HPS 0613 Morality and Medicine

Megan Delehanty
Spring 2004, CRN 25424
Thursday 6:00-8:30 PM
 CL 327

Office:		901M Cathedral of Learning
Phone:		(412) 624-3183
Email:		mcd7@pitt.edu
Office Hours:  Thursday 5:00-6:00, or by appointment

1. Course Description
Ethical dilemmas in the practice of health care continue to proliferate and receive increasing attention from members of the health care profession, ethicists, policy makers, and the general public as health care consumers. In this course we will examine a number of ethical issues that arise in the context of contemporary medical practice and research by analyzing articles and decision scenarios. Topics to be covered include the physician-patient relationship; informed consent; medical experimentation; reproductive technologies; euthanasia; global health issues; the health care system and health care reform. Students who successfully complete this course will be able to identify and analyze different philosophical approaches to selected issues in medical ethics; have gained insight into how to read and critically interpret philosophical arguments; and have developed skills that will enable them to think clearly about ethical questions as future or current health care providers, policy makers, and consumers. 
2.  Required Text
Thomas Mappes and David Degrazia (Editors), Biomedical Ethics, 5th Edition. New York: McGraw-Hill, 2001.
The textbook is available at the campus bookstore.  
3.  Additional Materials
Some of the assigned readings are not in the textbook.  These are identified in the weekly schedule of readings.   Some are posted on CourseWeb, others are available at the reserve desk in Hillman Library.
Before each class, I will post on CourseWeb a short set of questions about the topic to be covered.  These questions are intended to guide you as you read the material for the week.  They may also serve as a starting point for our discussion of the material.   

4.  CourseWeb
The questions noted above as well as most handouts and assignments will be posted on CourseWeb.  I will also use CourseWeb to post your grades.  You can access CourseWeb from any web browser at http://courseweb.pitt.edu.  You will need your University Computer Account username and password.
Important:  I will also use the email feature of CourseWeb to communicate with students outside of the class (to notify you of changes in assignments, provide answers to frequently asked questions, etc.).  Any such emails will be sent to your Pitt email account.  You are responsible for being aware of the content of any such messages, so please check your email and ensure that your account is not over quota.  If you normally use another account (Yahoo, AOL, etc.), you should have your Pitt email forwarded to that account.  (If you do not know how to do this, there are instruction sheets in the campus computer labs.)
5.  Prerequisites
There are no formal prerequisites for this class.
6.  Course Requirements and Grading
The general rule is that students should expect to spend 3 hours of out-of-class work for each hour of scheduled class time.  This means that you should anticipate spending about 7.5 hours a week doing the readings, writing your papers, studying, etc.  There is a fair amount of reading for this class (usually about 40 pages per week) and philosophy often needs to be read and re-read a few times before it makes sense!
The course requirements are as follows:
Paper #1  		7.5 points
Paper #2  		15 points
Participation		12.5 points
Midterm Exam	25 points
Final Exam		40 points
Total			100 points
(a)	Paper #1 (7.5 points) 
Due in class February 12
3-4 pages double spaced (absolute maximum 4 pages, not including references).

(b)	Paper  #2 (15 points)
Due in class April 8
4-5 pages double spaced (absolute maximum 5 pages, not including references).

General paper policies:
1)	Late papers.  Late papers will have their grade reduced by 5% for each day they are late. (i.e. if your paper deserved 85% but was 1 day late, you will receive 80%).
2)	Emailed papers.  I prefer to have you submit a hard copy of your paper in class the day it is due. If you must miss class for some reason or simply prefer to send an electronic copy, I will accept emailed papers (Word or WordPerfect files only) but if you choose to submit your paper in this way you must accept all responsibility for lost emails, forgotten attachments, corrupted files, or any other such problems.  If I don’t have your paper in a readable form by the end of the day that it is due, I will consider it late.  
3)	Paper topics.  Topics for both Paper #1 and Paper #2 will be distributed in class and posted on CourseWeb at least 2 weeks before that paper is due.  If you want to write on a topic of your own choosing  you are very welcome to do so.  However, if you do so, you must consult with me about the topic first so that I can be sure that the topic is appropriate.
4)	Grading requirements.  For information on what characteristics a good paper will have, please refer to the Philosophy Paper Guidelines at the end of this syllabus.

(c)	Participation (12.5 points)
This component of the grade consists of active participation in class discussion as well as completion of small homework assignments I will periodically assign to lead into group work or discussion. 

