Medical Ethics
Nita de Oliveira, Ph.D.
UT Blackboard ID access
Emails: Nita.De_Oliveira@utoledo.edu / nythamar@yahoo.com
PHIL 3370-902 MEDICAL ETHICS (download syllabus in PDF)
Spring Term
Distance Learning Course
Course Website: http://www.nythamar.com/bioethics.html
Personal Website: https://cdea.tche.br/nythamardeoliveira/
Course
Description:
PHIL 3370 - 902 MEDICAL ETHICS (Distance Learning Course)
[3 hours] The application of ethics to the practice of medical professionals. Topics include authority, paternalism, truth-telling, informed consent, health care reform, genetic manipulation, abortion, infanticide and euthanasia. UT Distance Learning course.
The course is an introduction to some central issues within the realm of medical ethics, bioethics, and contemporary applied ethics. No particular previous coursework in ethics is required. The course is accessible to students coming from various academic backgrounds related to the Health Sciences and its online format is very practical and pleasant. This course is being offered entirely online through the University of Toledo's Blackboard system, accessible through the MyUT Web Portal. Students encountering any technical difficulties should contact the IT Help Desk at 419-530-2400 or 419-383-2400, or email ITHELPDESK@utoledo.edu
Required Text:
Michael Dunn & Tony Hope, Medical Ethics: A Very Short Introduction. Second Edition. Oxford University Press, 2019. Paperback: ISBN-13: 978-0198815600, ISBN-10: 0198815603.
How to do well in this DL course
Further Reading / Reserved Materials (Library):
American College of Physicians Ethics Manual, Third Edition, 1993.
Beauchamp, T.L. and J.F. Childress. Principles of Biomedical Ethics. 6th edition. New York: Oxford University Press, 2011.
Beauchamp,T.L. "Methods and principles in biomedical ethics," Journal of Medical Ethics (2003): p. 269-274
Campbell, Alastair, Grant Gillett, and Gareth Jones (editors), Medical Ethics. Fourth Edition. Oxford University Press, 2004.
Campbell, Alastair V. Bioethics: The Basics. New York: Routledge, 2013.
Daniels, Norman. Just Health Care. New York: Cambridge University Press, 1985.
Engelhardt, H. Tristram. The Foundations of Bioethics, second edition, Oxford. 1996.
Foster, Charles. Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics And Law. Oxford: Hart Publishing, 2009.
Jecker, Nancy S., Albert Jonsen, and Robert Pearlman, Bioethics: An introduction to the History, Methods, and Practices. Sudbury, MA: Jones and Bartlett, 1997.
Jonas, Hans. The Phenomenon of Life: Toward a Philosophical Biology. 1966.
Jonas, Hans. The Imperative of Responsibility: In Search of Ethics for the Technological Age. New York : Oxford University Press, 2000.
Jonsen, Albert R. A short history of medical ethics. Oxford University Press, 2000.
Junkerman and Schiedermayer, Practical Ethics for Students, Interns, and Residents. University Publishing Group, 1998.
O'Neill, Onora. Autonomy and trust in bioethics. Cambridge University Press, 2002.
Pogge, Thomas W."Testing Our Drugs on the Poor Abroad," in Ezekiel Emanuel and Jennifer Hawkins, eds. Exploitation and Multi-National Research. Princeton: Princeton University Press 2006.
Pogge, Thomas W. "Harnessing the Power of Pharmaceutical Innovation," in Jillian Claire Cohen, Patricia Illingworth, and Udo Schuklenk, eds The Power of Pills: Social, Ethical, and Legal Issues in Drug Development, Marketing, and Pricing, London: Pluto Press 2006.
Pogge, Thomas W. "Montreal Statement on the Human Right to Essential Medicines," Cambridge Quarterly of Healthcare Ethics 15/2 (2006).
Potter, Van Rensselaer. Bioethics: Bridge to the Future. Englewood Cliffs, N.J.: Prentice-Hall, 1971.
Potter, Van Rensselaer. Global Bioethics: Building on the Leopold Legacy. East Lansing. Michigan State University Press, 1988.
