TOPICS IN HEALTH POLICY: PHILOSOPHICAL ETHICS



TOPICS IN HEALTH POLICY (PHIL 6250)

Thursday 6:10-8:00 p.m., Phillips 413

Spring 2014

D. D. DeGrazia, Professor, Department of Philosophy, GWU (and Senior Research Fellow, Department of Bioethics, NIH)

Rome 456, 994-6913, ddd@gwu.edu

Office Hours: Th 4-5 and by appointment

Intended for graduate students but occasionally open to undergraduates with the instructor’s prior permission, this course addresses the following topics in health policy from an ethical and philosophical perspective: (1) human and animal research; (2) the enhancement of human traits; and (3) health care allocation. After introducing the subject matter, clarifying expectations, and reviewing some key ideas in ethical theory, the course will examine specific issues organized under the themes listed in (1) – (3) above. In examining each specific issue, the class will (a) confront ethical and philosophical issues (e.g., moral status, personal identity, distributive justice) and (b) analyze policy dimensions, focusing on relevant laws and regulations as well as proposals for change.

Learning Objectives

1. to comprehend several leading approaches to moral reasoning, their similarities and differences, and some of their chief strengths and weaknesses

2. to become familiar with several central topics in health policy from an ethical and philosophical perspective, the major positions taken with respect to them, their strengths and weaknesses, the empirical facts that bear on them, and their policy dimensions

3. to become familiar with several contemporary readings on each of the central issues addressed in the class

4. to engage leading approaches to moral reasoning in analyzing and addressing these issues

5. to develop the ability to do the same (as in 4) in addressing an issue in health policy (or biomedical ethics more broadly) that is not covered in class: the term paper topic

6. to develop expertise on the term paper topic, as reflected in an independently researched, well-written term paper and an oral presentation on one’s findings

Texts

• DeGrazia, Mappes, and Brand-Ballard (eds.), Biomedical Ethics, 7th ed. (New York: McGraw-Hill, 2011) [BE]

• Presidential Commission for the Study of Bioethical Issues, Safeguarding Children (PCSBI, 2013) () [SC]

• President’s Council on Bioethics (PCB), Human Cloning and Human Dignity (Washington, DC: PCB, 2002) [HC] (this and other PCB reports available through )

• PCB, Beyond Therapy (Washington, DC: PCB, 2003) [BT]

• PCB, Reproduction & Responsibility (Washington, DC: PCB, 2004) [RR]

• Institute of Medicine, Chimpanzees in Biomedical and Behavioral Research (Washington, DC: National Academies of Science, 2011) [CBBR] (available through ).

• several articles available on Blackboard

Structure of Course by Date, Topic, and Assignment

INTRODUCTION

1/16 Review of Major Ethical Theories and Key Concepts

Reading: BE, chap. 1 (“General Introduction”).

HUMAN AND ANIMAL RESEARCH:

WHAT MEANS SHOULD WE TAKE TOWARD LAUDABLE ENDS?

1/23 The Permissibility of Using Human Subjects and the Issue of Placebo Controls

Readings from BE: Introduction to Chapter 4; “The Nuremberg Code”; “Declaration of Helsinki”; Hellman and Hellman, “Of Mice but Not Men”; Marquis, “How to Resolve an Ethical Dilemma Concerning Randomized Clinical Trials”; Litton and Miller, “A Normative Justification for Distinguishing the Ethics of Clinical Research from the Ethics of Medical Care.” Optional reading available at : The Belmont Report.

1/30 Placebo-Controlled AZT (and other) Trials in Developing Countries

Readings from BE: Glantz et al., “Research in Developing Countries”; Brody, “Ethical Issues in Clinical Trials in Developing Countries”; Participants in the 2001 Conference on the Ethical Aspects of Research in Developing Countries, “Fair Benefits for Research in Developing Countries.” Reading available on Blackboard: “Case Studies: The Havrix and Surfaxin Trials.”

2/6 The Use of Children in Research

Reading: SC. Readings available on Blackboard: Gutmann, “Safeguarding Children—Pediatric Research on Medical Countermeasures”; Wendler, “A New Justification for Pediatric Research without the Potential for Clinical Benefit.”

2/13 Cloning-for-Biomedical-Research and Embryonic Stem Cell Research

Readings from BE: NIH, “Stem Cell Basics”; McMahan, “Killing Embryos for Stem Cell Research”; PCB, “The Moral Case against Cloning-for-Biomedical-Research.” Readings from HC: “Executive Summary,” chap. 4 (“Scientific Background”), chap. 8 (“Policy Recommendations”).

