PHIL 233: Biomedical Ethics
Instructor:
Charlie Kurth
Email: ckurth [at] wustl [dot] edu Office Hours: Tuesdays, 4-5:30 pm, and by appointment
Office phone: 314-935-4753 Office Location: Wilson 112
Assistant to instructor:
Maria Altepeter
Email: m.r.altepeter [at] gmail [dot] com
Office Hours: Wednesdays, 11am-1pm and by appoint
Office Location: Wilson 116
Course Overview
Doctors, medical teams, and researchers provide extremely valuable services that have the potential to improve and save lives. But the practice of medicine is, at nearly every step, rich in ethical issues. Even seemingly easy questions, like determining who is dead, turn out to ethically complex. In this course, we will explore some of these issues. In the first part of the course (sections 1-3), we will look closely at the ethics of organ transplantation. Organ transplants have proven successful in saving people’s lives and improving their well-being. But these procedures also raise serious questions that shape and challenge our thinking across a range of ethical issues. For instance: When and by what means can we harvest organs from others? Given the scarcity of organs available for transplant, how should we decide who gets them? Exploring these issues will raise more general questions about how doctors ought to manage the responsibilities that they have both to their patients and to society more generally. So, in the second half of the course, we will turn to debates about the ethics of healthcare, and issues involving the doctor-patient relationship and medical experimentation.
The readings, lectures, and assignments in this course will not only introduce you to a variety of important moral issues in medicine and medical research, they will also help you develop the critical thinking skills that you will need to be able understand and assess the bioethical debates we will be examining. As we will see, there are no settled answers to the bioethical questions that we will be exploring. So sorting out which proposals might be better will require us to identify and assess the arguments given in defense of the answers that we get from philosophers and medical professionals. What central assumptions are being made in these arguments? Are these assumptions plausible? Have important features of the situation been left out or given insufficient consideration? Working through questions like these is crucial: if we don’t understand the arguments given to defend a particular answer to a bioethical issue, we will be unable to understand whether that answer makes any sense.
Texts
Selected readings available from the course web site
Assignments and Grading
This course will have four graded components. All written assignments will be graded by the teaching assistant (under the guidance and review of the primary instructor). All grading will be blinded, so please do not put your name on your assignments--use only your Student ID number. You can use the weightings below to calculate your performance throughout the semester.
Participation (10%)
You are expected to come to class having read--and thought about--the assigned readings. You are also expected to participate in the group and class discussions.
Short writing assignments (15%).
You will be asked to complete three short writing assignments (two double-spaced pages each) throughout the semester. These assignments are designed to allow you critically engage with the readings and to help prepare you for our class discussions. They will be evaluated for accuracy and effort. These short papers will be combined to determine your performance for this portion of the course (5% for each paper).
You need to turn in your short paper (by email, details below) before the start of class on the day that it is due. You should also bring a hard copy of your paper with you to class.
Please email your assignment to Nicky prior to class. Please also type "Phil 233 Assignment #" in the subject line of your email, and save the document using your Student ID number and the assignment number (example: 654321-SW1)
First long writing assignment (30%).
The first long writing assignment will cover material on sections 1 and 2 of the course. I will provide you with the prompt approximately one week before it is due. The assignment will be due at Noon on Friday, March 9 (details on LW1 to come; NOTE: this is the Friday before Spring Break).
Second long writing assignment (45%).
The second long writing assignment will cover material from sections 3-5 of the course and will be due at Noon on Sunday, May 6 (details on LW2 to come). I will provide you with the prompt during the final week of class.
If you are taking the course pass/fail, you need to complete all the assignments and finish the course with a grade of 70 or higher.
Advice and Resources
Many of the reading assignments for this course are short. But don’t let that fool you—philosophy is hard. How do you deal with this? Well, here are some suggestions: (i) Read the material more than once. (ii) After reading an essay, try and summarize the main claims and arguments in your own words—this will help you come up with questions and objections. (iii) Start the written assignments early (doing this will help you review your answers with a clear head). (iv) Most importantly, if you’re puzzled about something, ask questions!