Railton, Peter. Facts, values, and norms: essays toward a morality of consequence. Cambridge ; New York : Cambridge University Press, 2003.
Reich, Warren Thomas (ed.) Encyclopedia of bioethics. Nerw York, Macmillan, 1995.
Singer, Peter. Animal Liberation: A New Ethics for our Treatment of Animals, New York Review/Random House, New York, 1975; Cape, London, 1976; Avon, New York, 1977; Paladin, London, 1977; Thorsons, London, 1983.
Singer, Peter. Animal Rights and Human Obligations: An Anthology (co-editor with Thomas Regan), Prentice-Hall, New Jersey, 1976. 2nd revised edition, Prentice-Hall, New Jersey, 1989.
Singer, Peter. Practical Ethics, Cambridge University Press, Cambridge, 1979; second edition, 1993.
Vaughn, Lewis. Doing Ethics. W.W. Norton & Co., 2009. 2nd Revised Edition.
Vaughn, Lewis. Bioethics: Principles, issues, and cases. Third Edition. New York: Oxford University Press, 2017.
Wilkinson, D., J. Herring, and J. Savulescu. Medical Ethics and Law: The core curriculum, 3rd edition. Amsterdam: Elsevier, 2019.
Grading
Policy:
Grades are based on point accumulation throughout the semester (from Jan 16 thru May 3, 2024). There are 6 Homeworks/Essays, 2 optional Midterm/Bonus essays, and one Final Exam, worth 10 points each. Chapters on the schedule refer to the assigned readings from the textbook (10 chapters). Prepare all the readings before the date given. The reading assignments are usually short and hopefully pleasant. Every week you'll have the opportunity to post your comments (at least one posting per Unit on the Discussion Board, in order to get full credit for Participation, up to 30 points), as you prepare to take the quiz online or write a couple of paragraphs to address some of the suggested study questions. The quizzes and homework tabs are made available during the whole week for each Unit and will actually remain open until the last day of classes, so that at any time during this Spring course you can take the quiz online or use the Homework tab to turn in your essay (a couple of paragraphs, about 250-300 words, addressing one or two questions from the assigned chapter). Suggested dates are indicated for each Unit on the weekends, but you may take the Exam online or send in your Homework at any time. Students can earn up to 100 points in this course.
Final grades for the course
are based on the following scale: Academic
Honesty: Neither plagiarism (i.e., presenting the written work of another as one's own) nor cheating (i.e., providing answers to exam questions or receiving exam answers from another) will be tolerated. Any academic dishonesty will be disciplined according to the guidelines in the University of Toledo student handbook. Accessibility: If you need special accommodations to attend this class, please notify me immediately. Any student needing accommodation based on the impact of a disability and students with documented disabilities should contact the Office of Accessibility (419.383.5792 - http://www.utoledo.edu/centers/cci/web/accessibility.html) to coordinate reasonable accommodations.
COURSE SCHEDULE
The case for animal
liberation, Book Review / P. Singer
93-100 = A
90-92 = A-
87-89 = B+
83-86 = B
80-82 = B-
77-79 = C+
73-76 = C
70-72 = C-
60-69 = D
59 and Below = F
Jan 16 – Feb 3: Unit 1: Chapter 1: On why medical ethics is exciting / Medical Ethics in a Post-Pandemic Era of Technological Innovation
John Sarnecki, “Everything, Everywhere, All at Once: US Vaccine Distribution for Covid-19”. In Bioética, Neuroética e Ética de IA: Desafios Normativos das Novas Tecnologias, edited by N. De Oliveira and J. Tauchen. Porto Alegre: Fenix, 2023, p. 185-210.
