The course will focus on 3 research competencies in relation to end-of-life ethics:

Transcription

1 1 College: McAnulty College and Graduate School of Liberal Arts Syllabus: HCE-656, END OF LIFE ETHICS, Spring 2011 Course: Tuesday 6:00-8:40 pm., Fisher Hall 721 Office hours: Appointment, Fisher Hall 300; Tel. (412) Course instructor: Henk ten Have, M.D., Ph.D. Director and Professor, Center for Healthcare Ethics Duquesne University, 600 Forbes Avenue, Pittsburgh OUTLINE The course will focus on 3 research competencies in relation to end-of-life ethics: 1. Historical analysis - Focus on relevant moral traditions i. Hippocratic tradition ii. Sanctity of life tradition iii. Enlightenment tradition - Death and dying in history 2. Systematic examination of fundamental philosophical issues - goals of medicine and healthcare - suffering - futility - compassion 3. Critical clarification of ethical debates and concerns - withholding and withdrawing treatment - artificial food and nutrition - euthanasia - assisted suicide - palliative and hospice care COURSE OBJECTIVES a) Course description. The course will make students familiar with ethical issues related to the end of life. It will focus on the historical, philosophical and ethical analysis of these issues. Starting from a historical analysis of the major moral traditions (Hippocratic tradition, sanctity of life tradition and Enlightenment tradition) as well as the philosophical debate on the goals of health care, the notions of suffering, futility and compassion specific ethical problems will be

2 2 analyzed: withholding and withdrawing treatment, artificial food and nutrition, palliative care, euthanasia, and assisted suicide. b) Research competencies. Upon completion of the course students should master the following competencies, as should be demonstrated both in specific research projects and in the research essay: a. A historical analysis of the present-day debate on end-of-life issues, explaining on the one hand the moral traditions that are involved in this debate, as well as the evolution of attitudes towards death and dying over time; b. Systematic examination of fundamental philosophical issues, understanding and explaining how the contemporary debate is informed by fundamental interpretations of basic notions as goals of medicine and healthcare, suffering, futility and compassion; c. Critical clarification of ethical debates and concerns regarding practical issues in healthcare ethics, viz. withholding and withdrawing treatment, artificial food and nutrition, euthanasia, assisted suicide, palliative and hospice care. c) General HCE Program Learning Outcomes. Several of these Learning Outcomes pertain to HCE-656. a. Fundamental Knowledge. Students can understand and analyze HCE theory and methods as well as major applied topics in end-of-life ethics. b. Multi-disciplinary Study. Students can critically relate HCE with multi-disciplinary fields in health care, specifically in connection to the historical background and the philosophical interpretation of fundamental notions and evolving social and cultural attitudes. c. Scholarship Students can research and write scholarly essays, teach and communicate effectively, and present academic papers that: present cogent arguments(s), engage scholarly literature, and demonstrate critical thinking and analysis. COURSE PROCEDURES. a) Course components The 15 week semester will be divided into four components: i. Research Project #1 (10 pages), week 1-4; due Friday Feb.4 for Seminar #2, Feb.8 ii. Research Project #2 (10 pages), week 5-8; due Friday Mar.11 for Seminar #3, Mar.15 iii. Research Project #3 (10 pages), week 9-12; due Friday Apr.15 for

3 Seminar #4, Apr.19 iv. Research Essay (30 pages plus end notes & bibliography), weeks Submit Essay thesis, 1-page outline, basic bibliography, Friday Feb.4 2. Option to submit mid-term essay. For students who want to be assisted in their progress, a draft of the essay can be submitted for feedback; by Friday Mar Submit Research Essay by Thu. Apr.28. b) Research projects 1. Reading Requirements. Each 10-page Research Project will require students to critically engage the equivalent of 2 books to (a) master the relevant knowledge and (b) engage in critical reading and writing. 2. Research competencies. The research competencies in the course are identified by the three Research Projects: (a) historical analysis, (b) systematic examination of fundamental philosophical issues, and (c) critical clarification of ethical debates and concerns. Each Research Project will demonstrate that the student has mastered the specific competency. 3. Relation of Projects with Essay. The three 10-page Research Projects may be integrated into the Research Essay but not in a manner of cut-and-paste from one to the other. The Research Essay typically demonstrates that the student can apply and integrate all three research competencies in relation to a specific topic or issue in end-of-life ethics. 4. Projects: i. Research competency of historical analysis: 10 Page Project: Provide a critical analysis of changing attitudes concerning death in relation to changing moral traditions. Format: 10 pages plus minimally 30 references/end notes Required Readings: 1. Philippe Aries, Western attitudes towards death: From the Middle Ages to the present; 2. Various chapters and articles on moral traditions. ii. Research competency of systematic examination of fundamental philosophical issues: 10 Page Project: Analyse the notion of compassion in relation to the goals of medicine and healthcare. Format: 10 pages plus minimally 30 references/end notes Required Readings: 1. Eric Cassell, The nature of suffering and the goals of medicine; 2. Daniel Callahan, The Troubled Dream of Life: In Search of a Peaceful Death. iii. Research competency of critical clarification of ethical debates and 3

