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ExamsMid-term (to come)Final (to come)

Bioethics Syllabus

PHIL 233: Biomedical Ethics

Charlie KurthClass: Mon/Wed, 1:00-2:30pm (McDonnell 162)

Email: ckurth [at] wustl [dot] eduOffice Hours: Wed 2:30-4:30pm, and by app't

Office phone: 314-935-4753Office Location: Wilson 112

Teaching Assistants:

Nate Adams

■ Email: npadams [at] wustl [dot] edua Office Hours: Tues/Thurs, 1:00-2:00pm,

and by appointment■ Office Location: Wilson 11 6

David Winchell

■ Email: dswinche [at] wustl [dot] edu■ Office Hours: Tues/Thurs, 1 2:00-1:00pm,

and by appointment■ Office Location: Wilson 11 6

Course OverviewOrgan transplants have proven to be a successfulway of saving people's lives and improving theirwell-being. But these procedures also raise seriousquestions that shape and challenge our thinking

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across a range of ethical issues: When and by whatmeans can we harvest organs from others? Given thescarcity of organs available for transplant, how shouldwe decide who should get them? Given how risky andexpensive transplant surgeries can be, should weeven be doing them in the first place? Are thereethicai limits on what can be transplanted—forinstance, is it permissible to perform face transplants?In this course, we will take a close look at these andother issues as we examine the work of philosophers,doctors, and policy makers. Our aim will be to get abetter understanding of the ethics of organtransplantation. But, as we will see, the issues thatwe will investigate are also relevant to other areas ofbioethics, and to moral and political philosophy moregenerally.

TextsSelected readings available from the course web site

AssignmentsThis course will have three graded components:

■ Short writing assignments & participation(25%).You will be asked to complete four short writingassignments (1-2 double spaced pages each)throughout the semester. These assignmentsare designed to allow you critically engage withthe readings and help prepare you for our classdiscussions. They will be evaluated for accuracyand effort. These short papers will be combinedwith your class participation to determine yourperformance for this portion of the course.

m You need to turn in your short paper (byemail, details below) before the start ofclass on the day that it is due. You shouldalso bring a hard copy of your paper withyou to class. Please type "Phil 233Assignment #" in the subject line of youremail.

■ For assignments 1 and 3, email your

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paper to Nate.a For assignments 2 and 4, email your

paper to David.

Mid-term exam (30%).The mid-term will be take-home exam coveringmaterial on sections 2 and 3 of the course. I willprovide you with the questions approximatelyone week before they are due. The exam will bedue at 3:30pm on Friday, March 2.

Final exam (45%).The final exam will also be a take-home exam. Itwill cover material from sections 4-6 of thecourse and will be due on Wednesday, May 9(details to come). I will provide you with thequestions during the final week of class.

Advice and ResourcesMany of the reading assignments for this course areshort. But don't let that fool you—philosophy is hard.How do you deal with this? Well, here are somesuggestions: (i) Read the material more than once, (ii)After reading an essay, try and summarize the mainclaims and arguments in your own words—the willhelp you come up with questions and objections, (iii)Start the written assignments—especially themid-term and final—early (doing this will help youreview your answers with a clear head), (iv) Mostimportantly, if you're puzzled or confused aboutsomething, ask questions!

PoliciesIn order to help ensure a successful class, pleaseheed the following rules and policies:

a Due Dates.Baring unusual circumstances, the due dates(especially for the mid-term and final) on thesyllabus are non-negotiable. If you think you

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have reason to miss an assignment, it is best toinform me well in advance.

■ Classroom Environment.Please arrive to class on time. All cell phonesmust be turned off during class. Texting is notpermitted. Abuse of these courtesies may leadto penalties.

a Statement of Academic Integrity. Upon arrivalat Washington University, you signed astatement indicating that you have read and thatyou understand that you will abide by theUniversity's Academic Integrity Policy (availablehere). In this class, you will be expected tohonor that commitment. This means that allwork presented as original must, in fact, beoriginal; the ideas and contributions of others(be they quotes, summaries, or paraphrases)must be appropriately acknowledged. You areresponsible for (re)familiarizing yourself withthese policies; ignorance will not be an excuse.If you have any questions, feel free to talk to

Tentative Schedule of Readings andAssignmentsSection 1. Introduction

Wed, Jan 18:

-i Course introduction and overview

Section 2. Who is Dead?It seems like a simple question—who is dead? But, aswe will see, this question proves to be very difficult toanswer. Moreover, how we answer it has significantimplications for the supply of organs available fortransplant surgeries. So understanding the natureand ethics of death is central to debates about the

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permissibility of organ transplantation.

