Course Syllabus

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Medical Ethics

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Semester & Location:

Summer 2020 - DIS Copenhagen
Type & Credits:

Elective Course - 3 credits
Major Disciplines:

Ethics, Pre-Medicine / Health Science, Public Health, Philosophy
Faculty Member:

Elise Utke Schiøler
Program Director:

Susana LS Dietrich - sd@dis.dk
Time & Place:

Most days 9:30-13:45, TBD

Faculty

es Elise Schiøler
Cand. phil., MA (philosophy, University of Copenhagen). External lecturer in medical ethics and -theory of science, and philosophy of health technologies, University of Copenhagen, 2007-. External lecturer in theory of science, scientific method and argumentation analysis at The Defense College, 2012-. With DIS since 2011.


Course Description

The course is divided into three major sections:

  1.  Professional values and principles (introduced through clinical cases)
  2. Ethical theory (also introduced through clinical cases)
  3. Selected topics within the field

Introduction

Medical science and biotechnology in the 20th century have created a multitude of dilemmas for the healthcare provider in a hospital setting: issues of justice and healthcare access, of confidentiality, informed consent, reproductive technologies, end-of-life issues, etc. Difficult choices, evaluations, and decisions involving values, norms, principles, and priorities are pressing. The perplexity of many healthcare providers, patients, and relatives in complex ethical situations show the need for systematic, ethical reflection.

Ethics is the philosophical study of morality. It addresses questions such as, “How should I act?,” ”How do I decide whether one way I could validly act is morally better than another valid way?,” and “Is there a right and wrong?” In addressing the many contemporary issues of decisions and responsibilities facing health care providers, the course will use ethical theories, principles and reasoning as a foundation for the critical analysis of clinical situations. 

This course focuses on medical ethics that concerns the identification, analysis, and resolution of ethical questions and problems arising in planning for the care of patients. But for medical practice to live up to the required values and principles it must rest on a foundation of medical research, where basic clinical standards for prognosis etc. cannot prevail. Therefore we will also take a brief look on the ethics of clinical research.

Expected Learning Outcomes

The primary objective of this course is to provide students with the intellectual tools requisite for examining fundamental questions in medical ethics and in particular clinical ethics. It is designed to help the student acquire the skills of conceptual analysis and identification of presuppositions. Philosophical inquiry teaches the student to read, write, discuss critically, and appreciate diverse points of view. The course is a critical search for understanding through argumentation.

The course aims to discover connections between ethical conceptions, ethical approaches to medical cases, and apply knowledge of ethics to concrete cases in biomedicine.

More specific objectives include the clarification of central concepts and distinctions developed in the literature of moral philosophy and medical ethics and applications of those concepts and distinctions to concrete cases in medical practice.

In short, the course will:

  • Sensitize the student to value issues in medical practice
  • Develop their ability to reason ethically and frame dilemmas
  • Enforce their ability to work critically with moral statements
  • Ability to conduct an ethical debate
  • Enhance their ability to communicate difficult material
  • Teach good comparative, argumentative and problem-solving skills

 

Readings

  1. Beauchamp, Tom, "The Principle of Beneficence in Applied Ethics", The Stanford Encyclopedia of Philosophy (Spring 2019 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/spr2019/entries/principle-beneficence/>.
  2. Beauchamp, Tom L.; Walters, Leroy: The Hippocratic Oath. Contemporary Issues in Bioethics Wadsworth Publishing Company, 1994 ISBN: 0534584411
  3. Lægeforeningen; Schiøler, Elise: Lægeløftet/The Danish Oath. Lægeforeningen Url:http://www.laeger.dk/portal/page/portal/LAEGERDK/Laegerdk/R%C3%A5dgivning% 20og%20regler/ETIK/LAEGELOEFTET
  4. Beauchamp, Tom L.; Childress, James F.: Confidentiality. Principles of Biomedical Ethics Oxford University Press, 2009. ISBN: 9780195335705
  5. Devettere, Raymond J.: Infants and Children. Practical Decision Making in Health Care Ethics: Cases and Concepts Georgetown University Press, 2009. ISBN: 9781589012516
  6. Vederhus et el. (2020). Health related quality of life after extremely preterm birth: a matched controlled cohort studyHealth and Quality of Life Outcomesvolume 8, Article number: 53 
  7. Rendtorff, Jacob: Definition of the Basic Principles in Bioethics. Basic Ethical Principles in Bioethics and Biolaw Centre for Ethics and Law, 2000. ISBN: 8492352531
  8. Beauchamp, Tom L.; Childress, James F.: Autonomy. Principles of Biomedical Ethics Oxford University Press, 2013. ISBN: 9780199924585
  9. Zaner, Richard: Integrity and Vulnerability in Clinical Medicine. Bioethics and Biolaw, vol. II: Four Ethical Principles Rhodos, 2000. ISBN: 9788772458144
  10. Higgs, Roger: Truth-telling. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199
  11. Noddings, N. (2012). The Language of Care Ethics. Knowledge Quest;May/Jun2012, Vol. 40 Issue 5, p52
  12. Crawford, D.A. 2002). Circumcision: a consideration of some of the controversy. Journal of Child Health Care, vol.6, issue 4

  13.

