Part I: RIGHTS.
1. Physicians, Patients, and Others: Autonomy, Truth-Telling, and Confidentiality.
Cases and Contexts. Case Presentation: Dax Cowart Rejects Treatment--and Is Ignored. Social Context: Autism and Vaccination. Case Presentation: Suffer the Little Children. Case Presentation: HPV Vaccine: Hope or Hype? Social Context: Placebos and Transparency. Social Context: Health Cops: How Much Regulation is Too Much? Social Context: Medical Tourism. Case Presentation: Healing the Hmong. Case Presentation: The Vegan Baby. BRIEFING SESSION: Autonomy. Paternalism. State Paternalism in Medical and Health Care. Personal Paternalism in Medical and Health Care. Informed Consent and Medical Treatment. Free and Informed Consent. Parents and Children. Pregnancy and Autonomy. Truth-Telling in Medicine. Placebos. Dignity and Consent. Confidentiality (Privacy). Breaching Confidentiality. Duty to Warn? Managed Care. HIPP A Regulations. Ethical Theories: Autonomy, Truth-Telling, Confidentiality. DECISION SCENARIOS: 1. HPV Vaccination Required? 2. When Prayer is Not Enough. 3. Protecting Against Disease. 4. Weight Cops. 5. Baby vs. Mom. 6. Pregnancy and Autonomy-In Conflict? 7. Is Some Truth Better Than the Whole Truth? 8. When Does No Mean No? 9. Vampire Confession. 10. Whose Decision is It?
2. Research Ethics and Informed Consent.
Cases and Contexts. Social Context: Face Transplant: The Dream of Looking Ordinary. Case Presentation: Abigail Alliance v. FDA: Do Terminally III People Have a Right to Take Experimental Drugs? Social Context: Prisoners as Test Subjects? Case Presentation: Jesse Gelsinger: The First Gene-Therapy Death. Social Context: The Cold-War Radiation Experiments. Case Presentation: The Willowbrook Hepatitis Experiments. Case Presentation: Echoes of Willowbrook or Tuskegee? Experimenting with Children. Case Presentation: The Use of Morally Tainted Sources: The Pernkopf Anatomy. Case Presentation: Stopping the Letrozole Trial: A Case of "Ethical Overkill"? Case Presentation: Baby Fae. BRIEFING SESSION: Clinical Trials. The "Informed" Part of Informed Consent. The "Consent" Part of Informed Consent. Vulnerable Populations. Medical Research and Medical Therapy. Investigators and Financial Conflict. Placebos and Research. Therapeutic and Nontherapeutic Research. Research Involving Children. Research Involving Prisoners. Research Involving the Poor. Research Involving the Terminally Ill. Research Involving Fetuses. Research Involving Animals. Women and Medical Research. Summary. Ethical Theories: Medical Research, and Informed Consent. Utilitarianism. Kant. Ross. Natural Law. Rawls. DECISION SCENARIOS: 1. Boyd Rush: The First Animal-Human Transplant. 2. Phase I and Consent. 3. Stopping Tamoxifen. 4. Clinical Testing in Foreign Countries. 5. Genuine Consent? 6. When the Numbers are Small, Can a Trial Be Ethical? 7. Using Nazi Data. 8. Primate Head Trauma.
Part II: CONTROLS.
