NEW YORK CITY COLLEGE OF TECHNOLOGY THE CITY UNIVERSITY OF NEW YORK DIVISION OF LIBERAL ARTS AND SCIENCE SOCIAL SCIENCE

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1 NEW YORK CITY COLLEGE OF TECHNOLOGY THE CITY UNIVERSITY OF NEW YORK DIVISION OF LIBERAL ARTS AND SCIENCE SOCIAL SCIENCE PHIL2203/PH103.1 HEALTH CARE ETHICS (formerly HU305.1) (Available to health science students as an alternative to PH103 Ethics) COURSE DESCRIPTION: Health Care Ethics applies the ethical insights of philosophy to issues in life, bioethics, and medicine in an introductory way. By examining ethical issues which arise in medicine, out of medical technology or related areas of life, the course will cover both these issues and the with critical rigor with which they have been treated by recent philosophy. Students will learn to read philosophy articles critically, as well as discovering how different philosophers have approached ethical issues and applied them to prominent issues in bioethics. The course will examine the major ethical theories on what is morally right and wrong, and the meaning of moral concepts (e.g. the concepts of right and duty.) Focus, however, is upon ethical problems associated with the practice of medicine and biomedical research. Topics covered will include Professional Ethics, Patient Rghts, truth telling and informed consent, Abortion, and the rights of the unborn, declining treatment, euthanasia and Physician-assisted Suicide, access to health care, Biomedical Research and Human Rights, Experiments on Humans, and Genetic Testing, Genetic Therapy and Discrimination, Infertility and In Vitro Fertilization, Surrogate Parenting, Cloning, Public Health and Aids, Testing and Screening. This class will involve both lectures and discussion. It is expected that everyone will participate in these discussions, which will constitute a major part of the class. It is strongly advised that the text and other materials (handouts) be read prior to the class for which they are assigned, so that each student can contribute intelligently to the discussion. Participation will be a factor in your grade. Prerequisite: CUNY Certification in reading or writing: 3 class hours 3 credits Suggested Text: Beauchamp, Tom L. and LeRoy Walters, Contemporary Issues in Bioethics, 6th edition. Belmont, Ca.: Wadsworth Pub. Co., Alternate Texts: Arras, John and Bonnie Steinbock, Ethical Issues i Modern Medicine, 5th edition. Mountainview, CA: Mayfield Publishing Co

2 Beauchamp, Tom L. and James F. Childress, Principles of Biomedical Ethics, 5th edition. NY: Oxford University Press, 2001 Mappes, Thomas A. and David DeGrazia. Biomedical Ethics, 5th ed. NY: McGraw Hill, 2001 Munson, Ronald, ed. Intervention and Reflection, Basic Issues in Medical Ethics, 6th ed. Wadsworth Pub. Co., Belmont, Ca.:2000 Grading: Exam 1 20% Exam 2 40% Final or paper 40% We will also have debates on selected topics, such as abortion and euthanasia, for which participants on one side in a debate, e.g. abortion, pro or con, will receive extra credit. Those who prefer not to participate in the debate can do a report on a topic not covered in class, such as mental health, for extra credit. A sheet giving guidelines for writing papers will be handed out. Prepared by: Dr. D. McKinney August 1988 Revised by: Dr. D. McKinney February 1994 January 1997 Revised by: Prof. W. Brand February 2001 Revised by: Dr. H. McDonald April 2003, November 2006 Revised by: Dr. W. Brand, April WEEK OUTLINE HEALTH CARE ETHICS WEEK 1: INTRODUCTION TO HEALTH CARE ETHICS. In the introductory classes the student will be exposed to basic questions arising in the health care field. Just what is an ethics? What is the relation of ethics to philosophy? What is its relevance to the health care profession? What are the limits of responsibility for health care? Can we guarantee health? Should health care be universal? What of mental health? The student will be exposed to theoretical situations and questions relating to the ethics of health care and delivery of health care services. Specific situations that may give rise to ethical dilemmas and hard cases not covered by principles or where principles may conflict will be discussed. 2

3 WEEK 2: INTRODUCTION TO ETHICS I. Values and Ethics (definitions) A. Normative Ethics, including criticisms of each theory: 1. General normative ethics: a. teleological theories i. perfectionist (virtue) ethics ii. consequentialist ethics: Utilitarian and pragmatic b. nonteleological theories i. deontological ii. axiological c. relativism and scepticism i. Cultural Relativism ii. Ethical Relativism and Cynicism d. Naturalism, NonNaturalism, Aquinas s natural law theory of ethics and criticisms e. contract Theory ( e.g., Rawls) f. Metaethics (analytic ethics) and Noncognitivism, g. Nonnormative (Descriptive) Ethics 2. Applied normative ethics (Biomedical Ethics) WEEK 2: MORAL REASONING AND MORAL PRINCIPLES FOR MEDICAL PRACTICE: Beginning with an introduction to moral reasoning, the student will be exposed to principles and virtues especially appropriate to medical practice and research. A. Moral reasoning 1. Reasoning vs. emotionalism 2. The use of arguments in both general and applied ethics. Fallacies in reasoning. 3. Casuistics, examining individual issues in detail with only background appeal to major theories B. Major Moral Principles derived from or justified by ethical theories and relevant to medical practice and research: a. Principle of Nonmaleficence b. Principle of Beneficience c. Principle of Utility d. Principle of Distributive Justice: e. Equality, Need, Contribution, Effort f. Principle of Autonomy g. Principle limiting autonomy/liberty: public harm, offense, paternalism, social welfare 3

