Ethical Issues in Health Care PHL 344 Section 702

Ethical Issues in Health Care PHL 344 Section 702 Summer 2005 Michigan State University At Troy High School, 5/17/2005-6/30/2005

CONTACT INFORMATION Instructor: Barry DeCoster e-mail: [email protected] (This is probably the best way to get in touch with me. Weekdays, I will read email once a day; I will most likely not read it over the weekend.) Office: C-218 East Fee Hall, Center for Ethics Office Phone: 517-432-2691 Office Fax: 517-353-3289 Home Phone: 517-272-3020 (Please use respect, i.e., calls only between 10 am–8 pm.) Phone Messages: 517-355-4490, to leave messages with a person at the Philosophy Department Office Hours: 30 minutes before and after class, and especially by appointment. Office/Mailing Address: C-209 East Fee Hall, Center for Ethics and Humanities, MSU, East Lansing, MI 48824 -1316 Class Meetings: Tu, Th, 6.00-10.00 pm, Troy High School, 4777 Northfield Parkway (Located SW corner of Long Lake Rd and Northfield Parkway), Room 218, Troy MI Course Website: http://www.msu.edu/~decoste4/phl344/ (Check frequently. I will post announcements and most handouts here.)

COURSE DESCRIPTION In this course, we will critically examine a number of ethical issues arising from today’s healthcare system. These will include the relationship between healthcare professionals and patients, genetic engineering, reproductive technologies, cloning, human and animal experimentation, HIV and AIDS policies, and challenges in healthcare policy and reform.

These topics raise questions that do not have easy answers; many have reasonable-sounding solutions on both sides. Still, how we work towards solutions is important since we, our family, and our friends will be directly affected. This course will develop skills in recognizing and critically analyzing moral arguments, and lead to improved written and verbal arguments.

COURSE OBJECTIVES By the end of this course, you will have an overview of the topics in biomedical ethics. You will be able to identify ethical issues in the practice of healthcare, and discuss them in a thoughtful, informed, and respectful manner. In both your written work and in-class discussions, you will be able to develop a coherent set of reasons for a conclusion, and evaluate different forms of philosophical “arguments.”

04a22b6d77a40a443b3e24fff018b5b5.doc 1 REQUIRED TEXTS 1- Healthcare Ethics in a Diverse Society, Michael C. Brannigan and Judith A. Boss (Mayfield, 2001, 1st edition, ISBN 155934976X). (One copy is on reserve at the MSU main library. You can purchase this text and have it shipped to you from the MSU Bookstore, located in the International Center. Call 517- 355-3450; ask for the textbook desk. Other local bookstores or online stores like Amazon.com may have used editions for cheaper.) 2- Course pack [CP] These readings and a copy of the text will be available online at the course web page, or at the MSU Main Library reserve desk (West Wing, 2nd floor, and bring your student ID). At the library, you can check out the CP and textbook for up to two hours for copying time. If you do not have easy internet access, talk with Barry about this ASAP!

READING SCHEDULE Generally, we will stick very closely to the reading schedule (below). However, the point of this course is for you to learn. If we need to negotiate changes to the schedule, we can do so. Also, if you have suggestions about things I can do better in class, please let me know, and I will try to adjust the reading schedule or classroom dynamics so that we can maximize learning. I reserve the right to make changes in this schedule; if this occurs, changes will be announced in class and on the course website. Page numbers refer to Healthcare Ethics in a Diverse Society, unless otherwise noted. When articles are assigned, you are also responsible for reading and take time to consider your responses to the “Questions for Comprehension and Reflection.” If you are truly unsure of how to answer these, you likely need to reread. Important administrative dates have been noted between double brackets [[ ]].

OVERVIEW OF COURSE AND INTRODUCTION TO MORAL THEORIES IN HEALTHCARE ETHICS . Introduction to the course . What are the goals of ethics? . Review Syllabus . [in class video] “Discussions in Bioethics” Readings (to be read before class) Tu, May 17 . Brody & Tomlinson, “Ethics in Primary Care” [CP] Additional Reading (to completed by Tues, May 24) . Overview of Moral Theories in Healthcare Ethics, pp 1-23 Suggested Reading . Rachels, “What is Morality?” (Optional, but strongly recommended) [CP] CRITICAL THINKING AND MAKING GOOD ARGUMENTS . Arguments, 54-80 . Fallacies, pp 80-90 Th, May 19 . Reviewing breakdown of arguments in J.J. Thomson’s “A Defense of Abortion”, pp 95-107. . In-class video exercise and review of Arguments handout

04a22b6d77a40a443b3e24fff018b5b5.doc 2 THE RELATIONSHIP BETWEEN HEALTHCARE PROFESSIONALS AND PATIENTS . Utilitarianism, pp 23-28. . Rachels, “The Utilitarian Approach” and “The Debate over Utilitarianism” [CP] . Overview, pp 108-124. . Haddad, “The Nurse/Physician Relationship and Ethical Decision Making”, pp 139-142. Tu, May 24 . Benjamin and Curtis, “Recurring Ethical Issues in Nurse- Physician Relationships” [CP]

