As I do every fall semester, I am teaching an undergraduate course in bioethics. Although I try to entice my philosophy students, most students are pre-med bio majors, usually seniors. This is the only course in which I still use a textbook. there is far more in the one I use than could be completed by undergrads in a semester, and frequent revisions keep it up to date. I teach it in a fairly traditional manner, beginning with the physician-patient relationship, and moving on to topics in clinical ethics, research ethics, and distributive justice. I do very little straight philosophy, skipping entirely the first section on moral theories. I’m sure this is due to my experience working as a clinical ethicist: knowing the concepts unique to bioethics (informed consent, autonomy, equipoise, etc.) and having access to past cases, either one’s own, or famous ones, is much more helpful than theory. Theoretical questions may emerge, both in the clinic and in class, but when they do, addressing them feels less like an intellectual exercise and more like a necessity. I think my bioethics students manage to get a decent amount of ethical theory this way, actually.

The hospital where I consult is just a few miles from campus, so it’s easy to have guest speakers. Last year, we had a pediatric intensivist, trauma surgeon, family practice doc, and geneticist. It’s wonderful to hear them talk about ethics dilemmas they have faced, and how important bioethics is to their conception of being a good health care provider.

The one “innovation” in my course is the mock ethics consult. We set aside the last several class meetings (50 minutes each), and students in groups of 5 or 6 put on a case (either a famous one, or one they invent). It’s extremely fun (sometimes the students really get into it, with costumes and accents!) and a great way to put together what they’ve been doing all semester.

Here’s the syllabus:

Fall 2011

Jessica P. Miller, Ph.D.

Associate Professor, Department of Philosophy

COURSE DESCRIPTION: This course is an introduction to ethical issues in health care, aimed not just at students of the health professions, but at anyone who is curious about how biomedical advances call into question our notions of value, of right and wrong, and of the good life.  We will explore specific ethical issues arising from biomedical research and health care practice, including the doctor-patient relationship, informed consent, cloning, genetic screening, physician-assisted suicide, withdrawal of life sustaining care, research with human subjects, and justice in health care allocation.

COURSE OBJECTIVES:  To acquaint students with contemporary philosophical approaches to bioethical issues; to help students recognize the moral dimensions of issues in health care; to introduce them to various modes of analysis and response to these issues; and to give students the opportunity and some of the skills to begin their own systematic critical reflection on these issues.  By semester’s end, students should be able to articulate their own defensible positions on some of the most pressing issues in bioethics today.

REQUIRED TEXT: Bonnie Steinbock, John Arras, Alex London eds, Ethical Issues in Modern Medicine, 7^th Ed., McGraw-Hill, 2008.

EXPECTATIONS OF THE STUDENT: Students will be expected to…

1. Class participation: Students are expected to treat faculty and other students with respect. Do not disrupt class by arriving late, leaving during class, or chatting with friends. Be attentive to comments made by the instructor and other students. Do not sleep, do other coursework, text, surf, wear headphones, game, or read non-course materials while class is in session. Set cell phones to silent. Do not use abusive or vulgar language, and be sensitive to the way your comments may be interpreted by other students. Laptop use is a privilege that will be revoked if your laptop use is disruptive to me or to other students. If you find a fellow student’s laptop use distracting, please let me know. Students who violate these expectations will be asked to leave.

2.  Take three in-class examinations which will be composed of short answer and essay questions based on assigned readings and class discussions. Study guides will be distributed a few days prior to each exam. No make-ups for missed exams will be given, except under extreme circumstances. Make-up exams must be taken within one week of the missed exam. These exams each count for 25% of your course grade. There is no final exam.

3. Case analysis and presentation. Groups of students will role play members of an ethics committee consulting on a challenging case (which they discover or devise) with the patient and/or family member. Each group member will choose a case and write a 5 page position paper on it from his or her perspective as a physician, nurse, social worker, lawyer, chaplain, ethicist, etc. Then the group will engage in presentation and discussion of the case to the class. Students will be graded individually based on (a) their position papers and (b) their contributions to the group presentation. (25% of course grade).

A Note on Academic Integrity: Plagiarism or cheating will result in a grade of F for that assignment or exam. This includes falsifying attendance records. A student’s second violation will result in automatic failure of the course.  Plagiarism and cheating are violations of the University of Maine Student Conduct Code.  Please see the University of Maine Student Handbook, for definitions of “plagiarism” and “cheating”, as well as University policies relating to academic integrity.

A Note on Accommodations: If you wish to request an accommodation for a disability, please contact the instructor and the Coordinator of Services for Students with Disabilities (East Annex, 581-2319), as early as possible in the semester.

SCHEDULE OF READINGS AND ASSIGNMENTS:

This schedule is subject to change. Students are expected to check the course folder on First Class, where I will post updates and important course-related information. In the event of an extended disruption of normal classroom activities, the format for this course may be modified to enable its completion within its programmed time frame. In that event, you will be provided an addendum to the syllabus that will supersede this version.