4 WEEK 3: PROFESSIONAL ETHICS The goal of the study of professional ethics is to acquaint the student with the history of medical arts and sciences as a continuum aiming at healing and its philosophical roots as well as cultural context. It will include major developments in codes of ethics for doctors, nurses and other health professionals. Professional ethics will be placed within the context of philosophic ethics as well as a broader societal ethic: duties to society as members of society. The ultimate goal is to explain the role of ethical principles in health care delivery and have the students develop a critically informed judgement on ethical problems in medicine. 1. The Hippocratic Oath and the ANA Code for Nurses. 2. Is the Hippocratic Oath dated? Contemporary Codes. 3. Professionals obligations, including areas of responsibility and lines of authority. 4. Conflicts of Interest, economic aspects of Medicine. 5. The place of personal and professional honesty, integrity, accountability, competence and other virtues. 6. Examining a system of determination and clarification of alternatives within medicine, and decision making for addressing basic ethical questions. 7. Legal rights, responsibilities and resources for health care professionals, including liability and malpractice. 8. The importance of accurate, complete and correct methods of documentation as a legal and ethical obligation. 9. How professional ethics is different from legal responsibilities and surpasses it in scope and rigor. 10. The responsibility to keep up with new developments in the field: continuing professional education. WEEK 4: PATIENTS RIGHTS AND PROFESSIONALS OBLIGATIONS; THE PHYSICIAN-PATIENT RELATIONSHIP The goal is to examine ethical issues and concepts embodied in the principles of patients rights, the doctrine of informed consent and other issues relating to patients rights, e.g. confidentiality in medicine. Some attention will also be paid to the legal implications of professional liability, malpractice, professional negligence and carelessness and other legal doctrines applicable to professional practice. Certain specific legal terms will be covered. A. Patient Rights 1. Privacy and Confidentiality 2. The Legal and Philosophical Foundations of Right to Privacy 4. The basis of confidentiality in Ethical Theories 5. Arguments for and against confidentiality in medicine 6. Patient Rights and Truth Telling. B. The physician-patient relationship (paternalism, truth-telling and informed consent) 1. Paternalism, Truth Telling and Informed Consent 4

5 2. The distinction of state and personal paternalism in Medical and Health Care 3. Truth Telling in Medicine 4. Arguments for and against paternalism, and truth telling in medicine 5. The Role of Ethical Theories in truth telling and informed consent 6. The distinction of empathy and compassion for the patient and professional conduct: the virtuous health care professional. 7. Discussion of such medical virtues as sympathy, honesty, integrity and accountability. 8. Cultural factors in patient decisions and respect for patient autonomy in making decisions. WEEK 5: JUSTICE IN HEALTH CARE DISTRIBUTION AND ALLOCATION OF MEDICAL RESOURCES A. THE CLAIM TO HEALTH CARE 1. Claim Rights, Legal Rights, Moral Rights 2. Ethical Theories: The Right to Health Care 3. Principles of justice and criticisms 4. Arguments for and against medical care as a right 5. patient s rights and the claim to health care B. ALLOCATION OF MEDICAL RESOURCES 1. Scarce medical resources: organs, dialysis units, etc. 2. Ethical Theories* - Allocation of Scarce Medical Resources 3. Arguments (and criticisms) for criteria for selecting the recipients of scarce medical resources WEEK 6: Quiz; INFORMED CONSENT and DECLINING TREATMENT. A. Informed Consent 1. The elements and implications of informed consent. Standards for disclosure. 2. Arguments for and against informed consent in medicine a. The Informed Part of Informed Consent in Medicine b. The Consent Part of Informed Consent in Medicine B. Declining Treatment 1. The elements and implications of declining treatment. 2. Role of ethical theories in declining treatment: patient autonomy 3. Distinction of informing and leading patients in medical alternatives. 4. Cultural factors in patient decisions and respect for patient autonomy in making decisions. WEEK 7: EUTHANASIA, PHYSICIAN ASSISTED SUICIDE AND END OF LIFE DECISIONS A. Euthanasia 1. The Distinction of Active and Passive Euthanasia 2. The Distinction of Voluntary and Non-voluntary Euthanasia 3. The Distinction between Euthanasia and (Physician) Assisted Suicide 5

