PHIL 305: Biomedical Ethics
Spring 2006
Syllabus
MW 10:00 – 11:35; F 10:00 – 10:40
UL 306
Instructor: Dr. Ashley McDowell
Office: Humphrey House 202
Office phone: 337-7077
email: mcdowell@kzoo.edu or ashley.mcdowell@gmail.com
Office hours: MTWF 1:30 – 2:30;
and by appointment, except on Thursdays (unless there is an emergency)
Note on Moodle: this course website will
include at least some useful information – go to http://moodle.kzoo.edu/moodle/ and
find our course, and get yourself logged on.
Note on email: I will be sending mail to
the class alias, which only knows your K email address. Make sure your K email is forwarded to
whatever email account you use regularly, if it’s something else.
Teaching Assistant: Sharat Reddy
email: Sharat.Reddy02@kzoo.edu
Office hours: TBA, and by appointment
Texts and readings Tom Beauchamp & LeRoy Walters, Contemporary Issues in Bioethics, 6th ed. (“B&W”)
Anthony Weston, A Practical Companion to Ethics, 3rd ed. (“Weston”)
Readings on reserve as announced
This is a course in applied
ethics, which is the study of how ethical thinking can be used in real-life
situations and issues. In this case, we
will be exploring the ethics of biomedical issues. Those issues could include euthanasia, abortion, informed
consent, allocating medical resources, and treating impaired infants. What is the morally right thing to do in
various biomedical contexts? What are
good reasons for answers to that question and others like it? What kinds of things should we take into
consideration when making difficult moral decisions about these topics? What role should rights play? What about overall happiness? Are there certain rules of moral conduct that
should never be broken?
The Weston book is an accessible
overview of ethics as something to be integrated into your thinking and applied
in your life. It includes material on
ethical tools like identifying, weighing, and integrating values;
critical thinking; and creativity.
Using this text and the introductory ethics material in the Beauchamp
& Walters text, we will first learn about, discuss, and work on applying
ethical tools in general, and then we will turn to specific applications in
biomedical ethics. The selections in
the Beauchamp & Walters text are mostly academic philosophical articles,
along with some legal decisions and policy papers. For our in-class discussions and readings, we will focus on three
main topics: justice and access (especially on the right to health care
and issues of AIDS and public policy), eugenics and human genetics (including
genetic testing, gene transfer research, and genetic enhancement), and end-of-life
decision-making (including the right to die and assisted suicide). In addition, you and a classmate will
explore an additional biomedical ethical issue (chosen from among the other
issues in the Beauchamp & Walters book) in the form of a presentation.
Throughout this course, you will be learning how to
think for yourself – open-mindedly but critically – about the application of
ethical values and thinking. To do
this, you will learn about specific strategies, theories, concepts, and methods
that are the special emphasis of philosophy and ethics. You may not have come to final conclusions
about ethics or particular issues by the end of this course, or by the end of
your life, for that matter. But you
will almost certainly have made progress in thinking well about ethics
and its applications.
Those applications will include both decisions about
right and wrong actions and decisions about policy or law. We might think it’s wrong to smoke
cigarettes if you’re pregnant, but not think there should be a law against it –
rather, we might think about constructive ways to encourage right behavior
short of enforcement. The important
thing for purposes of this course is that you become adept at looking at as
many relevant aspects of moral issues as clear-headedly and constructively as
possible; and that you learn to present your views and the reasons for them in
the form of logically-constructed arguments.
Unless you have plans to become
a professional philosopher, which I expect few of you do, the most important
things you will gain from this course will not be detailed retention of
specific philosophical positions.
Rather, you should hope and strive to gain abilities in three main
areas:
Theoretical
learning:
-
appreciation
of applied ethics issues and their importance, and the ability to recognize
ethical problems and considerations in many contexts.
