PHIL 233: Biomedical Ethics
Charlie Kurth Class: Tues/Thurs, 10:00-11:30 (McDonnell 362)
Email: ckurth [at] artsci [dot] wustl [dot] edu Office Hours: Tues, 2:30-4:30pm, and by appointment
Office phone: 314-935-4753 Office Location: Wilson 112
TA: Bryan Stagner
Email: bryan [dot] r [dot] stagner [at] wustl.edu
Office Hours: Tues & Thurs, 11:30am-12:30pm
Office Location: Wilson 116
Course Overview
Organ transplants have proven to be a successful way of saving people’s lives and improving their well-being. But these procedures also raise serious questions that shape and challenge our thinking across a range of ethical issues: When and by what means can we harvest organs from others? Given the scarcity of organs available for transplant, how should we decide who should get them? Given how risky and expensive transplant surgeries can be, should we even be doing them in the first place? Are there ethical limits on what can be transplanted—for instance, is it permissible to perform face transplants? In this course, we will take a close look at these and other issues as we examine the work of philosophers, doctors, and policy makers. Our aim will be to get a better understanding of the ethics of organ transplantation. But, as we will see, the issues that we will investigate are also relevant to other areas of bioethics, and to moral and political philosophy more generally.
Texts
Selected readings available from the course web site
Assignments
This course will have three graded components:
Short writing assignments & participation (30%).
You will be asked to complete six short writing assignments (1-2 pages). There will be one for each section of the course. These assignments are designed to allow you critically engage with the readings and help prepare you for our class discussions. They will be evaluated for accuracy and effort (check plus, check, check minus). These evaluations will be combined with your class participation to determine your performance for this portion of the course.
You need to email a copy of your assignment to Bryan before the start of class on the day that it is due (please type "Phil 233 Assignment #" in the subject line of your email). You should also bring a hard copy of your assignment with you to class.
Mid-term exam (30%).
The mid-term will be take-home exam covering material on sections 2 and 3 of the course. I will provide you with the questions approximately one week before they are due. The exam will be due at noon on Monday, October 17.
Final exam (40%).
The final exam will also be a take-home exam. It will cover material from sections 4-6 of the course and will be due at 6:00pm on December, 20. I will provide you with the questions during the final week of class.
Advice and Resources
Many of the reading assignments for this course are short. But don’t let that fool you—philosophy is hard. How do you deal with this? Well, here are some suggestions: (i) Read the material more than once. (ii) After reading an essay, try and summarize the main claims and arguments in your own words—the will help you come up with questions and objections. (iii) Start the written assignments—especially the mid-term and final—early (doing this will help you review your answers with a clear head). (iv) Most importantly, if you’re puzzled or confused about something, ask questions!
Policies
In order to help ensure a successful class, please heed the following rules and policies:
Due Dates.
Baring unusual circumstances, the due dates (especially for the mid-term and final) on the syllabus are non-negotiable. If you think you have reason to miss an assignment, it is best to inform me well in advance.
Classroom Environment.
Please arrive to class on time. All cell phones must be turned off during class. Texting is not permitted. Abuse of these courtesies may lead to penalties.
Statement of Academic Integrity.
Students are expected to do their own work, as outlined in the University’s Academic Integrity Policy. Violations will not be tolerated. You are responsible for familiarizing yourself with these policies; ignorance will not be an excuse. If you have any questions about these policies, feel free to contact me.
Tentative Schedule of Readings and Assignments
Section 1. Introduction
Tues, Aug 30:
Course introduction and overview
Thurs, Sept 1:
Read syllabus, University’s Academic Integrity Policy, Jim Pryor, "How to read a philosophy article",
“The Value of Medicaid”
Short writing assignment 1
Section 2. Who is Dead?
It seems like a simple question—who is dead? But, as we will see, this question proves to be very difficult to answer. Moreover, how we answer it has significant implications for the supply of organs available for transplant surgeries. So understanding the nature and ethics of death is central to debates about the permissibility of organ transplantation.
Tues, Sept 6:
Harvard Medical School Definition of Brain Death
Presidential Commission Report
Thurs, Sept 8:
Veatch, “The Whole-Brain-Oriented Concept of Death: An Outmoded Philosophical Formulation”
Tues, Sept 13:
Singer, “Is the Sanctity of Life Ethic Terminally Ill?”
