PHL 344
Ethical Issues in Health Care
Section 701
Summer, 2000
Instructor: Barry DeCoster
Office Hours: I will be in the classroom 30 minutes before class begins both Tuesdays and Thursdays. When possible, I suggest you make an appointment. If we cannot find a better time, we can also meet after class.
Email :
(email is by far the best way to contact me)
Office Phone #: 517-355-3499 (leave messages)
Home Phone #: 517-272-3020
(Please use respect when calling, i.e., not after 9pm.)
Course Webpage: http://www.msu.edu/~decoste4/phl344/
(Check frequently. I will post announcements and most handouts here.)
Course Description:
We will develop a critical examination of a number of ethical issues arising from today's health care system, including informed consent, the right to refuse medical treatment, euthanasia, experimentation on human subjects, the effect of AIDS on how we have sex, new reproductive & genetic technologies, and justice issues surrounding the distribution of scarce medical resources.
These topics raise questions that do not have easy answers; many have reasonable-sounding solutions on both sides. Still, how we work towards solutions is important since we, our family, and our friends will be affected directly. This course will develop skills in critical analysis, and lead to improved written and verbal arguments.
Course Objectives:
By the end of this course, you will have an overview of the topics in biomedical ethics. You will be able to identify ethical issues in health care, and then discuss them in a thoughtful, informed, and respectful manner. In both your written work and in-class discussions, you will be able to develop a coherent set of reasons for a conclusion, and evaluate different forms of philosophical "arguments."
Texts:
1––Carol Levine, Taking Sides: Clashing Views on Controversial Bioethical Issues, eighth edition. [TS]
(This can be ordered & shipped from the MSU Bookstore: 1-877-267-4700)
2––Audre Lorde, The Cancer Journals, Aunt Lute Books.
(I recommend buying this through Amazon.com, and it is required.)
3––Additional readings from instructor [CP]
Tentative Schedule:
This course will meet Tuesday/Thursday, from 6:00pm – 10:00pm, from May 16 until June 29. You are expected to be ready to discuss readings in class for the days they are assigned.
This schedule is subject to change.
Week 1 may 16 & 18Tuesday / Introduction
--Discussion of syllabus
--What is Bioethics? Introduction and History
--Movie: Discussions in Bioethics, Refusal of Blood Transfusions[1]
--“Ethics in Primary Care: Setting Aside Common Misunderstandings” by Brody & Tomlinson [CP]
--Taking Sides, Introduction, pp. xiv-xxiv. (Read this introduction to become familiar w/ ethical theory, not for mastery.)
Thursday / Refusal of Life Saving Treatments
& Physician Assisted Suicide
--Movie: Dax's Case
--"Request for Assisted suicide: A Nursing Issue,” by Kopala and Kennedy [CP]
--(Issue 10) Should Adolescents Make Their Own Life-and-Death Decisions [TS] [2]
--(Issue 11) Do Parents Harm Their Children When They Refuse Medical Treatment on Religious Grounds? [TS]
Week 2 may 23 & 25
Tuesday / Informed Consent & Patient Autonomy
--(Issue 1) Is Informed Consent Still Central to Medical Ethics? [TS]
--(Issue 2) Can Family Interests Ethically Outweigh Patient Autonomy? [TS]
Thursday / Informed Consent & Duty to Warn
--"Vitaly Tarasoff et al., Plantiffs and Appellants, v. The Regents of the University of California et al." [CP] (just skim this)
--Case Study: Please Don’t Tell (Commentaries by Fleck and Angell) [CP]
--"Ignorance is bliss? HIV and moral duties and legal duties to forewarn" by Bennett, Draper, and Frith [CP]
--“Questioning Bioethics: AIDS, Sexual Ethics, and the Duty to Warn” by Ainslie [CP]
--(Issue 16) Are Placebo Studies of Maternal-Fetal HIV Transmission Ethical in the Developing World? [TS]
** Draft of Paper 1 Due ** (to be discussed in class)
Week 3 may 30 & june 1
Tuesday / **** Short Paper 1 Due ***
Genetics
--(Issue 13) Should Health Insurance Companies Have Access to Information from Genetic Testing? [TS]
--(Issue 14) Should Parents Always Be Told of Genetic-Testing Availability? [TS]
Thursday / More Issues in Genetics
--“Genetic testing and early diagnosis and intervention: boon or burden?” by Hepburn [CP]
--“Justice, Rights, and Alzheimer Disease Genetics” by Fleck [CP]
** mid-course questionnaire ***
Week 4 june 6 & 8
Tuesday / How do We Make Just Rationing Decisions?
