Reading and Assignment Schedule

(1) What is Bioethics? [show]

(1) What is Bioethics? [hide]

WHAT YOU NEED TO KNOW HOW TO DO

• Explain the difference between normative and descriptive sciences

• Explain the difference between metaethics and normative ethics

• Describe the “three dimensions of morality”

• Explain the nature of a moral dilemma

• Describe the different forms of moral disagreement

• Describe the difference between ethical subjectivism and ethical objectivism

• Describe and evaluate ethical relativism (Veatch: social relativism) and simple subjectivism (Veatch: personal relativism)

• Describe the difference between cultural relativism, ethical relativism, and ethical universalism

READINGS:

• CSBE, pp. 3-10

OTHER RESOURCES:

(2) Overview of Moral Theories [show]

(2) Overview of Moral Theories [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the difference between consequentialist and deontological ethics

• Explain the difference between act and rule utilitarianism

• Explain why utilitarianism and Hippocratic ethics are forms of consequentialism

• Explain the difference between intrinsic and extrinsic value, and final and instrumental value

READINGS:

• CSBE, pp. 10-18

OTHER RESOURCES:

(3) A Model for Problem-Solving [show]

(3) A Model for Problem-Solving [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe each of the five steps of Veatch’s model

• Apply the five-step model to a case study

READINGS:

• CSBE, ch. 1.

OTHER RESOURCES:

(4) Values and Moral Judgment [show]

(4) Values and Moral Judgment [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the difference between evaluative and nonevaluative statements, and be able to distinguish these

• Describe the different sorts of evaluative statements, and how moral statements might be distinguished from other evaluative statements (e.g., legal, prudential, technical)

• Describe what it means for an action to be morally required, supererogatory, prohibited, or irrelevant

• Describe the sources of moral truth discussed in Veatch

READINGS:

• CSBE, chs. 2-3.

OTHER RESOURCES:

(5) Beneficence and Nonmaleficence [show]

(5) Benefiting the Patient and Others [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the difference between Hippocratic and Utilitarian Ethics

• Explain the multiplicity of goods and the problem this presents to healthcare providers

• Describe the principles of beneficence, nonmaleficence, and utility, and explain how they differ and how they might come into conflict with one another

• Describe the different things a utilitarian might try to maximize

READINGS:

• CSBE, ch. 4.

OTHER RESOURCES:

(6) Bioethics at the Movies [show]

(6) Bioethics at the Movies [hide]

THINGS TO CONSIDER WHILE VIEWING THE FILM:

• Assuming that medical care must, at some point, be rationed, is it wrong that otherwise healthy individuals be denied organ transplants?

• Do we all have a right to healthcare (even if we cannot pay for it)?

• Are John Q.’s means justified by his intended end?  How would Kant view John’s actions?  How would Mill?

• What ethical principles are the attending physicians following?

• Hospitals are required, by law, to treat individuals who arrive at the emergency room with an emergent and life-threatening condition; this help is often left unpaid, when the patients are indigent.  Should hospitals also be required to provide free medical care for life-threatening but non-emergent medical problems?

• Do you think that the jury’s decision was fair?  How would you have voted?

• Does each of us have a duty to be listed as organ donors?

READINGS:

• John Q (2002; Dir. Nick Cassavetes [1h 56m]).  We will be watching this film in class, beginning an hour early (i.e., at noon).  Bring your lunch or snacks.

OTHER RESOURCES:

• Trailer: John Q (2002) [YouTube]

(7) Distributive Justice [show]

(7) Distributive Justice [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• List and describe the traditional areas of justice

• Explain why some theory or principle of distributive justice is needed

• Explain Nozick’s historical and end-state models of distributive justice

• Explain the difference between the moral problems facing individual healthcare providers and those facing policy-makers

READINGS:

• CSBE, ch. 5

OTHER RESOURCES:

•[EC] Film: Sicko (2007; Dir. Michael Moore; 2h 3m) [trailer]

(8) Autonomy [show]

(8) Autonomy [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the principle of autonomy

• Describe the three senses in which a person might be autonomous

• Explain those reasons conventionally offered for interfering with a person’s autonomy

• Explain paternalism, and the difference between weak and strong forms of paternalism

READINGS:

• CSBE, ch. 6

OTHER RESOURCES:

•[EC] Film: Wit (2001; Dir. Mike Nichols; 1h 39m) [trailer]

•[EC] Film: My Sister’s Keeper (2009; Dir. Nick Cassavetes; 1h 50m) [trailer]

(9) Veracity and Fidelity [show]

(9) Veracity and Fidelity [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the difference between “respect for autonomy” and “respect for persons”

