PHIL 305: Biomedical Ethics
Syllabus

Spring 2004: MWF 1:15 - 2:30, Olds-Upton 103
Instructor: Dr. Ashley McDowell
Office: 202 Humphrey House
Office phone: 337-7077
email me
Course website: http://kzoo.edu/~mcdowell/BME.htm
Office Hours: Mondays & Wednesdays 4 - 5, Tuesdays & Thursdays 3 - 5
and by appointment
(unless a change is announced)
M&M coffee: Tuesdays, 9-10 am, The Daily Grind

Textbooks:
· Tom Beauchamp & LeRoy Walters, Contemporary Issues in Bioethics, 6th ed. ("B&W")
· Anthony Weston, A 21st Century Ethical Toolbox ("Weston")

Course Description
This is a course in applied ethics, which is the study of how ethical thinking can be used in real-life situations and issues. In this case, we will be exploring the ethics of biomedical issues. Those issues could include euthanasia, abortion, informed consent, allocating medical resources, and treating impaired infants. What is the morally right thing to do in various biomedical contexts? What are good reasons for answers to that question and others like it? What kinds of things should we take into consideration when making difficult moral decisions about these topics? What role should rights play? What about overall happiness? Are there certain rules of moral conduct that should never be broken?

The Weston book focuses on ethical tools: identifying, weighing, and integrating values; critical thinking; and creativity. We will first learn about, discuss, and work on applying those tools in general, and then we will turn to specific applications in biomedical ethics. The selections in the Beauchamp & Walters text are mostly academic philosophical articles, along with some legal decisions and policy papers. For our in-class discussions and readings, we will focus on three main topics: end-of-life decision-making (including the right to die and assisted suicide), justice and access (especially on the right to health care and issues of AIDS and public policy), and reproductive technology (in particular, issues of cloning and stem cell research). In addition, you will individually explore an additional biomedical ethical issue in the form of a paper or presentation (chosen from among the other issues in the Beauchamp & Walters book).

Throughout this course, you will be learning how to think for yourself - open-mindedly but critically - about the application of ethical values and thinking. To do this, you will learn about specific strategies, theories, concepts, and methods that are the special emphasis of philosophy and ethics. You may not have come to final conclusions about ethics or particular issues by the end of this course, or by the end of your life, for that matter. But you will almost certainly have made progress in thinking well about ethics and its applications.

Those applications will include both decisions about right and wrong actions and decisions about policy or law. We might think it's wrong to smoke cigarettes if you're pregnant, but not think there should be a law against it - rather, we might think about constructive ways to encourage right behavior short of enforcement. The important thing for purposes of this course is that you become adept at looking at as many relevant aspects of moral issues as clear-headedly and constructively as possible; and that you learn to present your views and the reasons for them in the form of logically-constructed arguments.

This course will be a mix of lecture and discussion, with everyone expected to participate. You will learn what others have said on these issues as well as developing your own views. Students will be evaluated on their comprehension of the assigned readings and lectures, but will also be expected to make philosophical arguments of their own. This kind of argument is in the form of ordered reasons, and the aim is to get closer to the truth on these difficult issues. We will be approaching other views - and our own - with respect and with a critical eye. To engage in discussion of the issues, students will learn to give and take criticisms and suggestions in the spirit of mutual respect and the desire to formulate thoughtful positions. Some of these issues may inspire strong opinions and emotions - there is nothing wrong with that, but we will be learning about ways to learn from those opinions and emotions, both our own and those of others, not just to express them.

Class Format
This class will consist of a combination of lecture and discussion. I will spend time every day taking your questions about the reading and the previous class's material, and we will then go over and talk about the current day's material. I will sometimes have you break up into pairs or groups to work on an in-class assignment or discussion. A few days will be set aside for those among you who choose to do presentations to present those.

Philosophy is best learned through discussion and extended thought, so both participating in class and engaging with the readings are important for this class. You may want to allow yourself time to do the readings more than once, especially the academic philosophical articles. I will expect you each day to have read and thought about the readings, and to be prepared to discuss them. I will generally assume that you have understood the material, unless you indicate otherwise. I welcome questions, as they are one of the only ways for me to know what is unclear to you. I will probably give you occasional in-class or out-of-class assignments, which will rely upon sincere attempts to understand the readings. In addition, you will write short (one-page) journal-style response papers weekly, and these will be graded largely on the basis of how much you have genuinely grappled with the course material.