6 4. Arguments for Voluntary Passive Euthanasia 5. Arguments against Voluntary Passive Euthanasia 6. Arguments for and against Other Forms of Euthanasia 7. Legal considerations: laws covering euthanasia 8. Ethical Theories in relation to euthanasia B. End of Life Decisions 1. Living Wills, including their legal context and ethical ramifications. 2. Advanced Directives 3. The ethics of counseling for living wills and advanced directives. 8. Cultural factors in patient decisions and respect for patient autonomy in making decisions. WEEK 8: ABORTION 1. Biological background 2. Ontological status of the fetus 3. Moral status of the Unborn 4. Pro-Life Arguments (Against Abortion) 5. Pro-Choice Arguments (For Abortion) 6. Legal Considerations: laws covering abortion, esp. Roe vs. Wade and subsequent legal decisions 7. Ethical Theories in relation to abortion WEEK 9: Midterm Exam. MATERNAL-FETAL RIGHTS AND RESPONSIBILITIES. 1. Rights of pregnant women in the workplace 2. Maternal rights of pregnant women: involuntary hospitalization and the status of the fetus 3. Legal precedents and ramifications WEEK 10: BIOMEDICAL RESEARCH AND HUMAN RIGHTS: ETHICAL ISSUES IN MEDICAL EXPERIMENTATION A. Biomedical Research and Human Rights. 1. The practice of medicine and/or biomedical research: 2. Experimentation on humans and the history of cases of abuse of human rights 3. Research subjects - children, prisoners and animals 4. Ethical Theories in relation to medical research and human rights 6. Legal Considerations: laws covering Experiments on Humans and Animals; B. Stem Cell Research. WEEK 11: EUGENICS, HUMAN GENOME RESEARCH 1. Define and discuss eugenics, human genome research and their relation. 2. Examine the misuse of eugenics in the past, e.g. by the Nazis. 3. Discuss the Human Genome project in relation to genetically linked diseases and their cause. 6

7 4. Explore the ethical issues of genetic screening in relation especially to patient confidentiality and other rights. 5. Explain the genetic counseling responsibilities of health care providers 6. Legal Considerations: laws covering Eugenics, Human Genome Research WEEK 12: GENETIC TESTING; INFERTILITY AND IN VITRO FERTILIZATION A. Genetic Testing; 1. Define and discuss genetic testing, human genome research and their relation. 2. Examine the potential for misuse of confidential genetic information, e.g. for discrimination by Insurance Companies 3. Discuss the use of genetic testing in relation to genetically linked diseases and their cause. 4. Explore the ethical issues of genetic screening in relation especially to patient confidentiality and other rights. 5. Explain the genetic counseling responsibilities of health care providers. 6. Discuss the reproductive ramifications that knowledge of a genetic profile provides. 7. Legal Considerations: laws covering genetic information. B. Infertility and In Vitro Fertilization. 1. Discuss infertility issues and recent techniques for overcoming infertility 2. The ethical and legal ramifications of in vitro fertilization 3. Counseling for in vitro fertilization WEEK 13: CLONING 1. Define and discuss cloning, genetic enhancement and their relation. 2. Distinction of organ cloning and human cloning 3. Arguments for cloning: organ replacement 4. Arguments against cloning 5. Explore the ethical issues surrounding cloning 6. Legal Considerations: laws covering cloning. WEEK 14: PUBLIC HEALTH and AIDS. 1. Define and discuss the ethical issues that have arisen due to the AIDS epidemic. 2. Distinguish personal and public health issues. 3. Arguments for and against confining AIDS patients 4. Arguments for and against financial aid to poorer countries hit hard by the AIDS epidemic. 5. Explore the ethical issues surrounding AIDS transmission. 6. Legal Considerations. 7. Explain the AIDS counseling responsibilities of health care providers WEEK 15: REVIEW AND FINAL EXAM 7

8 The order can be changed as can any of the issues. Alternate issues (with a similar format for those given) are, for example: Genetics: Intervention, Control and Research; Involuntary Civil Commitment and Behavior control; Treating or Terminating: The Problem of Impaired Infants 14 WEEK BEHAVIORAL OBJECTIVES HEALTH CARE ETHICS At the end of the week indicated, the student should be able: WEEK 1: 1) To define ethics. 2) To distinguish between applied and general normative ethics 3) To explain the difference between the two types of general normative ethics: deontological and teleological theories 4) To distinguish between cultural and ethical relativism 5) To identify metaethical and non-normative theories, and to critically discuss the naturalist, nonnaturalist, and noncognitive or emotive positions 6) To critically discuss the different types of teleological ethical theories 7) To critically discuss the different types of deontological ethical theories WEEK 2: 1) To distinguish between particular moral judgments and general moral principles 2) To distinguish among claims based on reason, emotion, and intuition 3) To know what is required to justify a moral judgment 4) To define an argument, and to be able to identify common fallacies in moral arguments (e.g. false appeal to authority, ambiguity, hasty generalization, etc. 5) To critically discuss natural law theory of ethics 6) To critically discuss Rawls s theory of justice 7) To identify the major Moral Principles derived from or justified by ethical theories and relevant to medical practice 8) To express the distinctions among claim rights, legal rights and moral rights WEEK 3: PROFESSIONAL ETHICS 1) To know the different positions on the scope and limits of professional ethics including changes in the role of the health care provider over history and recent developments that affect the professional standing of health care professionals, e.g. Managed Care Providers. 2) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue. 3) To critically evaluate the position(s) on professional ethics that would be justified by ethical theories covered in previous weeks. 8

