Bioethics (PHIL 235)
Manchester University, Spring 2016 Instructor: Steve Naragon
Writing
[discussion forums] [discussion forum topics] [pre-class case studies] [extra credit journals] [writing tips] [plagiarism]
Discussion Forums [top]
Full credit in the course will require writing four posts and commenting on eight posts written by others (so, for each forum, you will write one post and comment on two posts by other students). Please consult the grading rubric before you write!
These forums will take place on D2L (under the "Communications" tab: select "Discussions"); both the initial post and the comments on posts are due by midnight of the day they are assigned (these are listed in green on the reading and assignment Schedule). NB: You are encouraged to make these posts as early as you can. Feel free to comment on posts as soon as they are available.
Each post [rubric] should be at least 500 words and is worth up to 6 points; the comments should be at least 100 words each, and each is worth up to 2 points.
A good post will show evidence of having worked through the relevant readings, perhaps also responding to class discussion, and is written free of grammatical errors and typos.
About the comments: [rubric]
(1) If a post already has two comments, then choose another post on which to comment.
(2) These comments should be more than simply praise or a note of agreement. I want you to interact with the claims made in the post, or with the argumentation: Do you agree or disagree, and why? Is the author overlooking something? You might offer further evidence for the author’s views, or else counter-evidence. Try to raise at least one useful question for furthering the discussion.
(3) Feel welcome to comment as often as you wish on the posts; for any given forum, I’ll grade your two most substantial comments (that appear to be 100 words or more), but shorter comments are also welcome, and can add immeasurably to the conversation.
Extra credit opportunity:
You may receive up to two additional points commenting on more than two posts and/or responding to comments on your own post. A point will be given for substantial comments or responses. (In general, I’m wanting to encourage conversations among you, and I am happy to reward your efforts in this direction.)
Discussion Forum Topics and Due Dates [top]
Forum #1: “Getting to Know You.” [rubric]
This first forum is dedicated to getting to know each other. Please post a three paragraph essay about yourself:
(1) The name you prefer to be called, where you grew up, your academic and non-academic interests, what you hope to learn or accomplish in this course, and anything else that you think might be helpful or interesting for others to know.
(2) Any bio- or medical-ethical issues that you've thought about or would like to explore and/or and films or TV shows (e.g. House) that you've watched and that seem relevant to this course.
(3) Conclude your essay with the epitaph that you would like to have engraved on your tombstone (i.e., the words with which you would most like to be remembered — if you aren't planning on having a tombstone, imagine some memorial plaque).
As with all the discussion forums, everyone needs to make two comments (on the posts of others) as well. For the purposes of this forum, your comments should take the form of follow-up questions: What else would you like to know about the person? [Original posters should feel free to respond to these questions, and so on, until we all get our proper fill of each other.]
Before you write the post and comments, be sure to check out the grading rubric. [rubric] Your writing will be graded on how well it measures up to this.
Due dates
... for the original post: Thu, Jan 28 (midnight)
... for the two comments: Tue, Feb 2 (midnight)
Forum #2: “Distributive Justice.” [rubric]
There are enormous inequalities in access to healthcare in the United States, with corresponding inequalities in health and life-expectancy. When is such inequality unjust? How should society decide to distribute scarce healthcare resources? For instance, should we let the marketplace decide who gets what? Make use of either Kant, Mill, or Rawls in your discussion.
Due dates
... for the original post: Thu, Feb 18 (midnight)
... for the two comments: Tue, Feb 23 (midnight)
Forum #3: “Abortion.” [rubric]
Apply utilitarian moral theory to the question of the legalization of abortion. Would a utilitarian favor or oppose legalization?
Due dates
... for the original post: Tue, Mar 15 (midnight)
... for the two comments: Fri, Mar 18 (midnight)
Forum #4: “Allocating Life.” [rubric]
Two questions to address. In answering them, be sure to make use of either Kant, Mill, or Rawls. (1) How should we allocate the kidneys available for transplantation? (2) Given the current shortage of kidneys, should we be allowed to buy kidneys from living donors? How else might we increase the supply of available kidneys?
