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Applied Ethics: Biomedical Ethics

Philosophy 34900
Fall 2010
Professor Jeffrey Blustein

OBJECTIVES:

This is an introductory course that will expose you to the field of biomedical ethics, or
bioethics, as it is usually called. Medical developments and innovations in medical
technology have had and continue to have a powerful effect on our society, our personal
lives, and our understanding of the human condition, and they give rise to ethical
problems with ever increasing frequency. We will take up some of the leading problems
in this area and apply philosophical methods, concepts and theories to their clarification
and analysis.

Specifically, this course will:


o Expose you to the leading theories, principles, concepts, and methods employed
in the field of biomedical ethics;
o Provide a philosophical framework to help you think through controversial ethical
issues in biomedicine and to guide moral reflection;
o Sharpen your analytic and reasoning skills;
o Demonstrate the difference between argument and mere opinion;
o Enhance your ability to identify and make informed judgments about ethical
aspects of biomedicine and technology;
o Explore a range of contemporary ethical issues in the field of biomedicine.
After completing this course, you will have had experiences in the following areas:
o Oral and written communication.
o Critical analysis of information and arguments.
o Accessing information relevant to course from various sources,
including the internet and library.

COURSE FORMAT:

The class meets twice a week, Tuesday and Thursday, from 11:00-11:50 am. Due to the
size of the class, it will be conducted largely as a lecture, although there will be some
opportunity for student input and interaction. In addition, each student is expected to
attend a section, each Friday. Attendance at section is mandatory.

REQUIREMENTS:

Students are expected to regularly attend both the Tuesday/Thursday class and the Friday
section and to keep up with the readings. Since the lectures are not drawn directly from
the readings, you will miss a great deal if you do not attend class. Three (3) unexcused
absences will be permitted without penalty. More than three unexcused absences will
count against your grade! Attendance in the course will be taken in your sections.

1
The breakdown of components of your graded work is as follows:

• A midterm examination. 20%


• A final examination. 30%
• Several short type-written papers (about 3 pages each) to be handed in to your
section leader. In these papers, you will be asked to analyze cases related to the
material discussed in class. I will assign specific cases, all of which will be put in
Blackboard. 40%
• Participation in sections. 10%

Your course grade will be based on the grades you receive on all of these, weighted as
indicated.

READINGS:
The textbook for this course is:

Ethical Issues in Modern Medicine, 7th edition, edited by Steinbock, Arras, and
London (McGraw-Hill, 2009). The book is on sale at CCNY Bookstore and also
available through Amazon.

In addition, there are a number of readings posted on Blackboard.

OFFICE HOURS:

My office is in the Philosophy Department, NAC Building, Room 5/145A. My hours are
Tuesday and Thursday, 12:30 p.m. -1:30 pm and by appointment. I can also be reached
by email at jblustein@ccny.cuny.edu.

COURSE SYLLABUS:

UNIT ONE: INTRODUCTION AND FOUNDATIONS OF BIOETHICS

Class #1

What is biomedical ethics? How is it related to developments in medicine and


technology? What is the relation between ethics, religion, and law?
How is biomedical ethics affected by developments in medicine and technology?

Reading:
• In anthology, “Introduction: Moral Reasoning in the Medical Context,” pp. 1-8.

Classes #2, 3, 4

Bioethics and moral theory: why do we need theory? What are the main theories
in bioethics?

2
Readings:
• In anthology, “Introduction,” pp. 8-41
• Blackboard: G. Graber, “Basic Theories in Medical Ethics“

UNIT TWO: PHYSICIAN AND PATIENT

Classes 5, 6, 7

What is the principle respect for autonomy? What role does the principle play in
bioethics? What is medical paternalism and is it ever ethically justified?

Readings:
• Blackboard: J. Childress, “The Place of Autonomy in Bioethics”
• In anthology: Goldman (pp. 62-70); Beneficence Today, or Autonomy (Maybe)
Tomorrow (pp. 70-73); Ackerman (pp. 73-77).

Classes # 8, 9

Why is informed consent so important in bioethics? What are the elements of


informed consent? Is informed consent always necessary or possible?

Readings:
• In anthology: Antihypertensives and the Risk of Temporary Impotence (p. 87);
Katz (pp. 89-96); Baylis (97-100).

Classes 10, 11

Why is there is a duty of truth-telling? Is it ever permissible to lie? Why is there a


duty of confidentiality? Can it ever be breached?

Readings:
• In anthology: Freedman (pp. 110-116); Vitaly Tarasoff v. Regents of U of
California (pp. 117-122); Please Don’t Tell (pp. 123-125); Ross (pp. 126-134).

UNIT THREE: ETHICAL ISSUES AT THE BEGINNING OF LIFE

Classes #12, 13

What does reproductive freedom encompass? What is assisted reproduction


technology? Who should have access to it? Is the use of assisted reproduction
technology ever unethical? Should payment for eggs be allowed?

Readings:

3
• In anthology: Robertson (pp. 599-609); Murray (pp. 618-623); Cohen (pp. 623-
626); Steinbock (pp. 627-636)

Class #14: MIDTERM

Classes # 15, 16

When, if ever, is abortion morally justified? What rights does the mother have?
Does the age of the fetus at the time of abortion matter, ethically?

Readings:
• In anthology: Marquis (pp. 547-555); Steinbock (pp. 555-566); Thomson (pp.
567-576).

Classes # 17, 18

Is it ethical to use prenatal testing to screen out embryos with genetic anomalies?
Is it ethical to use prenatal genetic testing to select the characteristics that one’s
offspring will have?

Readings:
• In anthology: Asch (pp. 675-685); Steinbock (pp. 686-694); Pinker (pp. 845-
848); Sandel (pp. 890-899)

UNIT FOUR: ETHICAL ISSUES AT THE END OF LIFE

Class #19

What is the definition of death? What does it mean for a patient to be “brain
dead?” Is someone who is brain dead really dead?

Readings:
• In anthology: Defining Death (pp. 339-348)
• Blackboard: M. Benjamin, “Pragmatism and the Determination of Death”

Classes # 20, 21, 22

How can we make life or death decisions for a patient who cannot make them him
or herself? How do we know when a patient lacks decisional capacity? What is
an advance directive?

Readings:
• In anthology: State of Tennessee v. Mary Northern (pp. 361-368); Buchanan and
D. Brock (pp. 368-378); Arras (pp. 420-428); Dresser and Robertson (pp. 436-
447).

4
Classes #23, 24, 25

What is the difference between withdrawal of life support, physician-assisted


suicide, and euthanasia? Is it ever ethical for a physician to assist a patient to
end his or her life?

Readings:
• In anthology: Arras (pp. 477-483); Philosopher’s Brief (pp. 488-496); Battin (pp.
496-510)
• Blackboard: Brock, “Voluntary Active Euthanasia”; Callahan, “When Self-
Determination Runs Amok”; Rachels, “Active and Passive Euthanasia”

UNIT FOUR: JUSTICE IN HEALTH CARE

Classes #26, 27, 28

Is there a moral right to health care? Is there a right to health care in the United
States? Is rationing of health care morally justified?

Readings:
• In anthology: “An Ethical Framework for Access to Health Care” (pp. 191-199);
Daniels (pp. 200-202); “Social Determinants of Health” (pp. 213-222); Kawachi
(pp. 222-230).
• Blackboard: Annas, “The Prostitute, the Playboy, and the Poet: Rationing
Schemes for Organ Transplantation”