Draft Fall 2014 Comparative Medical Practices, Ethics and Law PUBP Spring 2015

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1 Course Information Draft Fall 2014 Comparative Medical Practices, Ethics and Law PUBP Spring 2015 Bonnie Stabile, Ph.D. Research Assistant Professor School of Policy, Government and International Affairs George Mason University Meets: Thursdays, 4:30 7:10 pm, Founders Hall TBA Office Hours: Mondays and Thursdays, 3:00 4:00 pm, or by appointment, Room FH 652 Contact: or office phone Course Description This class will examine some of the most prominent and enduring ethical issues raised in medical practice in nations around the world. It will take a comparative look at those issues through the application of various ethical frameworks, and an examination of various legal and policy solutions derived to deal with them. The classic principles of biomedical ethics as outlined by Beauchamp and Childress respect for autonomy, nonmaleficence, beneficence and justice will help to guide our inquiry, as will consideration of several major schools of thought in political philosophy, including utilitarianism, libertarianism and communitarianism. Learning Outcomes A familiarity with some important bioethical, ethical and philosophical frameworks pertinent to medical policy issues. An ability to approach common bioethical dilemmas in medical policy from a variety of philosophical viewpoints. An ability to write effective analyses applying bioethics to medical policy issues. An ability to give effective oral presentations regarding bioethics and medical policy. An appreciation of a multiplicity of ethical and legal viewpoints and policy solutions regarding some current medical issues in the global community. 1

2 Course Requirements/Evaluation Class participation and presentations 25% Daily Contributions Current Event Article Expert 3 Policy Briefs (5 pages each) and Final Presentation 75% See Appendices for description of Participation, Research Paper and Topical Essay and assignments. A grade of A or A- indicates sustained excellence and outstanding performance on all aspects of the course. The grades of B and B+ denote mastery of the material and very good performance on all aspects of the course. The grade of B- is given for marginal quality work that is not quite up to graduate level standards. The grade of C denotes work that may be adequate for undergraduate performance, but is not acceptable at the graduate level. The grade of F denotes the failure to perform adequately on course assignments. The class participation grade takes into account a student s presence in class and contributions to the course dialogue. Conscientious participation entails: - earnest discussion and demonstrated knowledge of assigned readings - application of course concepts to relevant current events or the work circumstances and experience of individual students - courteous, professional, and respectful dialogue with course colleagues - use of name card during each class, for the benefit of the instructor and fellow students alike Meaningful and well-mannered participation in class discussions is particularly important for the purposes of this class. If you must miss more than one, or perhaps two, classes, you can mitigate (but not eliminate) the negative impact on your grade by submitting a written synopsis of 750 words about the missed night s readings. All written work is expected to be of the highest quality, representing both grammatically correct and carefully considered analysis. Elements of central importance to sound analysis include adequate depth, breadth, relevance and clarity of the concepts considered. Assignments must be submitted on time to receive full credit. Finally, all students are required to use their GMU accounts or have GMU s forwarded to their regular accounts, as this will be the primary means of correspondence with students regarding the class. Even if you do not regularly use your 2

3 GMU account, be sure to open it and place a forwarding address to the account that you regularly use so that you can get GMU and class announcements. Also be sure to empty your account occasionally, because if you do not and it exceeds the limit, you will not receive incoming until you have cleared the space. Required Readings Required books are available in the George Mason University bookstore. Other readings will be available by accessing e-reserves and e-journals through the George Mason University library website and electronic databases. Beauchamp, Tom L. and James F. Childress Principles of Biomedical Ethics 7 th Edition. Oxford: Oxford University Press. E-Reserves and E-Journals To access E-Reserves: Go to Click on "E-Reserves" just under the green box that says University Libraries Select "Stabile" from under the instructor's list, or select "PUBP 753 section B- 01" under course. (Do not select both.) The password is "medical" To access E-Journals: Go to Click on "E-Journals just under the green box that says University Libraries Enter journal title to continue search The SPGIA Policy on Plagiarism The profession of scholarship and the intellectual life of a university as well as the field of public policy inquiry depend fundamentally on a foundation of trust. Thus any act of plagiarism strikes at the heart of the meaning of the university and the purpose of the School of Policy, Government, and International Affairs. It constitutes a serious breach of professional ethics and it is unacceptable. Plagiarism is the use of another s words or ideas presented as one s own. It includes, among other things, the use of specific words, ideas, or frameworks that are the product of another s work. Honesty and thoroughness in citing sources is essential to professional accountability and personal responsibility. Appropriate citation is necessary so that arguments, evidence, and claims can be critically examined. 3

