Course Syllabus

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Medical Ethics B

 

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Semester & Location:

Fall 2024 - DIS Copenhagen
Type & Credits:

Elective Course - 3 credits
Major Disciplines:

Ethics, Pre-Medicine / Health Science, Public Health
Prerequisite:

None
Faculty Member:

Elise Utke Schiøler (current students please use the Canvas Inbox)
Program contact:

Science and Health Department

shsupport@dis.dk
Program Director:

Susana Dietrich
Time & Place:

Mondays & Thursdays 13:15 - 14:35 , Fi6-Metro 104

  

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. Listen: Introduction to ethical theories and values and principles in the medical profession
  2. Practice: Theories and values taught in section 1 will be applied in concrete issues of clinical ethics
  3. Exercise: Students will run discussions on self-chosen cases.

Introduction

Medical science and biotechnology 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 balancing of values, norms, principles, and priorities. 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, “What shall I do?,” ”How do I decide whether one way I could act is morally better than another valid way?,” and “Is there a right and wrong?” In addressing the many contemporary issues of the decisions and responsibilities that health care providers face, in some cases on an everyday basis, the course will introduce ethical theories, principles and critical thinking 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 intuitions and statements
  • Experience with facilitating and conducting an ethical debate
  • Enhance their ability to communicate difficult material
  • Teach good comparative, argumentative and problem-solving skills

 

 

Required Readings

  1. Singer, Peter; Kuhse, Helga: What is bioethics? A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199

  2. Singer, Peter; Kuhse, Helga: Introduction. Bioethics: An Anthology Blackwell Publishing Ltd., 2006 ISBN: 9781405129480

  3. Beauchamp, Tom L., ”The Principle of Beneficence in Applied Ethics" section 1-6.4,
    http://plato.stanford.edu/entries/principle-beneficence/

  4. Beauchamp, Tom L.; Walters, Leroy: The Hippocratic Oath. Contemporary Issues in Bioethics Wadsworth Publishing Company, 1994 ISBN: 0534584411

  5. 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

  6. Gillon, Raanan: Confidentiality. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199

  7. 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

  8. Beauchamp, Tom L.; Childress, James F.: Justice. Principles of Biomedical Ethics Oxford University Press, 2013. ISBN: 9780199924585

  9. Elwyn, G., et al.: Shared Decision Making: A Model for Clinical Practice, J Gen Intern Med 27(10): 1361-7, 2012

  10. Beauchamp, Tom L.; Childress, James F.: Respect for Autonomy. Principles of Biomedical Ethics Oxford University Press, 2009. ISBN: 9780195335705

  11. Rendtorff, Jacob: Definition of the Basic Principles in Bioethics. Basic Ethical Principles in Bioethics and Biolaw Centre for Ethics and Law, 2000. ISBN: 8492352531

  12. Zaner, Richard: Integrity and Vulnerability in Clinical Medicine. Bioethics and Biolaw, vol. II: Four Ethical Principles Rhodos, 2000. ISBN: 9788772458144

  13. Higgs, Roger: Truth-telling. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199 Beauchamp, Tom L.; Childress, James F.: Types of Ethical Theory. Principles of Biomedical Ethics Oxford University Press, 1994

  14. Noddings, Nel: The Language of Care Ethics, Knowledge Quest, v40 n5 p52-56 May-Jun 2012

  15. Rachels, James: Ethical theory and bioethics. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199

  16. Hare, R.M.: A Utilitarian approach. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199

  17. Crigger, Bette-Jane: AIDS and a Duty to Protect. Cases in Bioethics St. Martin's Press, 1998 ISBN: 0312067465

  18. Rachels, James; Rachels, Stuart: What Is Morality? The Elements of Moral Philosophy Random House, 1986. ISBN: 9780078038242

  19. Beauchamp, Tom L.; Childress, James F.: Confidentiality. Principles of Biomedical Ethics Oxford University Press, 2013. ISBN: 9780199924585

  20. Rachels, James: Are There Absolute Moral Rules? & Kant and Respect for Persons in The Elements of Moral Philosophy Random House, 1986. ISBN: 9780078038242

  21. Crigger, Bette-Jane: Can the Fetus Be an Organ Farm? Cases in Bioethics St. Martin's Press, 1998 ISBN: 0312067465

  22. 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

  23. Ridley, Aaron: Reproductive Rights and Abortion.Beginning Bioethics. Bedford Books of St. Martin's Press, 1998 ISBN: 0312132913

  24. Devettere, Raymond J.: Euthanasia and Physician Assisted Suicide. Practical Decision Making in Health Care Ethics: Cases and Concepts Georgetown University Press, 2009. ISBN: 9781589012516

  25. Kuhse, Helga: Why Killing is Not Always Worse - and Sometimes Better - Than Letting Die. Bioethics: An Anthology Blackwell Publishing Ltd., 2006 ISBN: 9781405129480

  26. Callahan, Daniel: When Self-Determination Runs Amok. Bioethics: An Anthology Blackwell Publishing Ltd., 2006 ISBN: 9781405129480

  27. Nagel, Thomas: In whose interest? Assisted Death: A Study in Ethics and Law Oxford University Press, 2003. ISBN: 9780199607983

  28. Devettere, Raymond J.: Infants and Children. Practical Decision Making in Health Care Ethics: Cases and Concepts Georgetown University Press, 2009. ISBN: 9781589012516

  29. Miller, Geoffrey: Personhood Extreme Prematurity Cambridge University Press, 2007 ISBN: 9780521862219

  30. Miller, Geoffrey: Quality of Life and Best Interests. Extreme Prematurity Cambridge University Press, 2007 ISBN: 9780521862219

