BANGOR THEOLOGICAL SEMINARY

 

ET 1711: Health Care Ethics
Spring 2001

Wednesdays, 1:00--3:50 p.m.
Instructor: Marvin M. Ellison

Portland office: (207) 774-5212
Bangor office: (800) 287-6781
E-mail address: Mellison@bts.edu
Office hours: By appointment

Course Description:

The right to die, abortion, patient-assisted death, new reproductive technologies, organ transplants, paternalism and patient rights, and the U.S. health care crisis are among the issues typically addressed in this course. The focus will be placed on the care of persons, the demands of justice within the health care system, and the role of clergy and laity as advocates for responsible health care. (3 credits)

Course goals:

  1. To explore medical, interpersonal, social, legal, and theological/ministerial dimensions of current issues in health care ethics.
  2. To clarify and assess different moral viewpoints as participants articulate their own ethical stance in dialogue with others.
  3. To stimulate interdisciplinary and inter-professional dialogue.
  4. To envision alternative possibilities for more equitable and life-enhancing health care policies and to strengthen the churches’ contribution to the well-being of persons, especially marginalized peoples.

Requirements:

  1. Regular attendance and responsible participation in class discussions. (25%)
  2. Prior to in-class discussion, prepare a 1-2 page written response to each of four (4) case studies in which you analyze the situation and provide your ethical assessment. (20%)

Guidelines for analyzing the case studies:

    1. Show evidence of insights gained from the assigned reading. Include citations as appropriate.
    2. Identify the ethical issue or dilemma in the case. Don’t focus exclusively on the pastoral issues involved.
    3. Provide a specific name for the ethical issue (e.g., end of life care options, distributive justice and the allocation of limited resources, etc.).
    4. Take a stand, and provide specific reasons for the choice you make. While you may wish to indicate, as well, the merits of different positions, explain why you weigh things out as you do.

3. Summary and response to religious responses to human cloning, due May 2. Read Ronald Cole-Turner’s edited volume, Human Cloning: Religious Response, and be prepared to lead the discussion on one of the chapters. In preparation, bring copies to class (for distribution to your classmates) of your 1-2 page (no longer!) summary-and-response on your chapter. (10%)

In your summary-and-response, please include the following:

    1. Provide the chapter title and author.
    2. Briefly summarize (3-4 sentences) the ethical problem or concern as named by this author.
    3. State why this problem is important from the author’s viewpoint. What are the stakes, and for whom?
    4. What change strategy does the author propose?
    5. Offer your own assessment of the strengths and/or weaknesses of the author’s ethical analysis.

4. A final research essay, approximately 12-15 pages typewritten, in which you reflect on an ethical issue in health care of your choice. Include the following in your essay: (1) a statement of the problem; (2) clarification of your interests, values, and social location; (3) review of pertinent literature [a minimum of 3-4 journal articles]; (4) analysis of the ethical issues, including insights from the Christian tradition; and (5) a constructive proposal for responding, including any policy recommendations. Due: May 21 for graduating seniors and May 25 for all others. (45%)

If you wish to have your final work returned, please submit it along with a SASE.

Grading system: A letter grade will be given unless a student requests in writing, no later than March 28, a Pass/D/Fail grade.

 

Course schedule:

#1. February 7 Introduction to this course and colleagues

Lecture: "Discerning the Patient (and Health Care Professionals) as Persons:

Ethical Issues for Health Care, Medicine, and Ministry"

Establishing Ground Rules

#2. February 14 Ethical discernment in the medical context

Due today: Case study #1 ("Severely Disabled Infant")

Reading: 

James B. Nelson and JoAnne Smith Rohricht, Human Medicine: Ethical Perspectives on Today’s Medical Issues, Preface and Ch. 1 ("Caring for Human Health"), pp. 11-30.

Daniel C. Maguire, Death by Choice, expanded and revised edition, Ch. 4 ("Ethics: How to Do It"), pp. 65-96.

Marilyn Martone, "Making Health Care Decisions Without a Prognosis: Life in a Brain Trauma Unit," Annual of the Society of Christian Ethics 20 (2000), 309-327.

Nicholas A. Christakis, " The Prophetic Art," University of Chicago Magazine (April 2000), 30-33.

 

February 21 Reading Week (no class)

 

#3. February 28 Physician-Patient relationship; paternalism and informed consent

Reading: Carol Levine (ed.), Taking Sides: Clashing Views on Controversial Bioethical Issues, Eighth Edition (1999):

Issue 1 ("Is Informed Consent Still Central to Medical Ethics?")

Issue 2 ("Can Family Interests Ethically Outweigh Patient Autonomy?")

Issue 5 ("Is It Ethical to Withhold the Truth from Dying Patients?")

Karen Lebacqz, "Empowerment in the Clinical Setting," in On Moral Medicine: Theological Perspectives in Medical Ethics, ed. Stephen E. Lammers and Allen Verhey, pp. 805-815.

Margaret E. Mohrmann, "The Practice of the Ministry of Medicine," Loma Linda University Center for Christian Bioethics Update 14:3 (October 1998), 1-7.