Debate and discussion of issues is absolutely central to philosophy, thus attendance and active participation are crucial to this course.  Each class will normally intersperse lecture with general discussion and/or group work.  It is the responsibility of each student to come to class prepared to actively engage in critical discussion of the week’s topic and readings.  Each of you will probably have picked up different points from the readings or have novel insights, so please share them!
[Quality counts – there is no algorithm for calculating this portion of your grade based simply on how frequently you speak.  If you miss more than one or two classes, however, it is very unlikely that you will be able to get the full 12.5 points.]
(d)  Midterm exam (25 points)
The midterm will be held on February 26 in the regular classroom (CL 327).  It will be designed to take 1 hour (though I will permit you to take a bit more time if you want it).  The exam will be a mixture of short answer (requiring a few sentences to answer) and essay type questions.  
(e) Final Exam (40 points)
The final exam will be held on the Thursday of exam week (April 22) in the regular classroom.  It will be designed to take 2 hours (though I will allow up to 2.5 hours if anyone should want extra time).  The exam will be the same format as the midterm (short answer plus essay), just longer.  While emphasis will be placed on material covered in the second half of the course, the exam will be cumulative.
(f)  Extra Credit Assignment
There will no extra credit assignments available.  
Grading:
The following table indicates the letter grade associated with each numerical grade.  The maximum number of points anyone can get is 100.
97-100	A+	
94-96.9	A	
90-93.9	A-	
86-89.9	B+	
83-85.9	B	
80-82.9	B-	
76-79.9	C+	
73-75.9	C	
70-72.9	C-	
66-69.9	D+	
63-65.9	D	
60-62.9	D-	
Less than 60	F	

7.  Special Needs

If you have a need for special testing accommodations or other classroom modifications, please notify both the instructor and Disability Resources and Services no later than the beginning of the second week of term.  Disability Resources and Services can be reached at (412) 648-7890.

8. Academic Integrity

You should be aware of the University’s policy on academic integrity (see http://www.pitt.edu/~graduates/ail.html).  Any form of cheating or plagiarism will be grounds for not accepting work and assigning a grade of zero to that assignment.  In some cases, it may lead to more severe consequences up to and including dismissal from the university.

9. Course Schedule 

	Date	Topic	Readings	
1	8 Jan.	Introduction	None	
2	15 Jan.	Ethical Theory	1) Biomedical Ethics (BE),  p.1-39 (skip section on W.D Ross p. 24-27)	
3	22 Jan.	The Physician-Patient Relationship	1) BE, p. 39-50, 56-80, 97-103, 132-136	
4	29 Jan.	Cross-Cultural Ethics	1)	BE, p. 117-125
2)	J. Rachels, “The Challenge of Cultural Relativism” (on reserve)
3)	 F. Althaus, “Female Circumcision:  Rite of Passage or Violation of Rights?” (Courseweb)
4)	A. Matias, “Female circumcision in Africa” (Courseweb)
5)	A. Apena,  “Female circumcision in Africa and the problem of cross-cultural perspectives” (Courseweb)	
5	5 Feb.	Human and Animal Research	1) BE, p. 225-238, 273-296	
6	12 Feb.	The Health Care System

PAPER #1 DUE
	1) BE, p. 598-610, 622-649
	
7	19 Feb.	Global Health Issues	1)	BE p. 253-258, 265-272
2)	Benatar, S.R., Daar, A.S., and Singer, P.A. (2003). "Global health ethics: the rationale for mutual caring".  International Affairs 79: 107-138. (Courseweb)	
8	26 Feb.	MIDTERM EXAM (CL 327)	

	
9	4 March	Mental Health	1) Stanford Encyclopedia of Philosophy entry on "Mental Illness"  http://plato.stanford.edu/entries/mental-illness/

2) Horwitz, A.V. (2002).  Creating Mental Illness.  Chicago: University of Chicago Press, Introduction and Chapter 1  (pp. 1-37)(on reserve)

3)	Caplan, P.J. (1995).  They Say You're Crazy.    New York: Addison-Wesley Publishing Company, Chapter 2 (pp. 33-58)(on reserve)
	
