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Phil 305-002 Health Care Ethics

Spring 1998 MWF 2-2:50 Classroom: CB 205

Dr. Christian Perring

Office: 1601 POT Phone: 7-7171 Office Hours: TR 4.00 - 6.00 p.m.

Internet Info.:

E-mail: cperring@pop.uky.edu

Class Web Page: with class notes, write-ups of student presentations, and links to other useful web sites. http://www.uky.edu/Classes/PHI305-002/

Listserv mailing list: Send an e-mail message to listserv@lsv.uky.edu [note listserv has no "e" on the end] with
"subscribe phi305 yourfirstname yourlastname"
in the body of the message [do not include the quotation marks].
If you have trouble subscribing, tell me via e-mail and I can do it for you.

Course Description:

This course has the following aims:

1) For students to learn some of the most controversial and important issues in modern medical ethics.

2) For students to learn the skills of looking at particular real life situations, analyzing what ethical issues are involved, and coming up with possible solutions.

3) For students to learn a systematic way of deciding which is the best solution for a particular situation.

Work Requirements:

You should spend at least an hour preparing for each class, reading the material assigned ahead of time. Attendance is required: Worth 10%. 1% off for each class missed without excuse. Class participation: 15%. There will be 5 tests on the reading and facts discussed in class: 35%. Debates and presentations: 20% each. There is no mid-term or final.

Presentations and Debates:

Each student must do two presentations, two debates, or a presentation and a debate. You should sign up for your presentations/debates as soon as possible. (Penalty for missing class on the day without excuse: 5%. Even if you have an excuse you should contact me and your other team members as soon as you know you can't be there.) It is often a good idea to use audio-visual aids such as a video, slides, transparencies or Powerpoint software with an overhead projector (use at least 14 point font!), and you should give me at least two days notice for me to order equipment for class. You should do your own research for a presentation, but you should consult with me about what resources would be useful. There are two parts to a presentation or debate: the performance (10%) and the write-up, of about 5 pages (10%). On the day of the performance, you should give to me a copy on disk of whatever written materials you show to the class. The write-up is due 10 days after the day of the performance. I would like both electronic and paper copies of the write-up. It should summarize what you said, and should also respond to any questions or criticisms you got from the class. Once I have the write-up, each person in a team should give me a page saying what grades you would give to those in your team, including yourself. The page should explain how much work you did compared to the others in your team and why you gave them the grades you did. This will help me in deciding what grade to give each person.

There should be 3 or 4 people on a presentation team. A presentation should last about 30-40 minutes. You should address the general topic of the presentation and make sure that you include an explanation of the particular issues specified in the class schedule. Each presentation must highlight 4 - 6 main ideas, facts, or arguments and explain them to the class. I would recommend using case studies. Your presentation will be graded on four criteria: informativeness, clarity, interest, and preparation.

There should be 2 or 3 people on a debate team. The two debate teams should not consult with each other ahead of time. A debate between two teams will last about 50 minutes. Each side starts with 10-15 minutes to set out its main arguments. You should highlight 2 or 3 main ideas, facts or arguments in making your case. Then each side has 5-10 minutes to respond to the other side. In the remaining time, other students can ask questions of either team, and at the end each side has a minute to summarize their case. You should prepare your research and strategy beforehand, anticipating the arguments of the other side and how you will respond to them. Debates will be graded on four criteria: quality of arguments, forcefulness in making the argument, preparation and group cooperation.

Class Participation:

You can get credit by asking questions in lectures or engaging in informal class discussion. It particularly helps to ask questions during student presentations and debates. You can also get full credit simply by contributing regularly to the e-mail discussion listserv.

Grading Scale. (We will not use the +/- system for this course.)

90 - 100 = A 80 - 89 = B 70 - 79 = C 60 - 69 =D Below 60 = E

Books:

Required: Philip Hébert, Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians (Oxford University Press, 1996)  [DR]

Optional: Aldous Huxley, Brave New World, (HarperCollins, 1989)  King Library F H982b

Robert M. Veatch & Harley E. Flack, Case Studies in Allied Health Ethics (Prentice-Hall, 1997)  
Several case studies will be taken from this book.