Mon, Jan 23:

■ Read: syllabus, University's Academic Integrity»gjl*]flirSETO»lim

article"a Harris, "New for Aspiring Doctors, the People

Skills Test"Harvard Medical School Definition of BrainDeath

* Presidential Commission Report [read pp. 3-12,31-38 only]

Wed, Jan 25:

■ Veatch, "The Whole-Brain-Oriented Concept ofDeath: An Outmoded PhilosophicalFormulation"

Mon, Jan 30:

a Singer, "Is the Sanctity of Life Ethic TerminallyHI?"

■ Short writing assignment 1

Wed, Feb 1:

■ McMahan, "The Metaphysics of Brain Death"

Mon, Feb 6:

■ McMahan, con't

Wed, Feb 8:

■ Stein, "Technigue Spots Patients Misdiagnisedas Being in 'Vegitative State'"

■ Veatch, "The Definition of Death: Problems forPublic Policy"

Section 3. Ethical Issues in Organ ProcurementThe number of people in need of organ transplantsgreatly exceeds the number of organs that isavailable. In light of this fact, doctors, philosophers,

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and policy makers have considered various—andmorally contentious—ways of increasing the supply.For instance, is it permissible for people to ask othersto donate their organs? Should we make organdonation compulsory? Should we allow the buyingand selling of organs? What other options might therebe?

If you're interested in registering as an organ donor,CiiC(\ here.

Mon, Feb 13:

■ Veatch, "Gift or Salvage: Two Models of OrganProcurement"

Wed, Feb 15:

m Veatch, "The Myth of Presumed Consent"

Mon, Feb 20:

MfSIikWim ITiTiWSi ■•fsT* KVStiSmBlfor Transplantation"

■ Short writing assignment 2

Wed, Feb 22:

■ Kluge, "Organ Donation and Retrieval: WhoseBody is it Anyway?"

Mon, Feb 27:

; Matas, "The Case for Living Kidney Sales"

Wed, Feb 29:

Kahn & Delmonico, "The Conseguences ofPublic Policy to Buy and Sell Organs forTransplantation"YouTube clip: trailer for the movie IndecentProposal

Friday, March 2: Mid-term Exam DUE by 3:30pm(details to come).

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Section 4. Resource Allocation: Who Gets theOrgans?Given the undersupply of organs available fortransplant, we need to make decisions about whoshould get them. But we want to be able to do this ina way that is morally justifiable. In this part of thecourse, we investigate questions like the following:Should we give priority to the neediest patients? Orshould the probability of success be given greaterweight? Should one's race or ability to contribute tosociety matter? Should those who led unhealthy lives(e.g., alcoholics) be given less priority? Is itappropriate to allow people to donate their organsonly to a specific individual (like their spouse)?

Mon, March 5:

■ Alexander, "They Decide Who Lives, Who Dies"

Wed, March 7

■ Childress, "Putting Patients First"

Mon, March 12

■ No class-spring break

Wed, March 14

■ No class-spring break

Mon, March 19

l̂ r»rTg:<SiM«iw<BiCiiwil[»gilw»]ii«]i[*^mti»]iii>raE|Eauallv for Liver Transplantation?"

Wed, March 21

:

Mon,

MiierDury,

March 26

i ne M lL*i«lll*]l l*fl l l l■m : «n : - l « l t ^ i M

■ Murphy, "Wbulci nny Story (*HI«!TISmiRvWed, March 28

:s Kluge, "DesismW-8EJ5R1ISBion

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Short writing assignment 3

Section 5. Resource Allocation: Transplants,Scarce Resources, and Health CareWhile transplant surgeries save lives, they are alsorisky and tremendously expensive. Moreover thereare other life-saving technologies that prove to bebetter with regard to both success and cost. In light ofthis, should we be allocating our scarce health careresources to risky and expensive treatments liketransplants, or are there better ways to use theseresources to provide medical services? In this part ofthe course, we look at both the theory and thepractice of allocating scarce resources and providingrisky treatments. We will also explore how thinkingabout resource allocation might inform our thinkingabout how to improve the US health care system.

Mon, April 2

■ Heathcare in the US (Munson)a Singer, "Why We Must Ration Health Care"

Wed, April 4

m Harris, "QALYfying the Value of Life"

Mon, April 9

a Daniels, "Justice, Health, and Healthcare"a Bradley & Taylor, "To Fix Health, Help the Poor"

Wed, April 11

■ Short writing assignment 4

Mon, April 16

■ Munson, Summary of Affordable Care Act(Obama Healthcare Law)

- Summary of Republican Health Care proposal

Section 6. Face Transplants: New Medical

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Technology, Well-being, and IdentityDoctors in France recently performed the firstcomplete face transplant on a 38 year-old womansuffering from a severe deformity that resulted from agenetic disorder. This surgery raised a series ofethical questions that have led some to conclude thatsuch procedures are not morally justified. Consider:Since the procedure is life improving (rather than lifesaving), why should we accept the costs and the risksthat it brings? Who should be eligible for suchsurgeries? Given that faces are so central to how werecognize one another, are these transplants fair tothe deceased donors (and their family and friends)?