4 Plagiarism is wrong because of the injustice it does to the person whose ideas are stolen. But it is also wrong because it constitutes lying to one s professional colleagues. From a prudential perspective, it is shortsighted and self-defeating, and it can ruin a professional career. The faculty of the School of Policy, Government, and International Affairs takes plagiarism seriously and has adopted a zero tolerance policy. Any plagiarized assignment will receive an automatic grade of F. This may lead to failure for the course, resulting in dismissal from the University. This dismissal will be noted on the student s transcript. For foreign students who are on a university-sponsored visa (eg. F-1, J-1 or J-2), dismissal also results in the revocation of their visa. To help enforce the SPGIA policy on plagiarism, all written work submitted in partial fulfillment of course or degree requirements must be available in electronic form so that it can be compared with electronic databases, as well as submitted to commercial services to which the School subscribes. Faculty may at any time submit student s work without prior permission from the student. Individual instructors may require that written work be submitted in electronic as well as printed form. The SPGIA policy on plagiarism is supplementary to the George Mason University Honor Code; it is not intended to replace it or substitute for it. ( Citation Rule of Thumb You are responsible for knowing how to properly cite referenced material. To be on the safe side, if you use more than three consecutive words of another author or speaker, put them in quotation marks and cite them. If you are citing five lines or more from another s work, those lines should be single-spaced and indented. Plagiarism will automatically result in a grade of F for the assignment. Plagiarism is using another s words or ideas and representing them as your own. In this age of clicking, cutting and pasting, it is easier than ever to plagiarize (and to detect plagiarism), but it is as important as ever to respect the rights of owners and originators in the marketplace of ideas. The use of quotation marks and meticulous, proper citation will help you to avoid going astray. Be sure that you are familiar with and adhere to the George Mason University Honor Code found at Students with Special Needs If you are a student with a disability and you need academic accommodations, please see me and contact the Disability Resource Center (DRC) at All academic accommodations must be arranged through the DRC. 4

5 New Voices in Public Policy Please consider submitting your proudest work for publication in New Voices in Public Policy. New Voices is a student- and faculty-reviewed journal that shares SPGIA's finest student work with the rest of the world. Weekly Readings and Assignments Session 1 (January 22): Course Introduction and Overview Beauchamp, Tom L. and James F. Childress Moral Norms, Chapter 1, and Moral Theories, Chapter 9 in Principles of Biomedical Ethics 7 th Edition. Oxford: Oxford University Press. Session 2 (January 29): Mental Health and Autonomy The principle of self-governance runs deep in moral thought and law, whether it refers to the liberty of groups or individuals. At times, medical conditions affecting mental health may cause us to consider instances in which personal autonomy might be constrained through policy. Such constraints raise important issues of implementation, and how we might safeguard both public and individual wellbeing, and the principle of autonomy itself. Beauchamp, Tom L. and James F. Childress Respect for Autonomy, Chapter 3 in Principles of Biomedical Ethics 7 th Edition. Oxford: Oxford University Press. Laakkonen, Marja-Liisa Ethical Care in Dementia. British Medical Journal 339:b3993. doi: /bmj.b3993. Richardson, Genevra Balancing Autonomy and Risk: A Failure of Nerve in England and Wales? International Journal of Law and Psychiatry 30: Roper, Cath E and Edan, Vrinda Autonomy in Jeopardy: Contrasting Participatory Health Models with Patient Decision Making Under Mental Health Law. Journal of Participatory Medicine. September 12, 3:e42. Available at 5