  14. Singer, Peter; Kuhse, Helga: What is bioethics? A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199
  15. Singer, Peter; Kuhse, Helga: Introduction. Bioethics: An Anthology Blackwell Publishing Ltd., 2006 ISBN: 9781405129480
  16. Rachels, James: Ethical theory and bioethics. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199
  17. Beauchamp, Tom L.; Childress, James F.: Types of Ethical Theory. Principles of Biomedical Ethics Oxford University Press, 1994
  18. Hare, R.M.: A Utilitarian approach. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199
  19. Crigger, Bette-Jane: AIDS and a Duty to Protect. Cases in Bioethics St. Martin's Press, 1998 ISBN: 0312067465
  20. Rachels, James; Rachels, Stuart: What Is Morality? The Elements of Moral Philosophy Random House, 1986. ISBN: 9780078038242
  21. Rachels, James: Are There Absolute Moral Rules? The Elements of Moral Philosophy Random House, 1986. ISBN: 9780078038242
  22. Crigger, Bette-Jane: Can the Fetus Be an Organ Farm? Cases in Bioethics St. Martin's Press, 1998 ISBN: 0312067465
  23. Foot, Philippa: The Problem of Abortion and the Doctrine of the Double Effect. Virtues and Vices: and other essays in moral philosophy, No. 5, 1967 Oxford Review. ISSN: None
  24. Ridley, Aaron: Reproductive Rights and Abortion.Beginning Bioethics. Bedford Books of St. Martin's Press, 1998 ISBN: 0312132913
  25. Gillon, Raanan: Confidentiality. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199
  26. Beauchamp, Tom L.; Childress, James F.: Justice. Principles of Biomedical Ethics Oxford University Press, 2009. ISBN: 9780195335705
  27. Det Etiske Råd; Schiøler, Elise: Et spil om liv og død (A Game of Life And Death). Det Etiske Råd/Danish Ethics Council. Url: http://etiskraad.dk/upload/publikationer/oevrige-udgivelser/spil-om-liv-og- doed/index.htm
  28. Spellecy, Ryan: Reviving Ulysses Contracts. Kennedy Institute of Ethics Journal, Vol. 13, No. 4, 2003 Johns Hopkins University Press. ISSN: 10546863
  29. Devettere, Raymond J.: Transplantation. Practical Decision Making in Health Care Ethics: Cases and Concepts Georgetown University Press, 2009. ISBN: 9781589012516
  30. Miller, Geoffrey: Personhood Extreme Prematurity Cambridge University Press, 2007 ISBN: 9780521862219
  31. Miller, Geoffrey: Quality of Life and Best Interests. Extreme Prematurity Cambridge University Press, 2007 ISBN: 9780521862219
  32. Miller, Geoffrey: Futility. Extreme Prematurity Cambridge University Press, 2007 ISBN: 9780521862219
  33. Kuhse, Helga: Why Killing is Not Always Worse - and Sometimes Better - Than Letting Die. Bioethics: An Anthology Blackwell Publishing Ltd., 2006 ISBN: 9781405129480
  34. Callahan, Daniel: When Self-Determination Runs Amok. Bioethics: An Anthology Blackwell Publishing Ltd., 2006 ISBN: 9781405129480
  35. Nagel, Thomas: In whose interest? Assisted Death: A Study in Ethics and Law Oxford University Press, 2003. ISBN: 9780199607983
  36. Chadwick, Ruth: Gene therapy. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199
  37. McConnell, Terrance: Genetic Enhancement, Human Nature, and Rights. The Journal of Medicine & Philosophy, Vol. 35, No. 4, 2010 Oxford Journals. ISSN: 03605310
  38. Levine, Robert J.: The Distinction between Research and Treatment. Ethics and Regulation of Clinical Research Baltimore, 1986. ISBN: 9780300042887
  39. Kass, Nancy: Ebola, Ethics, and Public Health: What's Next? Annals of Internal Medicine, 161, 10, 16 November 2014, 2014 American College of Physicians. ISSN: 00034819
  40. Griffiths, PD: Ebola and Ethics Reviews in Medical Virology, 24/6/November 2014, 2014 Wiley Online Library. ISSN: 10991654
  41. Singer, Peter: Famine, Affluence, and Morality. Philosophy & Public Affairs, Vol. 1, No. 3, 1972. Wiley-Blackwell ISSN: NONE
  42. Kendall, J. M.: Designing a research project: randomised controlled trials and their principles. Emergency Medicine Journal, Vol. 40 No. 2, 2003. BMJ Publishing Group Ltd. ISSN: 14720213
  43. Krasse, Bo: The Vipeholm Dental Caries Study: Recollections and Reflections 50 Years Later. Journal of Dental Research, Vol. 80, No. 9, 2001. American Dental Association. ISSN: 00220345
  44. World Medical Association: Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. World Medical Association Clinical Review & Education. Url: http://www.wma.net/en/20activities/10ethics/10helsinki/DoH-Oct2013-JAMA.pdf
  45. Møller, K.; Rossel, P. J. H.; Berg, R. M. G.: An ethical analysis of proxy and waiver of consent in critical care research. Acta Anaesthesiologica Scandinavica, Vol. 57, No. 5, 2013 Blackwell Publishing Ltd. ISSN: 00015172
  46. Rotham, David J.: The Shame of Medical Research. The New York Review of Books, Vol. 47, No. 19, 2000. Rea S. Hederman. ISSN: 002875


