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Public Health Ethics Writing Assignments

PHP 908

Thursdays from 5:30-9:30

University of New Hampshire, Manchester Campus

Professor Nick Smith, J.D. and Ph.D.

Assistant Professor of Philosophy

The Course Writing Assignments

Office hours: Given many of your work schedules, I will often be available before and after our evening class sessions for meetings. Please do not be shy about scheduling meetings with me.

For more information on what I expect from papers and how I grade responses and larger essays, see my

Writing, Rewriting, and Grading Philosophy Papers

My Insider’s Guide to Academic Success

Midterm due September 15: Universalism, Relativism and Public Health Objectives

BACKGROUND

An estimated 100 million northern African women undergo a traditional form of genital surgery known as female circumcision or infibulation. A typical procedure entails: “the amputation of the clitoris, the whole of the labia minora, and at least the anterior two thirds and often the whole of the medial part of the labia majora. The two sides of the vulva are then stitched together with silk, catgut, or thorns, and a tiny sliver of wood or a reed is inserted to preserve an opening for urine and menstrual blood. The girl’s legs are usually bound together from ankle to knee until the wound has healed, which may take anything up to 40 days.” Female midwives perform the procedures on prepubescent females at the request of the child’s parents and typically without anesthesia. Because the tradition signifies a venerated rite of passage, men and women in the culture both consider female circumcision a desirable trait, and therefore women who are not circumcised are often alienated from their community.

See also:

For and overview of female circumcision, see

http://www.who.int/reproductive-health/fgm/

For a comparison between female and male circumcision, see:

http://www.noharmm.org/morepages.htm

QUESTIONS

1) What is the best public health response to female circumcision? State a thesis, argue for your position, anticipate counter-arguments, and defend your thesis against these counter-arguments.

2) In coming to your conclusion, considerer whether you can distinguish female circumcision from procedures performed on children in the U.S. that supposedly make them more “attractive,” such as male circumcision, orthodontics, and various forms of plastic surgery. On what grounds might such distinctions be made, and are these distinctions philosophically defensible and convincing?

ADVICE FOR TACKLING THIS FIRST PAPER

Arguments may take many forms. Some papers may argue that the practice is ethically wrong because it violates universal ethical principles and therefore should be prohibited, and other papers may argue the opposite or even that the very idea of right and wrong is mistaken because of relativism. At root, most papers will need to commit to relativism or universalism to make a path through the question. Considering that this practice is ongoing and widespread, I am asking you to determine your position on this current social issue and argue for why you hold this position.

Keep a few things in mind when researching this topic. First, facts may help you support your argument, but they will not make an argument for you. In this respect, it is possible to write an excellent paper knowing nothing more about female circumcision than the description of the procedure I give above. In other words, devote your time to making your own argument rather than reading everyone else’s and gathering facts. Second, because this topic addresses the treatment of sexual organs, you may come across images or discussions that may be considered graphic by some. If you prefer to avoid this, or if you prefer not to rely on the internet for your research, see me and I will provide photocopies of adequate and appropriate materials.

EXTRA CREDIT OPPORTUNITIES

For all extra credit assignments in this class, write 1500 words on the assigned topic and receive one percentage point added to your final average for the course. Extra credit papers may be completed at any time until the books close at the end of the semester.

EXTRA CREDIT 1: Kant, Utilitarianism, and the Challenges of Public Health

Response questions for this week are below. You have many choices. Pick one, many, or anything else that gets your goat about the reading.

QUESTIONS ON KANT:

1. . Is reason real or just another myth cooked up by philosophers to make humans feel important? What evidence do we have either way? Is Kant’s theory of enlightenment true? Is this a trick question?

2. What is a hypothetical imperative? Give three examples. Why does Kant seek something beyond the hypothetical imperative? What does it mean to say that something has inherent value, and why is this so important for Kant?

3. What is the categorical imperative? How does it work? How is it supposed to establish the objectivity of ethical principles? State the practical imperative. List ten examples of violations of the practical imperative.

4. What does Kant mean by “self-governance”? If Kant is right, what should be the relationship between the moral law and the political law? Should everything that is immoral be illegal?