Suggested Reading . Mohr and Horton-Deutsch, “Malfeasance and Regaining Nursing’s Moral Voice and Integrity” [CP] . Deontology, pp 28-32. . Rachels, “Are There Absolute Moral Rules” and “Kant and Respect for Persons” [CP] Th, May 26 . Disclosure, Confidentiality, and Informed Consent, pp 124-138 . Bok, “Lies to the Sick and Dying” & . Lipkin, “On Telling Patients the Truth” pp 143-153 . Tarasoff Case, pp 164-170. EUTHANASIA, PHYSICIAN-ASSISTED SUICIDE, AND REFUSAL OF TREATMENT . Rights, Virtue Ethics, and the “Four Principles” of Healthcare Ethics, pp 32-42. . Overview, pp 473-504 Tu, May 31 . [in class video] Dax’s Case . Rachels, “Active and Passive Euthanasia”, pp 508-511 . Beauchamp and Childress, “Rachels on Active and Passive Euthanasia”, pp 512-515 . Tong, “Feminist Approaches to Ethics” [CP] (Note: the sub-section on ‘Care Ethics’ pp 38-48 is optional; you responsible for the rest of the article.) . Review Virtue Ethics, pp 34-38. . Wolf, “A Feminist Critique of Physician-assisted Suicide”, pp Th, June 2 523-542. . Brannigan, “Re-assessing the Ordinary / Extraordinary Distinction in Withholding / Withdrawing Nutrition and Hydration”, pp 516-523 . Terri Schiavo case overview [distributed in class] . Midterm Exam Distributed. Due Tuesday, June 7.

04a22b6d77a40a443b3e24fff018b5b5.doc 3 PARENTING IN THE AGE OF GENETIC & REPRODUCTIVE TECHNOLOGIES . Overview, pp 249-275. . McGee, “Parenting in an Era of Genetics” pp 313-318. . Rhodes, “Genetic Links, Family Ties, and Social Bonds: Rights Tu, June 7 [[6/8/05 - and Responsibilities in the Face of Genetic Knowledge, pp 291- Midpoint of 298. Course]] Suggested Reading . Overview, pp 276-284 . Murphy, “Should Lesbians Count as Infertile Couples?” [CP] . Sherwin, “Normalizing Reproductive Technologies and the Implications for Autonomy” [CP] Th, June 9 . King, The Politics of Reproductive Benefits [CP] . Is There a Right to Reproduce? (TBA)

PREJUDICE AND POLICIES: HIV, AIDS, AND FEAR OF INFECTIONS . Pp 549-573. . Rabinowitz, “The Great Hijack” pp 574-575 . Mohr, “AIDS, Gays, and State Coercion” pp 576-580 . Steinbock, “Harming, Wrongdoing, and AIDS” pp 581-588 Tu, June 14 Suggested Readings . Mandatory Smallpox Vaccinations in the Wake of 9-11 [CP] . Current news: “The Super HIV Outbreak” and “FDA to Implement Gay Sperm Donor Rules” [CP] . Review Tarasoff Case, pp 164-170 . “Please Don’t Tell” [CP] . Ainslie, “Questioning Bioethics: AIDS, Sexual Ethics, and the Duty to Warn” [CP] Th, June 16 Suggestions for Final Exam Questions Due

[[6/17/05 - Last day for withdrawal or dropping First Half Summer Session courses with no grade reported.]] QUESTIONING CLINICIANS’ ACTIONS OUTSIDE OF THE CLINIC: PARTICIPATION IN TORTURE AND CAPITAL PUNISHMENT . Lifton, “Doctors and Torture” [CP] . Bloche and Marks, “When Doctors Go to War” [CP] . Mason, “‘The Dogs that Did Not Bark’” [CP] Tu, June 21 . Troug & Brennan, “Participation of Physicians in Capital Punishment” [CP] . Puglusi, “Lethal Injection–Could you?” [CP] Th, June 23 . Conclude discussion of previous readings

04a22b6d77a40a443b3e24fff018b5b5.doc 4 . Group choice on topic and readings Tu, June 28 . [Scheduled catch-up day, and review for exam] Th, June 30 . Final Exam Due

ASSIGNMENTS (BRIEF CALENDAR) Reflection papers: TBA Reflection papers are not scheduled. Typically, these will be distributed in class. Midterm Exam: Due Tuesday, June 7 Final Exam: Due June 30

COURSE REQUIREMENTS AND EVALUATION Several Reflection Papers (5) 5 total 4 highest grades x 10% each= 40% Midterm (Essay) Exam 25% Final (Essay) Exam 25% Attendance 10%

Course requirements include a midterm exam (take-home), a final exam (take-home), several shorter writing assignments (called “reflection papers”), and attendance.

