UBC - OKANAGAN. COURSE OUTLINE Summer 2013 PHILOSOPHY BIOMEDICAL ETHICS

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1 GENERAL INFORMATION Professor: Dr John Pugsley Office location: TBA Office telephone: TBA Office hours: TBA UBC - OKANAGAN COURSE OUTLINE Summer 2013 PHILOSOPHY BIOMEDICAL ETHICS COURSE DESCRIPTION Moral problems arising in the health sciences Topics may include abortion, death and euthanasia, genetic engineering, behaviour modification, compulsory treatment, experimentation with human beings and animals, and/or the relationship between professionals and their patients, subjects, or clients TEXT Mappes, Thomas A et al Biomedical Ethics (7th Ed), New York: McGraw Hill, 2010 Custom Course Materials, Compiled by J Pugsley ASSIGNMENTS AND GRADING Quiz On Monday, week three there will be a short quiz on material from weeks one and two The quiz is worth 5% of the grade Tests There will be two tests The first will comprise eight questions, seven of which require answers three or four sentences in length and one of which will be a case study This first test will be worth 15% of the course grade The second test will require you to critically evaluate the views of a philosopher The test will be worth 20% of the course grade Paper There will be one word paper It will be due at the beginning of the last class The paper will be worth 25% of the course grade The paper topic is included in your package Final Examination The final exam will be worth 35% of the course grade The exam is two hours long All COMPONENTS MUST BE COMPLETED IN ORDER TO ACHIEVE A PASSING GRADE 1

2 PHILOSOPHY 233 BIOMEDICAL ETHICS DETAILED SYLLABUS WEEK 1 Commencing May 13 th MONDAY An introduction to the course and to philosophy A little bit of logic Meta-ethical theories; Relativism and Objectivism READING FOR NEXT CLASS: Chapter One, pp 4-23 & pp38-40 THURSDAY Meta-ethics continued Relativism and Objectivism Normative ethical theory Utilitarianism and Deontology READING FOR NEXT CLASS: Chapter One, pp & pp Chapter Two, pp WEEK 2 Commencing May 20 th MONDAY VICTORIA DAY NO CLASS READING FOR NEXT CLASS: On Telling Patients the Truth, Roger Higgs, p103 THURSDAY Ethical principles The Principle of Truth telling and The Doctrine of Paternalism READING FOR NEXT CLASS: The Problem of Abortion and The Doctrine of Double Effect, Philippa Foot, CCM REVIEW FOR QUIZ WEEK 3 Commencing May 27 th MONDAY QUIZ Ethical principles The Principles of Beneficence and Non-maleficence The Doctrine of Double Effect The principle of Justice READING FOR NEXT CLASS: Justice: A Philosophical Review, Allen Buchanan, p638 Autonomy, Equality and a Just Health-Care System, Kai Nielsen, p649 THURSDAY Discussion of Buchanan and Nielsen on The Principle of Justice Consideration of cases 1,2,3,4 and 5, pp READING FOR NEXT CLASS: Active and Passive Euthanasia, James Rachels p395 Rachels on Active and Passive Euthanasia, Beauchamp&Childress, CCM ``Àctive and Passive Euthanasia: An Impertinent Distinction``, TD Sullivan, CCM REVIEW FOR TEST #1 2

3 WEEK 4 Commencing June 3 rd MONDAY TEST #1 The Issue of Suicide and Euthanasia READING FOR NEXT CLASS: Killing and Allowing to Die, Daniel Callahan, p399 Voluntary Active Euthanasia, Dan Brock, p402 Cases 27,28 and 29, pp THURSDAY The Issue of Suicide and Euthanasia Discussion of the readings and of cases 27, 28 and 29 READING FOR NEXT CLASS: On the Moral and Legal Status of Abortion, Mary Anne Warren, p468 A Defense of Abortion, Judith Jarvis Thomson, p479 Abortion through a Feminist Lens, Susan Sherwin, CCM WEEK 5 Commencing June 10 th MONDAY The Issue of Abortion READING FOR NEXT CLASS In Defense of Abortion and Infanticide, Michael Tooley, CCM PREPARATION FOR TEST #2 THURSDAY TEST #2 The Issue of Abortion Discussion of the readings READING FOR NEXT CLASS: Chapter 8, pp Feminist Ethics and In Vitro Fertilisation, Susan Sherwin, p 548 Case #37 WEEK 6 Commencing June 17 th MONDAY The Issue of Reproductive Technology Discussion of readings and case #37 READING FOR NEXT CLASS: Ethical Debates About Infertility and Its Treatment, p553 ``IVF and Women`s Interests: An Analysis``, Mary AnneWarren, CCM THURSDAY TERM PAPER DUE The Issue of Reproductive technology Discussion of readings Course review and discussion of final examination MONDAY JUNE 24th FINAL EXAMINATION 3