5. Why, for Kant, should humans be afforded dignity? Is he right about this?

6. Is it even possible for public health to adopt Kantian ethical principles?

QUESTIONS ON BENTHAM:

1. According to Bentham's "Principle of Utility," actions are right when they increase happiness, and he defines utility as the property of producing happiness. The objective of utilitarianism, therefore, is to maximize utility/happiness. Bentham is also a hedonist, meaning that happiness for him is simply having pleasure and avoiding pain. Bentham designed this system in response to Kant, and he began his most famous work with the following challenge to Kant and all Kantians:

"Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as determine what we shall do. On the one hand the standard of right and wrong, on the other the chain of causes and effects, are fastened to their throne. They govern us in all we do, in all we say, in all we think: every effort we can make to throw off our subjection, will but serve to demonstrate and confirm it. In words a man may pretend to abjure their empire: but in reality he will remain subject to it all the while. The principle of utility recognizes this subjection, and assumes it for the foundation of that system, the object of which is to rear the fabric of felicity by the hands of reason and of law. Systems which attempt to question it , deal in sounds instead of sense, in caprice instead of reason, in darkness instead of light.....Has the rectitude of this principle ever been formally contested? It should seem that it had, by those who have not known what they have been meaning. Is it susceptible to any direct proof? it should seem not: FOR THAT WHICH IS USED TO PROVE EVERYTHING, CANNOT ITSELF BE PROVED: A CHAIN OF PROOFS MUST HAVE THEIR COMMENCEMENT SOME WHERE. TO GIVE SUCH A PROOF IS IMPOSSIBLE AS WELL AS IT IS NEEDLESS."

Besides Bentham's terrible punctuation, consider any of the following:

a) Is pleasure the right thing to build an ethical system around? Is happiness the right thing to build an ethical system around? Are either good?

b) Bentham calls Kant's project "needless" and dealing in "caprice rather than reason." Is he right? Are Bentnam and Mill more "reasonable" than Kant?

c) While Kant believes only motives and intentions can determine if an action is truly ethical, Bentham and Mill find the value of an act in its consequences only. Which position is stronger?

EXTRA CREDIT 2:

1. In the event of an avian flu pandemic, which of the infringements on personal autonomy listed on page 13 of Module 5 would be justifiable, and to what degree would they be justified?

EXTRA CREDIT 3: QUESTIONS ON WESLEY SMITH

1. Smith argues that the loss of the sanctity of life ethic will lead to very bad things, and utilitarians are happy to see it gone. How does utilitarianism eradicate the sanctity of life ethic? Is it justified in doing so? Why does Smith claim that our new medical practices are similar to those of Nazi doctors? Is this hyperbole?

2. Smith states: “modern bioethics, like eugenics before it, creates hierarchies of human worth intended to justify medical discrimination.” Is there anything wrong with such discrimination? Are all human lives really equal? What do we mean by “human equality”?

3. Smith claims that the health care system in the U.S. shares at least one core belief with the Nazis: Social Darwinism. Is he correct? What are the consequences of this for public health?

4. What are the proper objectives of health care? What are the objectives of business? Are they now in conflict?

5. Wesley Smith claims that “the welfare of each individual patient … must be each physician’s unqualified concern” (44-45) and that physicians therefore should NOT consider their own profit, the profit of their employer (hospital, insurance company etc.), the broad objectives of the health care ‘system’, or the social value of the patient when considering whether or how to care for a patient.” Is he right? What are the consequences of his claim? What obstacles prevent this belief from being realized in medicine? What does Smith believe will happen if we do not honor this principle? Is he exaggerating? If you work in public health, can you and will you honor this principle?

EXTRA CREDIT 4: Economic Justice and Public Health

An Auction of a Sex Slave

1. Is libertarianism, also know as pure capitalism, just? Evaluate the arguments provided by Hospers and Nathanson. Does capitalism maximize human well-being and the objectives of public health?

2. Should, as libertarians argue, all social goods (such as schooling, health care, land, and donor organs) be distributed according to one’s ability to pay? If so, what role might public health institutions play in an economic conservative administration?

3. Is there any aspect of public health that shouldn’t be determined by the laws of the market, or should free market principles preside over all aspects of life? Should, for example, public health institutions interfere with matters of “environmental” or “occupational” health?

4. Should public health institutions enforce bans or regulations on “unhealthy” products such as narcotics, nicotine, or fast food? Should the choices of individual consumers be restricted in order to improve the health of a population? Consider the question posed at the beginning of Module 6: “While it is generally accepted that each of us is, to a certain extent, "dangerous to our own health," there is far less agreement on what can or should be done about making people less foolish. In particular, there is the question of how far government should go in fashioning lifestyles to minimize the physical and mental harm we inflict upon ourselves and others in society through risky personal choices. Where does personal choice and collective responsibility begin? How we reconcile two of our most prized social values, personal freedom and good health?

5. Evaluate John Knowles’ claim cited in Module 6: “The idea of individual responsibility has been submerged in individual rights or demands to be guaranteed by government and delivered by public and private institutions. The cost of sloth, gluttony, alcoholic intemperance, reckless driving, sexual frenzy and smoking is now a national and not an individual responsibility. This is justified as individual freedom—[but] freedom in health is another man's shackle in taxes and insurance premiums. I believe the idea of a "right" to health [ought to be replaced by an] obligation to preserve one's health—a public duty if you will.”

