Medical Ethics Fall 2012 PRELIMINARY OUTLINE Course Number: UGS 303 Unique Numbers: 64450, 64455, 64460, 64465, 64470, 64475, 64480, 64485, 64490 Class Lectures: Monday, 4:00-6:00 p.m., 1.202 Ernest Cockrell Jr. Hall (ECJ) Instructor: William J. Winslade, Ph.D., J.D., Ph.D. James Wade Rockwell Professor of Philosophy in Medicine, UTMB Adjunct Professor of Philosophy, UT Austin E-mail: wwinslad@utmb.edu Cell Phone: 832-545-6663 Office Hours: Mondays, 3:00-4:00 pm; and by appointment Course Description: This course will introduce you to real cases and controversies in health care. Ethical and legal questions that confront patients, families, health professionals, attorneys, judges and policy makers will be explored by studying cases in detail to understand the value conflicts that arise and difficult decisions that must be made. The cases are analyzed from interdisciplinary and interprofessional perspectives. Insights from philosophy, history, law, psychology, religion and public policy will be combined with examination of the professional roles and responsibilities of health professionals. The responsibilities and rights of patients and families will also be considered. The first topic to be explored is normal conception and fetal development t, especially the significance of brain development. Attention will also be given to the capacities of normal newborns and infants. Next ethical and legal issues arising when newborn babies are extremely premature will be explored. A 60 Minutes segment will illustrate several legal and ethical conflicts. Several case studies involving severely brain damaged infants will be analyzed with particular emphasis on the practice of ethics consultation as well as legal issues. The first exam will cover these issues. The next topic traumatic brain injury will be introduced through three cases captured in a video documentary. These cases raise numerous legal, ethical, psychological, religious and economic issues. Another aspect of severe brain injury concerns total or nearly total loss of the capacity for consciousness. Classic legal cases will illustrate some of the significant controversies about public policy, ethics and law when individuals have lost consciousness. You will write a short (3-4) page analytical commentary about some aspects of traumatic brain injury and/or loss of consciousness. The next lectures will deal with patients right to refuse medical treatment as initially illustrated by the well-known cases of Dax Cowart and Elizabeth Bouvia. The topic of advance directives regarding health care treatment or UCS 303 Course Syllabus Fall 2012 Page 1
refusal will also be examined. The debates about end of life issues will include legal and ethical aspects of assisted suicide, physician assisted dying and euthanasia. Your second paper (4-5 pages) will be an analytical research paper (in contrast to a purely analytical paper). It will address topics related to treatment refusal or end of life decisions. You will have another writing assignment regarding advance directives; the details will be explained later. The last three lectures will cover various aspects of your rights concerning your body, organ transplantation, including obtaining and allocating organs for transplantation. The relevance of the definition of death and criteria for determining death will relate not only to organ transplantation but also end of life decisions generally. The last lecture will be a course review and summary. Meeting Times: Lectures on Mondays from 4:00-5:45 p.m. (no break) and scheduled discussion sections. Required Readings: Readings will be posted on the course Blackboard. Attendance and Participation: Class attendance will be taken on a daily basis. Students are required to attend lectures. Lecture material will be included in the examinations. Participation by students will be noted by the teaching assistants. Attendance at the discussion sections is required. Cell Phones and Computers: Grading: Cell phones must be put away during class and computers may be used only for notetaking or for class activities. Course Requirements: 1. Personal autobiography and writing sample (ungraded-due 9/7) 2. First essay exam (due 10/8) = 15% 3. First paper (due 10/29) = 15% 4. Second paper (due 11/19) = 20% 5. Advance directive report (due 11/26) = 10% 6. Final exam = 25% 7. Report of what you have learned (due 12/3) = 10% 8. Participation (in discussion sections) = 10% 9. Possible bonus points for participation = 5% UCS 303 Course Syllabus Fall 2012 Page 2
Some written assignments will be graded pass/fail. A (95%-100%) A- (90%-94%) B+ (86%-89%) B (83%-85%) B- (80%-82%) C+ (76%-79%) C (73%-75%) C- (70%-72%) D+ (66%-69%) D (63%-65%) D- (60%-62%) F (<60%) Examinations: 1. In class exam + in class final 2. Papers 3. Writing assignments Examinations will cover lectures, readings and class discussions. The format will include short answer and essay questions. Students will be permitted to use their class notes or notes from their readings. No books or articles are allowed in the examinations. In addition to in-class examinations, a short analytical research essay will be required. Specific details will be provided later. University Dates: Check the Academic Calendar for key dates. URL: http://registrar.utexas.edu/calendars Religious Holidays: By UT Austin policy, you must notify me of your pending absence at least fourteen days prior to the date of observance of a religious holy day. If you must miss a class, an examination, a work assignment, or a project in order to observe a religious holy day, you will be given an opportunity to complete the missed work within a reasonable time after the absence. Policy on Scholastic Dishonesty: Students who violate University rules on scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and/or dismissal from the University. Since such dishonesty harms the individual, all students, and the integrity of the University, policies on scholastic dishonesty will be strictly enforced. For further UCS 303 Course Syllabus Fall 2012 Page 3