3. Genetics Control.
Cases and Contexts. Case Presentation: Genae Girard and Gene Patents. Case Presentation: Huntington''s Disease-Deadly Disease, Personal Dilemmas. Social Context: Testing for Disease Predisposition-Is it Better Not to Know? Social Context: Predictive Genetic Testing-To Test or Not to Test? Social Context: GINA-Genetic Information Nondiscrimination Act. Social Context: What Are My Chances? Direct-to-Consumer Genetic Testing. Case Presentation: Gene Therapy--Slowly Delivering on the Promise. Social Context: The Human Genome Project--Genes, Diseases, and the Personal Genome. Social Context: Stem Cells: The End of the Battle? BRIEFING SESSION: Genetic Intervention: Screening Counseling and Diagnosis. Genetic Disease. Genetic Screening. Genetic Counseling. Prenatal Genetic Diagnosis. Ethical Difficulties with Genetic Intervention. Eugenics. Negative and Positive Eugenics. Use of Desirable Germ Cells. Ethical Difficulties with Eugenics. Genetic Research, Therapy, and Technology. Recombinant DNA. Gene Therapy. Biohazards. Ethical Difficulties with Genetic Research, Therapy, and Technology. DECISION SCENARIOS: 1. Improving Society One Embryo at a Time. 2. A Child Like Us. 3. Screening for Marriage. 4. A Duty Not to Reproduce? 5. Justified Test? 6. A Duty to Tell or To Remain Silent? 7. Tampering With Human Life? 8. Embryonic Stem Cells.
4. Reproductive Control.
Cases and Contexts. Case Presentation: The Octomom and the McCaughey Septuplets: The Perils of Multiple Pregnancy. Social Context: Shopping the Sperm Supermarket. Social Context: The Price of Eggs: Egg Donors: Rewards, Risks, and Exploitation. Social Context: Advances in Reproductive Cloning. Case Presentation: Louise Brown: The First "Test-Tube Baby." Case Presentation: Savior Sibling. Case Presentation: The Calvert Case: A Gestational Surrogate Changes Her Mind. Social Context: Postmenopausal Motherhood. Case Presentation: Baby M and Mary Beth Whitehead: Surrogate Pregnancy in Court. BRIEFING SESSION: Techniques of Assisted Reproduction. IVF, GIFT, ZIFT, IVC, ULER, PZD, ICSI, DNA Transfer, CD, and lUI. Need and Success Rates. Costs. Drawbacks. Potential Risk to Child. Multiple Births. Embryos, Eggs, and Transplants. Gestational Surrogates and Donor Ova. Criticisms of Assisted Reproduction Practices. Benefits of IVF and Other Forms of Assisted Reproduction. Ethical and Social Difficulties. Incest Potential. Eugenics. Weakening of Family. Attitudes of IVF Children. Cloning and Twinning. Artificial Insemination. The Procedure. Reasons for Seeking Artificial Insemination. Sperm Donors. Issues in Artificial Insemination. Ova Donors. Surrogate Pregnancy. Ethical Theories and Reproductive Control. DECISION SCENARIOS: 1. Child of a Civil Union. 2. Donor Responsibility. 3. Looking for the Family Tree. 4. Embryo = Person? 5. Allowable Discrimination? 6. The Ambiguous Status of Surrogacy. 7. Just a Matter of Autonomy? 8. Inherently Wrong or Just Impracticable? 9. The Possibility of Impairment.
Part III: TERMINATIONS.
Cases and Contexts. Social Context: The Conflict Begins: Roe v. Wade. Case Presentation: When Abortion was Illegal--Mrs. Sherri Finkbine and the Thalidomide Tragedy. Social Context: A Statistical Profile of Abortion in the United States. Social Context: The Morning-After Pills (Plan B and Ellen)--Emergency Contraception and Politics. Social Context: "The Abortion Pill." Social Context: The "Partial-Birth Abortion" Controversy. Social Context: Supreme Court Abortion Decisions After Roe v. Wade. BRIEFING SESSION: Human Development and Abortion. The Status of the Fetus. Pregnancy, Abortion, and the Rights of Women. Therapeutic Abortion. Abortion and the Law. Ethical Theories and Abortion. DECISION SCENARIOS: 1. Emergency Contraception. 2. After the Concert. 3. A Procedure by Another Name. 4. A Pregnant Mental Child. 5. Fetal Reduction. 6. A Family Tragedy. 7. Unexpected News. 8. A Matter of Convenience. 9. Whose Life? 10. Reducing Abortion by Making Abortion Legal?