• Describe the historical role of honesty in medical ethics codes

• Explain the “condition of doubt” and how it relates to the principle of veracity

• Explain the relationship between the principle of veracity and informed consent

• Describe the principle of fidelity

• Explain how financial conflicts of interest are at odds with the principle of fidelity

READINGS:

• CSBE, chs. 7-8

OTHER RESOURCES:

(10) Killing and Letting Die [show]

(10) Killing and Letting Die [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the different forms of active and passive euthanasia

• Discuss the difference between withholding and withdrawing treatment, and their relationship to active killing

• Explain the moral relevance of “extraordinary treatment”, and describe the difference between the extraordinary and the ordinary

• Explain the difference between direct and indirect killing

• Explain the principle of double effect

READINGS:

• CSBE, ch. 9

OTHER RESOURCES:

•[EC] Film: Million Dollar Baby (2005; Dir. Clint Eastwood; 2h 12m) [trailer]

(11) Assisted Suicide [show]

(11) Assisted Suicide [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the difference between physician-assisted suicide and euthanasia

• Explain and critique Callahan’s argument that killing and letting die are not morally equivalent

• Explain Callahan’s distinction between causality and culpability

READINGS:

• Daniel Callahan, “When Self-Determination Runs Amok” (1992) [see ANGEL]

OTHER RESOURCES:

•[EC] Film: You Don’t Know Jack (2009; Dir. Barry Levinson; 2h 14m) [trailer]

•[EC] Film: Kevorkian (2010; Dir. Matthew Galkin; 1h 30m) [trailer]

(12) Death and the Incompetent [show]

(12) Death and the Incompetent [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the difference between therapeutic medicine and palliative medicine

• Explain the term ‘medical futility’

• Explain the need for a definition of death, and describe the “whole brain definition” and the “higher-brain definition”

• Explain the difference between various forms of impaired states of cognitive being: locked-in syndrome, dementia, persistent vegetative state, comatose

• Describe a “living will,” and how it differs from a “proxy directive” (or “durable power of attorney for healthcare”)

• Explain the ethical differences in making end-of-life decisions regarding the competent, the “formerly competent,” and the “never competent”

READINGS:

• CSBE, ch. 18

OTHER RESOURCES:

• Form: “Indiana Advance Directive” [pdf]

•[EC] News Item: “Terminal Baby at Center of Treatment Battle Returns to Canada.” ABC News (21 April 2011) [pdf]

(13) Abortion: Whose Body? [show]

(13) Abortion: Whose Body? [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain how one might distinguish the concepts human being and person

• Describe, and give examples, of the different kinds of moral rights: positive in personam, positive in rem, active in rem, and passive in rem

• Describe the different possible ways of interpreting the right to life

• Describe and evaluate the violinist analogy used by Thomson in her essay

• Describe and evaluate the traditional arguments against abortion

• Explain the reasons for and against the claim that “the right to life is overriding”

READINGS:

• Judith Jarvis Thomson, “A Defense of Abortion” (1971) [see ANGEL]

OTHER RESOURCES:

•[EC] Legal Opinion: Justice Harry Blackmun, “Opinion on Roe v. Wade,” U. S. Supreme Court (22 January 1973) [web]

•[EC] Film: Vera Drake (2004; Dir. Mike Leigh; 2h 5m) [trailer]

•[EC] Editorial: William Saletan, “Abortion Forever?” Slate (1 December 2011) [web]

(14) Abortion: Rights and Duties [show]

(14) Abortion: Rights and Duties [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the following stages of embryological development: zygote, blastomere, embryo, fetus, neonate

• Describe the following terms: gestation, quickening, viability

• Explain and evaluate the following reasons for an abortion: the fetus is found non-viable, the fetus is found to suffer from Tay-Sachs, the fetus is not the desired gender, the fetus is the product of a sexual assault, the fetus is the product of an incestuous relationship, the pregnancy will prove lethal for the woman

READINGS:

• CSBE, ch. 10

OTHER RESOURCES:

•[EC] Film: If These Walls Could Talk (1996; Dir. Nancy Savoca and Cher; 1h 37m) [YouTube clip]

(15) Bioethics at the Movies [show]

(15) Bioethics at the Movies [hide]

THINGS TO CONSIDER WHILE VIEWING THE FILM:

• The film depicts several conversations between Homer Wells and Dr. Larch regarding abortion.  How would you characterize their views?

• Does the film take a position on the moral standing of the fetus?

• What do the cider house rules represent?  What is the metaethical position of this film?

READINGS:

• Film: The Cider House Rules (1999; dir. Lasse Hallström [2h 11m]).  We will be watching this film in class, beginning an hour early (i.e., at noon).  Bring your lunch or snacks.

