Biomedical Ethics

David L. Perry, Ph.D.
Dickinson College, Fall 2005

Course Objectives

Medicine is an ancient profession, and has always depended upon high standards of integrity, compassion and personal commitment on the part of its practitioners. In contemporary society, new and challenging ethical issues and dilemmas seem to arise nearly as frequently as advances in biological science and medical technology, continually testing the adequacy of our moral theories and confounding public consensus.

In biomedical realms as in other areas of life, it is important for us to nurture moral wisdom and moral courage: wisdom to recognize when an ethical problem arises, as well as to make sound decisions in situations of moral conflict; and courage to do what we know is right even when there are strong pressures or incentives to do otherwise. Hence, the primary objectives of this course are: 1) to increase your awareness of a wide range of ethical challenges that can arise in medicine and related fields; 2) to enable you to test the strengths and weaknesses of various moral beliefs and ethical arguments relevant to biomedical practices; and 3) to reinforce your personal sense of compassion and fairness in the context of your future professional roles.

Course Requirements

Your final grade in the course will be largely determined by averaging the letter grades of two essay exams and a 6-7-page paper. (In other words, each of those three elements is worth about 33% of your overall grade.) Regular attendance as well as informed and courteous participation in class discussions are also essential. (If you need to miss all or part of a class session, try to inform me of that beforehand, and why. In emergencies, let me know afterward.)

During the essay exams you won't be allowed to use any notes or books, with the exception of translation dictionaries (in print form, not pocket computers) for any students whose primary language is not English. I'll provide "bluebooks" for each exam.   You'll need to bring non-erasable ink pens to use during the exam.

Remember that cheating on exams and plagiarism on papers are serious breaches of academic ethics, and can lead not only to your flunking the course but also to other disciplinary actions, including expulsion from Dickinson. See also the section below on "Writing with Integrity."

Required Readings

1) Tom Beauchamp and LeRoy Walters, eds., Contemporary Issues in Bioethics, 6th edition (2003).
2) Articles on the web that you'll need to download and print.
3) Short news articles that I may distribute occasionally.

Course Schedule

August 29: Introduction: The nature and scope of ethics; the value of taking an ethics class; course requirements and schedule; and personal introductions.

August 31: Bad medicine: Kevles, "Eugenics and Human Rights," Glover, "Eugenics: Some Lessons from the Nazi Experience," Pence, "The Tuskegee Study," and Harris, "Factories of Death," in Beauchamp & Walters (B&W), Contemporary Issues in Bioethics, pp. 457-459, 467-472, 394-401 and 404-411.

September 5: No class (Labor Day holiday).

September 7: Ethical theory and bioethics: B&W pp. 1-33.

September 12: Patient autonomy, advance directives, and confidentiality: Thomasma, "Telling the Truth to Patients," Emanuel et al., "Advance Care Planning as a Process," and Gostin and Webber, "HIV Infection and AIDS in the Public Health and Health Care Systems," in B&W pp. 128-132, 164-170 and 691-697.

September 14: Contemporary research involving human subjects: World Medical Assoc., "Declaration of Helsinki" and "Note of Clarification," National Bioethics Advisory Commission, "Protecting Research Participants," and Guenter et al., "Ethical Considerations in International HIV Vaccine Trials," in B&W pp. 355-358, 371-378 and 750-756.

    Have you identified some possible topics for your paper? Have you begun researching them carefully? Do you need my advice on how to proceed?

September 19: Brain death and the persistent vegetative state: Excerpts from Bernat, Ethical Issues in Neurology (handout).

September 21: Dementia and mental retardation: Excerpts from Bernat, Ethical Issues in Neurology (handout). Time permitting, we'll view and discuss portions of a PBS film, "The Forgetting: A Portrait of Alzheimer's."

September 26: Euthanasia and assisted suicide in the Netherlands and the U.S.: Jochemsen and Keown, "Voluntary Euthanasia under Control?" Van Delden, "Slippery Slopes in Flat Countries--A Response," U.S. Supreme Court, Vacco v. Quill and Washington v. Glucksberg, and "The Oregon Death with Dignity Act," in B&W pp. 235-243, 205-211 and 201-204.

September 28: Euthanasia continued: Gert et al., "An Alternative to Physician-Assisted Suicide," and Quill et al., "A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia," in B&W pp. 244-259.

    How is your paper coming along? Are you pleased with what your research has turned up? Are you developing a tightly reasoned essay?

October 3: Justice in allocating medical resources: Buchanan, "Managed Care: Rationing without Justice, but Not Unjustly," and Fleck, "Just Caring: Oregon, Health Care Rationing, and Informed Democratic Deliberation," in B&W pp. 83-89 and 100-106.

October 5: Organ transplants: Perry, "Ethical Considerations in Organ Transplants," at http://home.earthlink.net/~davidlperry/organs.htm, and "Tough Choices on Heart Transplants," at http://home.earthlink.net/~davidlperry/heart.htm; and a chapter from Veatch, Transplantation Ethics (handout).