I expect regular attendance in this class. Although attendance makes up no official percentage of your grade, missing class will negatively affect it. Repeatedly missing class may result in a substantial lowering of your grade for the course.
There will be two avenues for further discussion of class materials: office hours and weekly lunches. Office hours are held for purposes such as discussing course materials, helping you understand readings, working on philosophical skills, and going over drafts of assignments. Please take full advantage of them. Additionally, I will be in The Daily Grind for a "Biomedical Ethics" coffee hour every Tuesday from 9 - 10. This weekly coffee hour is for us to informally discuss ideas brought up in class, perhaps in more depth than we can manage during class hours. Please feel free to drop by - caffeinate and philosophize.

Course Requirements and Grading Scheme

Papers (25% each)
You will be writing two relatively long (about 8-page) papers for this course. You will have the opportunity to choose two out of three possible papers to write: the due dates will be in weeks 6, 8, and 11 (exam week), and will be on topics relating to the three main biomedical topics (end-of-life decision-making, justice and access, and reproductive technology). You may only turn in two papers. These papers will be on assigned topics, although I will be open to papers on alternative topics if approved by me in advance.

The point of these papers is to construct and present a philosophical argument for an ethical thesis regarding a particular biomedical issue. One goal is to apply for yourself the principles of reasoning, insight, philosophical writing, and argumentation modeled and taught in this class. The other goal is to craft a carefully considered position on an issue, grappling with fundamental problems in your own way.

I may require you to turn in an outline or draft for one or more of the papers, or have you exchange outlines or drafts with other students in the class. I will be able to look at rough drafts, either turned in or during office hours; I will let you know details as the time gets nearer. I also encourage you to run rough drafts by each other or your peers at the Writing Center, even if I do not require you to do so. Whether I look at them or not, rough drafts and outlines of each of your papers will be due along with the final drafts.

Test on the ethical toolbox (15%)
In Week 4, you will have an in-class exam on the readings in weeks 1-3 (Weston Chs. 1-13 and Beauchamp & Walters Ch. 1). This material is the foundation for all of the argumentation and thinking that will be done in the application sections, so it is important that you feel familiar and comfortable with it. The exam will be at least partly in essay form; it may include some short-answer or other "objective" questions as well.

Presentation or short paper (15%)
In weeks 5, 8, and 10, time will be set aside for student presentations on sets of topics from the Beauchamp & Walters text. You may choose whether to do one of these (approx. 10-minute) presentations or to write a short (4-5 page) essay instead (due on presentation day for your chosen topic). In either case, you will choose your topic from a sign-up sheet that I will bring to each class. Whether you do a presentation or write an essay, the assignment will be essentially the same: to bring out the major issue and concern of your chosen topic and use tools from the ethical toolbox to explore the issue and discuss how we might either "get unstuck" or decide for ourselves. I will provide more information about this assignment in class.

Response papers (10%)
Every Friday, you will turn in a "response paper" on an assignment I will give you by Monday of that week. This will be a typed, double-spaced short essay, and it should be under a page in length. Response papers will generally involve you thinking about the material we've been discussing or reading in a personal way, either grappling with your own view on a topic or applying ethical ideas to things in your own life. These response papers may be shared with the class, unless you ask me (on the paper) not to do so - you may also ask me to only share your paper with the class anonymously, if you like.

The point of the essays is to integrate your academic learning of the material into your personal life and thinking, and to have the experience of constructing statements of your own reactions to the topics studied. They are meant to help you see the material as relevant to your life, and to see yourself as able to take a place in the ongoing debate about philosophical issues. I will grade these on the basis of how well I see you trying to do those things, not on the basis of your ability to regurgitate facts from the readings, or parrot back to me thoughts I or the philosophers studied have expressed.

Participation, in-class assignments, and other assignments (15%)
This will be a participation-intensive course. In a philosophy class of this kind, discussion is absolutely essential, and may be the way you learn most about the material. I know that participation is difficult for some people, but you can consider this a safe place to practice contributing to a group discussion, which you will surely need to do throughout your life. I will require and ensure that conversation in class, although probably critical of ideas, will not be critical of people. I expect that we will get to know each other well enough to feel comfortable talking relatively quickly. I also intend to make it apparent that you will not be thought worse of for saying anything, as long as you are speaking respectfully.

I will keep general track of your contributions in class. Keep in mind that contributions can take various forms, including asking for clarification, participation in group work, and giving helpful examples. Keep in mind also that more does not necessarily mean better: those who excessively dominate discussions, speak disrespectfully, or otherwise use their voices in a negative way may be penalized for doing so. If you are in doubt, ask me.