L. McGuire, Mark P. Aulisio, F. Daniel Davis, Cheryl Erwin, Thomas D. Harter, Reshma Jagsi, Robert Klitzman, Robert Macauley, Eric Racine, Susan M. Wolf, Matthew Wynia, Paul Root Wolpe & The COVID-19 Task Force of the Association of Bioethics Program Directors (ABPD) (2020): Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force, The American Journal of Bioethics, DOI: 10.1080/15265161.2020.1764138
Evandro Agazzi, The Coronavirus pandemic and the principle of common good. BIOETHICS UPdate (2020), DOI: 10.1016/j.bioet.2020.04.001
James Forsyth, 8 technology trends for innovative leaders in a post-pandemic world (WEF, 2022)
Jan 28 – Feb 3: HOMEWORK / QUIZ # 1
Feb 4-17: Unit 2: Chapter 2: Assisted dying: good medical practice, or murder?
Feb 11- 17: HOMEWORK / QUIZ # 2 / Bonus / Midterm # 1
Feb 18-Mar 3: Unit 3: Chapters 3 & 4: A toolbox of reasoning / People who don’t exist; at least not yet
Feb 25-Mar 3: HOMEWORK / QUIZ # 3
March 3-9: Spring Break (No classes)
Mar 10-23: Unit 4: Chapters 5 & 6: Inconsistencies about madness / Helping the helper
Mar 17-23: HOMEWORK / QUIZ # 4
Mar 24-Apr 6: Unit 5: Chapters 7 & 8: Establishing fair procedure / How modern genetics is testing traditional confidentiality
Mar 31-Apr 6: HOMEWORK / QUIZ # 5
Apr 7-20: Unit 6: Chapters 9 & 10: Culture, consent, and community / A glance into the future
Apr 14-20: HOMEWORK / QUIZ # 6
Apr 21-27: Make-Up / Bonus / Midterm # 2
Apr 28-May 3: FINAL EXAM (multiple-choice exam, covers all material Units 1-6)
Course Website: http://www.nythamar.com/bioethics.html
Related Links:
The Hippocratic Oath (Wikipedia)
Notes on the "Principles of Biomedical Ethics"
ACP Ethics Manual
Beauchamp & Childress Book Review
Wiki on Cultural Relativism
Critique of Cultural Imperialism in Bioethics
Paternalism in Med Ethics
Med Ethics in Japanese cultural context
Wikipedia's Intro to Genetics
Wikipedia on Genetic Testing
Wiki on Eugenics
Wiki on Cloning
Human Genome Project
American Society for Gene and Cell Therapy
Wiki on Biobank Ethics
List of Participant Rights (Harvard School of Public Health)
NY Mag: Med-Ethics Dilemmas
Wiki entry on abortion
Wiki entry on the abortion debate
Abortion Shineups
Ethics of Abortion
Socinians: Philosophers on Abortion
Wiki on Euthanasia
ACP position paper on Physician-Assisted Suicide
Hastings: Physician-Assisted Death
ACP position paper: Responding to Intractable Terminal Suffering
James Rachels, The End of Life: Euthanasia and Morality - PDF book
Justice and Access to Health Care (Stanford Encyclopedia)
Ethical choices in long-term care : what does justice require? (WHO report paper pdf)
With Health Care And Justice For All (Markkula Center)
R. Gillon, "Justice and medical ethics"
Human rights and medical ethics
Berman Institute of Bioethics (Johns Hopkins University)
Power Point Intro to Ethics (Vaughn book)
Power Point Relativism(Vaughn book)
Power Point Abortion (Vaughn book)
Power Point Euthanasia (Vaughn book)
Wiki on Medical Ethics
Wiki on Ethics Committee
ACP Ethics Manual
American Medical Association Code of Medical Ethics
Journal of Medical Ethics
The Hastings Center
MEDLINE
Merck Manuals
Wiki on Clinical Trial
Wiki on Placebo-controlled Studies
American College of Physicians (ACP)
Annals of Internal Medicine (ACP)
Is bioethics an American plot?