10	11 March.	SPRING BREAK 	

11	18 March	Obesity	1)	 Kaplan, “Born to be Fat?  Culture and the meaning of weight” (on reserve)
2)	Angier “Who is fat? It depends on culture” (on reserve)
3)	Barboza, “Rampant obesity, a debilitating reality for the urban poor” (on reserve)
4)	Proietto, “Why staying lean is not a matter of ethics” (Courseweb)
5)	Burry, “Obesity and virtue.  Is staying lean a matter of ethics?”  (Courseweb)
6)	Hill et al., “Obesity and the Environment: Where do we go from here?” (Courseweb)	
12	25 March	Death and Dying	1)	BE, p. 299-324, 327-334, 340-350 
	
13	1 April	Euthanasia and Physician-Assisted Suicide	1)  BE, p. 381-387, 398-407, 421-429, 436-444	
14	8 April	Abortion and Maternal-Fetal Conflicts

PAPER #2 DUE	1)  BE, p. 446-475, 478-482, 500-504	
15	15 April	Genetics and Reproduction	1)  BE, p. 507-515, 520-534, 561-564, 568-584	
16	22 April	FINAL EXAM (CL 327)		

Morality and Medicine 
Philosophy Paper Guidelines
 
The following remarks are only to be used and interpreted as a guide. This means that the instructor reserves the right to be the final judge of the level of philosophical skill the student has achieved in their writing. In other words, it is possible, though not likely, that a student will follow all the guidelines for achieving an A-paper yet not receive the A he or she thinks s/he deserves.  The reasons for this may be varied.  For example, perhaps there is a major flaw in the paper that the instructor could not possibly have foreseen in writing these guidelines.  In that case, it should be clear from the comments given by the instructor what the flaw is.  If it is not, you may come see me during office hours and I will explain my grade to you.

A range papers:
 
An  A-quality paper goes above and beyond the instructor’s expectations for the average student in this class.  In this type of paper, there will be a substantial level of philosophical sophistication apparent in the student’s writing.  More specifically, the paper must be an original essay that is flawlessly written, clear in its purpose, obviously well researched, and grammatically spotless.  The originality requirement is intended to guarantee that the student has thought sincerely and deeply about the subject matter.  The clarity requirement is intended to guarantee that the student has picked a specific thesis and knows how to keep from straying from the subject matter.  The research requirement guarantees the student has done a fair amount of reading and is educated to a sufficient degree concerning the subject matter.  The grammatical requirement shows that the student has been conscientious in writing a rough draft and then proceeds to proof read it before handing it in.  Writers of A-quality papers also include a bibliography.  The student will almost certainly have done outside research on the Internet or at the library (i.e. the bibliography will not consist only of texts assigned as class readings).  The writing style has a “flow” to it that shows that their final paper was not a hastily-written first draft.  The argument is convincing, thought provoking, and insightful.  The exposition of the subject matter is thorough and correct.  
 
B range papers:
 
Papers that receive a grade in the “B” range show a good level of knowledge concerning the subject matter at hand.  There will be few or no grammatical errors, typos or spelling errors.  The student covers all the relevant information that was covered in class or in the assigned readings, but does not make a concerted, sincere effort to go beyond the reading or the thoughts covered in class.  The B paper covers the major objections to the theory or argument at hand but refrains from making an original contribution, objection, or research point that was not mentioned previously by one of the authors we read (or by the instructor).  The B-style paper may have flaws like poor writing style, lack of sentence flow, ambiguous statements, unclear statements, or a general lack of sincere thought and analysis for the issue at hand.  In general, a B paper, while good, is not spectacular.  It may be well written, yet refrain from offering any new thoughts, giving the reader the sense that the writer has not put much thought into the subject matter.  Some differences between B-papers and A-papers may be the following: level of analysis, awkward transitions between sentences or paragraphs, grammatical errors, lower level of readability, lack of clarity in the writing, general lack of insightful ideas or examples, or an unconvincing or unpersuasive style of argument.
 
C range papers:
 
C papers generally have one of the following flaws:
 
1)      The paper is heavily laden with grammatical or spelling errors.
2)      The content of the writing indicates that the research was half-hearted or poorly done.  The arguments and exposition are at best incomplete.  They are analyzed at a superficial level without much explanation or thought given by the writer.
3)      The writer repeatedly states misguided or wrong information, showing a general misinterpretation or misunderstanding of material that was not only available throughout the readings, but that was also covered at length and in detail during class discussion.

D  range papers:

D papers generally contain more than one of the flaws noted above for C papers.