-
the
ability to recall, articulate and apply various approaches to moral problems,
particularly in biomedical contexts, and to appraise for yourself the routes
for dealing with important moral issues
Practical
learning:
-
the
ability to reproduce and compare various approaches to solving common human
problems that have ethical dimensions (particularly those in biomedical
contexts).
-
applying
ethical thinking to the “real world” – to everyday living, to specific problems
and puzzles, to social issues, to challenges in your career, and so forth.
-
constructing
a personal methodology based on discoveries made during this class.
Philosophical
methodology: These skills fall into three main sub-areas:
-
extracting
the main points from difficult material, following and reconstructing
arguments, and thinking questions through.
-
learning
to analyze and solve problems, considering them from many points of view and
assessing the pros and cons of different proposals.
-
learning
to express yourself clearly and persuasively.
-
skills
in making decisions and then justifying your position in a clear, logical, and
compelling way.
-
proficiency
at conducting investigations - learning to ask the right questions, and to
develop and assess methods and standards for answering those questions.
-
solving
problems using careful but innovative techniques and basing your conclusions on
reliable evidence.
As the course goes on, I will
expect different things out of you in terms of mastery and achievement. At first, assignments will be designed to
help you gain skills in understanding basic ethical concepts and their
significance. You will learn about
various ethical theories, principles, and tools, and learn how to apply all
those things for yourself on cases and issues.
I will expect you to be able to identify morally relevant factual,
linguistic, and inferential aspects of problems and situations. I will guide you to being able to deploy
specific tools for exploring issues, getting unstuck, making a case, and
deciding for yourself on moral issues.
As we move into studying the specific biomedical
issues, I will expect you not just to understand the tools, but to see how
ethical thinking plays out in rigorous argumentation on particular issues of
importance. I will assess your
achievements in grasping the issues the philosophers are trying to resolve, and
comprehending the differences between approaches and the advantages and
disadvantages of different approaches.
By the end of the course, I will expect you to be pulling everything
together – in particular, using the tools to become enabled to participate in
ethical debates and decision-making processes.
You will be able to evaluate others’ positions and arguments, assess
their strengths, and select a reasoned response, whether that involves
formulating an original position, reaching compromise, or reaching a deeper
understanding. You will be able to
distinguish different legitimate stances on the topics we’ll cover, compare and
contrast the arguments and principles underlying them, and be prepared to
defend your choice of the most reasonable positions and views.
By the end of this course, I will expect you to
locate yourself in the world of biomedical ethical concerns, becoming a
participant, assessor and defender rather than a passive regurgitator. In other words, the assignments and my
assessment criteria in this course will incrementally guide you to
become not a student of ethics but a practitioner.
Classes
will consist of a mixture of lecture, discussion, and in-class work, either
individual or in groups. You will learn
what others have said on these issues as well as developing your own views.
It will be expected that you
will have done the reading, thoroughly, before class. I will also expect you to have looked over
any study guides I might have given you, when that occurs. Class time will not be spent merely
repeating in lecture format what the readings have already said. Of course it’s to be expected that there
will be aspects of the readings that you will need guidance with after the
fact; for that reason, it’s best to read the material carefully so that you
know what to ask for more explanation about.
Lectures, discussion, groupwork, and in-class work will be done under
the assumption that everyone has made a sincere effort to understand the
reading, so doing so will make these activities much more fruitful for you and
your classmates.
You must bring with you to class
whatever text we are working on for that day.
Interaction
outside of class
Office hours: My office hours are posted above. They will be conducted on a first-come, first-served basis, and by appointment, with appointments taking precedence. You should feel absolutely free to come to them and discuss the course, the material, the assignments, or philosophy.