About three-quarters of the way through the course, I’ll ask for suggestions for final exam questions. The final exam will consist of a number of essay questions, distributed at least one week before the exam is due. The exam will have a number of different questions (say, seven), and you will be asked to answer some subset (say, four). (Note, the exact number of questions on the exam will be determined later, but this is the general format of the exam.)

Reflection papers will be short writing assignments (typically 2-3 pages, double-spaced, typed, following other standards for written work). The assignments will be distributed in class, are due the next class meeting, and they are not scheduled on the syllabus. I reserve the right, though, to ask you to write in class, as a tool to instigate discussion. If you are absent for any reason, it is your responsibility to contact a classmate and find out what you have missed.

Because of the controversial and complex nature of the topics we will be discussing, it is essential that you come to class prepared to discuss the day’s readings. Being prepared requires a range of actions. This requires that you have read the assignment for that day, and that you have thought about the material. My view on teaching this course is that your active participation is essential. While reading, note any questions that you have. After having finished the article, look back to see if your questions were answered. If not, please raise them in class. (As a student myself, it’s taken me a long time to realize that if I have a question about something, someone else in the class does, too.) Also, please bring all readings with you to class each day, since we will often refer to the text itself to determine what the author is arguing. Finally, being prepared means engaging your classmates in conversation and teaching about the topics we’ll investigate.

REWRITES All reflection papers may be rewritten once, after you have received comments. You should take these comments into account when rewriting. Fixing only these issues does not mean you automatically have earned a 4.0. When handing in a re-write, you must also include the

04a22b6d77a40a443b3e24fff018b5b5.doc 5 “original” with Barry’s comments on it. Note, it is theoretically possible to do worse on the rewrite, so if you choose to rewrite assignments, take them seriously. (See also comments on late work below.)

LATE WORK Due to the accelerated pace of this summer course, please plan out your work schedule in advance. All assignments are due at the beginning of class (6 pm). Any work passed in late will lose 0.5 points (out of 4.0 points) for each 24-hour-period that it is late. So, if you do not pass in your paper on a Thursday, you will lose significant points by the next Monday. These rules apply to reflection paper distributed in class; if you are absent, you must contact another student to see what you’ve missed. If you wish, you can email me any of your work as an attachment, rather than waiting until the next time we meet in class.

Late papers can be improved through rewrites, but grades lowered because the assignment was late will not loose the “late penalty”.

WRITTEN WORK All written work should be typed, double spaced, 12 point font, “normal” margins (1-inch on all sides), printed clearly, spell-checked!!!, stapled, with your PID and date at the top. [NOTE: write your name on the back of your paper; do not put your name on the top, since I will try to grade your papers in the “blind review” fashion.] I will provide a more detailed list of requirements for both our reflection papers and for our two papers, which will be distributed and discussed in advance of the assignments themselves.

ATTENDANCE The success of course depends on your active participation. Your presence and participation in class is necessary for your learning and the learning of your classmates. Therefore, you will be graded on your attendance. You will be allowed one absence (a four hour class meeting). After this, each unexcused absence will deduct from your attendance grade. You are fully responsible for finding out what was covered during any class time that you miss, and for completing any work that was assigned during that time. Videos covered in class will not be available for viewing outside of class time.

NOTES ON ACADEMIC HONESTY You are expected to know and follow MSU’s policies on plagiarism. In brief, do not plagiarize the ideas or work of others. If I discover work has been plagiarized, or a person has cheated, I reserve the right to fail the person for the assignment or for the course.

Note: I can gladly say that I have never had to invoke this policy, nor do I want to. Most confusion seems to revolve around how to talk in your writing about what other people have written, and how to use their ideas to facilitate your own discussion on these points. There will be times when you will want to refer to what was written in one of the articles we read; when you use/refer to these, be sure to cite them. The following are some general examples of plagiarism that must be avoided: . copying text without quotation marks; . paraphrasing someone else’s writing without acknowledgement; . using someone else’s facts or ideas without citing your source(s). Finally, I expect you to have read MSU’s policies on academic integrity, which are available at http://www.vps.msu.edu/SpLife/rule32.htm.

04a22b6d77a40a443b3e24fff018b5b5.doc 6 FOOD NOTE Please fee free to bring coffee, tea, or snacks with you to class. You cannot think and discuss readings at length on an empty stomach. So, eat before you come to class, and bring enough to keep you going.

ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES Students with disabilities should contact the Resource Center for People with Disabilities [353- 9642 or 355-1293 (TTY)] at the beginning of the semester to develop reasonable accommodations. Please notify me if you have any special requirements or needs of which I should be aware.

Welcome to the class! I’m glad we’ll be able to explore these topics together!

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