment
721-733
NCPHSBBR
The Belmont Report
734-740
Maurie Markman
Ethical Difficulties with Randomized Clinical Trials Involving Cancer Patients: Examples from the Field of Gynecological Oncology
741-744
Hellman and Hellman
Of Mice but Not Men: Problems of the Randomized Clinical Trial
744-749
12/4
Required RR for L13
Lurie and Wolf
Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries
757-762
12/7 L13
Global Research
Washington Post
Trovan Trial (collection)
Moodle
Rothman and Rothman
Case Study: The Willowbrook Hepatits Study
753-757
Alex London
Case Study: Children and “Minimal Risk” Research: The Kennedy-Krieger Lead Paint Study
762-765
(continued) 9
12/14
Skills Assignment #5
12/14 L14
Individual Duties in Context
12/21
Final Exam
Crouch and Arras
AZT Trials and Tribulations
766-770
Alex London
The Ambiguity and Exigency: Clarifying “Standard of Care” Arguments in International Research
771-780
Case Study
Moodle
Ezekiel Emanuel
The Lessons of SARS
118-121
Cantor and Baum
The Limits of Conscientious Objection- May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception
121-125
Scott Vrecko
Just How Cognitive Is “Cognitive Enhancement”? On the Significance of Emotions in University Students’ Experiences with Study Drugs
Moodle
Michael Sandel
The Case against Perfection: What’s Wrong with Designer Children, Bionic Athletes, and Genetic Engineering
829-838
Mark Bedau
The Intrinsic Value of Reprogramming Life
838-841
Martha Farah
Neuroethics: A Guide for the Perplexed
843-850
6:30-8:30pm
Anderson Hall 250
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