4 QUIZ, TESTS, PAPER AND EXAM QUIZ On Monday, week three there will be a short quiz on material from weeks one and two The quiz is worth 5% of the grade TEST #1 Test #1 will comprise eight questions, seven of which require answers a sentence or two in length and one of which will be a case study The test will be worth 15% of the course grade TEST #2 Test #2 rquires you to write an in-class essay Your essay will be a critical evaluation of the views of Judith Jarvis Thomson in her paper, A Defense of Abortion PAPER Your papers must be at least 1100 words long and no longer than 1200 words Correct spelling and proper grammar is essential The paper is due at, or before, the beginning of class on Thursday, June 20 th Your paper should be a critical examination of the following statement: When a competent adult chooses to end his or her own life others are morally obliged to interfere only to the extent of providing access to the help needed to achieve the goal NOTES FOR GUIDANCE 1 In this paper you will claim either that the title statement is true or that it is false You will then defend your claim by arguing that better reasons exist for accepting the claim than rejecting it The aim is not to prove your claim is true, rather you should try to show that an unbiased, clear-thinking person would have good reason to accept it There is no right answer 2 In the very first paragraph you must make your claim and preview how you intend to support it This is a requirement, it is not optional You can assume that the issue you are dealing with is important There is no need to say how important it is in your introduction 3 The paper is not a research paper, yet you must draw upon the readings from the text and from such other reading as you choose 4 When you are using the ideas of other authors you must make it clear that you are doing so 5 If you do use a direct quotation you must limit the quote to one sentence The aim is to paraphrase the other author s ideas, that is to say, you put the ideas into your own words Use of quotations longer than two sentences will be penalised 6 Proof-read your work very carefully to make sure that each sentence says exactly what you want it to say Check the spelling and the grammar 4

5 FINAL EXAM The final exam is scheduled for Monday June 24 th at 1:00pm The exam is 2 hours long All students must ensure that they are available to write the exam at this time It will not be possible to write the exam at any other time You will respond to two questions on the exam These are the questions 1 Some have said that the development of new reproductive technologies liberates women by giving them control over their reproductive systems Others suggest that these technologies contribute to the oppression of women by re-emphasising that the primary role of a woman is to bear and raise children Still others maintain that the new technologies are a socially dangerous, unwarranted interference with the natural order of things How do you respond to these various opinions? 2 Rosa J suffered a fatal seizure while she was 23 weeks pregnant After the seizure, Rosa J was placed on life-support systems but was declared brain-dead the next day She was kept on life-support systems for 9 weeks, however, until she gave birth to a healthy baby girl by caesarean section During this time the physicians used steroids to help the lungs of the foetus to mature and monitored foetal growth with ultrasound examinations Rosa J was fed intravenously and given antibiotics for infection when necessary After birth, the life-support systems were disconnected The baby was given an excellent chance to survive, although she weighed only three pounds From the time of the seizure, all decisions about Rosa J and the foetus she was carrying were made by physicians in consultation with family members In the nine week period of life-support was Rosa J a person and, therefore, an individual who ought not to be used as a means to others ends? There will be nothing other than these two questions on the exam 5