Facebook: Bioethics International
In order to understand what is at stake in contemporary debates about abortion, euthanasia, stem cell research, genetic dilemmas, eugenics, cloning, organ transplant, animal rights, and other so-called "Moral Problems" belonging to the vast fields of Medical Ethics, Bioethics, and Applied Ethics, one must inevitably refer to Ethical Theories and how they co-relate to both Law and Politics (for instance, in legislation, public policy making and many legal, procedural decisions relating to the Constitution and to the public opinion). Ethical Theories seek to justify our arguments and moral reasoning when dealing with contemporary moral problems. Applied ethics is, therefore, a discipline of philosophy that attempts to apply Ethical Theories to real decision-making processes (e.g. in legal procedures and political decisions), especially those involving moral dilemmas and world dilemmas, such as the ones found in bioethics (abortion, euthanasia, health care, stem cell research, cloning, and other problems in medical ethics), biotechnology (eugenics, genetic research, food processing), legal ethics and human rights (global ethics, global justice, public policy making, international law), environmental ethics, computer ethics, corporate social responsibility, and business ethics. See the Wiki entry on Applied ethics.
Bioethics is the interdisciplinary study of ethics as applied to the life sciences and health sciences, focusing especially on human life and human health problems. Medical Ethics is an independent and critical scrutiny of the ethical issues emerging in medicine and in health care as a whole. Hence, Medical Ethics and Bioethics are closely related to each other and in many ways come down to the same subject. Although there is no consensus on the demarcation of disciplinary, ethical-philosophical research in biology, notably whether it should be confined to humans and technological innovations that relate to human life: bioethics has been the most important area of research in applied ethics, involving not only metaethical and normative problems, moral and political, social philosophy, but also specific issues that raise in medical ethics, neuroscience, cybernetics, law, economics, and religion. Campbell, Gillet, and Jones (2006, p. 2) thus offer the following definition: "Medical ethics is an applied branch of ethics or moral philosophy. It attempts to unravel the rights and wrongs of different areas of health care practice in the light of philosophical analysis."
Again, for many experts, medical ethics and bioethics are one and the same thing, as the former was conceived and developed within Jewish, Christian, and Islamic ethical traditions prior to the emergence of a post-secular, self-understanding of bioethics via a vis medical practices. Following the now classic, seminal work by Beauchamp and Childress, Principles of Biomedical Ethics (already in its 8th edition), originally published in 1979, bioethicists set out to articulate a medical ethics in light of the four principles of respect for autonomy, non-maleficence, beneficence, and justice, as "these principles were argued to be mid-level principles mediating between high-level moral theory and low-level common morality, and they immediately became very popular in writings about medical ethics." (Beauchamp, 2003, p. 269) The descriptive and normative dimensions of theoretical insights and medical practices have been problematized as biotethics and medical ethics are approached by different cultures and must meet the normative challenges of relativism. Hence, as Jonsen put is so felicitously, one must ask anew: "Is medical ethics a set of rules expressed in a written code promulgated by medical associations or is it a study of how the general principles of morality pertain to medical practice? Is it hardly ethics at all but instead a set of doctor-created conventions to preserve professional prestige and monopoly?"(Jonsen, 2000, p. 8)
For more insights into how to address the broader question of philosophical inquiry as applied to ethics and moral problems, see: What is philosophy? -- follow the link to this question in previous editions of my DL course on Applied Ethics. Keep in mind that Ethics is a branch of Philosophy which deals with moral problems both in abstract, theoretical terms (such as in Meta-Ethics and Normative Ethics, for instance, to define "what is good") and in practical, concrete terms (Applied Ethics).
According to Benedict, Cultural Relativism inevitably leads to Moral Relativism. According to Rachels, however, it is possible to subscribe to Cultural Relativism without necessarily endorsing Moral Relativism.
Why, after all, should we be moral? The main lesson we learn from the story of Gyges' ring: no one is so virtuous that one could resist the temptation of being able to steal at will by the ring's power of invisibility.
For a broader presentation of Ethics, Applied Ethics and Ethical Theories, see the Power Point Presentations below.
