Biomedical Ethics
Philosophy 1105 – Spring 2007
Lecture time: Section 001, M, F 1:30-3:25 Rm A122a,
Lecturer: Dr. John Russell (Ph.D. Cornell)
Phone: 604-323-5453 (Langara), 604-877-1759 (home: before 9pm)
Office hours: Rm A167c, M 3:30-4:30, T,Th 2:30-3:30, Th 5:30-6:30, F 3:30-4:30, and by appointment
E-mail: [email protected]
Web site: Langara: http://www.langara.bc.ca/philosophy/members/jrussell/
COURSE DESCRIPTION
The course will survey some of the main ethical issues that arise in health care contexts and the methodologies for addressing them. The aim will be to provide students with the conceptual and practical skills necessary (1) to identify moral issues in health care contexts, and (2) to respond to those issues in an informed and constructive manner. The course should be of interest to those planning, or already in, careers in the health care professions and to anyone with a philosophical interest in the moral issues related to health care and treatment. The course will be divided into the following components. The first classes will be spent gaining some familiarity with the elements of moral theory. Following this, we will look at models for ethical decision-making in health care and begin to apply them to a variety of concrete practical cases that pose ethical issues and problems. At this point in the course, we will also be examining a number of ethical issues in health care such as the health professional/patient relationship, interdisciplinary relations, distribution of health care resources, end-of-life issues (including euthanasia), medical research on human subjects, ethical issues in reproductive technologies and human genetics, and other issues as time permits (see lecture schedule).
REQUIRED TEXTS
Readings in Biomedical Ethics: A Canadian Focus, edited by Eike-Henner W. Kluge, third edition. Alister Browne and Vincent Sweeney, Health Care Ethics: A Concise Introduction (Courseware). Overheads and other notes will be available from the instructor's web site. Some articles will be photocopied and distributed in class.
COURSE REQUIREMENTS
There will be one in-class exam (25% of total grade), one 5-6 page paper (25% of total grade), a group assignment of a case study of an ethical problem in biomedical ethics (20%), and a final exam (30% of total grade). The exams will be
principally designed to test whether students understand and can think critically about the material that has been covered in the lectures and, to a lesser extent, the readings. This makes class attendance crucial. Students who have kept up with the lectures and readings should not find preparation for the exams especially onerous. Both exams will include short answer questions and short essay questions in response to case studies in biomedical ethics. I will provide detailed information later in the term about preparing a group case study.
EVALUATION SCHEDULE
Exam #1 – Monday February 19th (review on Friday February 16th) Case Study – Friday, March 9th
Paper – Friday, March 30th (automatic one-week extension to April 6th without penalty, but no comments) Final Exam – TBA (review class on April 6th)
Reading Schedule (subject to minor amendment)
Readings are listed in order of importance under each heading. Readings with page numbers are from Readings in Biomedical Ethics, third edition, edited by Kluge. Readings from Browne and Sweeney refer to chapters from Health Care Ethics.
1. Introduction to Moral Theory: Metaethics and Normative Ethics (Week 1-3, Jan 8-26) Rachels, "The Challenge of Cultural Relativism" (handout)
Browne and Sweeney, “Ethical Decision-Making” Kluge “Ethical Theory” pp.1-22
2. Models for Ethical Decision-making in Biomedical Ethics. (Week 4, Jan 29-Feb 2)
Browne and Sweeney, "Ethical Decision-Making"
McDonald, “A Framework for Ethical Decision-Making” available at:
http://www.ethics.ubc.ca/people/mcdonald/decisions.htm.
3. Patient/Health Care Professional Relations: Autonomy, Paternalism, Informed Consent, Truth-telling, Confidentiality (Week 5-6, Feb 5-Feb 16)
Browne and Sweeney, “Autonomy, Paternalism, Informed Consent, Truth-telling” Reibl v. Hughes, pp. 148-157
Freedman, “A Moral Theory of Informed Consent” pp. 157-166
Hyun, “Waiver of Informed Consent, Cultural Sensitivity, and the Problem of Unjust Families and Unjust Traditions, pp. 167-180
Browne and Sweeney, “Confidentiality”
Harrison et al, “Involving Children in Medical Decisions” pp. 194-197
Storch, “Moral Relationships between Nurse and Client: The Influence of Metaphors” pp. 136-145 Childress and Siegler, “Metaphors and Models of Doctor-Patient Relationships: Their Implications for
Autonomy" pp. 125-136
Brody, “The Lie That Heals: The Ethics of Giving Placebos” pp. 227-240
4. Professional Autonomy and Professional Responsibility (Week 7-8, February 19 and 26th).
Browne and Sweeney, “Professional Relationships and Professional Autonomy: Truog et al, “The Problem with Futility”pp. 112-121.
Reading on Medical Mistakes TBA
5. Euthanasia (Week 8, Feb 26-Mar 2)
Browne and Sweeney, “Life and Death Decision-Making” Rodriguez v. British Columbia pp. 358-363.
Rachels, "Active and Passive Euthanasia" pp.364-368.
Doerflinger, “Assisted Suicide: Pro-Choice or Anti-Life?” pp. 368-374.
Quill et al, “The Rule of Double Effect: A Critique of Its Role in End of Life Decision Making” pp. 374-380.
Puccetti, “Does Anyone Survive Neo-Cortical Death?” pp. 289-300.
6. Medical Research on Human Subjects (Week 9-10, March 5-Mar 16) Weijer, “Placebo Trials and Tribulations” pp. 254-57.
Freedman, “Equipoise and the Ethics of Clinical Research” (on reserve)
Declaration of Helsinki (2000) available at: http://www.wma.net/e/policy/b3.htm.
The Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, pp. 244-252.
Manning, “Presumed Consent in Emergency Neonatal Research” pp. 266-274.
7. Distributive Justice and Allocation of Health Care Resources (Week 11-12, Mar 19- Mar 30) Browne and Sweeney, “Resource Allocation”
Canada Health Act, sections 7-12, 18-20 pp. 53-57
Report of the Royal Commission on the Future of Health Services in Canada, pp. 58-62 Nelson and Drought, “The Moral Acceptability of Rationing Medical Care” pp. 79-90
Freedman and Baylis, “Purpose and Function in Government Funded Health Coverage” pp. 63-75. Williams, “Rationing Health Care by Age” pp. 91-95.
Moss and Siegler, “Should Alcoholics Compete Equally for Liver Transplantations?” pp. 97-105.
8. Genetics and Human Reproduction (Week 13, Apr 2-6)
Excerpts from Bill C-13: An Act Respecting Assisted Human Reproduction, pp. 423-426. Respect for Human Life, pp. 431-448.
Overall, “Access to In Vitro Fertilization, Costs, Care and Consent” pp.448-461.
9. TBA (time permitting), perhaps something on the ethics of administering alternative/complementary therapies
