SOCS 645
Bioethics, Public Policy, and the Law

Barry Schaller

Course Description
This course examines leading issues in bioethics, public policy and law in relation to recent developments in medicine, public health and the life sciences. After tracing the historical background of bioethical issues and law and deciding on methods of legal and ethical analysis, we will consider how issues in contemporary medicine, public health, and science challenge traditional ethical principles as well as existing law and public policy. Among other topics, we will explore the tension between traditional biomedical ethics, centering on individual autonomy, and the public health model, focusing on the common good.

In addition to key issues involving the physician-patient relationship, reproduction, and the end of life, we will consider some or all of the following subjects: research and experimentation using human subjects, genetic testing, screening, and the use of DNA databases, genetic engineering, enhancement, and biotechnology, organ transplantation and allocation, ownership and the commodifying of life, and stem cell research and cloning. Other current issues that may be covered include the interaction of biotechnology and information technology, the green revolution -- genetically modified organisms, bioterrorism and public health, and futurist issues such as the applications of nanotechnology and artificial intelligence. Recent and ongoing legal cases and controversies will be closely followed along with other current developments in bioethics.

The course, which will be conducted as a seminar, involves critical examination of issues in their legal, ethical, economic, political, religious, and cultural context. We will evaluate the individual, social, and ethical questions raised, and explore the feasibility and effectiveness of legal regulation. An important goal of the course is to encourage each student to develop a method of analyzing bioethical problems from both legal and ethical perspectives.

Course Reading

The principal text will be Steinbeck, Arras, and London, Ethical Issues in Modern Medicine. Leading court cases in the bioethics field will be studied closely, including In re Guardianship of  Theresa Marie Schiavio (Schindler v. Schiavo); Gelsinger v. University of Pennsylvania; Tarasoff v. Regents of University of California; Planned Parenthood of Southeastern Pennsylvania v. Casey; Bouvia v. Superior Court; in re A.C.;  and In re Karen Quinlan.

Additional readings will be assigned from other sources, including legal and bioethical periodicals and professional publications. Readings will include classic expressions of ethical thought, legal cases and legislation, and timely articles and essays that deal with ethical and legal issues in their cultural context.

Among contemporary writers to be studied are Tom Beauchamp, Arthur Caplan, George Annas, and Leon Kass. Short works of fiction will explore other dimensions of the field, adding to the texture of the course, with selections drawn from authors such as William Carlos Williams, Alice Munro, Jose Saramago, Gabriel Garcia Marquez and others.

Course Assignments

Frequent short (1-2 pages) writing assignments will be given in addition to one or two medium length essays of an analytical nature on a wide range of legal/bioethical topics. With respect to one essay, students will have the opportunity to write in some depth about a topic of their own choice.

Course Calendar
The following schedule of topics for class sessions may be adjusted from time to time depending on student interest in particular topics and new developments, as well as progress with the materials. Guest speakers may be invited to join the class from time to time. Page references to reading material are to Steinbock, Arras & London, Ethical Issues in Modern Medicine, sixth edition, unless otherwise designated.
September 13 Introduction to Bioethics:
Course overview, schedule and methodology, participation requirements (reporting of developments and discoveries, discussion, oral presentations), introducing methods of legal and ethical analysis, guidelines for written exercises, briefing cases, class participation, sources of information about bioethics; case studies for ethical and legal analysis, history of bioethics, origins of ethical theory, relationship of bioethics to law, culture, philosophy and literature, multi-disciplinary nature of field, limitations of law, ethics.

Reading Material: Steinbock, Arras & London, eds., Ethical Issues in Modern Medicine, Sixth Edition: "Introduction: Moral Reasoning in the Medical Context," pp 1 - 41.

September 20 The Physician-patient relationship I:
foundations of the physician-patient relationship, historical perspective, exploring individual autonomy, the four models of the physician-patient relationship, disclosure and informed consent, Hippocratic oath, beneficence, non-maleficence, informed consent, methodology of making clinical ethical decisions.

Reading Material (Tentative): "Foundations of the Health Professional-Patient Relationship, pp. 43-54; "The Hippocratic Oath," p. 55; "Beneficence Today, or Autonomy (Maybe) Tomorrow?" and "Commentaries," pp. 64-67; "Four Models of the Physician-Patient Relationship," pp. 67-76; "Offering Truth," pp. 76-82; "Arato v. Avedon," pp. 83-90; "Transparency: Informed Consent in Primary Care," pp. 100-106;

September 27

 

The Physician-patient relationship II:
conflicting professional roles and responsibilities, liability of physicians, ethics in the health care bureaucracy, confidentiality, distributive justice considerations, allocating resources, health care policy.

