Philosophy 242 MEDICAL ETHICS SUM2014, M-F, 9:40-10:40, SAV 156 INSTRUCTOR: BENJAMIN HOLE OFFICE HOURS: M-F, 10:40-11  EMAIL: BVHOLE@UW.EDU

Agenda No Clicker Quiz Finish Dax’s Case Where we are and what we’re doing Discuss Dax’s Case

Where we are and what we’re doing Schedule Paper Writing Participation

Week Required June 22-26: Introduction to Bioethics in Philosophy Benjamin Hole, Phil242 Syllabus and Course Website Chapter 1 “Moral Reasoning in Bioethics” (3-32) Chapter 2 “Bioethics and Moral Theories” (33-40) June 29- July 3: Bioethics and Moral Reasoning   Writing Assignment due June 30 “Writing Philosophy” (PDF), Mark Woodhouse “The Principle of Utility” (PDF), Jeremy Bentham “Utilitarianism,” John Stuart Mill (52-54) “The Moral Law,” Immanuel Kant (55-60) July 6-10: Access to Healthcare Chapter 11, “Dividing up Health Care Resources” (681-695) “Famine, Affluence, and Morality” (PDF), Peter Singer “Lifeboat Ethics” (PDF), Garrett Hardin “The Survival Lottery,” (PDF) John Harris July 13-17: Patient Autonomy and Informed Consent Writing Assignment due July 14 Dax’s Case (in-class movie) Chapter 3, “Paternalism and Patient Autonomy” (71-83) Chapter 5, “Informed Consent” (180-185) “Confronting Death: Who Chooses, Who Controls?” (PDF), Robert Burt and Dax Cowart July 20-24: Disability and Culture Sound and Fury (in-class movie) “Paternalism,” Gerald Dworkin (84-93) “Ethical Relativism in a Multicultural Society,” Ruth Macklin (164-174) “Defending Deaf Culture,” (PDF) Robert Sparrow July 27-31: Disability and Biomedical Enhancement Writing Assignment due July 28 FIXED: The Science/Fiction of Human Enhancement (in-class movie) “A Fatal Attraction to Normalizing” (PDF), Anita Silvers “Ethical Issues in Human Enhancement” (PDF), Nick Bostrom & Rebecca Roache August 3-7: Reproductive Genetic and Ethics “Is Gene Therapy a Form of Eugenics?,” John Harris (571-577) “Genetic Dilemmas and the Child’s Right to an Open Future,” Dena Davis (553-562) “The Non-Identity Problem and Genetic Harms,” Dan W. Brock (567-570) “The Wisdom of Repugnance,” Leon Kass (483-498) August 10-14: Abortion Writing Assignment due August 11 “The Unspeakable Crime of Abortion” (PDF), Pope John Paul II “On the Legal and Moral Status of Abortion,” Mary Anne Warren (333-342) “Why Abortion is Immoral,” Don Marquis (317-328) “A Defense of Abortion,” Judith Thomson (307-316) August 17-21: Paper Conference and Review

This week Monday Tuesday Wednesday Thursday Friday Dax’s Case Tuesday Today Wednesday “Paternalism and Patient Autonomy” Thursday “Informed Consent” Friday “Confronting Death: Who Chooses, Who Controls?” Dax’s Case (in-class movie) Chapter 3, “Paternalism and Patient Autonomy” (71-83) Chapter 5, “Informed Consent” (180-185) “Confronting Death: Who Chooses, Who Controls?” (PDF), Robert Burt and Dax Cowart

Final Paper (35%)