4 4 concerns: 10 Page Project: Provide a critical assessment of moral arguments used to distinguish between euthanasia, assisted suicide and palliative sedation. Format: 10 pages plus minimally 30 references/end notes Required Readings: 1. David Kelly, Medical care at the end of life. A Catholic perspective; 2. Henk ten Have & David Clark (eds.), The ethics of palliative care. c) Research Seminars. There will be four seminars introducing each of the three research competencies. 1. Week 1. Seminar #1 to introduce Research Project #1 i. Introduction to the area of end-of-life ethics ii. Discussion of research essay requirements iii. Research Essay thesis and 1-page outline with basic bibliography to be submitted by end of week 4 2. Week 5. Seminar #2 to introduce Research Project #2 i. Discussion of progress on research essays ii. Discussion of completed Research Project #1 3. Week 9. Seminar #3 to introduce Research Project #3 i. Discussion of progress on research essays ii. Discussion of completed Research Project # 2 4. Week 14. Seminar #4 to discuss the Research Essay i. Discussion of completed Research Project # 3 ii. Brief presentations (10 min) of the research essays d) Research essay. The course research essay will require students to substantively apply the Course Research Competencies to a particular issue (theoretical or practical). Requirements: 1. Start to reflect on the thesis of your research essay from the beginning of the course. 2. Thesis and 1-page outline with basic bibliography to be submitted by the end of week 4 (Feb.4) ( to tenhaveh@duq.edu). 3. You will receive feedback in Seminar #2. 4. Progress will be reported in the Seminars. 5. Each student will briefly present the research essay (max. 10 minutes) during the final Seminar and submit a copy of the essay by date assigned. 6. The essay length should be 30 pages, double-spacing. 7. Students must adopt the format of the Chicago Manual of Style, as required by the College for dissertation submissions. 8. Select an Essay Title that identifies a research thesis. For example: i. The usefulness of the notion of futility in the debate on withholding life-sustaining treatment (combining historical,

5 5 philosophical and ethical analysis). ii. Another example: Is terminal sedation ethically justified in the context of palliative care? 9. Present a brief Introduction and Conclusion. 10. Notes to the references made in the essay. i. Use end notes (as opposed to foot notes at the bottom of the page). ii. Do not use notes for narrative explanations they belong in the main text. iii. There should be approximately 100 end notes in the essay. 11. Bibliography. List all the references in alphabetical order. Only list items actually referred to in the essay. 12. Divisions and subdivisions. Use major divisions and subdivisions, evenly distributed throughout the essay, to lay out the sequence of concepts. 13. Use of online references. Online references must be accurately identified with complete web address etc, including the date of access. HCE HANDBOOK. The Center for Healthcare ethics has developed a Handbook of Policies, Procedures, and Guidelines to guide students in all curriculum related matters. COURSE GRADE. There will be no examinations. The course grade will be assigned based on the quality of the course research essay and the three research projects. The grade will be a combination of 10% for each of the three research projects and 70% for the final essay. No midterm grades will be assigned. End of term grades will be assigned adopting grading policy in the McAnulty College and Graduate School of Liberal Arts, as follows: A 4.0 distinguished scholarly work A- 3.7 B+ 3.3 B 3.0 normal progress towards degree B- 2.7 C+ 2.3 C 2.0 warning; student subject to departmental action F 0.0 ACADEMIC INTEGRITY. This syllabus incorporates the Expectations of Academic Integrity. Cheating and plagiarism cannot be tolerated. All relevant policies of the McAnulty College and Graduate School of Liberal Arts apply. REASONABLE ACCOMMODATIONS.