Due dates
... for the original post: Tue, Apr 19 (midnight)
... for the two comments: Tue, Apr 26 (midnight)
Pre-Class Case Studies [top]
Before about one-third of the class sessions, either morning or afternoon, you will need to post a brief discussion of an assigned case study to your small group case study (on D2L). [rubric] These are due no later than 30 minutes before the start of class. Late entries will be penalized. These will be completed on D2L (in the appropriately numbered "dropbox" found under the "Assessments" menu)
Apart from reviewing the rubric, see the sample case studies below to get a better sense of my expectations for this assignment.
Case study assignments (by group)
[1] Values
Hippocrates: (3-4) The Eager Research Subject: Justifying External Moral Standards
Avicenna: (2-2) Treating Breast Cancer: Finding the Value Judgments
Semmelweis: (2-4) Baby Doe: Legal and Moral Options
[2] Autonomy
Hippocrates: (6-2) A mature 12-year old who refuses a heart transplant
Avicenna: (6-3) Re-addicting a heroin user: are prisoners free to consent to research?
Semmelweis: (6-4) A diabetic who refuses treatment for an infection
[3] Euthanasia
Hippocrates: (9-2) Karen Quinlan: The case of withdrawing a ventilator
Avicenna: (9-3) Separating conjoined twins: an unintended but foreseen killing?
Semmelweis: (9-5) Terri Schiavo: choosing to forgo nutrition
[4] End of Life and Proxies
Hippocrates: (18-3) The Cruzan Case: whether to forgo nutrition based on a patient’s views
Avicenna: (18-4) Joseph Saikewicz: withholding chemotherapy for an impaired patient
Semmelweis: (18-7) Demands for futile care
[5] Rationing and Insurance
Hippocrates: (15-1) The 6th Stool Guaiac
Avicenna: (15-7) Insurance and the Invincible Young Man
Semmelweis: (15-8) Hobby Lobby: Should Businesses Be Required to Include Contraceptives in Their Employee Health Insurance?
[6] Experimentation on Human Subjects
Hippocrates: (16-4) Abortion and Psychopathology: Research on Medical Records
Avicenna: (16-7) Justice in Research Design: Being Fair to the Critically Ill
Semmelweis: (16-8) Paying Clinicians to Recruit Research Subjects
The Five Parts of a Case Study
[1] Summary of the Problem:
[2] The Facts:
Clinical:
Situational:
[3] The values at stake are ...
[4] The options available:
[5] The relevant stakeholders are ...
Sample of an excellent case study entry [rubric]
Student Name — Case Study 17-1 (“Therapeutic Privilege: Scaring the Patient to Death with News about Risks”) [582 words]
[1] Summary of the Problem: Must a physician obtain patient consent for a necessary diagnostic test even if it is apparent that clarifying the risks would cause the patient to (irrationally) decline the test?
[2] The Facts:
Clinical: Patient is a 55 y.o. white male with a history of heart problems, hypertension, and unstable vetricular arrhythmia. He presented with a cramping pain in his legs, which the physician suspects is caused by blockage in his abdominal aorta. The indicated test (translumbar aortography) involves injecting the patient with a dye, and this carries with it certain risks: possible anaphylactic shock, paralysis, and even death.
Situational: The patient is highly apprehensive about his medical condition and unduly fearful. While viewing the procedure as beneficial for the patient, the physician also believes the patient will probably refuse to undergo the procedure if he is informed of all the risks (because of the patient’s irrational fears). The physician has presented the case to the hospital ethics committee for permission to perform the test without receiving the patient’s informed consent.
[3] The values at stake are (1) the beneficence of promoting the patient’s physical health by making a more accurate diagnosis and (2) respecting the patient’s autonomy, which requires that the patient’s informed consent be given before the procedure is performed. The physician is claiming “therapeutic privilege” in this case, which would allow her to perform the procedure without the patient’s consent. This involves a kind of paternalism that was common-place fifty years ago, but is considered much less permissible now. An additional value that could come into play is fidelity in the form of veracity, which speaks against the physician not fully-informing the patient of the risks involved with the test.