6. Evaluate Mill’s claim from On Liberty cited in Module 6: The only purpose for which power can be rightfully exercised over any member of the civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because in the opinion of others to do so would be wise or even right. These are good reasons for remonstrating with him or reasoning with him or persuading him or entreating him [but not for] compelling or visiting him with any evil in case he do otherwise. To justified that, the conduct from which it is desired to deter him must be calculated to produce evil to someone else. The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over its own body and mind, the individual is sovereign.”

7. Are the public health professions, by nature, “paternalistic”? Is this a moral problem? Consider the quotes from Knowles and Mill above.

8. If public health justifies protecting a population’s physical health, for example by limiting cigarette advertising, should it also protect a society’s mental health? What might this require?

9. Marx predicted that corporations would cannibalize cultures, strip them of their resources, and make a small minority of powerful business owners extremely wealthy at the wealth of the majority of people. Was he right? Does Marx’s critique of capitalism offer any insights to those working in public health?

10. Libertarians believe that the market, as determined by people’s buying habits, should determine the direction of our culture. Marx believes these decisions regarding our future should be made collectively through democratic voting. Which conception is better? The question can also be thought of in these terms: are people more rational and considerate of their collective future when they vote or when they buy? Should public health be driven by the market or the ballot?

11. Should health care be distributed according to need or ability to pay?

EXTRA CREDIT 5: Free Markets and Public Health

1. Evaluate Posner’s call for a free market in human infants? Should the process of human adoption be opened to the free market, such that genetic parent or parents would be paid by the adopting parent or parents? Adopted children would of course maintain all ordinary rights of children.

2. Should there be an open market in human organs? If I want to sell my lung in order to earn money to provide for my family, for example, should the law prohibit me from doing so? Does it make a difference if I want to sell my heart?

3. Evaluate Wilkinson’s claim on page 129-130: “The Westerner, it is said, uses poverty to “force” (coerce) the poor person into giving up the organ. On the picture sketched so far, this coercion claim is true only if the Westerner in question is responsible for the vendor’s property. But is she responsible? This question is simply too big to be taken on in any detail here, raising as it does fundamental issues in political philosophy about the distribution of goods and about duties of rich to the poor.”

4. According to Wilkinson, someone coerces me if they threaten to kill my dog unless I pay them $5000. But if a veterinarian refuses to treat my fatally injured dog unless I pay her $5000, she does not coerce me because she does not threaten my dog but rather offers to help me for a fee. Can he maintain this position?

5. Marx writes: “the value of a commodity represents human labour in the abstract.” Explain and assess this assertion, defining the meaning of value, commodity, human labour, and abstract.

6. From Ethics and Public Health Model Curriculum Module 7: Who is right about environmental-health threats, the Alvin Weinbergs or the Ralph Naders of the world? Are environmental-health risks minimal, but fueled by public ignorance and hypochondria? Or are environmental-health risks massive, but covered up by vested interests attempting to reduce manufacturing costs?

7. Do all citizens have equal rights to protection against threats to environmental health? Consider the case of Homer Louisiana discussed in Module 7.

8. From Ethics and Public Health Model Curriculum Module 7: Why do you think that environmental and medical communities on the one hand, and governmental and industrial communities on the other, would tend to differ in their accounts of the causes of cancer? What interests are at stake for each “camp?” How do the influences on each camp affect the research agendas of each group?

9. Consider these questions from Module 7 in the context of the Relativism vs. Universalism debate earlier in the semester: Can scientists and academics be truly “disinterested?” How can they reduce the degree to which they have vested interests or are insufficiently disinterested? If it is true that people always have interests and are always beholden to some people, projects, or priorities other than the pursuit of truth, is it better to be beholden to some people, projects, or priorities as opposed to others? What are the people, projects, and priorities that influence your research agenda and the

conduct of your work? How do these influences affect the outcome of your research? What are

the relevant differences among influences on the choice of research question, influences on the

funding of some research projects (and not others), influences on the outcome of research (i.e.,

findings), and influences on the dissemination of research findings? Are some sources, types,

and targets of influence more troubling than others?

EXTRA CREDIT 6

My dog, the Honorable E. Grady Jolley

Read Peter Singer’s “All Animals are Equal” (I will provide a copy on request). What is “speciesism”? Singer claims that “the speciesist allows the interest of his own species to override the greater interests of members of other species.” Why, according to Singer, is this immoral? Consider his argument: “If the experimenter is not prepared to use an orphaned human infant, then his readiness to us nonhumans is simple discrimination, since adult cats, mice, and other mammals are more aware of what is happening to them, more self-directing, and, so far as we can tell, at least as sensitive to pain, as any human infant. There seems to be no relevant characteristic the human infants possess that adult mammals do not have to the same or a higher degree.” See also his assertion that if “possessing a higher degree of intelligence does not entitle one human to use another for his own ends, how can it entitle humans to exploit non-humans?” To what extent should the well-being of animals be considered in public health ethics?