6 Students with documented disabilities are entitled to reasonable accommodations if needed. If you need accommodations, please contact the Office of Freshman Development and Special Student Services in 309 Duquesne Union ( ) as soon as possible. Accommodations cannot always be granted retrospectively. 6

7 7 COURSE READINGS HCE 656, End of Life Ethics, 2011 Spring Required reading: Books P. Aries: Western attitudes towards death: From the Middle Ages to the present. The Johns Hopkins University Press, Baltimore, 1974 Eric J. Cassell: The nature of suffering and the goals of medicine. Oxford University Press, New York/Oxford, 2 nd edition, Daniel Callahan: The Troubled Dream of Life: In Search of a Peaceful Death (Simon & Schuster, 1993; Georgetown University Press, 2004); David Kelly: Medical care at the end of life. A Catholic perspective. Georgetown University Press Henk ten Have & David Clark (eds.): The ethics of palliative care. Open University press, Buckingham/Philadelphia, ERES Course Readings: The ERES link to the readings is: duquesne.docutek.com/eres/coursepass.aspx?cid=1108 The password is: HCE656 Research competency #1: Historical analysis Book: P. Aries: Western attitudes towards death: From the Middle Ages to the present. The Johns Hopkins University Press, Baltimore, 1974 Other literature: 1. Relevant moral traditions - Hippocratic tradition a. Albert R. Jonsen: Do no harm. Annals of Internal Medicine 1978;88: b. Edmund D. Pellegrino: The Hippocratic ethic revisited, in Edmund D. Pellegrino: Humanism and the physician (The University of Tennessee Press, Knoxville, 1979): Relevant moral traditions - Sanctity of life tradition a. James F. Keenan: The concept of sanctity of life and its use in contemporary bioethical discussion, in K. Bayertz (ed.): Sanctity of life and human dignity (Kluwer Academic Publishers, Dordrecht, 1996): 1-18.

8 8 b. Owsei Temkin: The idea of respect for life in the history of medicine, in Owsei Temkin, William K. Frankena and Sanford H. Kadish: Respect for life in medicine, philosophy and the law (The Johns Hopkins University Press, Baltimore and London, 1975): c. William K. Frankena: The ethics of respect for life, in Owsei Temkin, William K. Frankena and Sanford H. Kadish: Respect for life in medicine, philosophy and the law (The Johns Hopkins University Press, Baltimore and London, 1975): Relevant moral traditions - Enlightenment tradition a. Gerald Dworkin: Moral autonomy, in Gerald Dworkin: The theory and practice of autonomy (Cambridge University Press, Cambridge, 1988): Death and dying 4.1 Historical perspectives a. P. Aries: Western attitudes towards death: From the Middle Ages to the present. The Johns Hopkins University Press, Baltimore, 1974 (111 pages). 4.2 Cultural perspectives a. L. Yiting, O. Döring, L. Fang, F. Li and S. Baoqi: End-of-life care in China: A view from Beijing, in R.H. Blank and J. C. Merrick (eds): End-of-life decision making. A cross-national study (The MIT Press, Cambridge (Mass.)/ London (England), 2005): b. J. C. Merrick: Death and dying: The American experience, in R.H. Blank and J. C. Merrick (eds): End-of-life decision making. A crossnational study (The MIT Press, Cambridge (Mass.)/ London (England), 2005): Research competency #2: Systematic examination of fundamental philosophical issues Books: Eric J. Cassell: The nature of suffering and the goals of medicine. Oxford University Press, New York/Oxford, 2 nd edition, Daniel Callahan: The Troubled Dream of Life: In Search of a Peaceful Death (Simon & Schuster, 1993; Georgetown University Press, 2004). Other literature: 5. Goals of medicine and health care a. James A Marcum: Reflections on humanizing biomedicine. Perspectives in Biology and Medicine 2008; 51(3): b. An International Project of the Hastings Center: The goals of medicine: Setting new priorities. Special Supplement. Hastings Center Report 1996; 26(6): S 1-27.