(for policies on all assignments and on specific
assignments, see “Policies” section below)
Exam
on the general ethical material (weeks 1 – 3): 15%
First
short paper (4-6 pages on justice and access): 15%
Second
short paper (4-6 pages on eugenics and human genetics): 20%
Third,
longer paper (7-9 pages on end-of-life decision-making): 30%
Pair
presentation: 10%
Participation
and conduct: 10%
In
class, Monday of 4th week (4/17)
This exam will cover the material in the Weston
text, Beauchamp & Walters Ch. 1, and associated readings. The purpose is to demonstrate your
understanding of the components and underlying framework of the ethical
concepts and tools, your grasp of the significance of these things, and your
ability to apply the tools and concepts for yourself. Without a proficiency in these areas, you wouldn’t be able to go
on to gain the skills and abilities this course ultimately aims to give you,
since you would lack the necessary framework, recognition of motivations, and
basic ethical decision-making skills.
The exam will be a combination
of types of questions (true/false, multiple choice, identification, mapping,
short answer, and so on). I will give
you a study guide ahead of time, and conduct a study session outside of
class. I will be grading this exam
primarily on the basis of whether you have accurately, clearly, and thoroughly
performed tasks such as recognition, classification, illustration, and
application of terms, concepts, and tools studied.
You will be writing two relatively short (4-6 page)
papers for this course, and one somewhat longer (7-9 page) paper. They will be on topics relating to the main
biomedical topics (justice & access; eugenics & human genetics; and
end-of-life decision-making). These
papers will be on topics you will construct and submit yourselves, although I
will be open to providing a topic for you if you prefer that.
The point of each of these papers is to construct
and present a philosophical argument for an ethical thesis regarding a
particular biomedical issue. One goal
is to apply for yourself the principles of reasoning, insight, philosophical
writing, and argumentation modeled and taught in this class. The other goal is to craft a carefully
considered position on an issue, grappling with fundamental problems in your
own way.
Sharat and I will be able to
look at rough drafts, either turned in or during office hours; I will let you
know details as the time gets nearer. I
also encourage you to run rough drafts by each other or your peers at the
Writing Center, even if I do not require you to do so. Whether I look at them or not, rough drafts
and outlines of each of your papers will be due along with the final drafts.
I will grade these papers based
on several main areas of assessment.
The most important thing is that they perform the goals they’re meant to
perform adequately, but there are various aspects of a paper that make that
happen. These include organization,
accuracy, thoroughness, clarity, accessibility, depth of interpretation,
success of illustration by example, and strength of reasons presented.
Your topic proposals will be due
the class after the material for that paper has been completed (6th
week, 8th week, and 10th week) and your final drafts due
a week after the proposals are submitted (7th week, 9th
week, and exam week).
In weeks 6, 8, and 10, time will be set aside for
presentations by pairs of students on sets of topics from the Beauchamp &
Walters text other than those we’ll be studying as a class. You will choose your topic from a sign-up
sheet that I will bring to class. In
the presentation, your pair will present the major issue and concern of your
chosen topic and find a way to help the rest of the class apply their ethical
thinking to the topic (you’ll design your presentation in consultation with me
and/or Sharat). These sessions will
last 15-20 minutes each (depending on the number of groups). Each group will read, in advance, one extra
chapter or chapter section that will not be read by the rest of the class.
These presentations will
function to help you explore a biomedical issue more independently. Presenting your thoughts to the class will
let you have the experience of constructing a thought process that is coherent
and engaging, and them have the experience of learning more about a topic they
otherwise would not be studying. Your
ideas on the issue should be designed to be truly helpful to both yourselves
and your classmates.
Team members will evaluate their own and each other’s performance on the following dimensions: organization, acceptance of responsibility, initiative/motivation, creativity, task completion, attendance, collaboration, participation, attitude, independence, communication, and responsiveness. I will evaluate the presentations based on the following dimensions: appropriate incorporation of reading material or outside information (if warranted), presentation of values, principles, or case studies (if warranted), breadth (didn’t try to do too much or too little), accuracy of representation of others’ views, clarity, quality of presentation of arguments, helpfulness of examples or illustrations (if any), overall mastery of the subject, depth of discussion, cooperation among team members, engagingness of presentation, success in getting the “audience” on board, organization, effectiveness, thoroughness, (appropriate) creativity or imagination, choice of most important aspects to focus on, incorporation of appropriate ethical tools, handling of discussion, division of labor.
