Course Texts:  Biomedical Ethics,  Thomas Mappes and David DeGrazia (McGraw Hill)

Course Description:
 In this course, we will examine some of the basic ethical dilemmas and problems that have arisen in the practice of medicine and medical research.  Key topics include: issues of justice and healthcare access, confidentiality, informed consent, end-of-life issues, research on humans and other animals, the human genome project, stem cell and genetic research.
While we will rarely agree upon a solution to these problems, our goal will be to analyze each issue from a variety of perspectives and to form well-reasoned conclusions.  We will begin with a brief overview of ethical theory and principles, but the emphasis of the course will be primarily on the practical application of these principles to issues of biomedical ethics.  By the end of the course, you should not only have knowledge of the specific issues we discuss but also be able to critically examine and evaluate ethical issues beyond those we cover in class.

Course Goals:
1. To provide you with the ability to clarify values, principles, and concepts central to medical ethics.
2. To help you understand and identify ethical issues and conflicts that arise in the context of healthcare.
3. To develop your ability to critically think and write about ethical arguments and dilemmas.

Course Requirements and Grading:                                                       Undergraduates              Graduates
        Two short essays (3-5 pages on issues covered in class):                     25% (each)                  20% (each)
        Test on Ethical Theory and Critical Thinking:                                       20%                             15%
        Final exam (essays on issues covered in class):                                    30%                             25%
        Research paper (10-12 pages on pre-approved topic)                          n/a                               20%

Expectations and Assessment:
 Philosophy is a discipline the emphasizes clarity of thought and expression.  Philosophy also demands reasons for one's conclusions.  Therefore, the assignments in this course will ask you to demonstrate the ability to clearly articulate ethical ideas and to formulate arguments for your own ethical conclusions.
 Both the essays and essay questions on exams will ask you to critically think about issues surrounding biomedical ethics, particularly those issues we cover in class.  You will be expected demonstrate clarity of thought and to be able to clearly articulate the ethical problems.  Further, you should be able to critically respond to the arguments given by the authors we read.  You need not agree with everything you read (in fact, many of the arguments we read will be mutually inconsistent), but you should be able to respond intelligently to why you agree or disagree with the arguments.  Finally, you will be asked to produce independent, creative thoughts about issues in biomedical ethics by showing that you can navigate these difficult problems and defend your position on these issues.

Tentative Schedule:  (This schedule is subject to change.  Depending on the interests of those in the class, we may wish shift the order of the topics.    I will announce any changes in class, but we will typically cover at least two readings in each class period.)

Introduction to Ethical Theory and Biomedical Ethics
    The Nature of Biomedical Ethics (pp. 1-4)
    Recently Dominant Ethical Theories (pp. 4-26)
    The Principles of Bioethics (pp. 26-27)
    Fundamental Concepts and Principles (pp. 40-53)

TEST (mid to late September)

Social Justice and Healthcare Policy
    Introduction (pp. 615-627)
Justice, Rights and Societal Obligations
    Allen Buchanan, Justice: A Philosophical Review (628-639)
    Kai Nelson, Autonomy, Equality and a Just Health Care System (639-645)
    Rationaing, Managed Care, and Health-Care Reform in the United States
    Norman Daniels, Is the Oregon Rationing Plan Fair? (645-652)
    Allen Buchanan, Managed Care: Rationing Without Justice, but Not Unjustly (652-660)
    Leonard M. Fleck, Rationing: Don't Give Up (660-663)
    Norman Daniels and James Sabin, Closure, Fair Procedures, and Setting Limits Within Managed Care Organizations (663-669)
    Ezekiel Emanuel, Health Care Reform: Still Possible (669-672)