OTHER RESOURCES:

• Trailer: The Cider House Rules (1999) [YouTube]

(16) Impaired Infants [show]

(16) Impaired Infants [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain Engelhardt’s position that neonates are not persons, and the implications of this view

• Explain and evaluate Engelhardt’s discussion of the “injury of continued existence”

READINGS:

• H. Tristram Engelhardt, “Ethical Issues in Aiding the Death of Young Children” (1975) [see ANGEL]

OTHER RESOURCES:

(17) Genetic Screening [show]

(17) Genetic Screening [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain and evaluate the choices facing the couple in case study 11-1. What ethical questions do they face?

• Describe the ethical concerns with the genetic screening of populations for inherited disorders.

• Explain, and argue for or against, the use of embryo biopsy for selecting embryos for implantation.

• Describe eugenics, and the reasons why one might support or oppose it.

READINGS:

• CSBE, ch. 11

OTHER RESOURCES:

•[EC] Film: Gattaca (1997; Dir. Andrew Niccol; 1h 46m) [trailer]

(18) Surrogate Mothers [show]

(18) Surrogacy [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the various forms that motherhood can take, and briefly explore the moral complications that this plurality can cause.

• Explain and defend the necessary and/or sufficient conditions of “being a parent.”

• Describe the Baby M case. Which mother should be regarded as the “social mother”? What confers this right or privilege?

READINGS:

• Bonnie Steinbock, “Defining Parenthood” (2006) [see ANGEL]

OTHER RESOURCES:

•[EC] News Item: “San Diego attorney pleads guilty in 'baby-selling ring'.” Los Angeles Times (9 Aug 2011) [web]

(19) Mental Health and Behavior Control [show]

(19) Mental Health and Behavior Control [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain why mental health intervention might be more problematic than other medical interventions

• Describe the different models for interpreting behavior

• Describe the difference between substantial and complete competence

• Describe aversion therapy

READINGS:

• CSBE, ch. 12

OTHER RESOURCES:

(20) Confidentiality [show]

(20) Confidentiality [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain how the principle of confidentiality is related to other moral principles, such as beneficence or fidelity

• Describe the requirement of, and limits imposed on, confidentiality by various professional codes of ethics

• Explain how the Brown case (CS 13-1) affected our understanding of the professional requirement of confidentiality

• Explain how the Tarasoff v. Board of Regents case (CS 13-2) affected our understanding of the professional requirement of confidentiality

READINGS:

• CSBE, ch. 13

OTHER RESOURCES:

(21) Organ Transplants [show]

(21) Organ Transplants [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the “dead donor rule” and its exceptions

• Describe the UNOS

• Explain a xenograft

• Explain the differences between the opting in and opting out policies for organ donation

• Explain the Pittsburgh Protocol

• Explain the ethical issues raised in case studies 14-3, 14-4, 14-5, 14-7, and 14-8

READINGS:

• CSBE, ch. 14

OTHER RESOURCES:

• Text: Ronald Munson, “Organ Transplantation.” Oxford Handbook of Bioethics, ed. by Bonnie Steinbock (Oxford U.P., 2007) [see ANGEL]

•Text: The Pittsburgh Protocol [pdf]

•[EC] Text: Sally Satel, “When Altruism Isn’t Moral” The American (30 Jan 2009) [web]

•[EC] Text: Larissa MacFarquhar, “The Kindest Cut” The New Yorker (27 July 2009) [see ANGEL]

•[EC] Text: Alan Zarembo, “How old is too old for a transplant?” Los Angeles Times (5 November 2006) [see ANGEL]

•[EC] Film: Dirty Pretty Things (2002; Dir. Michael Bay; 2h 16m) [trailer]

•[EC] Film: The Island (2005; Dir. Stephen Frears; 1h 37m) [trailer]

•[EC] News Item: “Organ Donation a Christian Duty.”BBC News (8 Oct 2007) [web]

•[EC] Text: Stephen Wilkinson, “The Sale of Human Organs.” The Stanford Encyclopedia of Philosophy [web]

(22) Health Insurance [show]

(22) Health Insurance [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the concept of an HMO [As Good As It Gets (clip)]

• Describe how the U.S. compares to other industrialized nations regarding the uninsured

• Describe the effect of income and race on access to healthcare in the United States

• Discuss the view that healthcare is a right

• Explain Rawls’ “original position,” and whether healthcare should be considered as a universal right

READINGS:

• CSBE, ch. 15

OTHER RESOURCES:

• Opinion Page: Ezekial Emanuel and Jeffrey Liebman, “The End of Health Insurance Companies” The New York Times (30 January 2012) [web]