On Reserve: Bernard Gert et al., Morality and the new genetics: a guide for students and health care providers (Jones and Bartlett, 1996) 
King Library RB155.M67 1996

Philip Kitcher, The Lives to Come: The Genetic Revolution and Human Possibilities, (Touchstone Books, 1997) 
Biological Sciences QH431 .K54 1996

Jill Smolowe, An Empty Lap: One Couple's Journey to Parenthood, (New York: Pocket Books)

Schedule (subject to revision)

("Presentation" or "Debate" indicates that you could sign up to do a presentation or debate that day.)

January W 14 Introduction to the Course

I want a page of information, with the name you want to be called in class, last 4 digits of your SS#, your phone number, e-mail address, major, list of philosophy, psychology and human biology classes taken, and your experience of health care settings. I also want a description of yourself and explanation of your interest in health care ethics, mentioning any particular issues you would like to learn more about - a few sentences for each.

Ethical Principles:

F 16 Ethics, DR Ch. 1

W 21 Patient autonomy, DR Ch. 2

F 23 Beneficence and Non-Maleficance, DR Ch. 6

M 26 Justice, DR. Ch. 7

When Can People Refuse Treatment for Themselves or Others?

W 28 Jehovah's Witnesses and Christian Scientists

Presentation: Explain the religious reasons for refusing treatment and UK hospital policy

F 30 Forcing pregnant women to have cesareans for the sake of the baby

Presentation: Explain what the courts have decided and what happened in actual cases

Feb M 2 Comatose Patients: Nancy Cruzan and Karen Quinlan

Presentation: Explain what happened and what the Courts decided

W 4 Competency to decide, DR Ch. 8, and Review

F 6 Test

M 9 Advance Directives

Presentation: Explain the different kinds, what KY law is

W 11 Presentation: Should mentally retarded girls and women be forced to use contraceptives (such as subdermal implants or IUDs)?

F 13 Buffer

Life and Death

M 16 When does a person start to exist?

Presentation: Explain the development of a fetus, biologically and psychologically

W 18 Brain Death, Persistent Vegetative States

F 20 Debate: Should a woman have the legal right to abort a fetus in the first two trimesters of pregnancy?

M 23 Degenerative neurological diseases (Take-Home Exam Given)

Presentation: Explain the biological and psychological development of Alzheimer's disease

W 25 No Class

F 27 No Class

Confidentiality and Truth Telling Concerning Medical Information

Mar M 2 When to breach patient confidentiality, DR Ch. 3 (Take-Home Exam Due)

Presentation: Explain the law, and the Tarasoff case

W 4 The benefits and dangers of telling the truth, DR Ch. 4

Presentation: Explain how best to give bad news to a patient

F 6 Debate: Should children of 7 years and older always be told about their serious illnesses?
(Cancelled: Lecture instead)

M 9 Whistleblowing, and Review

W 11 Test

F 13 Buffer

M 23 Cultural differences in truth telling

W 25 Genetic Testing

Presentation: Explain what genetic testing is, and the reasons for and against getting oneself tested for inherited disorders

Medical Research Ethics

F 27 Getting informed consent from patients

Presentation: Explain what procedures medical researchers must go through

M 30 Drug experimentation on mentally ill patients

April W 1 Presentation: Is too much needless experimentation done on animals in medical research?

Reproductive and Genetic Technology

(Extra credit 5%: write a 3 page account of how bioethical issues are raised either Gattacaor Brave New World)
[Unfortunately Gattaca will not be out on video before the end of the semester.]

F 3 Fertility Drugs and Selective Reduction

Presentation: Explain the health and emotional risks involved

M 6 Assisted Insemination and In Vitro Fertilization, and Review

W 8 Test

F 10 Buffer

M 13 The Human Genome Project

W 15 Presentation: Is it wrong to abort a fetus on the grounds that it has a strong chance of having Huntington's syndrome in its adult life?

F 17 Gene Therapy and Enhancement

M 20 Genetic Counseling

W 22 Debate: Should it be illegal in the US to clone human beings?

F 24 Possible extra debate: should it be legal to have a business cloning pets for profit?

M 27 Review

W 29 Test

May F 1 Buffer