2/20 Animal Research

Readings from BE: CIOMS, “International Guiding Principles for Biomedical Research Involving Animals”; Cohen, “The Case for the Use of Animals in Biomedical Research”; Hettinger, “The Responsible Use of Animals in Biomedical Research”; DeGrazia, “On the Ethics of Animal Research.” Additional readings available on Blackboard: Brody, “Defending Animal Research”; Engel, “The Commonsense Case Against Animal Experimentation”; Rowan, “Debating the Value of Animal Research.” Reading from CBBR: pp. 1 – 7 (“Summary”).

THE ENHANCEMENT OF HUMAN TRAITS WITH BIOTECHNOLOGIES:

WHAT SORT OF PEOPLE SHOULD WE BE?

2/27 Enhancement with Biotechnology: Overview and the Enhancement of Cognitive and Psychological Traits

Readings from BT: chap. 1 (“Biotechnology and the Pursuit of Happiness”), chap. 5 (“Happy Souls”), chap. 6 (“’Beyond Therapy’: General Reflections”). Readings from BE: Kramer, “Makeover”; Freedman, “Aspirin for the Mind?”; Mills, “One Pill Makes You Smarter.” Reading available on Blackboard: DeGrazia, “Enhancement Technologies and Human Identity.”

3/6 Genetic Enhancement

Readings from BE: PCB, “Selecting Embryos for Desired Traits”; Walters and Palmer, “Germ-Line Gene Therapy”; Michael Sandel, “Mastery and Gift”; Brock, “Genetic Engineering.” Reading from RR: chap. 4 (“Modification of Traits and Characteristics”). Optional readings available on Blackboard: Buchanan, “Human Enhancement and Moral Status” and DeGrazia, “Genetic Enhancement, Post-Persons, and Moral Status: A Reply to Buchanan.”

3/20 Moral Bioenhancement

Readings available on Blackboard: Douglas, “Moral Enhancement”; Faust, “Should We Select for Genetic Moral Enhancement?”; Persson and Savulescu, “The Perils of Cognitive Enhancement and the Urgent Imperative to Enhance the Moral Character of Humanity”; Harris, “Moral Enhancement and Freedom”; DeGrazia, “Moral Enhancement, Freedom, and What We (Should) Value in Moral Behaviour”

JUSTICE AND HEALTH CARE ALLOCATION:

WHAT SORT OF NATION SHOULD WE BE?

3/27 Distributive Justice

Readings from BE: Introduction to Chapter 9; Buchanan, “Justice: A Philosophical Review”; Nielsen, “Autonomy, Equality, and a Just Health Care System.” Reading available on Blackboard: “Persad et al., “Principles for Allocation of Scarce Medical Interventions.”

4/3 International Models and Perspectives

Deber, “Health Care Reform: Lessons from Canada”; Light, “Universal Health Care: Lessons from the British Experience”; Altenstetter, “Insights from Health Care in Germany”; Rodwin and Le Pen, “Health Care Reform in France—the Birth of State-Led Managed Care”

4/10 The Affordable Care Act and Other Reform Proposals for the U.S.

Readings from BE: Palmisano et al., “Expanding Insurance Coverage Through Tax Credits, Consumer Choice, and Market Enhancements”; Himmelstein and Woodhandler, “National Health Insurance or Incremental Reform: Aim High, or at Our Feet?”; Emanuel, “The Problem with Single-Payer Plans”; Emanuel and Fuchs, “Vouchsafe”; DeGrazia, “Single Payer Meets Managed Competition.”

4/17 Student Presentations

4/24 Student Presentations

Requirements and Grading

• Attendance of every class (missed classes counting heavily in your class contribution grade; penalty can be mitigated by notifying professor in advance and arranging for reading notes to be submitted prior to class)

• Quality, quantity, and constructiveness of contributions to class discussions (20%)

• Presentation (20%)

• Research progress as determined by two office visits in which student presents research plan (first visit) and outline, bibliography, and draft of introduction to term paper (second visit) (10%)

• Term paper of 20-25 pages (50%)

Academic Integrity

The GW Code of Academic Integrity defines plagiarism as “intentionally representing the words, ideas, or sequence of ideas of another as one’s own in any academic exercise; failure to attribute any of the following: quotations, paraphrases, or borrowed information,” (article I, sect. b). The penalty for plagiarism ranges from failure of the assignment to expulsion from the university. Please avoid this grave error and bring any questions about appropriate attribution to me.

Support of Students Outside the Classroom

• Disability Support Services (DSS). Any student who may need an accommodation based on the potential impact of a disability should contact the DSS office (Marvin Center 242) at 4-8250 to establish eligibility and coordinate reasonable accommodations. For further information refer to gwired.gwu.edu/dss/.

• University Counseling Center (UCC). The UCC (4-5300) offers assistance and referral to address students’ personal, social, and study skills problems. For further information refer to gwired.gwu.ed/counsel.

Security

In the case of an emergency, the class should shelter in place if at all possible.

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