EXTRA CREDIT 7

Watch Murderball, the 2005 documentary about full-contact quadriplegic wheelchair rugby. Consider any of the following questions:

1. Many of the quadriplegics in the film claim that their disability has actually made their life better. In one interview, Mark Zupan said that he would not turn back the clock and avoid his injury even if he could. How is this possible? How can we compare the loss caused by the injury with what they claim to have gained? Is there any way of achieving the benefits of the injury without actually suffering it?

2. Murderball chairs cost about $3000. Should tax dollars be spent on such gear for those who wish to play the sport? Does it matter if the injury occurred in a drunken motocross accident or serving the U.S. Military in Iraq?

3. At one point in their lives, the stars of this film were young men lying in hospital beds and being told that they would never walk again. Many of us could imagine few things more depressing. We now see them full of passion for life and sport. What is required to make this transformation? How would you respond to such a challenge? Consider the role of the will, as described by Kant or otherwise.

4. At one point in the film, one of the athletes recounts a story of having an acquaintance mistake the Quad Olympics for the Special Olympics. He takes this as a profound insult, mistaking him, in his words, for “a retard.” Is he justified in drawing such a sharp distinction between physical and cognitive disabilities?

EXTRA CREDIT 8

Watch The Corporation, which is now available at most video stores.

1. The film claims that corporations single-mindedly pursue one object: to maximize the return on investments for its shareholders. Is this correct? What are the consequences of this for public health? Is it problematic?

2. According to the logic of the film, none of the individuals working within a corporation necessarily need to do anything terribly immoral in order for the corporation to commit atrocities. How can this be? Can this be compared with the rather benign work of those who performed the administrative work of the holocaust?

3. Are corporations prototypes for humans of the future of medicine and public health?

4. One interviewee claims that many of our environmental problems could be solved if we privatized everything, including water. Is their any merit to this claim? How do we draw a line between privatizing water and privatizing food, land, healthcare, education, etc.?

5. Does the film underestimate to importance corporations have for our culture? How can we compare the costs with the benefits?

EXTRA CREDIT 9

View Stephen Frears’ Dirty Pretty Things. Consider any of the following questions:

1. What drives the characters to either sell or buy organs? What causes these motivations? Are the sellers responsible for the conditions that cause them to sell their organs? Do any of these motivations compromise their freedom to enter into these transactions?

2. Many of the donors sell their organs in desperation. What causes their desperation? Are they responsible for it? Can desperation be coercive?

3. Are any of the donors exploited or coerced in these transactions?

4. Would any of the difficulties experienced by the donors be removed if the transactions did not occur on a black market?

EXTRA CREDIT 10

Consider any of the questions below for the extra credit:

1. The President's Council on Bioethics released its report titled “Human Cloning and Human Dignity: An Ethical Inquiry (July 2002) Read it at:

http://www.bioethics.gov/reports/cloningreport/fullreport.html (the full report)

http://www.bioethics.gov/reports/cloningreport/execsummary.html (a summary)

What were its recommendations? Are they correct? Pay particular attention to use of the notion of “dignity” as it is used in the report.

2. The European Parliament has stated: “The cloning of human beings …. Cannot under any circumstances be justified or tolerated by any society, because it is a serious violation of fundamental rights and is contrary to the principle of human beings as it permits a eugenic and racist selection of the human race, it offends against human dignity and it requires experimentation on human … each person has a right to his or her own genetic identity and that human cloning is, and must be, prohibited.” Discuss.

3. Are human clones in any danger of being treated as morally and legally inferior? What protections does the U.S. Constitution provide? Will other nations provide similar rights for clones? Are we justified to worry that clones will be treated as inferior beings?

4. Is there a difference between cloning yourself and cloning someone else? What if someone want to clone you? Take you napkin or shake your hand? Do you have control over this? Is it your property? When does a child become no longer your property?

5. After reading Brock’s Cloning Human Beings: An Assessment of Ethical Issues Pro and Con, are the arguments for or against cloning stronger?

EXTRA CREDIT 11

Consider any of the questions below for the extra credit:

1. Purdy claims that “it is morally wrong to reproduce when we know there is a high risk of transmitting a serious disease or defect.” Is it immoral for some parents to have children if they know that there is a high risk of transmitting a serious defect to their offspring? Is it immoral, for example, for a couple who both suffer from Down’s Syndrome to reproduce? Should it be ILLEGAL for some parents to reproduce because of an increased likelihood that they will transmit a serious defect to their offspring?