[4] The options available:
(1) perform the procedure without the patient’s consent,
(2) seek the patient’s consent, but omit mention of those risks that would most upset the patient (this consent clearly would not be “fully informed”),
(3) explain all the risks of the procedure and accept the patient’s refusal,
(4) take additional time to explain all the relevant risks, both of the procedure and of not performing the procedure, with the hope that the patient will make the right choice.
[5] The relevant stakeholders are the physician, her patient, and the hospital ethics committee asked to approve of this use of “therapeutic privilege”.
Option (1) is overly paternalistic and probably illegal.
Option (2) is still paternalistic, at odds with veracity, and probably would expose the physician to a lawsuit should any of the bad side-effects occur — although one could plausibly argue that withholding information here would still be in the patient’s best interest, if disclosure meant foregoing the test.
Option (3) would protect the physician from a possible lawsuit, be veracious and honor the patient’s autonomy, but it otherwise would appear to be harmful for the patient and thus at odds with the principle of beneficence.
Option (4) is preferable. The physician, in taking the interests of the patient as primary, needs to find some way to convey the information in a manner that helps the patient — who is otherwise mentally competent — to understand that the fewest overall risks occur by performing the test. This might take more time to talk through — and so use up a valuable resource that won’t be available to other patients (a concern for utility) — but this will allow the physician both to promote the patient’s health as well as to respect the patient’s autonomy as a competent adult.
Sample of a good case study entry
Student Name — Case Study 17-1 (“Therapeutic Privilege: Scaring the Patient to Death with News about Risks”)
[1] Problem raised by the case study: Can a medical procedure take place without the patient’s informed consent?
[2] The physician believes that the procedure will benefit the patient, but that the patient will likely refuse the procedure if he is told of all the risks. The patient is bad at weighing risks.
[3] The values at stake are beneficence and autonomy. The procedure will likely benefit the patient; but doing the procedure without the patient’s informed consent will violate his autonomy.
[4] The physician could do one of the following: (1) perform the procedure without getting informed consent, (2) explain all the risks, and accept the patient’s rejection of the procedure, (3) explain the risks, both of the procedure and of neglecting the procedure, until the patient finally gives his consent.
[5] The physician should do (3), although that might take longer.
Sample of a poor case study entry
Student Name — Case Study 17-1 (“Therapeutic Privilege: Scaring the Patient to Death with News about Risks”)
A patient needs to have a test done, but he will probably refuse to have it done if he knows about some of the bad things that could happen to him from the test. The physician thinks he should have the test done. Is it OK to do the test, without getting the patient’s permission? I don’t think so. The patient might be scared or a little irrational, but he’s still a competent adult, and needs to be allowed control over his life. The physician just has to know when to let patients make the decisions.
Extra Credit Journals [top]
You may write brief essays for extra credit, if you wish. These are opportunities for exploring additional texts, films, videos, podcasts, etc., as listed under “Other Resources” on the Reading and Assignment schedule. A journal can be submitted on any item marked with an [EC]. These should be at least 600 words (about two pages), and will be graded on their length, content, and basic mechanics (see the rubric, and see the sample journal). The content should include two parts: a brief summary of the text, film, or talk, and a rather longer discussion of what was philosophically of interest.
These journals need to be turned in no later than one week after the date on which they were listed. [NB: I have provided links for trailers to many of the films; this is for your convenience. The journal needs to discuss the film itself, not the trailer.]
Please submit them to the “EC” drop box on D2L, with the title of the article or film in the subject line. You may write up to one journal per class session, and at the end of the semester, the very last journals are due on Thursday, May 5. Plan accordingly.
Each journal is worth up to 10 points, and up to 50 points may be accumulated. A full 50 points will add 4% to your course grade.
Writing Tips [top]
Please carefully proofread these writing submissions. You need to use complete sentences, proper punctuation, and correct spelling. Both in college and after you graduate you will be judged, in part, by how well you write. Typos, mispellings, poor grammar — in short, sloppy writing — is like so much stink coming from the bottom of your shoes. It won’t matter how nicely your hair is combed or your shirt is pressed if you can’t write a decent paragraph.
Words and Expressions Commonly Misused: at least once a year, everyone should read through this list from Strunk & White.