Participation is expected. In a philosophy class of this kind, discussion is absolutely
essential, and may be the way you learn most about the material. I know that participation is difficult for
some people, but you can consider this a safe place to practice contributing to
a group discussion, which you will surely need to do throughout your life. The rules for classroom civility and
discourse (see below) will help make this an inviting place to contribute your
voice.
I will keep general track of your contributions in
class. Keep in mind that contributions
can take various forms, including asking for clarification, participation in
group work, and giving helpful examples.
Keep in mind also that more does not necessarily mean better: those who
excessively dominate discussions, speak disrespectfully, or otherwise use their
voices in a negative way may be penalized for doing so. If you are in doubt, or if you are
interested in advice about how to participate more effectively or more easily,
ask me.
Your conduct in this class includes improvement and
effort. It also includes issues of
respectful behavior, such as tardiness, distracting behavior, or disrespectful
behavior towards members of the class.
See the “policies” section below for more information.
Attendance policy: Attendance is expected. Although it does not carry any formal weight in the grade, it
will make a difference to your participation and conduct grade if you are
absent excessively (more than a couple of times during the quarter) Absences will be excused for required sports
activities or practices or for a dire personal circumstance.
Assignment responsibilities:
-
It
is your responsibility to retain copies of all assignments you turn in, in a
reliable format.
-
You
must turn in your papers in class, with your name on the back, written
legibly. This is so no biases of mine
interfere with my grading of your work.
-
If
you turn in a paper late, by email (this is only possible with my permission),
or in any other way that makes it differently turned in from those of the rest
of the class members, you should not expect to get it back at the same time as
everyone else.
-
When
you turn in your papers, you must turn in a copy of a rough draft and an
outline of the paper (with your name written on the back of each). I cannot recommend outlining and revising
philosophy papers enough, and so I want to make absolutely sure you’re doing
both. An outline also sometimes helps
me understand the intentions of your paper better.
Late assignment policy: An assignment that is between one hour and 24
hours late will receive a ½ grade reduction.
An assignment that is between one day and two weeks late will receive a
full grade reduction. Assignments will
not be accepted more than two weeks late.
Changing grades: if you feel you have been assigned a grade unfairly
or inaccurately, you should by all means talk to me about it. My only requirement is that you prepare an
argument (a set of reasons and facts) before you do so.
In
this course, you will be expected to behave like what I’m sure you are – a
civil person interested in entering into an atmosphere that is maintained to be
courteous and respectful. Just so that
my expectations are clear, let me express some specific guidelines. In order to create a smooth and harmonious
learning community,
-
take
care not to disrupt class; please
o
wait
until class is over to pack up
o
turn
off cell phones
o
do
not look at any material other than class material
o
stay
awake during class
o
arrive
on time
-
to
allow everyone to stay focused on the class lecture or discussion,
o
only
one person at a time in the class should be speaking. Side conversations are distracting for surrounding students and
for me.
-
to
ensure the best possible environment for discussion, please
o
no
“hogging the floor”
o
no
blaming or shaming
o
no
personal attacks
o
always
respect the confidentiality of the classroom
o
keep
your contributions aimed at our common goals: discovery, progress, and
learning, not winning, making the “other side” look bad, or getting
attention.
§
If
you violate one of these discussion rules, I will likely point it out to you in
class or afterwards.
§
If
you think someone else is violating one of these discussion rules, I encourage
you to raise the issue (without blaming, shaming, or personal attack!)