2. Should we require abortion of fetuses with serious defects?

3. Why do we seek to prevent the birth of children with disabilities? Is this inappropriate discrimination against the disabled?

4. Will we be better off as a society if we eliminate the disabled? Should be forbid the disabled from reproducing?

5. Is pre-natal screening a form of eugenics? What are the ethical risks of these practices?

6. Is gene therapy a form of eugenics? If it is, is there anything wrong with it?

7. Warren claims that “the practice of sex selection has almost always meant the elimination of unwanted females.” Should this worry us?

EXTRA CREDIT 12

Consider any of the questions below for the extra credit:

1. Imagine that you are a potential parent and you or your partner has conceived. You are able to screen the fetus’ genes for these traits (or for statistical likelihood that these traits will be expressed). Which of these traits would you “correct” or “enhance” in your child if you could the genetic pre-selection or manipulation? Why will you or won’t you tinker with the “natural” process”? Which would cause you to abort?

2. Should parents be permitted to “shop for perfection” when having children?

3. Can we distinguish between corrective and enhancing genetic manipulation?

Are “disabilities” simply morphological or relative and socially constructed concepts?

4. What are the basic objectives of the discipline of genetics? Are they, at root, moral or immoral?

5. It seems entirely likely that future technology will allow us humans to be smarter, bigger, and stronger. It also seems likely that we will be able to live for a very long time, if not forever. Will there ever some a time when would should cease such “progress” and accept ourselves as flawed mortals?

6. If you could clone yourself and transplant and regenerate your brain, would you be approaching immortality? Should this be allowed?

7. Evaluate Joy’s worries from Why the Future Doesn’t Need Us.

8. Humans are surely not the conclusion of evolution. If it looks like evolution will leave humans behind, should we prevent this?

FINAL PAPER INFORMATION

SUGGESTED FINAL PAPER TOPICS

GENERAL GUIDELINES

The schedule for you final paper is below. The final paper must be a minimum of 5000 words. As we have seen through the course of our studies, much of the work of philosophy consists of asking the right questions. I encourage you all to conceive, fashion, and explore questions of your own creation, and therefore the suggestions below are genuinely mere suggestions. Use this as an opportunity to engage questions that you are curious or passionate about.

If you haven’t yet, read over some of my suggestions for writing a philosophy paper. PLEASE take these especiallyseriously given the amount of freedom you have in writing this paper. It will also refresh your memory about HOW I GRADE THESE PAPERS:

http://pubpages.unh.edu/~nicks/howtowrite.htm

You may incorporate any of your writing from your previous response papers into your final paper, but don’t be tempted to use it just for filler to meet the deadlines. Use whatever style and citation guidelines you prefer (MLA, Chicago Style, etc.), but be consistent and professional.

I have broken down the process into necessary stages in order to maximize the opportunity for feedback from me and to ensure that you are working at the correct pace for a project of this size. These deadlines are also necessary for me to be able to properly respond to you all.

For an excellent set of bibliographies on these issues, see:

http://bioethics.georgetown.edu/nrc/quickbibsbio.htm

DEADLINES FOR FINAL ESSAY

A. MEET WITH NICK TO DISCUSS FINAL PAPER, MID-SEPTEMBER

During this meeting we will chat generally about the course and begin discussing your final paper topic.

B. OPTIONAL FINAL PAPER OUTLINES Due on September 27 by 11:59 p.m.

This should be about four pages of 500-1000 words of detailed outline. Explain what you will be arguing and how you will argue it. List the questions you will be answering. Explain how you will organize the arguments. Explain the answers you intend to give and list potential counterarguments. I understand that you will not know everything about your paper at this stage. I require this so that you will be thinking seriously about your argument before our meetings on October 1-4 and we can dig right in.

C. MEET WITH NICK TO DISCUSS FINAL PAPERS October 2-9

During this meeting we can talk more intensively about the structure and arguments in your paper.

D. OPTIONAL FINAL PAPER DRAFTS Due on 3 by 11:59 p.m.

E. FINAL PAPER DUE OCTOBER 16

SUGGESTIONS FOR FINAL ESSAY TOPICS

REMEMBER: I encourage you all to conceive, fashion, and explore questions of your own creation, and therefore the suggestions below are genuinely mere suggestions. Use this as an opportunity to engage questions that you are curious or passionate about. You may also convert any of the papers above into final paper topics in consultation with me.

Must public health practitioners embrace a utilitarian ethical model? What are the costs and benefits of evaluating public health in terms of costs and benefits?

Evaluate the role of privacy in public health. Why do we value privacy? Is it valued too much? In what cases in any, and an individual’s privacy be infringed upon?