9 4) In light of (2) and (3) above, to critically discuss different arguments. 5) To critically discuss the various positions (including the student s own position) on professional ethics in medicine, and to identify fallacies in popular arguments on these issues. WEEK 4: PATIENTS RIGHTS AND PROFESSIONALS OBLIGATIONS 1) To define paternalism and to give examples of state paternalism and of personal paternalism in medical and health care. 2) To discuss the problems between physician and patient concerning truth-telling and confidentiality. 3) To critically evaluate the position(s) on the issues of paternalism, truth-telling and confidentiality that would be justified by each of the following ethical theories: utilitarianism, Kantian ethics, Ross s Prima Facie duties, natural law ethics, and Rawls s Principles of Justice. 4) To critically discuss the various positions (including the student s own position) on paternalism, truth-telling, and confidentiality in medicine, and to identify fallacies in popular arguments on these issues. 5) To express the ethical dilemmas concerning physicians orders and patients rights and to critically discuss the attempts to resolve these dilemmas. 6) To state the legal and philosophical foundations of the right to privacy. 7) To give the arguments for and against confidentiality in medicine WEEK 5: JUSTICE IN HEALTH CARE DISTRIBUTION 1) To identify the problem in the allocation of medical resources 2) To give the arguments for and against the right to medical care 3) To critically evaluate the allocation of scarce medical resources in terms of the ethical theories covered in previous weeks. 4) To critically discuss the arguments for criteria for selecting recipients of scarce medical resources 5) To critically discuss the various positions (including the student s own position) on the right to health care, the allocation of scarce medical resources, in terms of the ethical theories covered in previous weeks, and to identify fallacies in popular arguments on these issues. WEEK 6: Quiz; INFORMED CONSENT and DECLINING TREATMENT. 1) To define informed consent, including standards for disclosure, and to distinguish between actively and passively declining treatment. 2) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue. 3) To critically evaluate the positions on informed consent and declining treatment in terms of the ethical theories covered in previous weeks. 4) In light of (2) and (3) above, to critically discuss the arguments (including the student s own position) for and against informed consent in medicine, and arguments 9

10 for and against declining treatment and to identify fallacies in popular arguments on these issues. 5) To discuss the problems between physician and patient concerning informed consent. 6) To know the distinction of informing and leading patients in medical alternatives. 7) To be aware of cultural and familial factors in patient decisions and respect for patient autonomy in making decisions. WEEK 7: EUTHANASIA 1) To define euthanasia, and to distinguish between active and passive euthanasia, and between voluntary and nonvoluntary euthanasia 2) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue 3) To critically evaluate the positions on euthanasia in terms of the ethical theories covered in previous weeks. 4) In light of (2) and (3) above, to critically discuss the arguments for and against voluntary passive euthanasia, and arguments for and against other forms of euthanasia WEEK 8: ABORTION 1) To know the different positions on the ontological status of the fetus, and the consequent different views on the fetus s moral status and on abortion 2) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue. 3) To critically evaluate the position(s) on abortion that would be justified by ethical theories covered in previous weeks. 4) In light of (2) and (3) above, to critically discuss the pro-life and pro-choice arguments. WEEK 9: Midterm Exam. MATERNAL-FETAL RIGHTS AND RESPONSIBILITIES. 1) To demonstrate comprehension of material covered in weeks 1-8 in written exam. 2) To define maternal-fetal rights and responsibilities. 3) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue. 4) To critically evaluate the positions on maternal-fetal rights and responsibilities in terms of the ethical theories covered in previous weeks. 5) In light of (2) and (3) above, to critically discuss the arguments for and against maternal-fetal rights and responsibilities. WEEK 10: BIOMEDICAL RESEARCH AND HUMAN RIGHTS 1) To define biomedical research, and to distinguish between ethical and non-ethical research. 10