“It
is always important to think of the intellectual world as a community of mutual
dependence, mutual helpfulness, mutual protectiveness, and common delight. We take ideas from others and we give them
to others. We are indebted to others,
and others are indebted to us. In
sharing and acknowledging the community, we define ourselves more certainly as
individuals. The ability to describe
our sources is also an ability to define our own originality and our own
selves. All communities depend on
generosity, trust, definition, and the proper use of sources is part of the
mortar that holds the community of the mind together.”
-
Richard
Marius, Expository Writing Program, Harvard University
In this class, as in all classes at Kalamazoo
College, we will be operating under the Honor System. It is important that you familiarize yourself with that
system. You should also familiarize
yourself with proper procedures for collaborating, doing research, and citing
sources. I expect each of you to visit
my webpage and read the essay there called “Plagiarism and How to Avoid It”
(http://kzoo.edu/~mcdowell/Academic_integrity_and_plagiarism.htm). Should you
have any questions about citations, plagiarism, or honor system issues, please
visit or contact me.
Any assignment you turn in that I find to violate
academic integrity, either through dishonesty, plagiarism, lack of appropriate
citations, or unauthorized collaboration, will receive a grade of 0. Any further instance of a violation of academic
integrity will be punished by a failing grade in the class as a minimum
sanction.[1]
In
this class, we will be discussing issues that most people find important, and
on which many people have strong opinions.
We will not be merely exchanging opinions, but will be seeking the
truth. In that spirit, everyone’s
contributions will be both respected and open to thoughtful criticism. We will
be approaching other views – and our own – with an open-minded but critical
eye. The focus will be on providing and
assessing arguments for positions, to try to come to the most thoughtful
position possible on these questions.
Be careful not to take it personally if a view that you put forward is
criticized; this is helpful if what we’re after is really solving the
problems.
If
you have any special needs that I can accommodate, please let me know as soon
as possible.
This schedule is tentative. Any changes will be announced in class and by email and/or on the Moodle site. The reading assignments listed for each day must be completed before that class. Readings are found in your textbooks as indicated.
M 3/27 Introduction
to Class, Ethics, Philosophy, and Biomedical Ethics
W
3/29 Weston
Ch. 1, B&W Ch. 1 pgs. 1-7
F 3/31 Weston
Ch. 2, B&W Ch. 1 pgs. 7-12, Pojman, “Who’s To Judge? Ethical Relativism”
(on reserve)
M
4/3 B&W
Ch. 1 pgs 12-21
W 4/5 B& W Ch. 1 pgs. 21-33
F 4/7 Weston Chs. 3 & 4
M 4/10 Weston
Ch. 5, Cummins, “Minds in Groups” (on reserve)
W 4/12 Weston
Ch. 13, B&W pgs. 28 – 33
F 4/14 Review
M 4/17 Exam
PART TWO:
W 4/19 Introduction:
B&W pgs. 39 – 46
Just
health care and the right to health care:
Daniels, “Is There a Right to Health Care and, If
So, What Does It Encompass?” (B&W 46)
Veatch, “Justice, the Basic Social Contract, and
Health Care” (B&W 53)
Buchanan, “The Right to a Decent Minimum of Health
Care” (B&W 59)
F 4/21 Engelhardt,
“Rights to Health Care, Social Justice, and Fairness in Health Care
Allocations” (B&W 64)
WEEK FIVE
M 4/24 Managed care and access to care:
