CHV 333/ Phi 344: Bioethics: Clinical and Population-Level Spring semester 2015/16

Instructor: Johann Frick Classroom: 101 Marx Hall Office: 203 Marx Hall Office Hours: Mondays, 4:30-6:30pm. Email: [email protected]

Brief Course Description: This seminar aims to introduce you to a range of philosophical debates in clinical and population-level bioethics. Among the topics in clinical bioethics that we will discuss are

• The ethics of killing and the badness of death • Abortion • Physician-assisted suicide and euthanasia • Pre-commitment in bioethics • Genetic enhancement.

In population-level bioethics, questions we will discuss include

• The measurement and valuation of health • Cost-effectiveness and disability-discrimination • Treatment vs prevention in the fight against HIV/AIDS • Health inequalities and justice • Personal and social responsibility for health • Paternalism, nudges, and incentives • Standards of care in clinical trials in the US and abroad.

Course Requirements and Grading This course will be held in a seminar format. Seminars will take place Mondays, 1:30- 4:20pm in 101 Marx Hall. You will submit two short response papers (4-5 double-spaced pages) during the semester (30% of your grade); the first of these papers is due on February 28, the second on April 17. In addition, each student will serve as lead-discussant for one seminar meeting during the semester (10% of your grade). A further 30% of your grade will be for oral participation in seminars. The final 30% of your grade will be determined by a final exam.

Readings Readings should be done before the seminar indicated. There are two required books for this course:

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Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life (Oxford: Oxford University Press, 2003).

Frances Kamm, Bioethical Prescriptions: To Create, End, Choose, and Improve Lives (Oxford: Oxford University Press, 2013).

All other readings will be posted to the course website. In addition, you are strongly encouraged to consult the following online resources to learn how to read philosophical texts and to write philosophy papers: http://www.jimpryor.net/teaching/guidelines/reading.html http://www.jimpryor.net/teaching/guidelines/writing.html

SCHEDULE OF TOPICS AND READINGS

February 1. Session 1: Introduction to Consequentialist and Non- Consequentialist Ethical Theory 1. William Shaw, “The Consequentialist Perspective” in Contemporary Debates in Moral Theory, ed. James Dreier (Blackwell, 2006). 2. Frances Kamm, “Nonconsequentialism” in Intricate Ethics: Rights, Responsibilities, and Permissible Harm (Oxford: Oxford University Press, 2007), Sections I-IV.

February 8. Session 2: The Ethics of Killing 1. Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life (Oxford: Oxford University Press, 2003), Chapter 3, pp. 189-265.

February 15. Session 3: Abortion 1. Judith Jarvis Thomson, “A Defense of Abortion”, Philosophy and Public Affairs (1971). 2. Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life (Oxford: Oxford University Press, 2003), pp. 302-328; 362-397.

February 22. Session 4: Physician-Assisted Suicide and Euthanasia 1. Ronald Dworkin, “Assisted Suicide: The Philosophers’ Brief”, New York Review of Books, 44 (1997): 41-47, http://www.nybooks.com/articles/archives/1997/mar/27/assisted-suicide-the- philosophers-brief/ 2. J. David Velleman, “A Right of Self Termination?”, Ethics 109 (1999): 606-628.

2 3. Frances Kamm, “Some Arguments by Velleman Concerning Suicide and Assisted Suicide”, Bioethical Prescriptions: To Create, End, Choose, and Improve Lives (Oxford: Oxford University Press, 2013), pp. 84-98. Further reading: 4. Frances Kamm, “Problems With ‘Assisted Suicide: The Philosopher’s Brief’”, Bioethical Prescriptions: To Create, End, Choose, and Improve Lives (Oxford: Oxford University Press, 2013), pp. 42-52.

Feb 28: First response paper due at 10pm.

Feb 29. Session 5: Pre-Commitment in Bioethics 1. Dan Brock, “Precommitment in Bioethics: Some Theoretical Issues”, 81 Texas Law Review 1805-21 ( 2003). 2. John Robertson, “Precommitment Issues in Bioethics”, 81Texas Law Review 1849-1876. 3. Derek Parfit, “Commitments” in his Reasons and Persons (Oxford: Oxford University Press, 1984), pp. 326-329. Further reading: 4. Jon Elster, “Don’t Burn Your Bridge Before You Come to It: Some Ambiguities and Complexities of Precommitment”, 81Texas Law Review 1752-1787.

March 7. Session 6: Genetic Enhancement 1. Allen Buchanan et al., From Chance to Choice: Genetics and Justice (Cambridge: Cambridge University Press, 2001), Chapter 4, pp. 156-203. 2. Sandel, Michael, “The Case Against Perfection” The Atlantic Monthly, April 2004, https://www.theatlantic.com/past/docs/issues/2004/04/sandel.htm Further reading: 3. Frances Kamm, “What Is and Is Not Wrong With Enhancement? Evaluating Sandel’s Views”, Bioethical Prescriptions: To Create, End, Choose, and Improve Lives (Oxford: Oxford University Press, 2013), pp. 326-362.