Reading Material (Tentative): "Errors in Medicine: Nurturing Truthfulness," pp. 107-111; Tarasoff v Regents, pp. 111-116; "Please Don't Tell" and Commentaries, pp. 117-119; "The HMO Physician's Duty to Cut Costs," pp128-129; "The Doctor's Master," pp. 129-132; Cruzan v Missouri Dept. of Health; Watts, "Chronic Pain Syndrome"; Abse, "The Stethoscope";  Shakespeare, "Sonnet CXLVII";

October 4

 
Human research, experimentation and clinical trials I:
historical views of human experimentation, the Tuskegee Syphilis Experiment and its aftermath, research on vulnerable groups, experiments on the internet age, the Belmont Report, Nuremberg Code, regulation and the role of institutional review boards, clinical trials.

Reading Material (Tentative):"Experimentation on Human Subjects," pp. 693-703; "The Nuremberg Code," pp. 705-706; "The Jewish Chronic Disease Hospital Case,"pp. 706-717; "The Willowbrook Hepatitis Studies," pp. 717-721; "Willowbrook Revisited," pp. 722-727; "Racism and Research," pp. 727-738; "The Belmont Report," pp. 738-745; "The Ethics of Randomized Clinical Trials," pp. 747-759.

October 11 Human Research, experimentation and clinical trials II:
current status of clinical trials including malpractice liability of researchers; Belmont 25 years later.

Reading Material: To be assigned

October 25 Law and Medicine at the end of life I:
the right to refuse care and treatment, a good death, Dax's case, care of the dying, determining medical futility, truth-telling, clinical case management, defining death.

Reading Material (Tentative): “Defining Death, Foregoing Life-Sustaining Treatment, and Euthanasia," pp. 245-258; "Defining death," pp. 259-268; "The Impending Collapse of the Whole-Brain Definition of Death," pp.268-276; State of Tennessee v. Northern, pp. 283-290; "Deciding for Others: Competency," pp. 290-300; "A Chronicle: Dax's Case as it Happened," and Commentaries, pp. 301-308; "The Wendland Case and the Treacherous Road to Nonpersonhood," pp. 348-356; "Medical Futility: Its Meaning and Ethical Implications," "Dying Words;" "The Principle of Hope;"  How We Die; Dax's Case: Transcription; "Dealing with Catastrophe;" "On Why We Should Not Agree with Dax;" "Dax and Job: The Refusal of Redemptive Suffering;"  "Controlled NHBD Protocol for a Fully Conscious Person;" Chekhov, "The Examining Magistrate"; Chekhov, "The Doctor"; Oliver, "When Death Comes".

November 1 Law and Medicine at the end of life II:
The historical context of medical futility situations – Quinlan, Cruzan, Bouvia, et al; competency and disability; analysis of and reflections on the Terri Schiavo case; the legal and ethical implications.

Reading Material: To be assigned

November 8 Reproduction and Birth Issues I:
the maternal-fetal conflict, status of the pre-embryo, fundamentals of medicine, law and ethics in this field, parental rights and obligations, multiple parenthood, sperm and egg donation, disputes involving frozen embryos.

Reading Materials (Tentative): "Reprogentics," pp. 441-460; Planned Parenthood v. Casey;  Sternberg v. Carhart; "Ethical Issues Related to Prenatal Genetic Testing," pp. 513-523; "Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy," pp. 523-533; "Ethical Issues and Practical Problems in Preimplantation Genetic Diagnosis," pp. 534-543; "Using Preimplantation Genetic Diagnosis to Save a Sibling," pp. 544-545; "Reproductive Freedom and Prevention of Genetically Transmitted Harmful Conditions," pp. 546-552; Alice Munro, "Before the Change"; Brooks, "The Mother";  Bishop, "In the Waiting Room".

November 15 Reproduction issues II:
current status and implications of stem cell research; choosing our children, cloning and the "new genetics", assisted reproduction, genetic engineering, ownership of life issues.

Reading Materials (Tentative): "Whose Life is it, anyway?" (1987); In re A.C. (D.C. Ct. App. 1988); "The Presumptive Primacy of Procreative Liberty," pp. 595-605; "Instruction on Respect for Human Life in its Origin," pp. 605-614; "What is Wrong with Commodification?" pp. 615-624; "Selling Babies and Selling Bodies," pp. 625-630; Huxley, Brave New World.

November 22 The Body as commodity/justice issue forum:
organ donation, defining brain death, medical research, ownership issues, distributive justice, allocating scarce medical resources, increasing the supply of organs, sales and donations of reproductive materials, forum for issues in distributive justice.

Reading Material (Tentative): "Issues in Retrieval and Transplant of Organs; In re T.A.C.P., FL. (1992); L. Ross et al., Ethics of a Paired-Kidney-Exchange Program" (1997); Moore v. Regents, CA (1990); Committee on Xenograft Transplantation (1996);  Mead, "Eggs for Sale".

November 29 Environmental Ethics
the Green Revolution(s), genetically altered agricultural products, problems of population biology, political, social and economic implications of genetic modifications.

Reading Material: (on line, handouts).

December 6 Why the future DOES need us:
biotechnology and information technology, genetic engineering, artificial intelligence, nanotechnology, problems with post humanistic thinking, analytical problem-solving, conclusions and predictions. 

Reading: to be announced, including Hawthorne, "The Birthmark"; (on line, handouts).

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