Gostin, “Securing Health or Just Health Care? The Effect of the Health Care System on the Health of America” (B&W 72)
Powers, “Managed Care: How Economic Incentive Reforms Went Wrong” (B&W 79)
Buchanan, “Managed Care: Rationing without Justice, But Not Unjustly” (B&W 83)
W 4/26 The Global AIDS epidemic:
Intro, B&W 665 – 667
Fauci, “The AIDS Epidemic: Considerations for the 21st Century” (B&W 671)
UNAIDS/WHO, “AIDS Epidemic Update” (B&W) 677
Lamptey, “Reducing Heterosexual Transmission of HIV in Poor Countries” (B&W 685)
F
4/28 AIDS,
justice, and public health:
Yamey
and Rankin, “AIDS and Global Justice” (B&W 700)
Berwick,
“We All Have AIDS” (B&W 702)
Logie and Benatar, “Africa in the 21st Century: Can Despair Be Turned to Hope?” (B&W 704)
M
5/1 PRESENTATIONS
1
Paper
1 topic proposals due
PART
THREE:
W 5/3 Introduction: B&W pgs. 451-456
Eugenics
Programs in the Twentieth Century:
Kevles, “Eugenics and Human Rights” (B&W 457)
U.S. Supreme Court, Buck v. Bell (B&W 460)
Gould, “Carrie Buck’s Daughter” (B&W 462)
Glover, “Eugenics: Some Lessons from the Nazi Experience” (B&W 467)
F 5/5 The Human Genome Project:
Collins and McKusick, “Implications of the Human Genome Project for Medical Science” (B&W 473)
Watson, “Genes and Politics” (B&W 479)
Buchanan, et. al., “From Chance to Choice: Genetics and Justice” (B&W 485)
Paabo, “The Human Genome and Our View of Ourselves” (B&W 496)
WEEK SEVEN
M 5/8 Genetic Testing and Screening:
Roche and Annas, “Protecting Genetic Privacy” (B&W 500)
Burgess, “Beyond Consent: Ethical and Social Issues in Genetic Testing” (B&W 507)
Friedman Ross and Moon, “Ethical Issues in Genetic Testing of Children” (B&W 513)
W 5/10 Human
Gene Transfer Research:
Friedmann, “Principles for Human Gene Therapy Studies” (B&W 522)
Somia and Verma, “Gene Therapy: Trials and Tribulations” (B&W 526)
Savulescu, “Harm, Ethics Committees and the Gene Therapy Death” (B&W 531)
F 5/12 Genetic
Enhancement:
Glover, “Questions about Some Uses of Genetic Engineering” (B&W 534)
Gordon, “Genetic Enhancement in Humans” (B&W 544)
Parens, “The Goodness of Fragility: On the Prospect of Genetic Technologies Aimed at the Enhancement of Human Capabilities” (B&W 548)
WEEK EIGHT
M
5/15 PRESENTATIONS
2
Paper 2 topic proposals due
PART
FOUR:
END-OF-LIFE
DECISION-MAKING
W 5/17 [Day of Gracious Living
movable slot: move readings forward or back as necessary to accommodate DOGL]
F 5/19 Introduction: B&W pgs. 179-185
The right to die:
Kamm, “A Right to Choose Death?” (B&W 186)
WEEK NINE
M 5/22 Kass, “Is There a Right to Die?” (B&W 191)
The legal background in the U.S.: B& W pgs. 179 – 185, 201 – 215;
W 5/24 The moral foundations of public policy on physician-assisted death:
Brock, “Voluntary Active Euthanasia” (B&W 216)
Arras,
“Physician-Assisted Suicide: A Tragic View” (B&W 225)
F 5/26 Public policy in the
Netherlands on physician-assisted death:
Jochemsen and Keown,
“Voluntary Euthanasia under Control? Further Empirical Evidence from the
Netherlands” (B&W 235)
Van Delden, “Slippery
Slopes in Flat Countries – A Response” (B&W 241)
M
5/29 [Memorial
Day holiday]
W
5/31 Palliation
and other alternatives to physician-assisted death:
Gert, Culver, and Clouser, “An Alternative to
Physician-Assisted Suicide” (B&W 244)
Palliative options of last resort:
Quill, Lo, and Brock, “A Comparison of Voluntarily
Stopping Eating and Drinking, Terminal Sedation, Physician, Assisted Suicide,
and Voluntary Active Euthanasia” (B&W 252)
F
6/2 PRESENTATIONS
3
Paper 3 topic proposals due