Should prison populations be included in public health initiatives? Do prisoners deserved all of the health benefits as non-prisoners? Do they deserve, for example, privacy in their medical treatment as discussed in Doe v. Delie? (see Nick for a copy of the opinions).

Should animal populations be included in public health initiatives? Do non-human animals deserve all of the health benefits as humans? If not, how do we distinguish between species and between individuals within species?

What specific ethical questions arise for public health practitioners in a time of war?

Is medicine in the midst of or on the verge of a crisis? First, choose any one or several of the problems facing medicine, and explain that nature of crisis. Second, assess the accuracy of the analysis of the problem provided in our readings. Third, assess the possibilities of overcoming the crisis. You may of course argue that one or all of the crises feared are exaggerated and are not as troublesome as the alarmist thinkers lead us to believe. You may attack this problem at the most abstract level (for example, “Utilitarianism cannot be the ethical foundation for public health ethics. . . .”) or you may focus your efforts on any particular case in the readings or our discussions.

Have you been Enlightened through your engagement with philosophy this semester? How have your experiences either confirmed or denied the validity of the various conceptions of Enlightenment we have encountered? Is Enlightenment a myth? If not, what are the consequences?

Have you changed your mind about any philosophical issue over the course of the semester? If yes, describe your conversion. What precipitated this change? Was it the result of enlightened reasoning or social conditions? If you were previously mistaken about something, how can you be sure you aren’t also mistaken about other important beliefs?

During the semester we have consistently distinguished philosophy from both religion and science. Can we really draw firm and proper distinctions between philosophy and science and/or religion?

How would Kantian ethics treat humans who are arguably not fully rational, for example fetuses of those suffering from deep cognitive disabilities?

What is the sanctity of life ethic, and should medicine honor it or abandon it?

Wesley Smith claims that “the welfare of each individual patient … must be each physician’s unqualified concern” (44-45) and that physicians therefore should NOT consider their own profit, the profit of their employer (hospital, insurance company etc.), the broad objectives of the health care ‘system’, or the social value of the patient when considering whether or how to care for a patient.” Is he right? What are the consequences of his claim? What obstacles prevent this belief from being realized in medicine? What does Smith believe will happen if we do not honor this principle? Is he exaggerating? If you work in medicine, will you honor this principle?

If someone other than the mother knowingly and intentionally causes a fetus to be terminated, should they be found guilty of murder? If you are pro-choice in the abortion debate, what problems does this situation present and how might you resolve them? If you are pro-life in the abortion debate, how might such a set of facts strengthen your argument? In other words, what is the moral status of the fetus if it can be terminated by the parents? Should its moral status depend on who terminates it?

Is the notion of a disability an objective claim or a discriminatory social construction?

Why do we seek to prevent the birth of children with disabilities? Is this inappropriate discrimination against the disabled?

Is discrimination against the disabled different than racial or gender discrimination, in that we have no reservations about preventing disabilities and trying to avoid conceiving children with disabilities, but we obviously would not be comfortable (at this point) making the same efforts to eliminate minorities?

Watch Murderball, the 2005 documentary about full-contact quadriplegic wheelchair rugby. Consider any of the following questions: 1. Many of the quadriplegics in the film claim that their disability has actually made their life better. In one interview, Mark Zupan said that he would not turn back the clock and avoid his injury even if he could. How is this possible? How can we compare the loss caused by the injury with what they claim to have gained? Is there any way of achieving the benefits of the injury without actually suffering it?; 2. Murderball chairs cost about $3000. Should tax dollars be spent on such gear for those who wish to play the sport? Does it matter if the injury occurred in a drunken motocross accident or serving the U.S. Military in Iraq?; 3. At one point in their lives, the stars of this film were young men lying in hospital beds and being told that they would never walk again. Many of us could imagine few things more depressing. We now see them full of passion for life and sport. What is required to make this transformation? How would you respond to such a challenge? Consider the role of the will, as described by Kant or otherwise; 4. At one point in the film, one of the athletes recounts a story of having an acquaintance mistake the Quad Olympics for the Special Olympics. He takes this as a profound insult, mistaking him, in his words, for “a retard.” Is he justified in drawing such a sharp distinction between physical and cognitive disabilities?

Can medical or biological characteristics cause individuals to forfeit equality under the law? Consider the Supreme Court’s answer to this question in the contexts of a) race; b) gender and the ability to give birth and be statutorily raped; c) sexual orientation; d) age; e) status as HIV+; and f) disability (including the Court’s 5-4 ruling in 2001 striking key elements of the Americans with Disabilities Act)?

Smith states: “modern bioethics, like eugenics before it, creates hierarchies of human worth intended to justify medical discrimination.” Is there anything wrong with such discrimination?