Wed, April 18

a Freedman, "Equipoise and the Ethics of ClinicalResearch"

Mon, April 23

Transplantation Research"■ Photos of face transplant patients HERE

(note: graphic images)

Wed, April 25

a Butler et. al., "Face Transplantation: When andfor Whom?"

■ Freeman et. al., "Justifying Surgery's LastTaboo: The Ethics of Face Transplants"

m INTERVIEW with Charla Nash, face transplantrecipient.

Wed, May 9: Final Exam DUE at 1:00pm (details tocome)

Attachments (29)Atterbury-Alcoholic in Lifeboat.pdf - on Jan 2, 2012 6:04 PM byCharlie Kurth (version 1)304k Download

Bradley-To Fix Health Care.pdf - on Jan 3, 2012 7:32 PM byCharlie Kurth (version 1)55k Download

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Phil 233-Bioethics Spl2 https://sites.google.com/site/phil233bioethicsspl2/

Butler-FaceTransplants-WhenForWhom.pdf - on Jan 2, 20126:10 PM by Charlie Kurth (version 1)74k Download

Caplan-Transplantation at Any Price.pdf - on Jan 2, 2012 5:58PM by Charlie Kurth (version 1)38k Download

Childress-Putting Patients First.pdf - on Jan 2, 2012 6:03 PM byCharlie Kurth (version 1)366k Download

Daniels-JusticeHealthHC.pdf- on Jan 2, 2012 6:08 PM by CharlieKurth (version 1)1243k Download

Engelhardt-Rights to Health Care.pdf - on Jan 13, 2012 11:34AM by Charlie Kurth (version 1)430k Download

Freedman-Equipoise.pdf - on Jan 2, 201 2 6:09 PM by CharlieKurth (version 1)2484k Download

Freeman-LastTaboo-FaceTransplants.pdf- on Jan 2, 2012 6:10PM by Charlie Kurth (version 1)156k Download

Harris-QALYfying the Value of Life.pdf - on Jan 3, 2012 8:04 PMby Charlie Kurth (version 1)1291k Download

Harvard definition.pdf - on Jan 2, 2012 5:38 PM by CharlieKurth (version 1)2432k Download

Kahn&Delmonico-Consequences of Sales.pdf - on Jan 2, 20125:58 PM by Charlie Kurth (version 1)45k Download

Kluge-Directed Organ Donation.pdf - on Jan 2, 2012 6:04 PM byCharlie Kurth (version 1)2027k Download

Kluge-Donation&Retrieval.pdf - on Jan 2, 2012 5:53 PM byCharlie Kurth (version 1)1620k Download

Matas-Case for Living Kidney Sales.pdf - on Jan 2, 2012 5:58PM by Charlie Kurth (version 1)102k Download

McMahan-Metaphysics of BrainDeath.pdf - on Jan 2, 2012 5:44PM by Charlie Kurth (version 1)2133k Download

Moss&Siegler-Alcoholics and Livers.pdf - on Jan 2, 2012 6:03PM by Charlie Kurth (version 1)782k Download

Murphy-KidneyStory.pdf - on Jan 2, 2012 6:04 PM by CharlieKurth (version 1)223k Download

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New for Aspiring Doctors-NYT.pdf - on Jan 2, 2012 5:37 PM byCharlie Kurth (version 1)58k Download

PresCommissionl981-DefiningDeath.pdf - on Jan 2, 2012 5:39PM by Charlie Kurth (version 1)2835k Download

Singer-Sanctity of Life.pdf - on Jan 2, 2012 5:44 PM by CharlieKurth (version 1)936k Download

Singer-Why We Must Ration.pdf - on Jan 3, 201 2 8:02 PM byCharlie Kurth (version 1)100k Download

Spital-Organ Conscription.pdf - on Jan 2, 2012 5:52 PM byCharlie Kurth (version 1)1219k Download

Stein-PVS.pdf-on Jan 2, 2012 5:55 PM by CharlieKurth (version 1)78k Download

Veatch-Chl O.pdf - on Jan 2, 2012 5:49 PM by CharlieKurth (version 1)2508k Download

Veatch-Ch4.pdf - on Jan 2, 2012 5:43 PM by CharlieKurth (version 2 / earlier versions)11684k Download

Veatch-Ch5.pdf - on Jan 2, 2012 5:44 PM by CharlieKurth (version 2 / earlier versions)7735k Download

Veatch-Ch9.pdf-on Jan 2, 2012 5:45 PM by CharlieKurth (version 1)8926k Download

Wiggins-Ethics of FaceTransplants.pdf - on Jan 2, 2012 6:10 PMby Charlie Kurth (version 1)130k Download

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