11 2) To state the problems concerning experimentation and informed consent in general, and involving children and prisoners in particular. 3) To critically evaluate the issue of human experimentation with/without informed consent in terms of the ethical theories covered in previous weeks. 4) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue. 5) In light of (2) and (3) above, to critically discuss the arguments for the against biomedical research involving humans, animals and embryos. WEEK 11: EUGENICS, HUMAN GENOME RESEARCH 1) To define eugenics and to distinguish between negative and positive eugenics, and between voluntary and nonvoluntary eugenics. 2) To know the difference and relation between a moral and a legal right, and to critically evaluate the different positions on what is legally justifiable with respect to this issue 3) To critically discuss the various positions (including the student s own position) on eugenics in terms of the ethical theories covered in previous weeks, and to identify fallacies in popular arguments on these issues. 4) In light of (2) and (3) above, to critically discuss the arguments for the against eugenics, especially with regard to recent developments in human genome research. 5) To be aware of the most current research into human genetics and its ethical implications. WEEK 12: GENETIC TESTING; INFERTILITY 1) To define genetic testing, and to distinguish between different types of infertility treatment. 2) To know and to critically evaluate the different positions on what is legally and morally justifiable with respect to these issues. 3) To critically evaluate the positions on genetic testing and different types of infertility treatment in terms of the ethical theories covered in previous weeks. 4) In light of (2) and (3) above, to critically discuss the arguments (including the student s own position)for and against genetic testing, and arguments for and against certain treatments for infertility, and to identify fallacies in popular arguments on these issues. WEEK 13: CLONING 1) To define cloning and to distinguish between organ cloning and cloning an entire organism. 2) To critically evaluate the different positions in terms of what is legally justifiable with respect to this issue. 3) To critically evaluate the positions on euthanasia in terms of the ethical theories covered in previous weeks. 11

12 4) In light of (2) and (3) above, to critically discuss the arguments (including the student s own position) for cloning, both organ and whole persons, and to identify fallacies in popular arguments on these issues. WEEK 14: PUBLIC HEALTH AND AIDS 1) To discuss to distinguish between various issues surrounding AIDS. 2) To critically evaluate the different positions in terms of what is legally justifiable with respect to this issue. 3) To critically evaluate the positions on various issues surrounding AIDS in terms of the ethical theories covered in previous weeks. 4) In light of (2) and (3) above, to critically discuss the arguments (including the student s own position) for various issues surrounding AIDS, and to identify fallacies in popular arguments on these issues. WEEK 15: REVIEW AND FINAL 1) To demonstrate their ability to critically discuss a selection of issues from the above in Final Exam GENERAL EDUCATION General Education at New York City College of Technology, The City University of New York, provides students with a well rounded knowledge base, an appreciation of diverse cultural and intellectual traditions, an interest in relating the past to the contemporary world, and the skills necessary to reflect upon and shape society. A general education provides the opportunity to explore knowledge from various disciplines and perspectives, and to develop students abilities to read, write and think critically, and to assess information from a variety of sources. Further, and perhaps most importantly, general education develops students intellectual and creative curiosity and commitment to lifelong learning. GENERAL EDUCATION LEARNING OUTCOMES Communication Read and listen analytically, comprehending the meaning of texts, including identifying an argument s major assumptions and evaluating its supporting evidence. Write clearly and coherently in varied academic formats using standard English to critique others texts and to improve upon one s own texts. Present a formal or an informal spoken presentation, speaking to persuade or to describe. Listening to detail by way of analyzing the meanings of texts. Critical Thinking Learning the language of logic, formally and informally, for reasoned argumentation. Critical thinking involves the interpretation and criticism of texts, often primary sources. Philosophical positions are evaluated from a variety of sources. Information is integrated into one s own system of beliefs. The basic concepts of logic are identified and studied, i.e., truth and falsehood, the statement, the argument, premises and conclusion, deductive logic, validity, soundness, inductive 12

13 logic, strength and cogency, identifying fallacies, translating natural language into symbolic form, testing for consistency and entailment, studying and applying the scientific method. Information, Research and Computer skills Information literacy begins with knowing when information is needed. How is the information acquired and then evaluated for its quality? Information literacy allows us to synthesize information from multiple, perhaps, conflicting sources. The importance of using information ethically and legally is stressed throughout. Scientific and Mathematical Literacy Understanding logical argumentation as the basis for an understanding of the scientific method; scientific literacy studies the history of the sciences, and recognizes the contribution of science to human progress. It studies the interrelationships among the sciences and between science and the language of mathematics. An understanding of basic statistical analysis, for example, is necessary for evaluating scientific data and interpreting scientific literature. Humanistic and Social Inquiry Humanistic inquiry studies and comes to respect the diversity of human experience while learning the interconnectedness of global and local concerns. The diversity of cultural traditions is stressed throughout together with an understanding of social and political institutions. Humanistic and social inquiry recognizes a variety of perspectives that emerge from new scholarship on gender, race, and class as well as from non-western cultural traditions. The arts are stressed as a basic human activity. Art forms find their expressions culturally, politically, philosophically and ethically. ASSESSMENT OF GENERAL EDUCATION LEARNING OUTCOMES The methods for assessing general education objectives are generic but specificity may arise depending on which area of general education is being stressed. Multiple choice quizzes are especially useful for assessing reading comprehension of basic content as well as attention to detail. The written assignment is many and various depending on the purpose of the assignment. Assignments range from the low-stakes one-pager to the formal term paper. In class, group work resulting in formal/informal oral presentations. Short answer quizzes addressing basic reading comprehension. Collaborative, in-class editing of written work. 13