Accommodations based upon sexual assault: The University is committed to offering reasonable academic accommodations to students who are victims of sexual assault. Students are eligible for accommodation regardless of whether they seek criminal or disciplinary action. If you need to request such accommodations, please direct your request to Kim Webb (kim_webb@wustl.edu), Director of the Office of Sexual Assault and Community Health Services. Ms. Webb is a confidential resource; however, requests for accommodations will be shared with the appropriate University administration and faculty. The University will maintain as confidential any accommodations or protective measures provided to an individual student so long as it does not impair the ability to provide such measures.
Bias Reporting: The University has a process through which students, faculty, staff, and community members who have experienced or witnessed incidents of bias, prejudice or discrimination against a student can report their experiences to the University’s Bias Report and Support System (BRSS) team. See: brss.wustl.edu
Mental Health: Mental Health Services’ professional staff members work with students to resolve personal and interpersonal difficulties, many of which can affect the academic experience. These include conflicts with or worry about friends or family, concerns about eating or drinking patterns, and feelings of anxiety and depression. See: shs.wustl.edu/MentalHealth
Policies
In order to help ensure a successful class, please heed the following rules and policies:
Due Dates.
Baring unusual circumstances, the due dates on the syllabus are non-negotiable. If you think you have reason to miss an assignment, it is best to inform me well in advance. Any late assignments will be subject to a grade penalty.
Classroom Environment.
Please arrive to class on time. All cell phones must be turned off during class. Texting, surfing the web, and the like are not permitted. Abuse of these courtesies may lead to penalties.
For research indicating that computer use in class is strongly correlated with poorer performance on assignments and learning, see this.
Statement of Academic Integrity.
Upon arrival at Washington University, you signed a statement indicating that you understand that you will abide by the University's Academic Integrity Policy. In this class, you will be expected to honor that commitment. This means that all work presented as original must, in fact, be original; the ideas and contributions of others (be they quotes, summaries, or paraphrases) must be appropriately acknowledged.
Tentative Schedule of Readings and Assignments
Introduction
Wed, Jan 17:
Monte Python skit on Organ Donation here.
Section 1: Who is Dead?
It seems like a simple question—who is dead? But, as we will see, this question proves to be very difficult to answer. Moreover, how we answer it has significant implications for the supply of organs available for transplant surgeries. So understanding the nature and ethics of death is central to debates about the permissibility of organ transplantation.
Mon, Jan 22:
Read: Syllabus, University’s Academic Integrity Policy, Jim Pryor, "How to read a philosophy article"
Presidential Commission Report [read pp. 3-12, 31-38 only]
Wed, Jan 24:
Rich, "Postmodern Personhood"
Veatch, “The Whole-Brain-Oriented Concept of Death” [recommended]
Mon, Jan 29:
Wed, Jan 31:
Eichinger, “Brain Death, Justified Killings, and the Zombification of Humans”
Stein, "Technique Spots Patients Misdiagnosed as Being in 'Vegetative State'"
Mon, Feb 5:
Wed, Feb 7:
Conversation Project, "Starter Kit"
For information and resources concerning advanced directives, click here.
If you're interested in registering as an organ donor, click here.
Section 2: Ethical Issues in Organ Procurement
The number of people in need of organ transplants greatly exceeds the number of organs that is available. In light of this fact, doctors, philosophers, and policy makers have considered various—and morally contentious—ways of increasing the supply. But since these proposals have only had limited success, they have also had to consider how best allocate these scarce medical resources given that there is not enough to go around. In this and the next section, we take up these two sets of issues. While our focus will be on questions about what to do given that we don’t have enough transplantable organs, our investigation will help us understand some of the ethical issues concerning scarce medical resources more generally.
Mon, Feb 12:
Veatch, “The Myth of Presumed Consent”
Wed, Feb 14:
Spital & Erin, "Conscription of Cadaveric Organs for Transplantation"
Mon, Feb 19:
Section 3: Resource Allocation: Who Gets the Organs?