• Graphic: “Total health expenditure per capita, US Dollars (1995, 2000, 2005, 2007)” Wikipedia [image]

• Poll: Healthcare System Ratings: U.S., Great Britain, Canada [website]

• Website: Hoosiers for a Commonsense Health Plan [website]

•[EC] Film: Sicko (2007; Dir. Michael Moore; 2h 3m) [trailer] [Interviewing a London physician] [HMO testimony]

•[EC] Editorial: Paul Krugman, “Vouchers for Veterans.” The New York Times (13 November 2011) [web]

•[EC] Review: Michael Tomasky, “The Money Fighting Healthcare Reform.” The New York Review of Books (11 March 2010) [web]

(23) Healthcare Rationing [show]

(23) Healthcare Rationing [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the concept of marginal cost

• Explain the concept of QALY, and its use

• Evaluate Singer’s claim that healthcare rationing is inevitable

• Discuss whether cost should influence the recommendations of the healthcare providers

READINGS:

• Peter Singer, “Why We Must Ration Health Care” (New York Times, 15 July 2009) [web].

OTHER RESOURCES:

•[EC] Text: Atul Gawande, “The Hot Spotters” The New Yorker (24 January 2011) [see ANGEL]

•[EC] News Item: “Terminal Baby at Center of Treatment Battle Returns to Canada.” ABC News (21 April 2011) [pdf]

(24) Bioethics at the Movies [show]

(24) Bioethics at the Movies [hide]

THINGS TO CONSIDER WHILE VIEWING THE FILM:

• If you can save thousands by killing a few, shouldn’t you do that?  Aren’t you morally required to do that?

• Near the beginning of the film, Guy has two patients but only one operating room; does he send the right patient to the available OR?  Explain.

• Are the homeless men heroes or victims?  Explain.

• What bioethical principles are at work in this film?

READINGS:

• Film: Extreme Measures (1996; Dir. Michael Apted [1h 58m]).  We will be watching this film in class, beginning an hour early (i.e., at noon).  Bring your lunch or snacks.

OTHER RESOURCES:

• Trailer: Extreme Measures (1996) [YouTube]

(25) Experimentation on Human Subjects [show]

(25) Experimentation on Human Subjects [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Describe the values contained in the Nuremberg Code and the Helsinki Declaration

• Describe the function of an IRB

• Describe the Belmont Report

• List those principles most relevant to this topic of experimentation on humans, and explain their relevance

READINGS:

• CSBE, ch. 16

OTHER RESOURCES:

•[EC] Film: Miss Evers’ Boys (1997; Dir. Joseph Sargent; 1h 48m)

•[EC] News Item and Audio: Alex Chadwick, “Remembering Tuskegee” NPR Radio (25 Jul 2002) [web]

•[EC] Film: The Constant Gardener (2005; Dir. Fernando Meirelles; 2h 10m) [trailer]

•[EC] News Item: Chris McGreal, “US says sorry for ‘outrageous and abhorrent’ Guatemalan syphilis tests” The Guardian (1 Oct 2010) [web]

• Nuremberg Code (1949)

• Helsinki Declaration of the World Medical Association (1964)

• AMA Code of Ethics, 2.30 (Information from Unethical Experiments), 2.07-2.078 (Clinical Investigation)

(26) Research and the Public Good [show]

(26) Research and the Public Good [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain Jonas’ comment that “progress is an optional goal”

• Explain the different requirements of informed consent for medical research and therapeutic medicine

• Describe the population from which Jonas believes our experimental subjects should be drawn

• Describe and evaluate the moral principles or values in conflict in Jonas’ article

READINGS:

• Hans Jonas, “Philosophical Reflections on Experimenting with Human Subjects” (1969) [see ANGEL]

OTHER RESOURCES:

• [see material listed above]

(27) Consent and Refusing Treatment [show]

(27) Consent and Refusing Treatment [hide]

WHAT YOU NEED TO KNOW HOW TO DO:

• Explain the necessary conditions, or elements, of informed consent [glossary]

• Describe what therapeutic privilege is, and when it might be appropriate

• Explain the difference between professional, reasonable-person, and subjective standards

READINGS:

• CSBE, ch. 17

OTHER RESOURCES:

•[EC] Audio: Onora O'Neil on Informed Consent (Philosophy Bites)(13m 53s) [audio]

•[EC] Film: Wit (2001; Dir. Mike Nichols; 1h 39m) [trailer]

•[EC] Film: My Sister’s Keeper (2009; Dir. Nick Cassavetes; 1h 50m) [trailer]

•[EC] Text: P. Dalla-Vorgia, et al., “Is consent in medicine a concept only of modern times?” Journal of Medical Ethics 27 (2001): 59-61 [pdf]