Physician-Patient Relationship
    Introduction (pp. 59-70)
Physicians' Obligations and Virtues
    The Hippocratic Oath (70-71)
    Council of Ethical and Judicial Affairs, American Medical Association, Fundamental Elements of thePatient-Physician Relationship (71-72)
    Edmund D. Pellegrino, The Virtuous Physician and the Ethics of Medicine (72-76)
Physician-Patient Models and Patient Autonomy
    James F. Childress and Mark Siegler, Metaphors and Models of Doctor-Patient Relationships: Their Implications for Autonomy (76-85)
    Terrence F. Ackerman, Why Doctors Should Intervene (85-90)
Truth Telling
    Roger Higgs, On Telling Patients the Truth (90-95)
    Benjamin Freedman, Offering the Truth: One Ethical Approach to the Uninformed Cancer Patient (95-102)
Informed Consent
    Judge Spotswood W. Robinson III, Opinion in Canterbury v. Spence (102-106)
    President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research,
            The Values Underlying Informed Consent (106-112)
    Howard Brody, Transparency: Informed Consent in Primary Care (112-118)
The Practice of Medicine in a Multicultural Society
    Ruth Macklin, Ethical Relativism in a Multicultural Society (118-127)
    Kenneth Kipnis, Quality Care and the Wounds of Diversity (127-131)
Conflicts of Interest, Problems of Conscience, and Managed Care
    Marcia Angell, The Doctor as Double Agent 144-149)
    Daniel Callahan, Managed Care and the Goals of Medicine (149-154)
    James F. Childress, Conscience and the Conscientious Actions in the Context of MCO (154-159)

Hospitals, Nurses, Families, and Medical Confidentiality
    Introduction (pp. 162-169)
The Role and Responsibilities of Nurses
    Lisa H. Newton, In Defense of the Traditional Nurse (173-180)
    Helga Kuhse, Advocacy or Subservience for the Sake of Patients? (180-188)
    Amy H. Haddad, The Nurse/Physician Relationship and Ethical Decision Making (188-192)
Families and Medical Decision Making
    Thomas A. Mappes and Jane S. Zembaty, Patient Choices, Family Interests, and Physician Obligations (192-201)
    Bonnie Poitras Tucker, Deaf Culture, Cochlear Implants, and Elective Disability (201-207)
    Sherri A. Groveman, The Hanukkah Bush: Ethical Implications in the Clinical Management of Intersex (207-211)
Confidentiality
    Justice Mathew O. Tobriner, Majority Opinion in Tarasoff v. Regents of the University of California (211-215)
    Justice William P. Clar, Dissenting Opinion in Tarasoff v. Regents of the University of California (215-218)
    Please Don't Tell!: A Case About HIV and Confidentiality (with commentaries by Leonard Fleck and Marcia Angell) (218-222)

Essay #1 (due mid to late October)

Death and Decisions Regardling Life-Sustaining Treatment
    Introduction (pp. 302-308)
The Definition and Determination of Death
    President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Why "Update" Death? (309-312)
    Charles M. Culver and Bernard Gert, The Definition and Criterion of Death (312-319)
    Martin Benjamin, Pragmatism and the Determination of Death (319-327)
Competent Adults and the Refusal of Life-Sustaining Treatment
    Council on Ethical and Judicial Affairs, American Medical Association, Withholding and Withdrawing
     Life-Sustaining Treatment (327-330)
    Tia Powell and Bruce Lowenstein, Refusing Life-Sustaining Treatment After Catastrophic Injury: Ethical Implications (330-335)
    Vicki Michel, Suicide by Persons with Disabilities Disguised as the Refusal of Life-Sustaining Treatment (335-340)
DNR Orders and Medical Futility
    Tom Tomlinson and Howard Brody, Ethics and Communication in Do-Not-Resuscitate Orders (340-345)
    Mark R. Wicclair, Medical Futility: A Conceptual and Ethical Analysis (345-350)
Advance Directives and Treatment Decisions for Incompetent Adults
    Thomas A. Mappes, Some Reflections on Advance Directives (350-357)
    Norman L. Cantor, My Annotated Living Will (357-363)
    Rebecca Dresser, The Conscious Incompetent Patient (363-365)
The Treatment of Impaired Infants
    John A. Robertson, Involuntary Euthanasia of Defective Newborns (365-371)
    Members of The Hastings Center Research Project on the Care of Imperiled Newborns, Standards of Judgment for Treatment of Imperiled
            Newborns (371-375)
 