6. Treating or Terminating: The Dilemma of Impaired Infants.
Cases and Contexts. Case Presentation: The Agony of Bente Hindriks. Social Context: The Dilemma of Extreme Prematurity. Case Presentation: Baby Owens--Down Syndrome and Duodenal Atresia. Social Context: The Baby Doe Cases. Case Presentation: Baby K--An Anencephalic Infant and a Mother''s Request. BRIEFING SESSION: Genetic and Congenital Impairments. Specific Impairments. Down Syndrome. Spina Bifida. Hydrocephaly. Anencephaly. Esophageal Atresia. Duodenal Atresia. Problems of Extreme Prematurity. Testing for Impairments. Ethical Theories and the Problem of Birth Impairments. Envoi. DECISION SCENARIOS: 1. Doing the Right Thing? 2. No Food, No Water? 3. Murder or Temporary Insanity? 4. The Messenger Case. 5. Another Ashley? 6. Pointless Suffering?
7. Euthanasia and Assisted Suicide.
Cases and Contexts. Case Presentation: Karen Quinlan--The Debate Begins. Social Context: When the Diagnosis is Death. Case Presentation: Elizabeth Bouvia''s Demand to Starve--Request for Assisted Suicide? Social Context: The Cruzan Case--The Supreme Court Upholds the Right to Die. Case Presentation: Terri Schiavo. Case Presentation: Jack Kevorkian--Moral Leader or Dr. Death? Social Context: Assisted Suicide--The Oregon Experience. Case Presentation: The Awakening-A Brief Miracle. BRIEFING SESSION: Active and Passive Euthanasia. Voluntary, Involuntary, and Nonvoluntary Euthanasia. Defining "Death." Advance Directives. Ethical Theories and Euthanasia. DECISION SCENARIOS: 1. The Timothy Quill Case. 2. What Would He Want? 3. The Bartling Case. 4. Angel of Mercy? 5. Dutch Practices.
Part IV: RESOURCES.
8. Organ Transplants and Scarce Medical Resources.
Cases and Contexts. Case Presentation: Did Steve Jobs Cheat? Case Presentation: The Prisoner Who Needed a Heart. Case Presentation: Playing God with Dialysis. Case Presentation: Transplants for the Mentally Impaired? Social Context: Acquiring and Allocating Transplant Organs. Case Presentation: The Drug Lottery--The Betaseron Shortage. BRIEFING SESSION: Transplants, Kidneys, and Machines. Controlling Rejection. Allocation and Scarcity. Seattle and Kidney Machines. Dialysis Costs and Decisions. Microallocation vs. Macroallocation. Ethical Theories and the Allocation of Medical Resources. DECISION SCENARIOS: 1. First-Come, First-Served? 2. Robbing the Dead? 3. Taking a Chance for Love. 4. Buying a Liver. 5. Selling a Kidney. 6. Lifestyle Factors. 7. How Many Livers Are Fair? 8. Who Gets the Ventilators?
9. Distributing Health Care.
Cases and Contexts. Case Presentation: The Way it was--Robert Ingram Can''t Afford to be Sick. Social Context: Affordable Care Act. Social Context: In Crisis Mode--Background to Health Care Reform. BRIEFING SESSION: Recognizing a Need, Not a Right. Claim-Rights, Legal Rights, and Statutory Rights. Moral Rights. Political Rights. Health Care as a Right. Objections. DECISION SCENARIOS: 1. Insurance Not Required. 2. Liver Transplant. 3. Custodial Care. 4. Not the Best Option.
Part V: CHALLENGES.