Guest Lectures
Katrine Kirk, MBA & Ph.D., partner at “Par 3 Consultants”. Par 3 specializes in how to create patient centered organizations in the health care sector.

TBA

Approach to Teaching

The brief lectures will take starting point in preliminary discussions. The discussions, led by the professor, will take the form of a  dialogue between the students, facilitated by the instructor, often preceded by student discussions in smaller groups. There will be reading assignments for each class.

In a class like this, active attendance is crucial. Each student is expected to come prepared to discuss the assigned material, engage themselves in the lecture and to complete all assignments. Others cannot benefit from your input if you are not present or prepared.


Evaluation

  • Preparation for and participation in class as well as online debates and sharing ideas.
  • 6 individual reflections.
  • A midterm group report.
  • Final project, presented in a synopsis and in class.

 

Participation

Credit for participation is earned in the following ways:

Prepare for class by

  1. Reading according to the syllabus, and
  2. Taking the relevant quizzes on Canvas, and
  3. Engaging in online discussions on Canvas before and after class. And
  4. Giving reasoned responses to questions and considerations posed in class by peers or instructor. And
  5. Asking questions that help clarify or extend the concepts and issues under discussion. And
  6. Entering into discussions both in class and on Canvas to make a valid point or try out a thought on matter discussed, ask questions, offer a different perspective, or respond to other students' questions and comments. And
  7. Contributing to an open, positive, and inquisitive dialogue in the classroom.
  8. Absence must be explained to the instructor via either Canvas or elise.utke@dis.dk. When a student is seen using any electronical device for other purposes than doing research to strengthen debate, this will count as being absent from the entire session. This is also the case during field studies.

 

Canvas debates

Before each class after having finalized the readings, students are highly encouraged to engage in discussion on Canvas. It is important that an actual discussion is going on, so before posting a point, please make sure that another student hasn't already stated the same point. Thus, engaging in discussion is first and foremost to respond to peers' thoughts.

It is of course a good idea to frame your point or question, but please keep it short; think of your discussion posts as posts on other social media. You are NOT expected to explain the assigned readings.

The discussion forum can in general be used for sharing thoughts on the particular forum's topic, raising questions, and pointing out issues for class discussion. And again: the forum only works, if you also respond to others' posts!

These debates will both affect the content of each class and count in the participation grade as 'class activity.

The participation grade is broken into these categories:

1. Preparation     40%

2. Attendance      20%

3. Class activity   40%

 

Individual reflections

The first six class session will be concluded by 15 minutes to write a reflection on the current topic. These must be submitted before the following class session.

 

Group project

The group project must be based on a case relevant to medical ethics, and this must be briefly explained. Further, you must make a vox pop on the case, addressing minimum 5 persons, who are not in the Medical Ethics class. The questions in the vox pop must not mention the values and theories taught in class, but you should be able to 'diagnose' the responses according to these.

 

Final project

The final project is a group project, and consists in a synopsis, a brief presentation, and facilitation of a brief class debate.  The synopsis must be submitted on the day before the presentation.

Course Summary:

Date Details Due