Suicide, Physician-Assisted Suicide, and Active Euthanasia
    Introduction (pp. 377-384)
The Morality of Active Euthanasia
    James Rachels, Active and Passive Euthanasia (395-399)
    Daniel Callahan, Killing and Allowing to Die (399-401)
    Dan W. Brock, Voluntary Active Euthanasia (401-404)
Physician-Assisted Suicide, Active Euthanasia, and Social Policy
    Timothy E. Quill, Christine K. Cassel, and Diane E. Meier, Care of the Hopelessly Ill: Proposed Clinical Criteria for Physician-Assisted Suicide (417-420)
    The Oregon Death with Dignity Act (420-426)
    Franklin G. Miller, Timothy E. Quizz, Howard Brody, John C. Fletcher, Lawrence O. Gostin, and Diane
     E. Meier, Regulating Physician-Assisted Death (426-431)
    John D. Arras, On the Slippery Slope in the Empire State: The New York State Task Force on Physician-Assisted Death (431-438)
    James L. Bernat, Bernard Gert, and R. Peter Mogielnicki, Patient Refusal of Hydration and Nutrition:
     An Alternative to Physician-Assisted Suicide or Voluntary Active Euthanasia (438-445)

Genetics and Human Reproduction
    Introduction (pp. 511-520)
Reproductive Risk, Prenatal Diagnosis, and Selective Abortion
    Leon R. Kass, Implications of Prenatal Diagnosis for the Human Right to Life (521-526)
    Laura M. Purdy, Genetics and Reproductive Risk: Can Having Children Be Immoral? (526-532)
Reproductive Technologies
    Peter Singer, IVF: The Simple Case (532-536)
    Susan Sherwin, Feminist Ethics and In Vitro Fertilization (536-541)
    The New York State Task Force on Life and the Law, Ethical Debates About Infertility and Its Treatment (541-548)
    President's Council on Bioethics, Assisted Reproduction (548-553)
Gamete Donation and Surrogacy
    Thomas H. Murray, Families, the Marketplace and Values: New Ways of Making Babies (553-561)
    Bonnie Steinbock, Surrogate Motherhood as Prenatal Adoption (561-565)
Human Cloning
    Leon R. Kass, Cloning of Human Beings (565-568)
    Thomas H. Murray, Even If It Worked, Cloning Wouldn't Bring Her Back (568-571)
    Robert Wachbroit, Genetic Encores: The Ethics of Human Cloning (571-577)
Preimplantation Genetic Diagnosis
    John A. Robertson, Extending Preimplanation Genetic Diagnosis: Medical and Non-Medical Uses (577-583)
    President's Council on Bioethics, Selecting Embryos for Desired Traits (583-586)
Gene Therapy
    Sophia Kolehmainen, The Dangerous Promise of Gene Therapy (586-590)
    Marina Cavazzana-Calvo, Adrian Thrasher, and Fulvio Mavilio, The Future of Gene Therapy: Balancing the Risks and Benefits of Clinical Trials (590-594)
    LeRoy Walters and Julie Gage Palmer, Germ-Line Gene Therapy (594-601)
Genetic Enhancement
    Walter Glannon, Genetic Enhancement (601-606)
    Dan W. Brock, Genetic Engineering (606-612)

Essay #2 (due before Thanksgiving break)

Research on Embryonic Stem Cells
    Introduction (pp. 448-456)
Research on Embyronic Stem Cells
    National Institutes of Health, Stem Cells: A Primer (493-498)
    Bonnie Steinbock, What Does "Respect for Embryos" Mean in the Context of Stem Cell Research? (498-501)
    President's Council on Bioethics, The Moral Case against Cloning-for-Biomedical-Research (501-508)

Final Exam