9 9 6. Suffering a. Stan van Hooft: The meanings of suffering. Hastings Center Report 1998; 28(5): b. Julia E. Connelly: The avoidance of human suffering. Perspectives in Biology and Medicine 2009: 52(3): c. Daniel Callahan: Death, mourning, and medical progress. Perspectives in Biology and Medicine 2009: 52(1): The notion of futility a. Henk ten Have and Rien Janssens: Futility, limits and palliative care, in Henk ten Have and David Clark (eds.): The ethics of palliative care (Open University Press, Buckingham/ Philadelphia, 2002): b. Eric Chwang: Futility clarified. Journal of Law, Medicine & Ethics 2009: Compassion a. André Comte-Sponville: Compassion, in André Comte-Sponville: A small treatise on the great virtues (Henry Holt & Company, New York, 2001): b. David C.Thomasma and T. Kushner: A dialogue on compassion and supererogation in medicine. Cambridge Quarterly of Healthcare Ethics 1995; 4: c. Charles J. Dougherty and Ruth Purtilo: Physicians duty of compassion. Cambridge Quarterly of Healthcare Ethics 1995; 4: d. Jos V.M. Welie: Sympathy as the basis of compassion. Cambridge Quarterly of Healthcare Ethics 1995; 4: e. Roger Crisp: Compassion and beyond. Ethical Theory and Moral Practice 2008; 11: Research competency #3: Critical clarification of ethical debates and concerns Books: David Kelly: Medical care at the end of life. A Catholic perspective. Georgetown University Press Henk ten Have & David Clark (eds.): The ethics of palliative care. Open University press, Buckingham/Philadelphia, Other literature: 9. Artificial food and nutrition

10 10 a. Porter Storey: Artificial feeding and hydration in advanced illness, in K.Wildes (ed.): Birth, suffering and death (Kluwer Academic Publishers, Dordrecht, 1992): Palliative care 10.1 Development and concept a. Cicely Saunders: The evolution of palliative care, Patient Education and Counseling 2000; 41: b. C. Sepulveda et al: Palliative care: The World Health Organization s global perspective. Journal of Pain and Symptom Management 2002; 24(2): c. L. Gwyther, F. Brennan and R. Harding: Advancing palliative care as a human right. Journal of Pain and Symptom Management 2009; 38(5): Palliative care ethics a. Kevin O Rourke: Pain relief: Ethical issues and Catholic teaching, in K. Wildes (ed.): Birth, suffering and death (Kluwer Academic Publishers, Dordrecht, 1992): Palliative sedation a. P. Claessens, J. Menten, P. Schotsmans and B. Broeckaert: Palliative sedation: A review of the research literature. Journal of Pain and Symptom Management 2008; 36(3): b. M. Maltoni, C. Pittureri, E Scarpi, et al Palliative sedation therapy does not hasten death: results form a prospective multicenter study. Annals of Oncology 2009; 20(7): Euthanasia and assisted suicide History a. Henk ten Have and Jos Welie: Euthanasia and medical power, in Henk ten Have and Jos Welie: Death and medical power. An ethical analysis of Dutch euthanasia practice (Open University Press, Maidenhead, 2005): Practice a. M. Dees, M. Vernooij-Dassen, W. Dekkers and C. Van Weel: Unbearable suffering of patients with a request for euthanasia or physician-assisted suicide: an integrative view. Psycho-Oncology 2010; 19(4): b. J.E.van Alphen, G.A.Donker and R.L.Marquet: Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act. British Journal of General Practice 2010; 60: c. Judith A.C.Rietjens et al.: Two decades of research on euthanasia from the Netherlands. What have we learnt and what questions remain? Bioethical Inquiry 2009; 6: Ethical debate

11 11 a. Henk ten Have and Jos Welie: Justifying the practice of euthanasia, in Henk ten Have and Jos Welie: Death and medical power. An ethical analysis of Dutch euthanasia practice (Open University Press, Maidenhead, 2005): b. Henk ten Have: Euthanasia: moral paradoxes. Palliative Medicine 2001; 15: COURSE SCHEDULE Tuesday Jan.11. Seminar #1 Research competency #1: Historical analysis Project #1 Jan.18, 25, Feb.1, Research Project #1 Submit Project # 1 by Fri. Feb.4 Submit Essay Thesis, 1-page outline, basic bibliography, by Fri.Feb.4 Tuesday Feb.8. Seminar #2 Research competency #2: Systematic examination of fundamental philosophical issues Project #2 Feb 15, 22, Mar.8, Research Project #2 Submit Project #2 by Fri. Mar.11 Optional: submit mid-term draft Research Essay, by Fri.Mar.4 Tuesday Mar.15. Seminar #3 Research competency #3: Critical clarification of ethical debates and concerns Project #3 Mar.22,29, Apr.5,12, Research Project #3 Submit Project 3# by Fri.Apr.15 Tuesday Apr.19. Seminar #4 Research essay Submit Research Essay by Thu. Apr.28