6 What is Philosophy? INTRODUCTION TO PHILOSOPHY - NOTES This question is extremely difficult to answer because it is itself a philosophical question, the answer to which is in dispute among philosophers It might seem sensible to take the various answers which have been offered and distill from them the common, core elements The advantage of this procedure is that we will avoid begging important philosophical questions about the nature of the discipline The disadvantage is that we end up with something that is too general to be really informative Wilfred Sellars found that the best he could come up with was that philosophy is concerned with " how 'things', in the most general sense of the term, 'hang together', in the most general sense of the term" I am sure this is true, yet it does not tell us very much I suggest the following approach: Talk about the AIMS of philosophy When we get clear about the aims, we can say that whenever people are directing themselves toward the achievement of these aims, then they are doing philosophy Philosophy is the enterprise which seeks to fulfill these aims The five aims of philosophy 1 The critical scrutiny of our beliefs and convictions John Stuart Mill's claim Believing what happens to be true, if you are dogmatic and closed minded about it, is worse than believing what happens to be false, as long as you are open minded and willing to discuss your beliefs and change them in the light of evidence, discussion and criticism 2 The uncovering of our hidden assumptions or presuppositions An assumption or presupposition is a belief which is taken for granted and, hence, of which we are not conscious I claim that as long as we are unaware of our assumptions we are not intellectually free If we are unaware of them, we are enslaved to them and to all the consequences they entail We are not free because all our thinking is confined to the limits set by our unrecognised assumptions We need to become aware of them, subject them to critical scrutiny, and continue to hold them or reject them according as they measure up 3 The quest for a genuinely worthwhile life Socrates' claim The unexamined life is not worth living 4 The effort to keep alive our sense of wonder about the world Aristotle's claim Philosophy begins with wonder 5 The posing of certain questions which are not dealt with by other disciplines and the attempt to answer them 6

7 What is philosophy about? The four core areas of philosophy 1 Metaphysics Metaphysics is concerned with the ultimate components of reality, the types of things that exist 2 Epistemology Epistemology is theory of knowledge 3 Axiology Axiology is theory of value 4 Logic Logic is the study of the basic structure of reasoning To the limited extent that we learn logic in this course, it is the study of arguments A LITTLE BIT OF LOGIC Philosophy is centered in the analysis and construction of arguments The study of arguments is called logic An argument is a set of statements at least one of which is a premise and one of which is a conclusion such that the premise(s) give reasons for accepting the conclusion A statement is a declarative sentence also called a proposition Statements purport to say something true Statements are either true or false Arguments do not have the property of being true or false There are two very different types of argument, Deductive and Inductive DEDUCTIVE ARGUMENTS Deductive arguments are valid or invalid, sound or unsound A Definition of validity An argument is valid when it is the case that if the premises are true, then the conclusion must be true A Definition of soundness An argument is sound when it is valid and the premises are true We say that a valid deductive argument is truth preserving INDUCTIVE ARGUMENTS Inductive arguments are strong or weak, persuasive or unpersuasive Inductive Arguments are not truth-preserving Good inductive arguments yield a high degree of probability 7

8 The premises of an inductive argument purport to give evidence for the conclusion If the evidence is substantial, then the argument is a strong inductive argument If the evidence is relatively insubstantial, then the argument is a weak inductive argument CONDITIONAL ARGUMENTS A conditional argument is an argument in which one of the premises is a conditional statement A conditional statement is either a statement of the form If A Then B, or a statement which is logically equivalent to a statement having that form Two Valid Conditional Argument Forms Modus Ponens IF A, THEN B A THEREFORE, B Modus Tollens IF A, THEN B NOT-B THEREFORE, NOT-A Two Fallacious Imposters Affirming The Consequent IF A, THEN B B THEREFORE, A Denying The Antecedent IF A, THEN B NOT-A THEREFORE, NOT-B