--(Issue 18) Should Patient-Centered Medical Ethics Govern Managed Care? [TS]
--Rational Democratic Deliberation (readings to be announced) [CP]
--Rationing Issues (readings TBA) [CP]
Thursday / --(Issue 6) Should Doctors be Able to Refuse Demands for Futile Treatments? [TS]
--(Issue 17) Should Health Care for the Elderly be Limited? [TS]
--"Futility and the Ethics of Resuscitation" by Tomlinson & Brody [CP]
--"Why Physicians Cannot Determine if Care is Futile" by Veatch [CP]
** Draft of Paper 2 Due** (to be discussed in class)
Week 5 june 13 & 15
Tuesday / *** Short Paper 2 Due ***
Selling body parts
--(Issue 19) Should There be a Market in Body Parts? [TS]
-- “Selling Babies and Selling Bodies” by Ketchum [CP]
Thursday / Reproduction & Reproductive Technologies
--"Should Lesbians be Treated as Infertile Couples" by Murphy [CP]
--"Just Caring About Maternal-Fetal Relations: the case of Cocaine-using pregnant women" by Tong [CP]
Week 6 june 20 & 22
Tuesday / Children in Medicine
Allison Wolf, guest lecturer
--Ch 11 of Women and Children in Health Care by Mahowald
--"Giving Information to Sick Children" by Rozsos [CP]
--Dilemmas of "Informed Consent" in Children [CP]
Thursday / Audre Lorde, The Cancer Journals: Intro., Sections 2 and 3.
Week 7 june 27 & 29
Tuesday / WrapUp Day--Connecting It All
Thursday / Final Exam
Condensed Calendar of Written Assignment:
Reflection Papers / Each ThursdayPaper 1 / Tuesday, May 30
(draft due previous Thursday)
Paper 2 / Tuesday, June 13
(draft due previous Thursday)
Exam / (in class) June 29
Basis for Grade:
Reflection Papers (6 total, w/ lowest dropped) / (6% x 5=30%)2 Short Papers / (15% x 2=30%)
Final Exam / (25%)
Participation and Attendance / (15%)
Participation and Attendance:
In this class, full participation is necessary from each of us. The small class size means that this will only work if each person has done the readings, comes to class, and discusses his/her opinions. Attendance will be calculated into your grade as the following: if you miss more than one class, you will loose 0.2 (out of 4.0 pts) for each unexcused absences. For excused absences, I ask for some sort of proof for why you had to be out that day.
Participation will be judged on how prepared you are for class, and how engage the others in the class. I know not everyone feels comfortable speaking in public; I, myself, do not often enjoy it. In this course, though, input from different points of view will help discussions run smoothly.
Related to this, politeness is also critical to a successful course. While you may disagree with someone's point, you should respond in a way that encourages further discussion, not in a way that is rude or directly attacks any individual.
Food Note:
Please feel free to bring coffee, tea, or snacks. Since this class takes place during dinner time (and some of you may be coming right from work), I don't want you to not have eaten. You cannot think and discuss readings for four hours on an empty stomach. So, eat before you come to class, and bring enough to keep you going.
Notes on Academic Honesty:
You are expected to know and follow MSU's policies on plagiarism. If I discover work has been plagiarized, or a person has cheated, I reserve the right to fail the person for that assignment or for the course.
Note: I can say that I am glad I've never had to invoke that, nor do I want to. Most confusion seems to revolve around how to talk in your writing about what other people have written, and how to use their ideas to facilitate your own discussions. These are important times when you'll want to refer to what was written in one of the articles we read; when you use/refer to these, be sure to cite them.
Late work:
Due to the accelerated pace of this course, please plan out your work schedule in advance. All work is due at the beginning of class (6 PM). Any work passed in late will lose 0.5 points (out of 4.0 points) for every day late. Note: this is not each class period, but each 24 hours.
Goals for Writing:
All written work should be in the following format : Typed, double spaced, 12 pt font, ”normal" margins, spell-checked!!!, stapled, with your name at the top.
Reflection papers will be due each Thursday, except for June 29 (the exam day). You will have six reflection papers passed in, and the lowest grade will be dropped. Reflection papers should be two-three pages long. In them, you should identify two specific questions that you feel remain unanswered in the readings. After noting the question, the emphasis of the paper is to explain why it is important to answer this. Finally, briefly begin to answer the question. (Note: it may not be possible to give a complete and final solution, but you should always be able to point your reader in the direction of your solution.
"Short" papers will be due May 30 and June 13. I will provide a specific topic for you to write on at least one week before the paper is due, but probably earlier than that. Time in the class before the final draft is due will be devoted to going over rough drafts of your papers; we’ll review each other's work in a workshop fashion. The goal of these papers is to try to improve your writing skills to make clear and balanced arguments. To this end, short papers will need to look at the problem given, lay conflicting points of view, and then give your solution in detail (which should respond to the conflict you laid out earlier). To do this well, papers should be about 5 pages long. If you're falling under this, you need go back and expand certain sections.
More formal criteria for written work will be attached to the assignment / paper topic.
3
344 Syllabus.doc
Updated 05/16/00
[1] Most class meetings will include discussion of a video tape to be shown in class. These videotapes are an integral part of the course, and there will no other opportunity to view them.
[2] For each reading noted from the Taking Sides text, you are to read the “Introduction,” the Yes posision, the No position, and the Postscript.