14 BIBLIOGRAPHY: HEATH CARE ETHICS Compiled by: Dr.D.McKinney 1994 Revised by: Dr.D.McKinney 1997 Revised by: Prof. Brand 2001 ETHICAL THEORY: GENERAL: Anthologies, etc. Abelson, Raziel and Marie-Louise Friquegnon, Ethics for Modern Life, 4th ed. NY: St. Martin s Press 1991 Ayer, A.J., Freedom and Morality and other Essays. NY: Oxford University Press 1986 Arthur, John. ed. Morality and Moral Controversies. NJ: Prentice Hall Becker, Lawrence C. and Charlotte B. Becker, eds. Encyclopedia of Ethics. Hamden, Ct.: Garland Publishing Co Becker, Lawrence C. and Charlotte B. Becker, eds. A History of Western Ethics. Hamden, Ct.: Garland Publishing Co Bonecav, Daniel. Today's Moral Issues: Classic and Contemporary Perspectives. 2nd ed. Mountain View, Cal.: Mayfield Pub.Co., 1996 Bowie, G. Lee, Kathleen Higgins and Meredith W. Michaels. Thirteen Questions in Ethics. Chicago,Ill.: Harcourt Brace, Denise, T.C. and S.P. Peterfreund. Great Traditions in Ethics, 7th ed. Belmont, Ca.: Wadsworth 1992 Erwin, Edward, and Sidney Gendin and Lowell Kleiman, eds. Ethical Issues in Scientific Research. Hamden, Ct.: Garland Pub. Co.1993 Fischer, John Martin and Mark Ravissez. Ethics: Problems and Principles. Chicago, Ill.: Harcourt Brace, 1992 Frey, R.G. and Morris, C.W., eds. Value, Welfare and Morality. NY: Cambridge Univ. Press 1993 Goldberg, David Theo.Ethical Theory and Social Issues: Historical Text and Contemporary Readings. Chicago, Ill. Harcourt Brace,1989 Grassian, Victor. Moral Reasoning: Ethical Theory and some Contemporary Moral Problems. 2nd edition. NJ Prentice Hall 1992 Haber, Joram. Doing and Being: Selected Readings in Moral Philosophy. NY: MacMillan Pub. Co

15 Hare, R.M. The Language of Morals. NY: Oxford Univ. Press Essays in Ethical Theory. NY: Oxford Univ.Press 1989 Harris, C.E. Applying Moral Theories. Belmont, Ca. Wadsworth Pub.Co Harrison, Jonathan. Challenges to Morality. NY: Macmillan 1993 Hinman, Lawrence M. Ethics: A Pluralistic Approach to Moral Theory. Chicago, Il.: Harcourt Brace, Johnson, Oliver A. Ethics: Selections from Classical and Contemporary Writers. 7th ed. Chicago,Ill: Harcourt Brace, 1994 Kerner, George. C. Three Philosophical Moralists: Mill, Kant and Sartre. NY: Oxford Univ. Press 1990 Louden, Robert B. Morality and Moral Theory. NY: Oxford U.P.1992 Lucas, J.R., Responsibility. NY: Oxford University Press 1993 Luper-Foy, Steven and Curtis Brown. The Moral Life. Chicago, Ill: Harcourt Brace, 1992 May, Larry and Shari Collins Sharratt. Applied Ethics: A Multicultural Approach. NJ: Prentice Hall 1994 Mills, Claudia, Values and Public Policy. Chicago, Ill.: Harcourt Brace, 1992 Moore, Brooke N., and R. Stewart. Moral Philosophy: A Comprehensive Introduction. Mountain View, Ca.: Mayfield Pub. Co., 1994 Norman, Richard. The Moral Philosophers. An Introduction to Ethics: Plato, Aristotle, Hume, Kant, Mill, Marx & Freud. NY: Oxford University Press 1984 Paul, E.F. and Paul, J. eds. The Good Life and Human Good. NY Cambridge Univ. Press 1992 Paul, E.F. and Paul, J. eds. Altruism. NY: Cambridge U.Press 1993 Pojman, Louis. Ethical Theory. Classical and Contemporary Readings. 2nd ed. Belmont, Ca.: Wadsworth 1995 Rachels, James. The Right Thing To Do, Basic Readings in Moral Philosophy, NY: Random House