Plagiarism: information, please visit the Student Judicial Services web site: http://deanofstudents.utexas.edu/sjs. If you use words or ideas that are not your own you must cite your sources. Otherwise you will be guilty of plagiarism. To learn more go to the following URL: http://deanofstudents.utexas.edu/sjs/scholdis_plagiarism.php. Students with Disabilities: Any student with a documented disability (physical or cognitive) who requires academic accommodations, should contact the Services for Students with Disabilities area of the Office of the Dean of Students at 512-471-6259 (voice) or 512-471-4641 (TTY for users who are deaf or hard of hearing), as soon as possible to request an official letter outlining authorized accommodations. September 3 September 7 September 10 September 17 Topical Course PRELIMINARY OUTLINE Labor Day (no lecture class) Discussion sections will meet on 9/7/12. First writing assignment: autobiography and writing sample to include the following: 1. Personal autobiography (family history, personal interests and aspirations, anecdotes about health care experiences (especially those that raise ethical issues). 2. Why are you taking this class? What do you hope to learn? How do you think it might be useful to you? 3. What do you think medical ethics includes? 4. What is an interdisciplinary class? 5. At the end of this course we will ask you to summarize in writing what you think you have learned. This writing exercise is ungraded but is required. We want to obtain preliminary information about how you write, think, and organize ideas. First Lecture Conception, Birth, and Assisted Reproduction 1. Introduction of instructors. 2. Description of interdisciplinary perspectives studies relevant to this class. 3. Focus on individuals. From conception to birth (video). Emphasis on brain development. Moral and legal status of the fetus and newborn infants. Preliminary comments on abortion and assisted reproduction, especially in vitro fertilization (IVF). Abortions 1. Is abortion morally wrong or morally permissible? 2. Is abortion legal or illegal? Under what circumstances? 3. Why are many women ambivalent about abortion? 4. Why has IVF become more common? UCS 303 Course Syllabus Fall 2012 Page 4
5. What is the legal status of frozen embryos? What is the moral status of frozen embryos? How does a fetus in utero differ from a frozen embryo? September 24 October 1 October 8 October 15 October 22 October 29 November 5 Extremely Premature Newborns 1. The Miller Case What were the ethical issues? What were the legal issues? 2. How did the Case of Baby C differ from The Miller Case? 3. What position does John Robertson advocate in his article? 4. Which of the letters responding to Robertson are most persuasive? 5. How does the Clinical Ethics framework help in analyzing and interpreting ethical conflicts? Brain Damaged Newborns (Case Studies) Baby K (Anencephaly) Baby Sun (Thanatophoric Dysplasia) Baby S (Trisomy 18) Baby D (Trisomy 21 + severe brain damage) Baby V 1. The roles of ethics consultation, legislation and judicial decisions in dealing with these cases? 2. Do you think these cases were decided correctly or incorrectly? In what respects? 3. Who should decide doctors, parents, legislators or judges? On what basis? In class essay exam (short answers and longer essays) Traumatic Brain Injury (TBI) 1. Battered Brains video 2. Do you think Matthew Kosbob s medical treatment was appropriate or inappropriate? Why or why not? 3. What are the major causes of TBI? 4. Why are concussions so much in the news? 5. What are the best ways to prevent TBI? Loss of consciousness (Vegetative and Minimal Conscious States) 1. What are the differences among coma, vegetative states and minimal consciousness? 2. What accounts for unexpected recoveries from vegetative states? 3. Is a long term vegetative lead to loss of personhood? Is it a fate worse than death? 4. What policies should be adopted regarding persons who are minimally conscious? Accepting or Refusing Medical Treatment? 1. Who should decide whether a patient should be treated? 2. How was the law changed regarding treatment refusal? 3. When should a patient s refusal of treatment be overridden? On what grounds? Assisting Dying, Assisted Suicide and Euthanasia in the US and the Netherlands UCS 303 Course Syllabus Fall 2012 Page 5
November 12 November 19 November 26 December 3 1. What are the laws regarding assisted dying, assisted suicide and euthanasia? 2. How did Dr. Jack Kevorkian influence the end of life debates? 3. What role should advance directives play in the end of life decisions? Rights, Duties and Permissions Concerning Your Own Body 1. Should you be able to sell parts or products of your body? 2. What does the law permit you to donate? 3. Do you own your body? To what extent? 4. Why should or should not a person be a living donor after death of parts or all of his/her body? Organ Transplantation 1. Who should get access to organ transplants? 2. How should organs for transplantation be allocated? 3. What should be done to increase the supply of organs for transplantation? 4. Case Study: The Cowan Twins. Should Sidney donate skin to Jennifer? Brain and Cardiac Death: Current Controversies 1. When should a person be declared dead for organ transplantation? 2. What criteria should be used to determine that a person is dead? 3. Should individuals be able to choose their own definition of and criteria for determining death? Course Review Final Exam (date to be announced later) University Lecture Series: The University Lecture Series gives first-year students an opportunity to interact with leading members of our faculty scholars, scientists, and civic leaders who are nationally and internationally renowned. Signature Course students will be required to attend one of the offered lectures, each designed to create a campus-wide conversation. The School of Undergraduate Studies produces the University Lecture Series each fall semester. Faculty teaching during the summer sessions are encouraged to have their students attend an appropriate event on campus or in town to fulfill this requirement. All students, faculty, alumni, staff and community guests are invited, but the events will be aimed at entering first-year students. The University Lecture Series is generously brought to UT Austin by the Audre and Bernard Rapoport Excellence Fund for Undergraduate Studies. To learn more information go to the following URL: http://www.utexas.edu/ugs/uls. University Lecture Series Fall 2012 Monday, September 17, 2012 Research that Changes the World 7:00 p.m.-8:00 p.m. Bass Concert Hall UCS 303 Course Syllabus Fall 2012 Page 6
Tuesday, September 18, 2012 Election 2012: History, Rhetoric, Politics Featuring H.W. Brands, Ph.D.; Sharon Jarvis, Ph.D.; and Daron Shaw, Ph.D. 7:00 p.m.-8:00 p.m. Bass Concert Hall UCS 303 Course Syllabus Fall 2012 Page 7