Short writing assignment 2
Thurs, Sept 15:
McMahan, “The Metaphysics of Brain Death”
Tues, Sept 20:
McMahan, con’t
Thurs, Sept 22:
Veatch, “The Definition of Death: Problems for Public Policy”
Section 3. Ethical Issues in Organ Procurement
The number of people in need of organ transplants greatly exceeds the number of organs that is available. In light of this fact, doctors, philosophers, and policy makers have considered various—and morally contentious—ways of increasing the supply. For instance, is it permissible for people to ask others to donate their organs? Should we make organ donation compulsory? Should we allow the buying and selling of organs? What other options might there be?
Tues, Sept 27:
Veatch, “Gift or Salvage: Two Models of Organ Procurement”
Thurs, Sept 29:
Veatch, “The Myth of Presumed Consent”
Tues, Oct 4:
Spital & Erin, “Conscription of Cadaveric Organs for Transplantation”
Thurs, Oct 6:
Kluge, “Organ Donation and Retrieval: Whose Body is it Anyway?”
Short writing assignment 3
Tues, Oct 11:
Matas, “The Case for Living Kidney Sales”
Thurs, Oct 13:
Caplan, “Transplantation at Any Price?”;
Kahn & Delmonico, “The Consequences of Public Policy to Buy and Sell Organs for Transplantation”
Mon , Oct 17: Mid-term Exam DUE by Noon.
Section 4. Resource Allocation: Who Gets the Organs?
Given the undersupply of organs available for transplant, we need to make decisions about who should get them. But we want to be able to do this in a way that is morally justifiable. In this part of the course, we investigate questions like the following: Should we give priority to the neediest patients? Or should the probability of success be given greater weight? Should one’s race or ability to contribute to society matter? Should those who led unhealthy lives (e.g., alcoholics) be given less priority? Is it appropriate to allow people to donate their organs only to a specific individual (like their spouse)?
Tues, Oct 18
Alexander, “They Decide Who Lives, Who Dies”
Thurs, Oct 20
Childress, “Putting Patients First”
Tues, Oct 25
Moss & Siegler, “Should Alcoholics Compete Equally for Liver Transplantation?”
Thurs, Oct 27
Atterbury, “The Alcoholic in the Lifeboat”
Tues, Nov 1
Murphy, “Would my Story Get Me a Kidney?”
Short writing assignment 4
Thurs, Nov 3
Kluge, “Designated Organ Donation”
Section 5. Resource Allocation: Transplants and Scarce Resources
While transplant surgeries save lives, they are also risky and tremendously expensive. Moreover, there are other life saving technologies that prove to be better with regard to both success and cost. In light of this, should we be allocating our scarce health care resources to risky and expensive treatments like transplants or are there better ways to use these resources to provide medical services? In this part of the course, we look at both the theory and the practice of allocating scarce resources and providing risky treatments.
Tues, Nov 8
Harris, “QALYfying the Value of Life”
Thurs, Nov 10
Lockwood, “Quality of Life and Resource Allocation” [focus on material in pp. 44-55]
Tues, Nov 15
Bodenheimer, “The Oregon Health Plan: Lessons for the Nation”
Bennett “To the Editor”
Short writing assignment 5
Thurs, Nov 17
Daniels, “Is the Oregon Rationing Plan Fair?”
Tues, Nov 22
Daniels, “Rationing Fairly”
Thurs, Nov 24
No Class—Thanksgiving Break
Tues, Nov 29
Fleck, “Just Caring”
Section 6. Face Transplants: Medicine, Well-being, and Identity
Doctors in France recently performed the first complete face transplant on a 38 year-old woman suffering from a severe deformity that resulted from a genetic disorder. This surgery raised a series of ethical questions that have led some to conclude that such procedures are not morally justified. Consider: Since the procedure is life improving (rather than life saving), why should we accept the costs and the risks that it brings? Who should be eligible for such surgeries? Given that faces are so central to how we recognize one another, are these transplants fair to the deceased donors (and their family and friends)?
Thurs, Dec 1
Wiggins, et. al., “On the Ethics of Face Transplantation Research,”
Butler et. al., “Face Transplantation: When and for Whom?”
Tues, Dec 6
Freeman et. al., “Justifying Surgery’s Last Taboo: The Ethics of Face Transplants”
Short writing assignment 6
Thurs, Dec 8
TBD
Tues, Dec 20, 6:00pm: Final Exam DUE