16 Rachels, James. The Elements of Moral Philosophy, NY: Random House 1993 Raphael, D.D. Moral Philosophy, 2nd. ed. NY: Oxford U.P Rogerson, Kenneth F. Introduction to Ethical Theory. Chicago, Ill: Harcourt Brace, 1991 Rosen, Bernard. Ethical Theory: Strategies and Concepts. Mountain View, Cal.: Mayfield Pub Co., 1993 Rosenstand, The Moral of the Story: An Introduction to Questions of Ethics and Human Nature. Mountain View, Ca,: Mayfield 1994 Ruggiero, Vincent Ryan. Thinking Critically about Ethical Issues, 3rd. edition. Mountain View, Cal.: Mayfield Pub. Co., 1992 Scheffler, Samuel. ed. Consequentialism and its Critics. NY: Oxford U.P The Rejection of Consequentialism. A Philosophical Investigation of the Considerations underlying Rival Moral Conceptions. Rev. ed. NY: Oxford Univ. Press 1994 Schneewind, J.B., ed. Moral Philosophy from Montaigne to Kant: An Anthology, 2 vols. NY: Cambridge University Press: 1990 Sher, George. Moral Philosophy, Selected Readings. Chicago, Ill: Harcourt Brace, 1987 Singer, Peter. ed. A Companion to Ethics. Cambridge, Mass.: Blackwell Pub Ethics. NY: Oxford University Press 1994 Sommers, Christina and Fred Sommers. Vice and Virtue in Everyday Life: Introductory Readings in Ethics. 3rd edition. Chicago, Ill: Harcourt Brace, 1993 Stocker, M. Plural and Conflicting Values. NY: Oxford U. P Strawson, Galen. Freedom and Belief. NY: Oxford Univ. Press 1987 (paper 1991) Temkin, Larry. Inequality. NY: Oxford University Press 1993 Thiroux, Jacques P. Ethics: Theory and Practice, 4th ed. NY: MacMillan Pub. Co Wagner. Michael F. An Historical Introduction to Moral Philosophy. NJ: Prentice Hall

17 Williams, Bernard. Morality. NY:Cambridge Univ. Press ARISTOTLE AND VIRTUE ETHICS: Annas, Julia, The Morality of Happiness, NY: Oxford U.P Biffle, Christopher. A Guided Tour of Selections from Aristotle's Nicomachean Ethics. Mountain View, Cal.: Mayfield Publ Co Casey, John. Pagan Virtue An Essay in Ethics. NY: Oxford U.P.1990 Hurka, Thomas. Perfectionism. NY: Oxford Univ. Press 1993 Irwin, T., trans. Aristotle, Nicomachean Ethics. Indianapolis, IN: Hackett Pub. Co., 1985 Sherman, Nancy. The Fabric of Character. Aristotle's Theory of Virtue. NY: Oxford University Press 1989 (paper 1991) Slote, Michael. From Morality to Virtue. NY: Oxford U.P Sommers, Christina and Fred Sommers. Vice and Virtue in Everyday Life: Introductory Readings in Ethics. 3rd edition. Chicago, Ill: Harcourt Brace, 1993 HUME: Hendel, Charles W. Hume: An Inquiry concerning the Principles of Morals. NY: MacMillan, LLA, 1989 KANTIANISM: Abbott, Thomas K. Kant: Fundamental Principles of the Metaphysics of Morals. NY: MacMillan LLA 1989 Beck, Lewis White. Kant: Foundations of the Metaphysics of Morals. 2nd ed. NY: MacMillan, LLA, 1990 Beck, Lewis White. Kant: Foundations of the Metaphysics of Morals and What is Enlightenment?. NY: MacMillan, LLA, 1989 Caygill, Howard. A Kant Dictionary. Cambridge, Mass.: Blackwell Pub Gregor, Mary, trans. Immanuel Kant. The Metaphysics of Morals. NY: Cambridge University Press

18 Guyer, P. ed. The Cambridge Companion to Kant. NY: Cambridge Univ. Press Hare, R.M. Essays in Ethical Theory. NY: Oxford Univ. Press NATURAL LAW: Baumgarth, W.P. and R.F. Reagan, eds. Aquinas. On Law, Morality and Politics. Indianapolis, IN: Hacket Pub. Co., Goodwin, Robert. Aquinas: Selected Writings. NY: MacMillan, Library of Liberal Arts SOCIAL CONTRACT: R.E. Ewin, Virtues and Rights. The Moral Philosophy of Thomas Hobbes. Boulder, Col: Westview Press, 1991 Schneider, Herbert W. Hobbes: Leviathan I and II. NY: MacMillan, LLA 1989 Wolff, R.P. Understanding Rawls. NJ: Princeton University Press UTIITARIANISM: Brandt, Richard. Morality, Utilitarianism and Rights. NY: Cambridge Univ. Press 1992 Glover, Jonathan. Utilitarianism and its Critics. NY: MacMillan Pub. Co Hooker, Brad, ed. Rationality, Rules and Utility. New Essays on the Moral Philosophy of Richard B. Brandt. Boulder, Col.: Westview Press 1993 Jackson, Julius. A Guided Tour of John Stuart Mill's Utilitarianism. Mountain View, Cal.: Mayfield Pub. Co., 1993 Piest, Oskar. Mill: Utilitarianism. NY: MacMillan LLA 1957 Shields, Currin V. Mill: On Liberty. NY: MacMillan LLA 1989 APPLIED ETHICS: MEDICAL ETHICS AND HEALTH CARE 18