I may occasionally ask you to do an in-class or homework assignment, designed to help facilitate learning and/or discussion. I will let you know details of such assignments as they come up.

Class conduct
Class conduct does not carry an official weight in this course, but will be taken into account at final grade time. Your conduct in this class includes improvement and effort. It also includes issues of respectful behavior, such as tardiness, distracting behavior, or disrespectful behavior towards members of the class or me.

Assignment responsibilities
All assignments must be turned in as hard (paper) copies - no emailed assignments will be accepted except by special permission. It is your responsibility to retain copies of all assignments you turn in, in a reliable format. Late assignments will be assessed a grade penalty of half a grade for each day late, except in the most extreme extenuating circumstances (for instance, severe illness). The formal requirements for all assignments will be announced in detail well ahead of time, either in class, by email, on the website, or all three.
A note on changing grades: if you feel you have been assigned a grade unfairly or inaccurately, you should by all means talk to me about it. My only requirement is that you prepare an argument (a set of reasons and facts) before you do so.
A note on reading: don't succumb to the misconception that in order to read something you only have to move your eyes over the lines, or "read it out loud in your head," so to speak. What I expect is that you will read the material in a more sophisticated way, thinking as you go. You should be asking yourself the main points, making sure you understand the structure of the reading, thinking about how this reading relates to others you've done, and otherwise working to comprehend the material, not just to complete a technical "reading" of it. You might try highlighting, underlining, making marginal notes, or outlining - whatever helps you focus and understand. By the way, don't forget to read the footnotes as well as the main text in your readings.

Grading scheme:
Two long papers: 25% each
Test on ethical toolbox: 15%
Presentation or short paper: 10%
Response papers: 10% (average of all)
Participation and other assignments: 15%

Academic integrity and the Honor System

"It is always important to think of the intellectual world as a community of mutual dependence, mutual helpfulness, mutual protectiveness, and common delight. We take ideas from others and we give them to others. We are indebted to others, and others are indebted to us. In sharing and acknowledging the community, we define ourselves more certainly as individuals. The ability to describe our sources is also an ability to define our own originality and our own selves. All communities depend on generosity, trust, definition, and the proper use of sources is part of the mortar that holds the community of the mind together."
- Richard Marius, Expository Writing Program, Harvard University

In this class, as in all classes at Kalamazoo College, we will be operating under the Honor System. It is important that you familiarize yourself with that system, and so I am attaching a copy of the College's statement of it. You should also familiarize yourself with proper procedures for collaborating, doing research, and citing sources. Should you have any questions about citations, plagiarism, or honor system issues, please visit or contact me.
Any assignment you turn in that I find to violate academic integrity, either through dishonesty, plagiarism, lack of appropriate citations, or unauthorized collaboration, will receive a grade of 0. Any further instance of a violation of academic integrity will be punished by a failing grade in the class as a minimum sanction.

Special needs
If you have any special needs that I can accommodate, please let me know as soon as possible.

Office hours
My office hours are posted above. They will be conducted on a first-come, first-served basis, unless you make a prior appointment. I am also available at other times by appointment. You should feel absolutely free to come to them and discuss the course, the material, the assignments, or philosophy.
I request that each of you take a few minutes to visit me during my office hours sometime in the first week of classes. It will be an opportunity for us to chat one-on-one for the first time, and to get to know each other a bit more.

Schedule of Readings

This schedule is tentative. Any changes will be announced in class and by email, and most likely on the website as well. The reading assignments listed for each day must be completed before that class. Readings are found in your textbooks as indicated.

WEEK ONE
M 3/29 Introduction to Class, Ethics, Philosophy, and Biomedical Ethics

PART ONE:
THE ETHICAL TOOLBOX

W 3/31 Weston Intro, pgs. 1-5; Chs. 1 & 2
F 4/2 Weston Chs. 3 & 4
WEEK TWO
M 4/5 Weston Ch. 5, B&W Ch. 1 pgs 1 - 28
W 4/7 Weston Chs. 6 & 7
F 4/9 Weston Chs. 8 - 10
WEEK THREE
M 4/12 Weston Chs. 11 & 12
W 4/14 Weston Ch. 13, B&W pgs. 28 - 33
F 4/16 Weston Chs. 14 & 15