6 Session 3 (February 5): Helping Someone Die: Assisted Suicide, Euthanasia and the Principle of Nonmaleficence Does Assisted Suicide constitute a violation of the principle of nonmaleficence the Hippocratic Oath s admonition to do no harm? Or does it constitute an act of compassion and afford autonomous individuals an opportunity to die with dignity? Few nations have legalized assisted suicide. What is the ethical basis of this outcome and what are the implications in medical practice? Beauchamp, Tom L. and James F. Childress Nonmaleficence, Chapter 4 in Principles of Biomedical Ethics 7 th Edition. Oxford: Oxford University Press. Lagay, Faith Physician Assisted Suicide: The Law and Professional Ethics. Virtual Mentor (American Medical Association Journal of Ethics) January 5 (1). Available at Lewis, Penney Euthanasia in Belgium Five Years After Legislation. European Journal of Health Law 16: The Fight for the Right to Die CBC News Canada. February 9. Available at Session 4 (February 12): Obesity and Paternalism: Beneficence or Bureaucracy? Should the government have a role in planning our meals? If children, or adults for that matter, are fat, is personal moral failure or systemic environmental change to blame? What policy responses have different nations in the international community devised in response to the burgeoning problem of obesity, and what is the ethical basis of such policies? Beauchamp, Tom L. and James F. Childress Beneficence, Chapter 5 in Principles of Biomedical Ethics 7th Edition. Oxford: Oxford University Press. Branca, Franceso, Haik Nikogosian and Tim Lobstein, Editors The Challenge of Obesity in the WHO European Region and the Strategies for Response. World Health Organization. Available at data/assets/pdf_file/0010/74746/e90711.pdf. Crombie, Iain K., Linda Irvine, Lawrence Elliott and Hilary Wallace Public Health Policy to Tackle Obesity: An International Perspective. Commissioned and funded by NHS Health Scotland. Available at 6

7 Holm, Soren Parental Responsibility and Obesity in Children. Public Health Ethics 1: National Council of State Legislatures Childhood Obesity 2008 Update on Legislative Policy Options. Available at Session 5 (February 19): Justice and Access to Health Care First Policy Brief Due Does justice require broad access to healthcare? Is there a minimum standard of care to which everyone has a right? How do different ethical and legal constructs contend with these questions? Beauchamp, Tom L. and James F. Childress Justice, Chapter 6 in Principles of Biomedical Ethics 7th Edition. Oxford: Oxford University Press. Daniels, Norman "Justice and Access to Health Care", The Stanford Encyclopedia of Philosophy (Spring Edition), Edward N. Zalta (ed.). Available at Session 6 (February 26): Moral Character and Health Care Provision: From Conscientious Refusal to Exceptional Heroism Certain attributes of Moral Character as described by Beauchamp and Childress can help us consider the complexities of health care policy and provision. The five focal virtues for health professionals include compassion, discernment, trustworthiness, integrity and conscientiousness. While this latter virtue can at times lead to a refusal of care, what the authors describe as exceptional heroism leads some to offer care in extraordinary circumstances, such as the treatment of Ebola patients, which places providers at considerable personal risk. Beauchamp, Tom L. and James F. Childress Moral Character, Chapter 2 in Principles of Biomedical Ethics 7th Edition. Oxford: Oxford University Press. McGill, Natalie Health workers put themselves at risk for Ebola while saving lives: Shortage of staff, supplies a concern The Nations Health. October (44) 8: 1-16 Shaw, Jacquelyn and Jocelyn Downie Welcome to the Wild, Wild North: Conscientious Objection Policies Governing Canada's Medical, Nursing, Pharmacy, and Dental Professions. Bioethics: Special Issue: Let Conscience Be Their Guide? Conscientious Refusals in Health Care. January (28) 1:

8 Session 7 (March 5): Moral Status and Reproductive Technology How might we apply the concept of moral status, as defined by Beauchamp and Childress, to sort through contentious policies relating to embryos where personhood, abortion, infertility treatment and contraception are concerned? Beauchamp, Tom L. and James F. Childress Moral Status, Chapter 3 in Principles of Biomedical Ethics 7th Edition. Oxford: Oxford University Press. Farsides, Bobbie and Rosamund Scott No Small Matter for Some: Practitioner s Views on the Moral Status and Treatment of Human Embryos. Medical Law Review Winter (20) 1: March 12 No Class Today GMU Spring Break! Session 8 (March 19): Organ Transplantation How can access to viable organs be ethically expanded to meet the growing need for them? What frameworks derived from markets and/or morality might best guide efforts to expand organ availability? Farrell, Anne-Maree, Price, David and Quigley, Muireann A Principled and Pragmatic Approach to Organ Shortage, Chapter 1 in Organ Shortage: Ethics, Law and Pragmatism, Anne-Maree Farrell, David Price and Muireann Quigley (ed.). Cambridge: Cambridge University Press, Available on E-Reserve (Password is choice ). Farrell, Anne-Maree Addressing Organ Shortage in the European Union: Getting the Balance Right, Chapter 15 in Organ Shortage: Ethics, Law and Pragmatism, Anne-Maree Farrell, David Price and Muireann Quigley (ed.). Cambridge: Cambridge University Press, Available on E-Reserve (Password is choice ). Session 9 (March 26): Palliative Care and Hospice: The Quality of Death Second Policy Brief Due Modern medicine, which proffers many miraculous interventions, can nonetheless offer no antidote to death. What does it mean to die well? How is our experience of death influenced by varying medical practices, ethics and law? Al-Shahri, Mohammad The Future of Palliative Care in the Islamic World. Western Journal of Medicine 176 (1):