What is ETHICS ? (Power Point)
You Tube: Kant's Ethics
You Tube: Sartre's Existentialist Ethics
The ethics of virtue / Aristotle, Nicomachean Ethics
The moral law / Kant, The Groundwork
Utilitarianism / Consequentialism, J.S. Mill
Existentialist ethics, J.-P. Sartre / Ethics Without Religion / Outline
Scent of a Woman: Al Pacino's speech on character
Scent of a Woman (Wiki)
What is Virtue Ethics ? (Power Point)
COGNITIVIST vs. NONCOGNITIVIST Ethical Theories:
COGNITIVIST: Ethical principles can be known and established in objective terms
1.VIRTUE ETHICS (TELEOLOGICAL)
2.UTILITARIAN (CONSEQUENTIALIST)
3.DEONTOLOGICAL (DUTY-ORIENTED)
NONCOGNITIVIST: Ethical principles cannot be known and are rather chosen for different subjective reasons (by the very affirmation of subjective choices, individual freedom, emotions or by personal preferences or subjective expressions)
4. EXISTENTIALISM
See the Power Point Presentations below:
Utilitarianism Power Point
John Rawls Power Point Presentation
Existentialism Power Point (advanced)
Sartre's Existentialism in a Nutshell (PDF)
Aristotle's teleological view of ethics: the highest end of human life is eudaimonia (the flourishing of one's moral character and development of moral, intellectual capabilities)
Moral virtue is the mean between two vices of excess and deficiency
Ethical life is to be cultivated within social, political institutions
Rationality (rational animal) ↔ Sociability (political animal)
Kant's categorical imperative: "Act only according to that maxim whereby you can at the same time will that it should become a universal law." As a formal procedure (to decide how to proceed morally) it must pass the triple test of:
Universalizability: the maxim must be universalizable (moral law is universal)
Humanity as an end: each person must be treated as an end in itself
Self-legislation: we must act as legislators in a realm of ends (a moral community)
Human Persons: free, moral agents who rationally act from duty
Good will: to will what ought to be willed (universal, equal freedom shared by all)
Medical Ethics - Law - Politics
Utilitarianism: an action is morally good insofar as its consequences are the best; the moral worth of an action is solely determined by its outcome (utility principle).
Existential Ethics: Since there is no presupposed belief in God, one must start from nothingness, so as to create her/his own values and make life meaningful: existence precedes essence, the freedom of the individual has primacy over the State and the Establishment.
The dilemma of determinism / Ethical dilemmas
Freedom of the will and human responsibility / A critique
Freedom of the will and the concept of a person
Discussion: Freedom of Choice and Moral Responsibility
Dilemma: two propositions seem to be plausible leading to a paradox or undecidable situation.
See the Wiki entry on Ethical Dilemmas
Determinism: all events are determined by natural laws (for instance, physical laws, such as the laws of gravity) or by some form of conditioning (such as psychological, sociological or cultural conditioning).
Free Will: Human beings have the individual capacity for free choice
Nature-Nurture: what is innate (DNA, genetic features) vs. what is acquired (socialization, cultural and psychological features acquired in human behavior)
Behaviorism: stimulus → organism → response (Pavlov's dog)
Libertarianism: Individuals are free, regardless of natural, social or other constraints.
Soft Determinism (William James) as an alternative to Hard Determinism.
Compatibilism: one can make compatible both Free Will and Determinism either by resorting to a Soft Determinism (e.g. James) or by resorting to a dualism (e.g. Kant's reconciliation of Nature and Freedom).
Insofar as they are free, humans are said to be responsible for their actions.
First-order desires: To will something.
Second-order desires: To will to will something.
Only human persons (as opposed to nonhuman animals) can have volitions of the second order.
Applied Ethics: Abortion
You Tube: The Abortion Debate
You Tube: Roe v. Wade Summit Recap Video
An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. Induced abortion is the removal or expulsion of an embryo or fetus by medical, surgical, or other means at any point during human pregnancy for therapeutic or elective reasons.
Once a sperm fertilizes an egg cell, the result is a cell called the zygote that has all the DNA of two parents. In humans, it is called an embryo from the moment of fertilization until the end of the 8th week, whereafter it is instead called a fetus.
Conception (human fertilization) - zygote - embryo - fetus
Prior to 1973, almost all states in the United States had laws prohibiting abortion except when it was necessary to save the mother's life. However, in 1973 the Supreme Court ruled in Roe v. Wade that such laws are unconstitutional.
Noonan: A being with a human genetic code is a human being. Therefore, abortion is not morally permissible.