October 10: Visit Carlisle Regional Medical Center, hosted by Dr. Greg Lewis

October 12: Midterm examination.

October 17 & 19: No classes (Mid-Term Pause).

October 24: Abortion: Perry, "Abortion and Personhood: Historical and Comparative Notes," at http://home.earthlink.net/~davidlperry/abortion.htm; Marquis, "Why Abortion Is Immoral," and U.S. Supreme Court, Planned Parenthood v. Casey, in B&W pp. 270-277 and 312-318. (Also recommended: Compare the official position of the Catholic Church, at http://www.usccb.org/prolife/issues/abortion/procured.htm, with Catholics for a Free Choice, at http://www.catholicsforchoice.org/new/questionsbottompg2.asp.)

October 26: Fetal-protection policies: U.S. Supreme Court, Automobile Workers v. Johnson Controls, D.C. Court of Appeals, In Re: A.C.,Capron, "Punishing Mothers," and Deville and Kopelman, "Moral and Social Issues regarding Pregnant Women Who Use and Abuse Drugs," in B&W pp. 322-341.

October 31: Reproductive technologies: Robertson, "IVF, Infertility, and the Status of Embryos," and ISLAT Working Group, "ART into Science: Regulation of Fertility Techniques," in B&W pp. 569-578 and 589-591.

November 2: Human reproductive cloning: Brock, "Cloning Human Beings: An Assessment of the Ethical Issues Pro and Con," and Kass, "The Wisdom of Repugnance," in B&W pp. 593-617.

November 7: Human stem cells: Univ. of Minnesota Center for Bioethics, "Human Stem Cells: An Ethical Overview," at http://www.bioethics.umn.edu/publications/Stem_Cells.pdf, and National Bioethics Advisory Commission, "Ethical Issues in Human Stem Cell Research," in B&W pp. 636-645.

November 9: Genetics: Collins and McKusick, "Implications of the Human Genome Project for Medical Science," Buchanan et al., "From Chance to Choice: Genetics and Justice," and Paabo, "The Human Genome and Our View of Ourselves," in B&W pp. 473-478 and 485-499. (Also recommended: Browse the website for a new PBS series called "DNA" at http://www.pbs.org/wnet/dna/. E.g., see the link for "Ethical Challenge" at episode #4, http://www.pbs.org/wnet/dna/episode4/index.html. In class if there's enough time, we'll view and discuss a segment of that film series.)

    Are you nearly ready to turn in a carefully written draft paper to me? Have you checked it for clarity, grammar, and spelling? Have you sought advice from writing tutors? Does your draft satisfy the Guidelines explained at the end of this syllabus?

November 14: Genetic testing: Roche and Annas, "Protecting Genetic Privacy," Burgess, "Beyond Consent: Ethical and Social Issues in Genetic Testing," and Ross and Moon, "Ethical Issues in Genetic Testing of Children," in B&W pp. 500-520.

November 16: Guest speaker: James Bernat, M.D., of Dartmouth Medical School.

November 17 (Thursday): Dr. Bernat will give a public lecture on "Ethics in Neurological Practice: Discerning Appropriate Medical Care in Cases of Severe Brain Injury and Disease." (Your attendance is highly recommended but not required.)

November 21: Genetic therapies: Friedman, "Principles for Human Gene Therapy Studies," Somia and Verma, "Gene Therapy: Trials and Tribulations," and Savulescu, "Harm, Ethics Committees and the Gene Therapy Death," in B&W pp. 522-533. (Also recommended: "Fixing Our Genes" at the PBS "DNA" site, http://www.pbs.org/wnet/dna/episode4/essay1.html.) This is the last day I'll accept draft papers for comment. Submitting a draft of your paper is recommended, but not mandatory.

November 23: No class (Thanksgiving break).

November 28: Genetic engineering: Glover, "Questions about Some Uses of Genetic Engineering," Gordon, "Genetic Enhancement in Humans," and Parens, "The Goodness of Fragility: On the Prospect of Genetic Technologies Aimed at the Enhancement of Human Capacities," in B&W pp. 534-553.

November 30: Animals in biomedical research: DeGrazia, "The Ethics of Animal Research: What Are the Prospects for Agreement?" in B&W pp. 418-425; views of the Foundation for Biomedical Research, http://www.fbresearch.org/education/fact-vs-myth.htm, and guidelines of the American Psychological Assoc., http://www.apa.org/science/anguide.html.

December 5: Biomedical ethics and war: Gross, "Bioethics and Armed Conflict" (handout); Spencer and Lightfoot, "Preparedness and Response to Bioterrorism," and Barbera et al., "Large-Scale Quarantine Following Biological Terrorism in the United States," in B&W pp. 768-782.

December 7: Concluding discussions.

December 9 (Friday): The final versions of your paper are due in my Philosophy Dept. inbox by noon.

December 12: Final Examination.

    You may pick up your graded paper and final exam after I turn in grades to the Registrar. Or if you would rather that I mail your materials to you, provide me with a 9x12 envelope with your name, address, and 3 oz. worth of postage.