  31. Miller, Geoffrey: Futility. Extreme Prematurity Cambridge University Press, 2007 ISBN: 9780521862219

  32. Vederhus, B.J., Markestad, T., Eide, G.E. et al. Health related quality of life after extremely preterm birth: a matched controlled cohort study. Health Qual Life Outcomes 8, 53 (2010). https://doi.org/10.1186/1477-7525-8-53

  33. Crawford, Doreen A.: Circumcision: a consideration of some of the controversy. Journal of Child care, Vol 6(4) 259-270, 1367-4935(200212)6:4, 2002

  34. Mazor, J.: The child's interests and the case for the permissiblity of male circumcision. J Med Ethics 2013;39:421-428

  35. Davis, Dena S.: Ancient rites and new laws: how should we regulate religious circumcision of minors? J Med Ethics 2013;39:456-458

  36. Thorup, J., et al.: Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J, 2013;60(8):A4681

  37. Fisher, Alec: Decision-making: options, consequences, values and risks. In Critical Thinking. An Introduction. Cambridge UP, 2011

  38. Devettere, Raymond J.: Transplantation. Practical Decision Making in Health Care Ethics: Cases and Concepts Georgetown University Press, 2009. ISBN: 9781589012516

  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. Chadwick, Ruth: Gene therapy. A Companion to Bioethics Blackwell Publishing Ltd., 1998 ISBN: 9780631230199

  43. McConnell, Terrance: Genetic Enhancement, Human Nature, and Rights. The Journal of Medicine & Philosophy, Vol. 35, No. 4, 2010 Oxford Journals. ISSN: 03605310

  44. Doudna, Jennifer A., & Sternberg, Samuel H.: Should we use gene editing to produce disease-free babies? Ideas.ted.com, Aug 22, 2017

  45. Barnes, Elizabeth: Valuing Disability, Causing Disability. Ethics 125 (October 2014): 88-113.

  46. Ereshefsky, Marc: Defining 'health' and 'disease'. Studies in History and Philosophy of Biological Sciences 40 (2009) 221-227

  47. Kovács, Jósef: xconcept of health and disease. Medicine, Health Care and Philosophy 1: 31-39, 1998

  48. Sandel, Michael J.: The Case Against Perfection. The Atlantic, April 2004

  49. Offit, Paul A.: America's Master Race in Pandora's Lab. Seven Stories of Science Gone Wrong, National Geografic, Washington D.C., 2017

  50. NIH (2019): Help Me Understand Genetics. Precision Medicine. http://ghr.nlm.nih.gov

  51. Topol, Eric: Deep Discovery. In Deep Medicine, Basic Books, New York 2019

  52. Wendler, David, "The Ethics of Clinical Research", The Stanford Encyclopedia of Philosophy (Winter 2017 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/win2017/entries/clinical-research/>. Section 1-4

  53. Levine, Robert J.: The Distinction between Research and Treatment. Ethics and Regulation of Clinical Research Baltimore, 1986. ISBN: 9780300042887

  54. 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

  55. 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

  56. 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

  57. 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


Guest Lecturers
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.

Guest speaker: MD, Ph. D. & Dr. Med. Helle Bruunsgaard, immunologist and chief physician at Rigshospitalet, the national teaching hospital.

 

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.
  • An 80-minute online midterm exam.
  • One group project (oral and written). The synopsis must be handed in the day before the panel debate.
  • Final group class facilitation where students in groups will be responsible for preparing and running a class on an already given topic.

 

Participation

Credit for participation is earned in the following ways:

Credit for participation can be earned in the following way:

  1. Prepare for class by a. reading according to the syllabus and b. reflecting upon the readings,
  2. Contribute to an open, positive, and inquisitive dialogue in the classroom.
  3. Enter into discussions 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
  4. Give reasoned responses to questions and considerations posed in class by peers or instructor. And
  5. Ask questions that help clarify or extend the concepts and issues under discussion. And
  6. Explain eventual absence ahead (if possible) 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.

 

 

Midterm exam

The midterm exam is an online test that can be taken within 80 minutes, but the students will have at least 24 hours to take the test. The test will present a case that has not been read in class, and asks questions about professional values and ethical theories taught in class, relating these to the test case.

 

Euthanasia Group Project 

In class #12 students will be divided into four groups, each group holding a specified perspective to a given case. These groups will prepare for a panel debate on the case - an actual euthanasia request - in class #14. The day before the panel debate each group hand in a synopsis outlining the courses of argument. This synopsis must be both submitted under 'Assignments' and uploaded in the 'Euthanasia' discussion forum.

 

Final group class facilitation

Students will in groups be responsible for preparing and running a class on an already given topic.

The task for each group is to

   A. Prepare a class. It is up to the group to decide

  1. which activities you want to include (presentation, induce group discussions, moderate class discussions, playing a game, or role play or other - think in terms of what have worked for you in this and other courses),
  2. how much time you'll spend on each activity,
  3. and how your fellow class mates must prepare for class.

   B. Run the class as you have planned it.

   C. Hand in a brief work report, describing how you prepared and divided tasks among you.

 

 

Grading 

Participation                             25%

Midterm                                  25%

Euthanasia group project      25%

Final Group                             25%

 

Laptop Policy

Laptops are not allowed in class. Tablets and phones can be used for research qualifying the discussion.


Academic Regulations  

Please make sure to read the Academic Regulations on the DIS website. There you will find regulations on: 

DIS - Study Abroad in Scandinavia - www.DISabroad.org

 

Course Summary:

Date Details Due