I hope it never comes to this, but my comments on your writing might make use of some of the following abbreviations:
awk: awkward. This is a sentence problem; the sentence should be re-written for greater clarity.
frag: sentence fragment. Another sentence problem; your sentence is lacking something vital. Like a subject. Or a verb. Don’t fall into the trap of writting essays that sound like advertising copy. We all can do better than that!
wc: word choice. You might find a better word to suit your sentence. Consult your dictionary for a more accurate meaning.
sp: spelling. Consult your dictionary!
?: Huh? You’ve lost your reader.
TS?: Topic sentence? This is a paragraph problem. There needs to be a topic sentence (normally, the lead sentence of the paragraph) that indicates what the paragraph is all about (what you are hoping to do in the paragaph; or it’s the claim for which the paragraph will now offer support, or an observation for which the paragraph will now offer some elaboration, etc.).
CO?: Cohere? Another paragraph problem; the sentences in this paragraph don’t fit together very well. Try re-arranging them. Ask yourself: (a) What goal am I trying to acheive with this paragraph? and (b) Is each sentence working towards this goal?
Q?: Quotation? Quotations should be used only when a paraphrase will not do the job as effectively. Common problems include failing to properly introduce a quotation, failing to properly cite a quotation, quoting more than is helpful, and using a quotation when a paraphrase would be better.
Academic Dishonesty [top]
[This text is copied from the college Catalog]
Membership in the Manchester University community requires a devotion to the highest principles of academic and personal integrity, a commitment to maintain honor, and a continuous regard for the rights of others. There can be no rights without individual responsibility.
Manchester University faculty are committed to teaching and learning as a career and a profession. Each instructor is presumed to develop and use methods and techniques which enhance learning and which best fit his or her personality and subject matter area. At the same time, the instructor is expected to abide by the general principles of responsible teaching which are commonly accepted by the academic profession. These principles suggest that faculty keep complete records of student performance and that they develop and apply express, uniform criteria for evaluating student performance.
Students are free to take reasoned exception to the data or views offered in any course of study. While they may reserve judgment about matters of opinion, they are responsible for learning the content of any course in which they are enrolled. At the same time, students are expected to abide by the general principles of academic honesty which are commonly accepted in educational settings.
When a student chooses not to follow the general principles of academic honesty, the following policies and procedures will apply.
Plagiarism
Plagiarism is the presentation of information (either written or oral) as one’s own when some or all of the information was derived from some other source.
Specific types of plagiarism encountered in written and oral assignments include the following:
● Sources have been properly identified, but excerpts have been quoted without proper use of quotation marks; or the material has been slightly modified or rephrased rather than restated in the student’s own words.
● Key ideas or items of information derived from specific sources that present material that is not common knowledge have been presented without proper identification of the source or sources.
● Unidentified excerpts from other sources have been woven into the student’s own presentation.
● A paper or speech may be a mosaic of excerpts from several sources and presented as the student’s own.
● An entire paper or speech has been obtained from some other source and presented as the student’s own.
● Texts in another language are translated into English and presented as the student’s own.
Cheating
Cheating consists of any unpermitted use of notes, texts or other sources so as to give an unfair advantage to a student in completing a class assignment or an examination. Intentionally aiding another student engaged in academic dishonesty is also considered cheating.
Submission of the same work (essay, speech, art piece, etc.) to fulfill assignments in separate classes requires the permission of both faculty members (if both courses are being taken in the same semester), or the permission of the second faculty member (if they are taken during different semesters).
Penalties
• Unintentional Plagiarism. In cases of plagiarism in which no deception is intended (such as ignorance of proper citation of sources), the student should expect a reduction in the paper’s grade; in some cases, the student may be given an option to rewrite the paper. No disciplinary letter will be filed.
• Deliberate Plagiarism and Cheating. In cases of deliberate plagiarism, and in all cases of cheating and attempted cheating, the work assigned will be failed. At the instructor’s discretion, the student may also fail the course (regardless of the grade-weight of the work assigned).
In either a case of deliberate plagiarism or cheating, a disciplinary letter recording the deception will be sent to the student, with copies sent to the associate dean of academic resources and the student’s academic advisor. For more information, as well as for information regarding your rights of appeal, see the MU Source.
Manchester University // Registrar // Department of Philosophy and Religious Studies // Last updated: 22 Jan 2016