Should the Americans with Disabilities Act be eradicated or expanded? Evaluate the ethical and political arguments for both positions.

Is it immoral for some parents to have children if they know that there is a high risk of transmitting a serious defect to their offspring? (Purdy) Should it be ILLEGAL for some parents to reproduce because of an increased likelihood that they will transmit a serious defect to their offspring?

What is “speciesism”? Singer claims that “the speciesist allows the interest of his own species to override the greater interests of members of other species.” Why, according to Singer, is this immoral? Consider his argument: “If the experimenter is not prepared to use an orphaned human infant, then his readiness to us nonhumans is simple discrimination, since adult cats, mice, and other mammals are more aware of what is happening to them, more self-directing, and, so far as we can tell, at least as sensitive to pain, as any human infant. There seems to be no relevant characteristic the human infants possess that adult mammals do not have to the same or a higher degree.” See also his assertion that if “possessing a higher degree of intelligence does not entitle one human to use another for his own ends, how can it entitle humans to exploit non-humans?”

Sunstein provides two opposing hypothetical options on human cloning from the Supreme Court. Which opinion is stronger?

The President's Council on Bioethics released its report titled Human Cloning and Human Dignity: An Ethical Inquiry (July 2002): http://www.bioethics.gov/cloningreport/ What were its recommendations? Are they correct?

Imagine that you are a potential parent and you or your partner has conceived. You are able to screen the fetus’ genes for these traits (or for statistical likelihood that these traits will be expressed). Which of these traits would you “correct” or “enhance” in your child if you could the genetic pre-selection or manipulation? Why will you or won’t you tinker with the “natural” process”? Which would cause you to abort?

What are the basic objectives of the discipline of genetics? Are they, at root, moral or immoral?

Discuss the Bush administration’s policy on stem cell research. Is it appropriate?

Is pre-natal screening a form of eugenics? What are the ethical risks of these practices? Are those risks justifiable?

Is gene therapy a form of eugenics? If it is, should we discontinue the practice?

Should parents be permitted to “shop for perfection” when having children? Consider Sandel’s argument.

Can we distinguish between corrective and enhancing genetic manipulation?

“All Mean Are Created Equal.” What does this mean, and how might it apply to medicine. Is equality a metaphysical or physical concept?

The European Parliament has stated: “The cloning of human beings …. Cannot under any circumstances be justified or tolerated by any society, because it is a serious violation of fundamental rights and is contrary to the principle of human beings as it permits a eugenic and racist selection of the human race, it offends against human dignity and it requires experimentation on human … each person has a right to his or her own genetic identity and that human cloning is, and must be, prohibited.” Evaluate this position.

Are human clones in any danger of being treated as morally and legally inferior?

Discuss the dystopian visions of clones in science fiction, and assess their probability.

Warren claims that “the practice of sex selection has almost always meant the elimination of unwanted females.” Should this worry us?

Is the world becoming more diverse or more homogenous? Does it matter?

Is there a difference between cloning yourself and cloning someone else? What if someone want to clone you? Take you napkin or shake your hand? Do you have control over this? Is it your property? When does a child become no longer your property?

Purdy claims: “It is morally wrong to reproduce when we know that there is a high risk of transmitting a serious disease.” Is this correct? Should reproduction be illegal for those at risk?

What is transhumanism, and what dangers does it present?

What is the relationship between law (political or divine) and ethics? Do we freely fashion ethical principles and then record them in the law, or does the law indoctrinate us into what we must think is ethical by demanding that we comply with its rules?

How does medicine create our perception of what is healthy, beautiful, and good?

How do legal and medical conceptions of sexuality create social norms? How do these institutions respond to a) children born intersexed (without clear designation that they are male of female); b) homosexuality and “sex-changes”; c) promiscuity and prostitution; d) birth control and reproductive technology; or e) population control?

Should health care be provided according to need or wealth? Should, for example, limited antidotes to biological weapons be sold to the highest bidder?

What should guide our society: the market or the government? Are their any attractive alternatives to these choices?

Should all medical goods and services be bought and sold? Should there be an open market for buying and selling organs? Infants?

Evaluate the court’s opinions in Bowers v. Hardwick and Texas v. Johnson.

Is the very idea of “human nature” an excuse for the status quo?

Are some forms of corporal punishment just? Consider the propriety of forced sterilization, castration, psychosurgery, involuntary medication, torture, and death as punishment.

Should medicine and drugs be regulated? Pay particular attention to whether the use of drugs such a Prozac, ecstasy, marijuana, and heroin should be legally controlled.

Are drug addicts rational? If not, can they freely choose to use drugs?

Should doctors always tell patients the truth?