10. Women and Medicine.
Cases and Contexts. Case Presentation: Angela Carder''s Ordeal. Social Context: Gender Exceptionalism: Is Men''s Health Being Neglected? Social Context: Mammograms: The Continuing Debate. Social Context: Pregnancy, Drugs, and the Law. BRIEFING SESSION: Women Excluded. Include Women, Study Women. Women-Specific Studies. Equivalent Care. Women Shortchanged. Office of Women''s Health. Office of Men''s Health? Women, Pregnancy, and Society. Outcome. DECISION SCENARIOS: Pregnancy and Clinical Trials. Lumpectomy vs. Mastectomy. A Mammogram to Feel Safe. Prostate Cancer and Fairness. Tabita Bricci is Taken to Court.
11. African Americans and Medicine.
Cases and Contexts. Case Presentation: Bad Blood, Bad Faith--The Tuskegee Syphilis Study. Social Context: Race-Based Medicine? Social Context: Is Health About Status, Not Race? BRIEFING SESSION: Special Claim by African-Americans. African-Americans and Health Care. HIV/AIDS. Black/White Treatment Differences. Why the Gap? The Tuskegee Effect. Clinical Trials. Organ Transplants. Closing the Gap. DECISION SCENARIOS: 1. Tuskegee Effect. 2. Racial-Differences Research. 3. Designated Donor by Race. 4. Social Construction. 5. Cultural Competence.
12. Epidemic! AIDS and HIV.
Cases and Contexts. Case Presentation: Darren Chiacchia--Criminal or Victim? Case Presentation: The Way it was--Tod Thompson, Dallas 1984. Social Context: The Nightmare Begins--Discovering AIDS. Social Context: Pandemic--AIDS Worldwide. Social Context: Testing AIDS Drugs in the Third World. Social Context: Origin of the AIDS Virus. Social Context: Searching for the AIDS Vaccine. BRIEFING SESSION: AIDS/HIV: The Disease and the Virus. HIV Tests. AIDS at Bay. Potential for New Drug. U.S. Epidemic in Profile. Death Rate. Infection Rates. Protease Inhibitors and HAART. Treatment Limits. Costs. DECISION SCENARIOS: 1. Duty to Warn. 2. Duty to Violate Confidentiality? 3. Mandatory Testing, Mandatory Treatment? 4. Registering the HIV-Positive. 5. Cultures in Conflict. 6. Tuskegee in the Congo?
Part VI: FOUNDATIONS OF BIOETHICS: ETHICAL THEORIES, MORAL PRINCIPLES, AND MEDICAL DECISIONS.
13. Basic Ethical Theories.
Utilitarianism. The Principle of Utility. Act and Rule Utilitarianism. Preference Utilitarianism. Difficulties with Utilitarianism. Kant''s Ethics. The Categorical Imperative. Another Formulation. Duty. Kant''s Ethics in the Medical Context. Difficulties with Kantian Ethics. Ross''s Ethics. Moral Properties and Rules. Actual Duties and Prima Facie Duties. Ross''s Ethics in the Medical Context. Difficulties with Ross''s Moral Rules. Rawls''s Theory of Justice. The Original Position and the Principles of Justice. Rawls''s Theory of Justice in the Medical. Context. Difficulties with Rawls''s Theory. Natural Law Ethics and Moral Theology. Purposes, Reasons, and the Moral Law as Interpreted by Roman Catholicism. Applications of Roman Catholic Moral-Theological Viewpoints in the Medical Context. Difficulties with Natural Law Ethics and Moral Theology.
14. Major Moral Principles.
The Principle of Nonmaleficence. The Principle of Beneficence. The Principle of Utility. Principles of Distributive Justice. The Principle of Equality. The Principle of Need. The Principle of Contribution. The Principle of Effort. The Principle of Autonomy. Autonomy and Actions. Autonomy and Options. Autonomy and Decision Making. Restrictions on Autonomy. Theories Without Principles. Virtue Ethics. The Virtues. Virtue Ethics in the Medical Context. Difficulties with Virtue Ethics. Care Ethics. Values, Not Principles. Care Ethics in the Medical Context. Difficulties with Care Ethics. Feminist Ethics. Feminist Ethics in the Medical Context. Difficulties with Feminist Ethics. Retrospect.