PART TWO:
END-OF-LIFE DECISION-MAKING

WEEK FOUR
M 4/19 The legal background in the U.S.: B& W pgs. 179 - 185, 201 - 215;
The right to die:
Kamm, "A Right to Choose Death?" (B&W 186)
Kass, "Is There a Right to Die?" (B&W 191)
W 4/21 The moral foundations of public policy on physician-assisted death:
Brock, "Voluntary Active Euthanasia" (B&W 216)
Arras, "Physician-Assisted Suicide: A Tragic View" (B&W 225)
F 4/23 Exam on the ethical toolbox
WEEK FIVE
M 4/26 Public policy in the Netherlands on physician-assisted death:
Jochemsen and Keown, "Voluntary Euthanasia under Control? Further Empirical Evidence from the Netherlands" (B&W 235)
Van Delden, "Slippery Slopes in Flat Countries - A Response" (B&W 241)
W 4/28 Palliation and other alternatives to physician-assisted death:
Gert, Culver, and Clouser, "An Alternative to Physician-Assisted Suicide" (B&W 244)
Palliative options of last resort:
Quill, Lo, and Brock, "A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician, Assisted Suicide, and Voluntary Active Euthanasia" (B&W 252)
F 4/30 Discussion on end-of-life decision-making;
Presentations on topics in B&W Chs. 3 and 5

PART THREE:
JUSTICE AND HEALTH CARE

WEEK SIX
M 5/3 B&W 39 - 46
Just health care and the right to health care:
Daniels, "Is There a Right to Health Care and, If So, What Does It Encompass?" (B&W 46)
Veatch, "Justice, the Basic Social Contract, and Health Care" (B&W 53)
W 5/5 Buchanan, "The Right to a Decent Minimum of Health Care" (B&W 59)
Engelhardt, Jr., "Rights to Health Care, Social Justice, and Fairness in Health Care Allocations" (B&W 64)
F 5/7 Managed care and access to care:
Gostin, "Securing Health or Just Health Care? The Effect of the Health Care System on the Health of America" (B&W 72)
Powers, "Managed Care: How Economic Incentive Reforms Went Wrong" (B&W 79)
Buchanan, "Managed Care: Rationing without Justice, But Not Unjustly" (B&W 83)
WEEK SEVEN
M 5/10 The Global AIDS epidemic:
Intro, B&W 665 - 667
Fauci, "The AIDS Epidemic: Considerations for the 21st Century" (B&W 671)
UNAIDS/WHO, "AIDS Epidemic Update" (B&W) 677
W 5/12 Lamptey, "Reducing Heterosexual Transmission of HIV in Poor Countries" (B&W 685)
Gostin and Webber, "HIV Infection and AIDS in the Public Health and Health Care Systems" (B&W 691)
F 5/14 AIDS, justice, and public health:
Yamey and Rankin, "AIDS and Global Justice" (B&W 700)
Berwick, "We All Have AIDS" (B&W 702)
Logie and Benatar, "Africa in the 21st Century: Can Despair Be Turned to Hope?" (B&W 704)
WEEK EIGHT
M 5/17 Discussion of justice and health care,
Presentations on topics in B&W Chs. 6 and 9
W 5/19 (Day of Gracious Living? If not, adjust schedule accordingly)

PART FOUR:
REPRODUCTIVE TECHNOLOGIES AND
HUMAN EMBRYONIC STEM CELL RESEARCH

F 5/21 Intro, B&W 563 - 567
Reproductive cloning:
Brock, "Cloning Human Beings: An Assessment of the Ethical Issues Pro and Con" (B&W 593)
WEEK NINE
M 5/24 Kass, "The Wisdom of Repugnance" (B&W 603)
W 5/26 Cloning human beings:
National Bioethics Advisory Commission (B&W 618)
Gillon, "Human Reproductive Cloning: A Look at the Arguments Against It and a Rejection of Most of Them" (B&W 621)
National Research Council, "Scientific and Medical Aspects of Human Reproductive Cloning" (B&W 633)
F 5/28 Human embryonic stem cell research:
National Bioethics Advisory Commission, "Ethical Issues in Human Stem Cell Research" (B&W 636)
McGee and Caplan, "The Ethics and Politics of Small Sacrifices in Stem Cell Research" (B&W 646)
WEEK TEN
M 5/31 Memorial Day Holiday - no class
W 6/2 Meilaender, "The Point of a Ban: Or, How to Think about Stem Cell Research" (B&W 649)
National Research Council and Institute of Medicine, "Stem Cells and the Future of Regenerative Medicine" (B&W 656)
National Research Council, "Using Nuclear Transplantation to Produce Embryonic Stem Cells" (B&W 658)
F 6/4 Discussion of cloning and stem cell research,
Presentations on topics in B&W Chs. 7 and 8