 

#4. March 7 Experimentation and Patient Non-Compliance

Reading: Nelson and Rohricht, Human Medicine, Ch. 3 ("Human Experimentation"), especially pp. 71-79.

Levine, Taking Sides:

Issue 15 ("Should Animal Experimentation Be Permitted?")

Issue 16 ("Are Placebo Studies of Maternal-Fetal HIV Transmission Ethical in the Developing World?")

Emilie M. Townes, Breaking the Fine Rain of Death: African American Health Issues and a Womanist Ethic of Care (1998), Introduction and Ch. 1- 4 (pp. 1-106).

#5. March 14 Decision about Death and Dying

Due today: Case Study #2 ("God and My Children Will Know What’s Best")

Reading: Nelson and Rohricht, Human Medicine, Ch. 6 ("Humanizing the Dying Process"), pp. 142-175.

Levine, Taking Sides:

Issue 3 ("Are Some Advance Directives Too Risky for Patients?")

Issue 10 ("Should Adolescents Make Their Own Life-and-Death Decisions")

Issue 11 ("Do Parents Harm Their Children When They Refuse Medical Treatment on Religious Grounds")

 

#6. March 21 Decisions about Death and Dying, continued

Reading: Levine, Taking Sides:

Issue 4 ("Should Physicians Be Allowed to Assist in Patient Suicide?")

Studies in Christian Ethics 11:1 (1998):

William F. May, "After the U.S. Supreme Court Decisions: The Politics of Assisted Suicide and the Church’s Role," 48-62.

Ruurd Veldhuis, "Tired of Living: Reflections on the Practice of Euthanasia in the Netherlands," 63-76.

The Center for Bioethics, University of New England, "Physician-Assisted Suicide and End-of-Life Care: A Report on the Proceedings of the Conference on the Maine Death with Dignity Act" (June 9, 2000). [17 pages]

Recommended:

Govert Den Hartogh, "The Slippery Slope Argument," in A Companion to Ethics, ed. Helga Kuhse and Peter Singer (1998), pp. 280-290.

 

#7. March 28 Taking Stock: Health Care Challenges and the U.S. Health Care Crisis

Reading: Teresa Maldonado, "Sick of Being Poor," in Lammers and Verhey (eds.), On Moral Medicine, pp. 1001-1004.

Ezekiel J. Emanuel, "Justice and Managed Care: Four Principles for the Just Allocation of Health Care," Hastings Center Report 30:3 (May-June, 2000), 8-16.

Nelson and Rohricht, Human Medicine, Ch. 8 ("Medical Care for a More Human Society"), pp. 200-216.

#8. April 4 Distribution of Limited Resources

Due today: Case Study #3 ("One Team, Two Patients")

Reading: Levine, Taking Sides:

Issue 6 ("Should Doctors Be Able to Refuse Demands for "Futile" Treatment?")

Issue 17 ("Should Health Care for the Elderly Be Limited?")

Kulse and Singer, A Companion to Ethics:

John Harris, "Micro-Allocation: Deciding Between Patients"

Daniel Wikler and Sarah Marchand, "Macro-Allocation: Dividing Up the Health Care Budget"

Norman Daniels, "Is There a Right to Health Care and, If So, What Does It Encompass"

 

April 11 Easter Recess (no class)

 

#9. April 18 Choices in Reproduction

Due today: Case Study #4 ("Clare and the Unexpected Pregnancy")

Reading: Levine, Taking Sides:

Issue 7 ("Should Abortion Late in Pregnancy Be Banned?")

Issue 8 ("Should Pregnant Women Be Punished for Exposing Fetuses to Risk?")

Daniel C. Maguire, "Visit to an Abortion Clinic," in Maguire, The Moral Revolution, pp. 157-168.

Nelson and Rohricht, Human Medicine, Ch. 2 ("The Humanity in Abortion"), pp. 31-64.

#10. April 25 New Reproductive Technologies

Reading: Nelson and Rohricht, Human Medicine, Ch. 4 ("Human Factors in Reproductive Technologies"), pp. 85-114.

Paul Robinson, "Prenatal Screening, Sex Selection, and Cloning," in Kuhse and Singer, A Companion to Ethics, pp. 173-185.

Christine E. Gudorf, "Dissecting Parenthood," Conscience (Autumn 1994), 15-22.

 

#11. May 2 Human Cloning

Due today: Summary and Response to a Chapter in Human Cloning

Reading: Ronald Cole-Turner (ed.), Human Cloning: Religious Responses (1997).

Levine, Taking Sides: Issue 12 ("Should Human Cloning Be Banned?")

 

#12. May 9 The HIV/AIDS and Sexually Transmitted Diseases Pandemic

Reading: Townes, Breaking the Fine Rain of Death, Ch. 6 ("And All the Colored Folks Is Cursed: The Impact of HIV/AIDS on African Americans"), pp. 121-144.

Levine, Taking Sides: Issue 20 ("Should Cases of HIV Infected Be Reported By Name?")

#13. May 16 Reports on Research Topics; Course Evaluation