9 Economist Intelligence Unit The Quality of Death: Ranking End of Life Care Across the World. The Economist. A report commissioned by the Lien Foundation. Available at Gawande, Atul What Should Medicine Do When it Can t Save Your Life? The New Yorker. August 2. Stanley, John M What the People Would Want if they Knew More About It: A Case for the Social Marketing of Hospice Care. Hastings Center Report Special Supplement 33 (2): S22-S23. Session 10 (April 2): Ethical Conduct of Medical Research Despite the principles established in such foundational sources as the Nuremburg Code, the Declaration of Helsinki, and the Belmont Report, it seems that ethical dilemmas in the conduct of research are routinely raised. What such ethical dilemmas have recently been brought to light around the world, and what ethical or policy guidelines might mitigate them? Belmont Report. Available at Ehni, Hans-Jorg and Weising, Urban Testing Drugs Together with Those Who Need Them. World Medical & Health Policy 4 (1). Nuremberg Code. Available at Presidential Commission for the Study of Bioethical Issues Research Across Borders. Executive Summary and selected sections. Available at World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Using Human Subjects. Available at Session 11 (April 9): Electronic Medical Records and Privacy Technological advances in managing information may well improve the quality of medical care, but they also raise concerns of potential threats to patient privacy. What varying ethical and legal frameworks inform the proliferation of the use of electronic medical records around the world? 9

10 Beauchamp, Tom L. and James F. Childress Professional-Patient Relationships, Chapter 8 in Principles of Biomedical Ethics 7th Edition. Oxford: Oxford University Press. Buckler, Grant Canada Lags in Electronic Medical Records. CBC News January 28. Available at Kopola, Beverly and Mitchell, Mary Ellen Use of Digital Health Records Raises Ethics Concerns. JONA s Healthcare Law, Ethics and Regulation 13 (3): Session 12 (April 16): Third Policy Brief Due Begin Student Research Presentations Session 13 (April 23): Student Research Presentations Session 14 (April 30): Student Research Presentations Course Wrap-Up Appendix A: Participation I. Daily Participation a. Show up for class b. Participate meaningfully in discussion on the day s topics. Prepare by actively reading the literature assigned for each session. II. Current Event Policy Analysis Over the course of the summer session, each student must contribute one current event for class discussion. Beginning with session 2 and ending with session 11, students will take turns discussing an article from the popular press on a pertinent policy issue of current interest or importance. Each student will lead a brief (just a couple of minutes) discussion during which he or she will: 10

11 Identify the policy issue and its parameters Apply a specific element of analysis from the course readings to illuminate some facet of the policy dialogue III. Article Expert Each student will intensively prepare one of the assigned course readings and be ready to serve as the article expert in an agreed upon session. Everyone must choose at least one article for this purpose. Appendix B: Policy Briefs and Presentations Each student must write three policy briefs* of five pages in length (for a total of 15 pages). Each brief will focus on a different principle of biomedical ethics: Respect for Autonomy; Nonmaleficence; Beneficence; or Justice, and will apply that principle as the framework of analysis to a particular health policy of interest in a nation other than the United States. As part of the analysis, the brief should concisely characterize the principle at hand, identify the nation and its policy, and offer a brief consideration of the treatment of the policy in the US for comparative purposes. Each student will give a presentation of his or her favorite policy brief during one of the final three sessions of class. This presentation will be 15 minutes in length, including time for questions and discussion. The format (whether to include power points, video clips or handouts, for instance) is up to each presenter; the goal is to have the essence of the central ethical and policy themes of each research project well conveyed to colleagues. *Instructions for submission of policy briefs: double-spaced, 12 pt font, standard margins submitted as an attachment 11

12 labeled with student last name, course number and brief number references required (APSA style) page count does not include references submitted to instructor at by the beginning of the class session on the due date 12