Medical Ethics Syllabus Instructor: Brad Thames Email: Phone: Office: Office Hours: Course Webpage: Course Number Time Location I. Required Materials: All readings will be available either in the course packet or on e- reserve. II. Course Description and Objectives: This course will explore the major ethical issues confronting the practices of medicine and biomedical science. We will become familiar with legal and institutional positions, consider and debate opposing arguments on the various topics, and examine relevant case studies. The objectives of the course are to: 1. Achieve familiarity with some basic ethical frameworks and understand how these ethical frameworks can help us think through contemporary questions in medical ethics. 2. Think clearly and carefully through your own positions on important issues in contemporary medical ethics and the compatibility of these positions with broader philosophical commitments (i.e. what is a person, what rights do persons have, what constitutes human flourishing etc.) 3. Express your own views clearly in class discussion and engage the views of your classmates. 4. Craft well- argued, well- written papers that show understanding of and analytical engagement with the subject matter. II. Assignments and Grades: The final grade will be 40% papers, 20% midterm, 20% final, and 20% participation. Papers (40%): The ability to express yourself clearly and articulately in writing will be vitally important not only throughout college but also for the rest of your lives. Thus this class will put strong emphasis on learning to write organized, thoughtful papers. You will write four 2-3 page papers. Topics will include responses to case studies, objections to scholarly articles, and defenses of a position. 1
Papers will be graded on thoughtfulness, accuracy to the texts and ideas, clarity of expression and correct grammar/mechanics. Please read through the writing guide and grading standards, which will be provided as a handout and will be available on the course webpage. You should not need to consult any sources other than the assigned texts, unless I suggest something else that might help you given your topic. If you do consult outside sources, they must be properly cited according to the Academic Code of Honor (see http://www.nd.edu/~hnrcode/docs/studentguide.pdf). Academic dishonesty (including plagiarism) will not be tolerated and will be dealt with according to university policy. Penalties will range from failure for a particular assignment to failure for the course to tar- and- feathering, depending on the severity of the infraction. Internet sources should not be used under any circumstance. I encourage you to meet with me in preparation for the papers. I will not read drafts submitted over email but I will look at one version of a draft per paper if you bring it to me in person and have specific questions. Papers are to be turned in by the beginning of class on the due date. Please submit your papers both in hardcopy and electronic form (via Concourse). Unexcused late papers will be penalized one full letter grade per day. This policy is not subject to exception unless there are cases of extreme, unexpected health or family hardship. Due Dates: Exams (40%): The midterm will cover all the material in the first half of the course. The final will be focused on the material from the second half of the course, but will include some references to the material in the first half (i.e., don t forget what you learned). Both exams will consist of short answer and essay questions. NB: you are responsible for understanding all assigned material, regardless of whether or not we discussed it in class. So it is important to come see me outside of class if there is anything you haven t quite understood (and this pertains to what we discuss during class as well). Midterm Final Exam: Participation and Attendance (10%): The participation grade will be based on the quality of your in- class participation minus any penalties for lack of attendance. Participation: In a class of this nature, lively, informed discussion will make the difference between a mediocre classroom experience and an excellent one, and the quality of your contribution will factor into your participation grade. Since some of us are naturally inclined to verbal participation and others are not, I recognize that frequency of verbal input isn t always 2
