This is a discussion post of 6 different topics and each topic should have its own paragraph and 150+ words each. I will put each indiviudal topic with its instructions.
Topic 1: Medical Research on Human Subjects
Instructions:
Non-human animals aren’t the only ones who suffer in the name of medical research. Once non-human animal testing is successfully concluded, research using human subjects begins. The moral obligations of researchers to their subjects has long been understood differently than the obligations of physicians to their patients. Here are some (there are others) moral principles, values, and concepts to consider as you study this topic.
duty to protect vulnerable populations
informed consent
nonmaleficence
exploitation
experimental research
therapeutic research
physician-scientist
Assignment: Imagine that you are a researcher proposing a project that involves the use of live human research subjects. Explain your project (it doesn’t have to be something that is actually currently being researched – you can choose a historical example or something science fiction-y). What are you hoping to discover through this research? Why do you need to use live humans for this research? What population will you tap for subjects (why that population in particular)? What are the potential risks this project poses to the research subjects? What safeguards will you take to protect your subjects from these risks?
Topic 2: Public Health
Instructions:
The field of public health focuses not on individual patients, but on maximizing health outcomes for populations. Public health measures such as vaccination programs and public sanitation have been instrumental in reducing the spread of infectious disease and raising the mortality rates of populations. However, since public health looks at large swaths of people, rather than at individuals, moral red flags are sometimes raised. Here are some key moral principles, values, and concepts to think about as you study public health ethics.
the right to privacy
the right to bodily autonomy
fair distribution of resources
the right to refuse treatment
paternalism
public goods
free-riding
Assignment: Public health initiatives, campaigns, and policies aim to improve health outcomes for a population. During the 1980s, huge public health campaigns promoting condom use and other safe sex practices were instrumental in reducing the spread of HIV. Starting in the early 1900’s, the FDA began issuing pamphlets promoting healthy diets (the most recent iterations of this were the Food Pyramid and the current MyPlate).
Imagine that you are a public health worker. You are proposing a project that aims to improve a particular health outcome (could be curbing the spread of an infectious disease, promoting physical activity or healthy diet, discouraging use of a harmful substance, etc.) for a particular population (could be nationwide, in a local community, a school, workplace, etc).
Explain your project. What specific health outcome are you addressing? How does your project aim to promote this health outcome? Are you using nudges? What is your target population? Why is this an important public health issue (as opposed to simply a matter of individual health)? What moral principles are at play? Why should your target population buy into this project? Give a moral argument in support of your project.
Topic 3: The Just Allocation of Scarce Medical Resources
Instructions:
The just allocation of scarce medical resources is often a public health issue – how do we decide how to disperse needed preventative interventions or treatments across a population (macro-allocations), when there’s not enough to go around? Even if there is enough, how do we decide who gets to go first? What about at the level of individuals (micro-allocations)? Who gets the life-saving organ? This topic, more than any other, has strong roots in political philosophy and justice studies. Here are some moral principles, values, and concepts to keep in mind as you study this material.
justice
social worth
merit-based justice
egalitarianism
liberal conception of the good life
Assignment: Imagine that you are the CFO of a hospital, and it’s your responsibility to create its budget. How would you decide how to spend the money that you have available? Keep in mind that you have a limited amount of money, so whatever you choose to prioritize means something else will be deprioritized. What medical treatments and interventions do you choose to prioritize in your hospital’s budget? Why? Give an argument, explaining what principles and/or allocation system you’re appealing to in making your decision.
Topic 4: Epitesmic Injustice
Instructions:
Unlike public health ethics, which looks at big-scale issues across populations, clinical ethics centers on moral issues that arise in the very personal context of the physician-patient relationship. Epistemic injustice, which arises in many contexts, is especially acute in this setting, due to the significant power awarded to doctors by society, and and the vulnerability inflicted by illness. Here are some key moral principles and concepts to consider as you read.
shared decision-making
epistemic injustice
testimonial injustice
hermeneutical injustice
paternalism
beneficence
non-maleficence
patient autonomy
patient empowerment
Assignment: Many patients report experiences of epistemic injustice in health care, with their reports of pain or descriptions of symptoms being denied or dismissed. To combat this problem, clinical bioethicists emphasize the important of the physician-patient relationship, arguing that a focus on respect, clear communication, and shared decision-making are ways to promote epistemic justice for patients.
Describe an encounter between a patient and a health care provider in which you believe epistemic injustice occurred. Many of you probably have a story of your own, or from someone you know, but there are plenty of cases that made the news, as well. Identify what aspects of the encounter were epistemically unjust. Be as clear and detailed in your moral reasoning as you can.
Topic 5: Precedent Autonomy
Instructions:
Autonomy and beneficence are two of the foundational principles of bioethics – yet they so often come into conflict. This week, our in depth moral examination looks into clinical care of patients with dementia. To do so, we must think deeply about autonomy – why do we value it, and does it make sense to say we should honor it in an individual who no longer has the ability to make autonomous decisions? Here are some key moral concepts to consider as you study.
precedent autonomy
contemporary autonomy
evidential view of autonomy
integrity view of autonomy
critical interests
experiential interests
personal identity
This reading center on particular moral concerns that arise regarding patients with dementia who had previously expressed preferences regarding their care which now conflict with their current preferences. Although this is a very common occurrence regarding patients who have dementia, patients actually change their minds all the time. The best laid birth plans are often revised on the fly when the reality of labor hits. People who were very sure they “wouldn’t want to live like that” suddenly change their minds when the alterative to “living like that” is death.
Some argue that the frequency with which patients revise their preferences when actually confronted with the experience of illness suggests that the concept of precedent autonomy – and the practice of creating advanced directive that allow our former (presumably autonomous) selves to speak on behalf of our current (incompetent) selves, is flawed.
Assignment: Do you think that you can know now what medical interventions you will want (or not want) in the future? If so, explain what moral values you hold that lead you to believe your mind will not change on these matters? If not, identify the moral values that you hold which lead you to believe your views on this matter are changeable.
Topic 6: Ethics of Biotechnology
Instructions:
When something new is created, there are no rules in place to govern its use (because who needs rules for something that doesn’t exist)? Medical biotechnology brings new medical interventions to our world – often for the better – but almost always without a well-considered understanding of the moral issues it brought into existence with it. For the final week of course content, we consider CRISPR technology, which holds great promise for medical advances in the coming years. Here are some moral principles and concepts to consider as you think about this technology.
precautionary principle
gene editing
gene therapy
somatic gene therapy
germline gene therapy
chimeras
personhood
fetuses as involuntary research subjects
ASSIGNMENT: I’d like each of you to do a little research and find an example of current biotechnological research (not the ones from the course readings) with potentially morally questionable implications. Briefly describe the research and/or provide a link.
After describing the example of biotech research you have found, offer the strongest argument you can in support of your position regarding the moral permissibility of that research. Be clear and specific, taking care to identify the relevant moral principles that are involved.