M 8/29                        Introduction: Ethical Theories, Principles of Bioethics

I. FOUNDATIONS OF THE HEALTH PROFESSIONAL-PATIENT RELATIONSHIP

Autonomy, Paternalism, and Medical Models

W 8/31                        Hippocratic Oath

*Modern version:

http://www.pbs.org/wgbh/nova/doctors/oath_modern.html

Beneficence Today or Autonomy (Maybe) Tomorrow? + 2 Commentaries

F 9/2                        Why Doctors Should Intervene

Four Models of the Physician-Patient Relationship

Informed Consent and Truth-Telling

W 9/7                        Antihypertensives and the Risk of Temporary Impotence

Informed consent—Must it Remain a Fairy Tale?

F 9/9                         Bioethics in a Different Tongue

Offering Truth

Conflicting Roles and Responsibilities

M 9/12                        Vitaly Tarasoff et al. v. University of California et al….

Please Don’t Tell! + 2 Commentaries

Disclosing Misattributed Paternity

W 9/14                        SARS Plague: Duty of Care or Medical Heroism?

The Lessons of SARS

What Should the Dean Do? + 3 Commentaries

II. ALLOCATION, SOCIAL JUSTICE, AND HEALTH POLICY

Justice, Health, and Health Care

F 9/16                          An Ethical Framework for Access to Health Care

Equal Opportunity and Health Care

M 9/19                         Freedom and Moral Diversity

Social Determinants of Health: The Solid Facts

W 9/21                        Why The United States is Not Number One in Health

Justice, Health, and Healthcare

F 9/23                        Opportunity is Not the Key

Allocating Scarce Resources

M 9/26                         Bone Marrow Transplants for Advanced Breast Cancer: Christine deMeurers

Justice and the High Cost of Health

Imposing Personal Responsibility for Health

Responsibility in Health Care: A Liberal Egalitarian Approach

Organ Transplantation: Gifts Versus Markets

W 9/28                        The Case for Allowing Kidney Sales

An Ethical Market in Human Organs

Body Values: The Case Against Compensating for Transplant Organs

F 9/30                        **Test 1

 

III. FORGOING LIFE-SUSTAINING TREATMENT, AND EUTHANASIA

Decisional Capacity and the Right to Refuse Treatment

M 10/3                         State of Tennessee Dept. of Human Services v. Mary Northern

Deciding for Others: Competency

W 10/5            Keith Burton, “A Chronicle: Dax’s Case as it Happened”

Robert B. White, Commentary, H. Tristram Engelhardt, Commentary

Choosing for Once-Competent Patients

F 10/7                        Erring on the Side of Theresa Schiavo

“Human Non-Person” Terri Schiavo, Bioethics, and Our Future

The Severely Demented, Minimally Functional Patient

Quality of Life and Non-Treatment Decisions for Incompetent Patients

Physician Assisted Death

W 10/12             Death and dignity

Physician-Assisted Suicide: A tragic View

Assisted Suicide: The Philosophers’ Brief, Introduction

F 10/14                        Atul Gawande, “Letting Go”, The New Yorker

online: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

M 10/17                        *Case Discussions

IV. REPRODUCTION

Assisted Reproduction

W 10/19             Presumptive Primacy of Procreative Liberty

Instruction on Respect for Human Life

F 10/21                        What are Families For?

Grade A: The Market for a Yale Woman’s Eggs

Payment for Egg Donation

V. Genetics

Prenatal Genetic Testing

M 10/24            Prenatal Diagnosis and Selective Abortion: A Challenge to Practice

Disability, Prenatal Testing and Selective Abortion”

Case Study on Molly and Adam Nash

Therapeutic cloning and stem cell research

W 10/26                        Embryo Ethics

Acorns and Embryos

Surplus Embryos

F 10/28                        **Test 2           

VI. EXPERIMENTATION ON HUMAN SUBJECTS

Born in Scandal: the Origins of U.S. Research Ethics

M 10/31             Nuremburg Code

The Jewish Chronic Disease Hospital Case

The Willowbrook Hepatitis Studies

W 11/2                        Racism and Research

The Belmont Report

The Ethics of Randomized Clinical Trials

F 11/4                        Ethical Difficulties with Randomized Clinical Trials

Of Mice but Not Men

A Response to a Purported Ethical Difficulty…

Ethical Issues in International Research

M 11/7                        Unethical Trials of Interventions…

AZT Trials and Tribulations

The Ambiguity and the Exigency…

W 11/9                        Case discussion

M 11/11                        Class cancelled – Professor at conference

VII. EMERGING TECHNOLOGIES

Emerging Technologies

M 11/14                        The Designer Baby Myth

Applications of Behavioural Genetics

Neuroethics

 

Enhancement

W 11/16                        Growth Hormone Therapy for Disability of Short Stature

The Genome Project, Individual Differences, and Just Health Care

F 11/18                        Genetic Interventions and the Ethics of Enhancement of Human Beings

The Case Against Perfection

Anyone for Tennis, at the Age of 150?

M 11/21                        **Test 3

VIII. GROUP CASE PRESENTATIONS: M 11/2 -