Given the undersupply of organs available for transplant, we need to make decisions about who should get them. But we want to be able to do this in a way that is morally justifiable. In this part of the course, we investigate questions like the following: Should we give priority to the neediest patients? Or should the probability of success be given greater weight? Should one’s race or ability to contribute to society matter? Should those who led unhealthy lives (e.g., alcoholics) be given less priority?
Wed, Feb 21:
Alexander, “They Decide Who Lives, Who Dies”
Saleh & Larson, “Adult Liver Transplantation in the USA” [recommended]
Mon, Feb 26:
Kluge, "Designated Organ Donation"
Murphy, "Would My Story Get Me a Kidney?"
Wed, Feb 28:
Scheper-Hughes, "The Tyranny of the Gift"
Mon, Mar 5:
Moss & Siegler, “Should Alcoholics Compete Equally for Liver Transplantation?”
Cohen, "Alcoholics and Liver Transplantation"
Section 4: Access to Healthcare—How Much and for Whom?
The ethical challenges of allocation don’t just concern specific treatments like organs or vaccines. There are also more general ethical questions about how to allocate healthcare in general. In this section of the course, we look at recent debates about healthcare policy in the U.S. Do individuals have a right to healthcare? What kinds of healthcare services, if any, do people have a right to? Why?
Wed, Mar 7:
Munson, Heathcare in the US [Recommended]
Munson, Summary of Affordable Care Act (Obama Healthcare Law)
Singer, "Why We Must Ration Health Care"
Fri, Mar 9:
Mar 10-18: Spring Break
Mon, Mar 19:
Harris, "QALYfying the Value of Life"
Wed, Mar 21:
Daniels, "Justice, Health, and Healthcare"
Bradley & Taylor, "To Fix Health, Help the Poor"
Mon, Mar 26:
Frank, "Be Careful What You Wish For"
Wed, Mar 28:
Brooks, "Guns and the Soul of America"
Galea, "Too Many Dead"
Swanson, "Gun Violence is Contagious"
Section 5: Informed Consent, the Doctor/Patient Relationship, & Medical Research
In this final section of the course, we look at ethical issue that concern doctors’ relationships with their patients. We’ve already seen that questions of patient consent and autonomy are important. But what does respecting autonomy amount to when doctors discuss treatment options with their patients? Relatedly, what biases and confusions might doctors and their patients have? How do these affect health care choices and outcomes? Can a doctor override a patient’s decision about what treatment they want? On what grounds? Turning to the ethics of medical research and experimentation—how are doctors and medical professionals to balance the need to assess the potential of a new medical technology while, at the same time, ensuring that their patients get the best treatment available?
Mon, Apr 2:
Emanuel & Emanuel, "Four Models of the Physician-Patient Relationship"
Wed, Apr 4:
Ashton et. al., "Racial and Ethnic Disparities in the Use of Health Services"
Herbst, "This is the Kind of Sexism Women Who Want to be Doctors Deal with in Med School"
Mon, Apr 9:
Harris & Darby, "Shame in Physician-Patient Interactions: Patient Perspectives"
Wed, Apr 11: Class Canceled
Mon, Apr 16:
Bayne & Levy, “Amputees by Choice”
Wed, Apr 18:
Emanuel et al., “What Makes Clinical Research Ethical?”
Grady, "Uterus Transplants May Soon Help Some Infertile Women"
Mon, Apr 23:
"Wiggins, et al., “On the Ethics of Face Transplantation Research”
Freeman et al., “Justifying Surgery’s Last Taboo: The Ethics of Face Transplants"
INTERVIEW with Charla Nash, face transplant recipient.
Photos of face transplant patients HERE (note: graphic images)
Wed, Apr 25:
Savulescu, "Genetic Interventions and the Ethics of Human Enhancement" (the section 'Current Interest in Enhancement' can be skimmed)
Sunday, May 6:
Long Writing 2: Must be turned in by Noon