19 Ackerman, Terence and Carson Strong. A Casebook of Medical Ethics. NY: Oxford University Press Alpern, Kenneth. ed. The Ethics of Reproductive Technology. NY: Oxford Univ. Press 1992 Battin, Margaret. Ethical Issues in Suicide. 2nd ed. NJ: Prentice Hall 1995 Battin, Margaret, The Least Worst Death: Essays in Bioethics on the End of Life. NY: Oxford University Press: 1994 Beauchamp, Tom and James F. Childress. Principles of Biomedical Ethics. 4th ed. NY: Oxford Univ. Press 1994 Benjamin, Martin and Joy Curtis. Ethics in Nursing. 3rd ed. NY: Oxford Univ. Press 1992 Bloch, Sidney and Paul Chodoff. Psychiatric Ethics. NY: Oxford Univ. Press 1991 Brody, Baruch. Ethical Issues in Drug Testing, Approval and Pricing, NY Oxford University Press Life and Death Decision Making. NY: Oxford University Press 1988 Brody, Baruch A. and H. Tristam Englehardt. Bioethics: Readings and Cases. NJ: Prentice Hall 1987 Bulger, Heitman, and Reiser. eds. The Ethical Dimensions of the Biological Sciences. NY: Cambridge Univ. Press 1993 Campbell, Alastair V., Grant Gillett and D. Gareth Jones. Practical Medical Ethics. NY: Oxford Univ. Press 1992 Cassell, Eric. The Nature of Suffering and the Goals of Medicine. NY: Oxford Univ. Press 1991 Charlesworth, Max. Bioethics in a Liberal Society. NY: Cambridge Univ. Press 1993 Dwyer, Susan and Joel Feinberg. The Problem of Abortion 3rd ed. Belmont Ca. Wadsworth Pub. Co., 1997 Engelhardt, H. Tristram. The Foundations of Bioethics. An Introduction and Critque. 2nd. ed. NY: Oxford Univ. Press Erwin, Edward, and Sidney Gendin and Lowell Kleiman, eds. Ethical Issues in Scientific Research. An Anthology. Hamden, Ct.: Garland Pub. Co.,

20 Faden, Ruth. A History and Theory of Informed Consent. NY: Oxford Univ. Press 1986 Fox, Rene C. and Judith P. Swazey. Spare Parts. Organ Replacement in American Society. NY: Oxford U.P Garrett, Thomas and H. W. Baillie and R. M. Garrett. Health Care Ethics: Principles and Practices. 2nd ed. NJ: Prentice Hall 1993 Gorovitz, Samuel. Drawing the Line. Life, Death and Ethical Choices in an American Hospital. NY: Oxford U.P Doctors' Dilemmas. Moral Conflict and Medical Care. NY: Oxford Univ. Press 1985 Grodin, Michael and Leonard H. Glantz. Children as Research Subjects. Science, Ethics, and Law. NY: Oxford U.Press 1994 Harris, John. Wonderwoman and Superman. The Ethics of Human Biotechnology. NY: Oxford U.Press 1992 Jameton, Andrew, et al. Nursing Practice: The Ethical Issues. NJ: Prentice Hall Kamm, F.M., Creation and Abortion. A Study in Moral and Legal Philosophy. NY: Oxford University Press Kuhse, Helga. The Sanctity of Life Doctrine in Medicine. NY: Oxford Univ. Press Lakin, Martin. Ethical Issues in the Psychotherapies. NY: Oxford Univ. Press 1988 Lidz. Charles et al. The Erosion of Autonomy in Long-Term Care. NY: Oxford Univ. Pres 1992 Macklin, Ruth. Enemies of Patients. NY: Oxford Univ. Press Mahowald, Mary B. Women and Children in Health Care. An Unequal Majority. NY: Oxford University Press, 1993 Menzel, Paul. T. Strong Medicine. The Ethical Rationing of Health Care. NY: Oxford Univ. Press 1990 Overall, Christine. Human Reproduction. Principles, Practices, Policies. NY: Oxford Univ. Press

21 Pellegrino, Edmund and David C. Thomasma. The Virtues in Medical Practice. NY: Oxford Univ. Press 1993 Rodwin, Marc A. Medicine, Money and Morals, Physicans' Conflicts of Interest. NY: Oxford University Press 1993 Singer, Peter et al., eds. Embryo Experimentation, Ethical, Legal and Social Issues. NY: Cambridge University Press 1990 Singer, Peter. Practical Ethics. NY: Cambridge Univ. Press 1993 Steinbock, Bonnie. Life before Birth. The Moral and Legal Status of Embryos and Fetuses. Y: Oxford U. P Weir, Robert. Abating Treatment with Critically Ill Patients. Ethical and Legal Limits to the Medical Prolongation of Life. NY: Oxford University Press 1989 Wolf, Susan M. Feminism and Bioethics Beyond Reproduction NY: Oxford University Press 1995 Zucker, Arthur, Donald Borchert and David Stewart. Medical Ethics: A Reader. NJ, Prentice Hall