Week Required June 22-26: Introduction to Bioethics in Philosophy Benjamin Hole, Phil242 Syllabus and Course Website Chapter 1 “Moral Reasoning in Bioethics” (3-32) Chapter 2 “Bioethics and Moral Theories” (33-40) June 29- July 3: Bioethics and Moral Reasoning   Writing Assignment due June 30 “Writing Philosophy” (PDF), Mark Woodhouse “The Principle of Utility” (PDF), Jeremy Bentham “Utilitarianism,” John Stuart Mill (52-54) “The Moral Law,” Immanuel Kant (55-60) July 6-10: Access to Healthcare Chapter 11, “Dividing up Health Care Resources” (681-695) “Famine, Affluence, and Morality” (PDF), Peter Singer “Lifeboat Ethics” (PDF), Garrett Hardin “The Survival Lottery,” (PDF) John Harris July 13-17: Patient Autonomy and Informed Consent Writing Assignment due July 14 Dax’s Case (in-class movie) Chapter 3, “Paternalism and Patient Autonomy” (71-83) Chapter 4, “Informed Consent” (180-185) “Confronting Death: Who Chooses, Who Controls?” (PDF), Robert Burt and Dax Cowart July 20-24: Disability and Culture Sound and Fury (in-class movie) “Paternalism,” Gerald Dworkin (84-93) “Ethical Relativism in a Multicultural Society,” Ruth Macklin (164-174) “Defending Deaf Culture,” (PDF) Robert Sparrow July 27-31: Disability and Biomedical Enhancement Writing Assignment due July 28 FIXED: The Science/Fiction of Human Enhancement (in-class movie) “A Fatal Attraction to Normalizing” (PDF), Anita Silvers “Ethical Issues in Human Enhancement” (PDF), Nick Bostrom & Rebecca Roache August 3-7: Reproductive Genetic and Ethics “Is Gene Therapy a Form of Eugenics?,” John Harris (571-577) “Genetic Dilemmas and the Child’s Right to an Open Future,” Dena Davis (553-562) “The Non-Identity Problem and Genetic Harms,” Dan W. Brock (567-570) “The Wisdom of Repugnance,” Leon Kass (483-498) August 10-14: Abortion Writing Assignment due August 11 “The Unspeakable Crime of Abortion” (PDF), Pope John Paul II “On the Legal and Moral Status of Abortion,” Mary Anne Warren (333-342) “Why Abortion is Immoral,” Don Marquis (317-328) “A Defense of Abortion,” Judith Thomson (307-316) August 17-21: Paper Conference and Review

Discuss Dax Cowart Dax’s Case

Please Let Me Die was filmed in 1974 A follow-up documentary titled Dax's Case was filmed in 1984

Discussion Question Reflect on the arguments from ethical theory we discussed earlier this quarter. From a perspective of ethical theory, how would you describe Dax Cowart’s rationale for the right to refuse treatment?

Construct Arguments 1. 2. _____________________________ 3. Therefore, Dax Cowart should have been allowed to refuse treatment 1. 2. _____________________________ 3. Therefore, Dax Cowart should not have been allowed to refuse treatment.

Construct and Objection and Response 1. 2. _____________________________ 3. Therefore, X premise from my argument is false. Response 1. 2. _____________________________ 3. Therefore, Y argument from the possible objection is false.

Discussion Question One of the physicians says that, in severe cases, burn patients are incompetent to make decisions when they first enter the hospital because they are in such a great deal of pain. However, patients such as Dax can be in a great deal of pain for a very long time. In such cases, what should be done to determine competence, and when should this be done? What options, if any, should Dax have been offered immediately after his accident? He says that he expressed a wish not to be taken to any hospital. Presumably, no one paid any attention. Should severely burned patients be offered the choice of not being treated?

Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree In severe cases, burn patients are incompetent to make decisions when they first enter the hospital because they are in such a great deal of pain. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Discussion Question Dax says that he could see no future for himself, after the accident. He does not want to live as a “blind cripple” (his words) “selling pencils” (mother’s words). Could his outlook on life have clouded his judgment? Did his outlook undermine his competence? Since the accident, Dax has had a career as a lawyer, he has been married, and grew to value his life after the accident. Does the fact that Dax’s outlook on his life changed undermine his original refusal of treatment?

After the accident, Dax’s pessimism about his future undermined his competence. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

Discussion Question Part of Dax’s plan for stopping treatment was that he would leave the hospital and go home, but that rather than die from the inevitable wound infection, he would seek some way to hurry up the dying process.  Suppose that you are the physician and found Dax to be fully competent, and suppose that he requests your help as a physician in hastening his death, either by giving him a lethal drug he could take himself (physician-assisted suicide) or by injecting a deadly drug (voluntary active euthanasia).  Would you agree to this request?  What considerations besides respect for patient autonomy would be relevant to your answer?

Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree If you were Dax’s physician and found him to be fully competent to refuse treatment, you would respect his request and hasten his dying process. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

injecting a deadly drug (voluntary active euthanasia) You would respect Dax’s refusal of treatment and hasten his dying process by: giving him a lethal drug he could take himself (physician-assisted suicide) injecting a deadly drug (voluntary active euthanasia) it doesn’t matter (whether you choose A or B) neither

Construct and Objection and Response 1. 2. _____________________________ 3. Therefore, X premise from my argument is false. Response 1. 2. _____________________________ 3. Therefore, Y argument from the possible objection is false.