SPRING BREAK

March 21. Session 7: Deciding Whom to Help – Healthy vs. Disabled 1. Trude Arneson and Erik Nord, “The value of DALY life: problems with ethics and validity of disability adjusted life years”, BMJ 1999; 319: 1423–5. 2. Singer et al, “Double Jeopardy and the Use of QALYs in Health Care Allocation”, Journal of Medical Ethics 21(1995), pp. 144-50. 3. Frances Kamm, “Deciding Whom to Help, Health-Adjusted Life Years and Disabilities”, in S. Anand, F. Peter, and A. Sen, eds., Public Health, Ethics, and Equity, pp. 225-242. Further reading: 4. Frances Kamm, “Aggregation, Allocating Scarce Resources, and the Disabled”, Bioethical Prescriptions: To Create, End, Choose, and Improve Lives (Oxford: Oxford University Press, 2013), pp. 424-485.

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March 28: Session 8: Treatment vs Prevention in the Fight Against HIV/AIDS 1. Dan Brock and Dan Wikler, “Ethical Challenges In Long-Term Funding For HIV/AIDS”, Health Affairs 28(6), 2009 2. Norman Daniels, “Reasonable Disagreement about Identified vs. Statistical Victims”, Hastings Center Report 42, no.1 (2012): 35-45. 3. Johann Frick, “Treatment vs Prevention in the Fight Against HIV/AIDS and the Problem of Identified vs Statistical Lives”, in G. Cohen, N. Daniels and N. Eyal, Identified versus Statistical Lives (Oxford: Oxford University Press, 2015). Further reading: 4. Johann Frick, “Contractualism and Social Risk: How to Count the Numbers Without Aggregating”, Philosophy & Public Affairs 43.3 (2015): 175-223.

April 4. Session 9: Health Inequalities and Justice 1. Daniel Hausman, “What’s Wrong with Health Inequalities?”, Journal of Political Philosophy 15(1) 2007, pp. 44-66. 2. Norman Daniels, “When Are Health Inequalities Unjust? The Social Determinants of Health”, Just Health: Meeting Health Needs Fairly (New York: Cambridge University Press, 2008), pp. 79-102. 3. Sarah Marchand et al., “Class, Health, and Justice”, Milbank Quarterly 76(3), 1998, pp. 449-67.

April 11. Session 10: Personal and Social Responsibility for Health 1. Daniel Wikler, “Personal and Social Responsibility for Health”, in S. Anand, F. Peter, and A. Sen (eds.), Public Health, Ethics, and Equity, Chapter 6. 2. Kristin Voigt, “Smoking and Social Justice” Public Health Ethics 3(2), pp. 91-106, 2010 3. Howard Leichter, “‘Evil Habits' and ‘Personal Choices’: Assigning Responsibility for Health in the 20th Century”, Milbank Quarterly 81(4), 2003, pp. 603-26. Further reading: 4. Brian Barry “The Cult of Personal Responsibility”, Section IV of his Why Social Justice Matters, 2005.

April 17: Second response paper due at 10pm.

April 18. Session 11: Paternalism, Nudges, and Incentives 1. Cass Sunstein and Richard Thaler, “Libertarian Paternalism is not an Oxymoron”, University of Chicago Law Review 70(4), 2003, pp. 1159-1202. 2. Daniel Hausman and BrynnWelch, “Debate: To Nudge or Not to Nudge”, Journal of Political Philosophy 18(1), 2010, pp. 123-136.

4 3. Daniel Wikler, “Persuasion and Coercion for Health: Ethical Issues in Government Efforts to Change Lifestyles”, Milbank Quarterly 56(3), 1978 306- 317 (excerpt). Further reading: 4. Harald Schmidt, Kristen Voigt, and Daniel Wikler, “Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives”, New England Journal of Medicine Dec. 30, 2009.

April 25. Session 12: Standards of Care in Clinical Trials in the US and Abroad 1. Harvard Program on Ethical Issues in International Health Research, “The Debate Over Clinical Trials of AZT to Prevent Mother-to-Infant Transmission of HIV in Developing Nations” (online case study: http://www.hks.harvard.edu/case/azt/ethics/home.html) 2. Marcia Angell, “The ethics of clinical research in the third world”, New England Journal of Medicine (September 18, 1997) 337; 12: 847-849. 3. Alan Wertheimer, “Exploitation in Clinical Research”, in Jennifer S. Hawkins and Ezekiel J. Emanuel, Exploitation and Developing Countries: The Ethics of Clinical Research, 2008, pp. 63-104. Further reading: 4. Thomas Pogge, “Testing Our Drugs on the Poor Abroad” in Jennifer S. Hawkins and Ezekiel J. Emanuel, Exploitation and Developing Countries: The Ethics of Clinical Research, 2008, pp. 105-142.

Date TBD: Final Exam

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