the most reliable indicator of who s prepared and involved. If you are someone who experiences a great deal of difficulty with talking in class, please speak to me and we will make sure your participation grade isn t adversely affected, perhaps by having personal or email discussions about the material outside of class. Since we will be engaging some of the most controversial and passion- fueled debates in our society, it is imperative to maintain a spirit of cordiality, respect, and dialogue. I am committed to finding a way for everyone s ideas to be heard and discussed in a welcoming and non- judgmental environment. If I find someone to regularly act or speak in disrespectful, scornful, or disparaging ways towards other students, this will reflect poorly on his or her participation grade. Attendance: Attendance is very important frequent absences disrupt the momentum of the class and diminish the vitality of class discussions. FOUR unexcused absences will result in a deduction of one letter from your participation grade, with an additional letter for every subsequent unexcused absence. SEVEN or more will result in a deduction of one letter from your overall final grade (which will already take into account the participation penalty). So students with excessive unexcused absences risk failing the course. If you are absent due to documented illness or another university- excused reason, you may make up missed work. If you know ahead of time that you will miss a class for any reason, please let me know and submit any assignments before your absence. Students who fail to display basic respect towards me and other students (holding private conversations, showing up late, falling asleep, smacking your gum, etc.) will be marked absent. In particular, cell phones must not be used in class for any reason (which includes sending or reading received text messages) it s a distraction and discourtesy to other students and to me. If I notice you using a cell phone in class, I will mark you absent for that class period. I would prefer that you not use a laptop in class. It can easily be a distraction, and often results in students simply writing down what the teacher says in lieu of trying to comprehend it. (In fact, studies have shown that students who use laptops in class tend to do worse overall than students who don t.) However, I realize that some of you may find it very difficult to take notes without one, and if you are such a person please come talk to me. Note that the same policy regard cell phones would apply here: if I notice you using your laptop for any purpose other than taking notes (and yes, I can tell), you will be marked absent. 3
III. Course Calendar Topic Ethical Theories Contemporary Approaches to Medical Ethics Doctor- Patient Relationship Confidentiality Truth Telling Autonomy, Paternalism & Informed Consent Abortion Readings Solomon, Normative Ethical Theories Gillon, Four Scenarios Beauchamp, Methods and Principles in Biomedical Ethics Gardiner, A Virtue Ethics Approach to Moral Dilemmas in Medicine Harris, In Praise of Unprincipled Ethics Strong, Specified Priniciplism Chambers, The Fiction of Bioethics Shorter, History of the Doctor- Patient Relationship Cruess et. al., Professionalism- An Ideal to be Sustained Patient- Physician Relationship, AMA Code of Medical Ethics Nolan, The Professional Patient Relationship - CHC Manual Confidentiality, AMA Code of Medical Ethics Kopaczynski, AIDS, Confidentiality, Privacy, and Ethics Committees - CHC Manual Applebaum, Privacy in Psychiatric Treatment Siegler, Confidentiality- A Decrepit Concept Truth Telling, AMA Code of Medical Ethics DeVita, Honestly, Do We Need a Policy on Truth? Bok, Lies to the Sick and Dying Fan, Truth Telling in Medicine- The Confucian View Kant, On A Supposed Right to Lie Dworkin, Autonomy and Informed Consent Cappozi, et. al., Paternalism AMA Code of Medical Ethics, Informed Consent and Surrogate Decision- Making AAP Committee on Bioethics, Informed Consent Vinicky, et. al., The Jehovah's Witness and Blood Corrigan, The Problem with Informed Consent Roe v. Wade and Doe v. Bolton Abridged AMA - Statements on Abortion Protestant Abortion Statements Thomson, A Defense of Abortion Warren, On the Moral and Legal Status of Abortion Tooley, Abortion and Infanticide Ehrenreich, Owning Up to Abortion 4
Seriously Ill Infants Euthanasia/Assisted Suicide Medical Experimentation Justice and the Health Care System Biotechnology Wolf, Rethinking Pro- Choice Rhetoric Mathewes- Green, The Lessons of Roe Marquis, Why Abortion is Immoral Noonan, An Almost Absolute Value in History Campbell, When Care Cannot Cure: Medical Problems in Seriously Ill Babies Hentoff, Getting Rid of Damaged Infants Verhagen - The Groningen Protocol Singer, Pulling Back the Curtain Johnson, Unspeakable Conversations Robinson, End of Life Legal Issues in the US Singer, Voluntary Euthanasia Rachels, Active and Passive Euthanasia The Philosophers Brief Velleman, A Right of Self- Termination? Kass, Why Doctors Must Not Kill Alexander, Medical Science Under Dictatorship Jonas, Experimentation with Human Subjects The Nuremberg Code JAMA Willowbrook Study (Abridged) Willowbrook Letters Pence, Tuskegee Syphilis Study Angell, The Ethics of Clinical Research in the Third World Cohn, Uncharitable? Pellegrino, The Commodification of Medical and Health Care; Mackey, The Whole Foods Alternative to ObamaCare; Goldhill, How American Health Care Killed My Father Pelligrino, The Commodification of Medical and Health Care Daniels, Justice, Health, and Healthcare Buchanan, The Right to a Decent Minimum of Healthcare Krugman, Health Economics 101 Rauch, If Air Travel Worked Like Health Care Sandel, The Case Against Perfection Kass, The Wisdom of Repugnance Condic, Getting Stem Cells Right Melo- Martin and Gillis, Ethical Issues in Human Stem Cell Research Hershenov, An Argument for Limited Human 5
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