PHL 333: Biomedical Ethics University of South Alabama, Fall 2016

TR 2 – 3:15 pm, Humanities 136 Professor: Dr. Anne Jeffrey Email: ajeffrey@southalabama.edu

Office: Humanities 133 Office Hours: TR 4:30-5:30 pm

COURSE DESCRIPTION Human beings are embodied. And because we’re embodied, much of how well our lives go depends on our health. Medicine aims to benefit people by promoting health and curing illness, making embodied life better. But medicine deals with human persons whose wills and values ought to be respected, persons in communities who can make claims on each other, and where resources ought to be distributed justly. This means that not every way of achieving the goal of medicine, health, is good or permissible. A doctor might be able to prolong a patient’s life using some new treatment, but if the patient isn’t willing to endure the side effects or the family can’t bear the cost, should the doctor respect the patient’s wishes or prioritize the patient’s health? A couple using fertility technology might be able to select the genetically optimal embryo, but should they? What risks can researchers to expose their human subjects to when results of their research will benefit the wider population? What kinds of public health mandates and interventions by the state are justifiable if the state is to respect individuals’ rights? These are all ethical questions: questions about how we ought to live. More specifically, they fall under the heading of biomedical ethics because they ask how we should live in

light of the particular challenges and opportunities created by our medical practices, technological advancements, and research. Bioethicists answer these questions through a process of careful philosophical reasoning from ethical theory and relevant facts on the ground, whether they are facts about biology, medicine, law, public policy, cultural history, or social practices.

In this course, you’ll learn about bioethics by practicing it. You’ll investigate cases that represent prominent bioethical issues today. The weekly assigned readings will help you better understand the underlying philosophical issues the cases raise and the arguments that support conflicting positions about what people involved in the cases ought to be doing. In writing assignments, you’ll articulate and defend a position on the ethics of cases; you’ll dig deeper into the cases as well as the philosophical views and arguments that underwrite your position and challenges to it. Finally, you’ll participate in two debates where you will present your position papers and answer questions and objections from your classmates.

COURSE GOALS The course is designed to help you cultivate the critical reasoning and communication skills to: • Identify important ethical considerations in cases • Make valid arguments and offer justification for your positions about tough cases • Communicate charitably and articulately with others about the positions you hold

and why you hold them • Come to agreement with others about the values and best courses of action in cases

You should leave the course with a better understanding of: • Pressing bioethical issues we face today • Philosophical arguments supporting various positions on these issues • How to approach difficult cases, research ethically relevant considerations, and

provide arguments for conclusions about the cases

Bioethics is not an abstract science. It brings us face to face with concrete difficulties faced by real people in challenging circumstances. Doing bioethics well is like walking a tightrope—it takes a delicate balance between being a sympathetic interlocutor, being able to see things from many peoples’ perspectives, and being an incisive thinker, challenging the status quo. I will ask that you help make our class an environment where we

can learn to strike that balance by showing humility, sensitivity, respect, and openness to others as we share ideas, experiences, and arguments. If you invest in this class, I hope you will emerge equipped to advance fruitful discussions about these issues with your friends, family, and fellow citizens.

ASSIGNMENTS

Reading Assignments. There is one required textbook-- The Bioethics Reader, eds. Chadwick, Kuhse, Landman, Schuklenk, Singer (ISBN 978-1405175227). All other readings will be made available on Sakai. I reserve the right to modify reading assignments; I will notify you of changes in class and by updating the reading schedule online. You are responsible for checking for changes. If a substantial portion of the class isn’t reading carefully, I will institute Monte-Carlo quizzes and adjust the grading policy accordingly. Participation. One of the goals of this course is to foster intellectual community and camaraderie. So you will receive a participation grade based on the consistency and quality of your contributions in class and your thoughtful, respectful engagement with others. I expect you to engage thoughtfully—giving me and others your undivided attention, preparing for class with thorough reading, being mindful of how often and long you speak relative to others, and communicating your thoughts clearly by choosing your words carefully. I expect you to engage respectfully—taking a posture of readiness to learn from me and others, listening closely to others’ comments and questions, giving due recognition to your peers for their insights and ideas, and responding directly or incorporating the comments of your peers in your own comments and questions. Position Papers. You will choose two of the assigned cases to analyze and write a position paper on each case. This paper gives an overview of the ethically relevant features of the case, any other facts that are important to determining how we should evaluate what is going on, and then argues for a position regarding an ethical evaluation of the case. You will complete each paper in multiple stages: outline, draft, and final draft. The outline will be graded pass/fail. The draft will be peer reviewed; you will turn in your review of a peer’s draft with your own draft for a grade. The final position paper should incorporate feedback from your peer as well as my feedback. Debates. There will be two in-class debates, one midterm and one final. You will present a summary of one of your position papers at one of the debates and will act as an opposing team member in the other debate. One of your position papers will be selected for the debate either at the midterm or the end of the semester. You and your teammates will share your position papers with each other, meet to explain the details of your position and consider potential questions that your opponents might ask you. In the debate, two teams will go up against one another. You must be prepared to either present the main argument of your paper or rebut someone writing on the same case as your position paper in the debate.