Warren: Human in the genetic sense (a member of the biological species homo sapiens) must be, however, differentiated from the moral sense (a full-fledged member of the moral community). Abortion is, therefore, morally permissible.
For Jane English, the central question is not whether the fetus is a person. She maintains that even if the fetus is a person, it doesn't simply follow that abortion is wrong. But she goes on to argue that even if the fetus is not a person, it doesn't follow that abortion is simply acceptable in all circumstances. Hence, the moderate position: "In the early months of pregnancy when the fetus hardly resembles a baby at all, then, abortion is permissible whenever it is in the interests of the pregnant woman or her family. The reasons would only need to outweigh the pain and inconvenience of the abortion itself. In the middle months, when the fetus comes to resemble a person, abortion would be justifiable only when the continuation of the pregnancy or the birth of the child would cause harm -- physical, psychological, economic or social -- to the woman. In the late months of pregnancy, even on our current assumption that a fetus is not a person, abortion seems to be wrong except to save a woman from significant injury or death."
Applied Ethics: Sexual Morality, Marriage, and Same-Sex Marriage:
YouTube Debate on Same-Sex Marriage
Wikipedia entry on Sexual Ethics
Human sexuality
Sexual orientation
Marriage
Same-sex marriage
Michel Foucault, History of Sexuality (3 vols)
Foucault's Genealogy of Modernity
Youtube: Michel Foucault short talk (in French)
YouTube: Foucault-Chomsky debate (subtitles in Dutch and English)
YouTube: Judith Butler on Gender Self-Identity (English with subtitles in French)
YouTube: Memorializing Simone de Beauvoir
On the Genealogy of Modernity: Foucault's Social Philosophy
Michel Foucault Archives (France)
Foucault Texts On-Line (English, French, Spanish, Portuguese, German)
The case against animal rights / Carl Cohen
Ali G on Animal Rights
Discussion: Animal Rights and Environment
According to Peter Singer, we must extend the argument for equal rights to nonhuman animals just as we did to other humans who were systematically excluded, following the women's rights movement, the civil rights movement, and gay rights movement. Otherwise we would be inconsistent in our own conception of egalitarianism, as many other animals have also the capacity for feeling pain and suffering (i.e. they are also sentient beings). We should thus denounce speciesism as a prejudice in favor of one's own species (namely, the human species, as opposed to nonhuman species).
According to Carl Cohen, animals don't have moral rights because they are not rational, self-legislative beings and cannot be morally autonomous or morally accountable for their actions. Cohen makes thus a case for speciesism, refuting the utilitarian assumption that all sentient animals have equal moral standing. Because humans owe to other humans a degree of moral regard that cannot be owed to nonhuman animals, Cohen goes on to argue for the use of live animals in biomedical research.
Other Suggested & Related Links:
Philosophy Dept - UT
Wikipedia entry on Ethics
Internet Encyclopedia of Philosophy entry on Ethics
Stanford Encyclopedia entry on Morality
Ethics Updates
You Tube: Monty Python: The Meaning of Life - Intro
You Tube: Monty Python: The Meaning of Life - Death
You Tube: Ali G - Abortion
You Tube: Ali G - Medical Ethics
Ruth Benedict
The challenge of Cultural Relativism.
James Rachels
Why should I be moral? Gyges' ring and Socrates' dilemma
The Internet Encyclopedia of Philosophy: Ethics
Ethics Updates
Moral Philosophy
Applied Ethics Resources on WWW
Abortionfacts.com
Abortion: All Sides of the Issue
Abortion and Ethics
The Moral Status of Animals
Stanford Encyclopedia of Philosophy: The Moral Status of Animals
Stanford Encyclopedia of Philosophy: Theory and Bioethics
Rock Ethics Institute
Centre for Applied Philosophy and Public Ethics
Carnegie Council for Ethics in International Affairs
PHIL 3750 Social and Political Philosophy
REL 1220-011 WORLD RELIGIONS and GLOBALIZATION
PHIL 2200-021 Introduction to Philosophy
In God's Name: Reformed, Catholic, Jewish