What constitutes informed consent?

What are “medical ethics consultants,” and are they problematic?

How would a Marxist view the current state of our health care system?

Are sympathy and empathy obstacles to serving the health care system? Are they necessary to providing quality care? Should doctors be trained in coldness? Are there dangers to such training?

Is libertarianism, also know as pure capitalism, just? Evaluate the arguments provided by Hospers and/or Nathanson. Does capitalism maximize human well-being?

Are ethics relevant to economics? Isn't economics just ruthless competition for survival?

Should, as libertarians argue, all social goods (such as schooling, health care, land, and donor organs) be distributed according to one’s ability to pay?

Should health care be provided according to need or wealth?

Evaluate the ethics merits of socialized vs. privatized medicine.

Should limited antidotes to biological weapons be sold to the highest bidder?

Should everything be for sale, such as body parts, sex, infants, or rights to vote, pollute, or kill? If I want to sell my lung in order to earn money to provide for my family, for example, should the law prohibit me from doing so?

Evaluate Posner’s call for a free market in human infants.

Is paid surrogacy moral?

Should DNA be patentable?

Evaluate how any one or more ethical concepts relate to commodification: objectification, exploitation, coercion, harm, consent, and/or instrumentalization.

View Stephen Frears’ Dirty Pretty Things. Consider any of the following questions: 1. What drives the characters to either sell or buy organs? What causes these motivations? Are the sellers responsible for the conditions that cause them to sell their organs? Do any of these motivations compromise their freedom to enter into these transactions?; 2. Many of the donors sell their organs in desperation. What causes their desperation? Are they responsible for it? Can desperation be coercive?; 3. Are any of the donors exploited or coerced in these transactions?; 4. Would any of the difficulties experienced by the donors be removed if the transactions did not occur on a black market?; 5. What support does the film provide for the “displacement thesis”?

What does it mean for the U.S. to give cash awards to civilians killed by our military in Iraq or Afghanistan? Should all of these lives equal the same amount? How do these payments contribute to the international conception of the U.S. and its values?

Is the September 11^th Compensation fund just? Should compensation be allocated by how much the victim earned? Is the loss of an investment banker worth more than the loss of a janitor?

Is there anything morally wrong with the orgies described in “The Lost Children of Rockdale County”?

If you could clone yourself and transplant and regenerate your brain, would you be approaching immortality? Should this be allowed?

Evaluate Joy’s worries from Why the Future Doesn’t Need Us.

Many of the debates appear to force a choice between the Luddite position and the “scientistic” position. Is this a false dilemma?

Can humans do anything that machines cannot?

It seems entirely likely that future technology will allow us humans to be smarter, bigger, and stronger. It also seems likely that we will be able to live for a very long time, if not forever. Will there ever some a time when would should cease such “progress” and accept ourselves as flawed mortals?

How long would the perfect human live? Life expectancy at birth in the United States in 1901 was 49 years. At the end of the century it was 77 years, an increase of just over 57%. Philosophers of biology understand death as a “series of preventable illnesses.” Should we continue to try to live longer and healthier lives? Is that the goal of medicine? Consider Leon Kass (remember him from the President’s commission on cloning): "simply to covet a prolonged life span for ourselves is both a sign and a cause of our failure to open ourselves to procreation and to any higher purpose. … [The] desire to prolong youthfulness is not only a childish desire to eat one’s life and keep it; it is also an expression of a childish and narcissistic wish incompatible with devotion to posterity. Also: "the finitude of human life is a blessing for every individual, whether he knows it or not."

What if only some can afford genetic enhancements/therapy for their children? What would be the social consequences? Is this any different from only some parents being able to afford the best schools for their children? Would inequalities become exponentially greater?

What are the moral ramifications if Kurzweil’s predictions are even somewhat accurate? If, for example, we have such difficulty in 2006 distinguishing between the natural and the enhanced, will lines between nature and technology become even more blurred such that it no longer makes sense to speak of humans vs. robots just as it doesn’t make much sense to speak of “natural” medicine vs. scientific medicine?

Evaluate McKibben’s argument that we should decide when we have “Enough” medical technology? Can and should we decide when humans have become powerful enough, and then go no further? Where should we draw that line?

What are the existential ramifications of living a much longer life with these enhanced capacities? How would the meaning of human life change?

What are the religious overtones of becoming a being with one billion times our current computational power?

If we don’t like an “enhanced” future, can it be stopped given the competitive and economic forces driving it?

How do current controversies regarding steroids use among professional athletes relate to our discussions of human enhancement?

What, ultimately, are the goals of medicine? Could we solve the problem of health once and for all?

Nick Smith · Associate Professor of Philosophy · University of New Hampshire · Nick.Smith@unh.edu