COURSE POLICIES Academic Integrity. You are responsible for knowing and abiding by the University’s regulations regarding academic honesty. Here is a good rule of thumb for avoiding plagiarism: If it’s a direct quotation, cite it. If it’s a paraphrase of someone else’s idea, cite it. If it’s an idea you got from a discussion or reading, cite it. If in doubt, cite it. The only ideas not cited are those you come up with independently or that belong to general knowledge.* Plagiarism may result in an automatic failure of the course. Accommodation. Please notify me in the first week of class if you need academic accommodation. You will need to provide certification from Disability Services (Office of Special Students Services, located in Room 270 of the Student Center, 251–460–7212). Additionally, I encourage all students to make use of the Writing Center at Marx Library. Attendance. Attendance is mandatory and will be recorded every class period. Each unexcused absence will result in deducted points from the total grade. If you have a medical emergency or a university-sponsored event, you may present me with a note from the medical professional, director of the event, or your academic dean for an excused absence. Assessment. Grades will be calculated as follows: 10% participation, 20% debates, 10% position paper outlines, 20% position paper drafts, 40% final position papers. 100 ≥ A ≥ 90 (outstanding; awarded for the highest achievement) 90 > B ≥ 80 (very good; awarded to above-average achievement) 80 > C ≥ 70 (good; awarded for achieving the minimum standard) 70 > D ≥ 60 (passable; does not consistently meet requirements) 60 > F ≥ 0 (fails to meet requirements, not at college level) Electronics. Cell phones must be stowed and silenced during class. You may use a laptop or tablet for notes or readings; I will record other use as an unexcused absence. Important dates. 8/19 add/drop 10/21 last day to drop 9/13 position paper 1 outline 11/1 position paper 2 outline 9/27 position paper 1 draft 11/15 position paper 2 draft 10/4 midterm debate 11/29 final debate * I am grateful to Mark Murphy for this suggestion.

10/5 position paper 1 final 11/30 position paper 2 final

READING SCHEDULE

What Is Bioethics? 8/16 Syllabus and introduction 8/18 Pence, “Ethical Reasoning, Moral Theories, Principles, and Bioethics” Autonomy & Informed Consent Case: Dax Cowart 8/23 Beauchamp and Childress, “Respect for Autonomy” pp. 57-60

Pellegrino and Thomasma, “Conflict between Autonomy and Beneficence in Medical Ethics” pp. 23-32

8/25 O’Neill and Manson, “Consent: Nuremburg, Helsinki, and Beyond” Euthanasia Case: A Child’s Right to Die 8/30 Rachels, “Active and Passive Euthanasia”

Foot, “Euthanasia” 9/1 Bovens, “The Extension of the Euthanasia Legislation to Minors in Belgium” Advance Directives & Proxy Decision Making Case: Never Let You Go 9/6 Kuczewski, “From Informed Consent to Substituted Judgment” 9/8 Jim Stone, “Advance Directives, Autonomy, and Unintended Death” Physician-Patient Relationships Case: Concussions, High School, and College Football 9/13 Draper and Sorell, “Patients’ Responsibilities in Medical Ethics” 9/15 Robeson and King, “Loss of Possession”

Bishop and Brodkey, “Personal Responsibility and Physician Responsibility — West Virginia's Medicaid Plan”

Psychotropic Drugs & Mental Illness Case: Drug Habit 9/20 Thachuk, “Stigma and the Politics of Biomedical Models of Mental Illness” 9/22 Frances, “America is Over Diagnosed and Over Medicated” Paternalism Case: Jodie and Mary 9/27 Dworkin, “Paternalism”

9/29 Rachels, “Jodie and Mary”

10/4 *** Midterm Debate*** Public Health: Vaccines Case: Dismissing the Family Who Refuses Vaccines 10/11 Midterm debate continued 10/13 Caplan and Schwartz, “Vaccination Refusal: Ethics, Individual Rights, and the

Common Good” 10/18 10/20

Madison Powers, Ruth Faden, and Yashar Saghai, “Liberty, Mill, and the Framework of Public Health Ethics” Farmer and Gastineau Campos, “Rethinking Medical Ethics”

Public Health: Access To Care Case: India v. Big Pharma 10/25 Resnik, “Developing Drugs for the Developing World” Brock, “Some Questions about the Moral Responsibilities of Drug Companies in

Developing Countries” Daniels, “Social Responsibility and Global Pharmaceutical Companies”

Research & Equipoise Case: Clinical Trials for Ebola Virus Disease 10/27 London, “Equipoise and International Human Subjects Research” Pence, “Equipoise” Genetic Testing & Conscientious Exemption Case: A PPACA Controversy 11/1 Pence, “Ethical Issues of the Affordable Care Act” selections 11/3 Karnein, A Theory of Unborn Life, selections (pp. 103-109) Disability & Genetic Engineering Case: Infertility and IVF 2013 5 11/8 Glannon, “Genes, Embryos, and Future People” 11/10 Barnes, “Disability, Minority, and Difference” Abortion Case 7: Baby S 11/15 Judith Jarvis Thomson, “A Defense of Abortion” 11/17 Rosalind Hursthouse, “Virtue Theory and Abortion” 11/29 *** Final Debate***

12/1 Wrap-up discussion