Guidelines for Your Paper

Topics and Sources - The paper must deal in some way with biomedical ethics, and incorporate ideas from at least two sources outside of the assigned course readings. (You may use our assigned readings, too, but you aren't required to do so.)   Newspaper or magazine articles may be cited, but your main sources should be scholarly. Since the paper is to be fairly short (6-7 pages), it's important to focus your topic narrowly in order to do it justice. I strongly recommend that you elicit feedback from me on your paper topic soon, so that I can steer you away from inappropriate subjects and toward useful research sources.

You may use the paper to argue in support of one side of an ethical issue. If so, then you should not only find substantial arguments in support of that position, but also tackle substantial arguments against that position. In other words, try to show that your position successfully withstands strong criticism. Alternatively, you might want to explore an ethical issue without taking a firm stance on either side. In that case also, find substantial arguments that produce conflicting conclusions, and analyze their strengths and weaknesses. Don't choose a topic where the only credible ethical arguments favor one side: e.g., don't write a paper on why the Nazi medical experiments on concentration camp inmates were immoral.

The Dickinson library has some useful research tools, including Encyclopedia of Bioethics, MEDLINE, Philosopher's Index and ATLA Religion Index. Also, I have listed some relevant sites on my personal web page, http://home.earthlink.net/~davidlperry/weblinks.htm. You might also want to scan back issues of scholarly publications like Hastings Center Report to see if particular topics addressed there are of interest to you.

Format - Your paper should be typed and double-spaced, have one-inch margins on all sides, and employ a 12-point font in a style like Times Roman (not
Courier). Do not add covers or a title page; simply provide your name and the title at the top of the first page of the body of your essay, and staple the pages together in the upper left corner.

Editing - I am willing to comment on a draft of your paper at least two weeks prior to the due date for the final product.  Check carefully to eliminate all errors in spelling and grammar, even in your draft. My energies should be spent analyzing the quality of your arguments rather than correcting mistakes that you could easily have caught yourself.

Writing with Integrity - Hugo Bedau wrote in Thinking and Writing about Philosophy, p. 141: "Writers plagiarize when they use another's words or ideas without suitable acknowledgement. Plagiarism amounts to theft--theft of language and thought. Plagiarism also involves deception.... [Plagiarism] wrongs the person from whom the words or thoughts were taken and to whom no credit was given; and it wrongs the reader by fraudulently misrepresenting the words or thoughts as though they are the writer's own." I would add that plagiarism is also unfair to your fellow students, since in contrast to their honest and hard work, it involves almost no effort to steal another author's words.

Finally, although it sounds like a cliche, when you plagiarize you also cheat yourself: first, by not developing the discipline and diligence to research, write and edit well; second, because taking credit for other people's ideas will induce outrage and resentment against you; and third, because a habit of plagiarism can end your career and destroy your reputation.

To avoid plagiarism, you must cite your sources everywhere in your paper where you use their ideas, and not only when you quote them directly, but also where you paraphrase their points in your own words. In general, you should only use direct quotes when you find the authors' wording to be especially effective. But your paraphrasing or summaries of authors' points should be thorough: it's not fair to an author to change only a couple of words in a paragraph of his or hers, and then imply (by not using direct quotes) that the paragraph is entirely your own prose. (It might help to imagine the author reading over your shoulder.)

Some additional practices are unethical for similar reasons:

1) You may not submit a paper that you did not write yourself, whether given to you by a sympathetic friend, purchased on the web, or written by a paid "tutor." Although (unlike plagiarism) this would not represent a case of theft, it would nonetheless be unfair to your peers, and would also perpetrate a fraud on your professor.

2) You may not submit a paper to me that is substantially similar to one that you wrote for another class, since both I and your fellow students rightly assume that you will be doing new research for this course.

List full references alphabetically at the end of your paper, using the following format:

1) Book (non-anthology): author's name, book title (date). An example: Hugo Bedau, Thinking and Writing about Philosophy (1996).

2) Article in an anthology: name of the article's author, "article title," name of the editor(s) of the anthology, book title (date), pages. An example: Dan Brock, "Voluntary Active Euthanasia," in Tom Beauchamp and LeRoy Walters, eds., Contemporary Issues in Bioethics, sixth edition (2003), pp. 216-225.

3) Periodical article: author, "article title," periodical title volume/issue (date): pages. An example: Dan Brock, "Voluntary Active Euthanasia," Hastings Center Report 22/2 (March-April 1992): 10-22.

4) Web page: author, "title of page or article," date, URL. An example: David Perry, "Tough Choices on Heart Transplants," 2002, http://home.earthlink.net/~davidlperry/heart.htm.

Within your text, e.g., at the end of a paragraph or a direct quote, you may refer to a source simply as (author, pages).  An example: (Bedau 141).


The syllabus, lectures and discussion questions for this course are copyrighted by David L. Perry, and may not be sold or distributed without his explicit permission.


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