9 VALID/ INVALID EXAMPLES ALL PHYSICIANS ARE EDUCATED ALL SURGEONS ARE PHYSICIANS ALL SURGEONS ARE EDUCATED ALL BIRDS ARE MAMMALS ALL RABBITS ARE BIRDS ALL RABBITS ARE MAMMALS SOME PHYSICIANS ARE CANADIANS SOME WOMEN ARE PHYSICIANS SOME WOMEN ARE CANADIANS NO PHYSICIANS ARE CANADIANS ALL WOMEN ARE CANADIANS NO WOMEN ARE PHYSICIANS ALL BIRDS ARE MAMMALS NO BIRDS ARE FISH NO FISH ARE MAMMALS SOME NORTH AMERICANS ARE TALL ALL CANADIANS ARE NORTH AMERICANS SOME CANADIANS ARE TALL ALL NORTH AMERICANS ARE TALL SOME NORTH AMERICANS ARE CANADIANS SOME CANADIANS ARE TALL ALL RABBITS ARE BIRDS ALL MAMMALS ARE BIRDS ALL MAMMALS ARE RABBITS 9

10 NOTES ON META-ETHICAL THEORIES COGNITIVIST THEORIES Moral judgements are statements They are either true or false, ie, they have a truth value OBJECTIVIST THEORIES What makes moral judgemnets true or false are facts about the act, the person or the state of affairs being judged NATURALISM What makes moral judgements true or false is the presence or absence of natural properties in the act, the person or the state of affairs being judged Natural properties are those, the presence or absence of which, is ascertainable by empirical means INTUITIONISM What makes moral judgements true or false is the presence or absence of non-natural properties in the act, the person or the state of affairs being judged Non-natural properties are those, the presence or absence of which, is only ascertainable by ethical intuition SUBJECTIVIST THEORIES PRIVATE SUBJECTIVISM What makes moral judgements true or false are facts about the attitudes and beliefs of the individual making the judgement CULTURAL RELATIVISM What makes moral judgements true or false are facts about the attitudes and beliefs of the group with which the person making the judgement typically identifies NON-COGNITIVIST THEORIES Moral judgements are not statements They are neither true nor false They do not have a truth value EMOTIVISM Moral judgements are disguised expressions of emotion IMPERATIVISM Moral judgements are disguised commands 10

11 Definition of a Teleological Ethical Theory NOTES ON NORMATIVE ETHICAL THEORY An ethical theory is teleological if it maintains that the rightness or wrongness of an act is exclusively a matter of the goodness or badness of the consequences of the act Definition of a Deontological Ethical Theory An ethical theory is deontological if it maintains that the rightness or wrongness of an act act is not exclusively a matter of the consequences of the act The Ultimate Principle of Act Utilitarianism An agent is morally obligated to perform that individual act which will produce the greatest balance of good over harm, everyone considered The Objections to Act Utilitarianism The Free Rider Problem The Rights/ Justice Problem The Saints and Heroes Problem The Special Relationships Problem The Ultimate Principle of Rule Utilitarianism An Agent is morally obligated to act in accordance with the rule which, if generally followed, will produce the greatest balance of good over harm, everyone considered KANTIAN DEONTOLOGY Kant attempted to discover the rational principle that would stand as a categorical imperative grounding all other ethical judgments The imperative would have to be categorical rather than hypothetical, or conditional, since true morality should not depend on our individual likes and dislikes or on our abilities and opportunities These are historical "accidents;" any ultimate principle of ethics must transcend them Among the various formulations of the categorical imperative, two are particularly worth noting: Always act in such a way that you can also will that the maxim of your action should become a universal law or Act so that you treat humanity, both in your own person and in that of another, always as an end and never merely as a means Although ultimately these are formally equivalent, the first illustrates the need for moral principles to be universalizable The second points to the radical distinction to be made between things and persons, and emphasizes the necessity of respect for persons 11

12 Kant's theory is an example of a deontological or duty-based ethics : it judges morality by examining the nature of actions and the will of agents rather than goals achieved (Roughly, a deontological theory looks at inputs rather than outcomes) One reason for the shift away from consequences to duties is that, in spite of our best efforts, we cannot control the future We are praised or blamed for actions within our control, and that includes our willing, not our achieving This is not to say that Kant did not care about the outcomes of our actions--we all wish for good things Rather Kant insisted that as far as the moral evaluation of our actions was concerned, consequences did not matter As suggested by the first version of the categorical imperative above, if the maxim or rule governing our action is not capable of being universalized, then it is unacceptable Note that universalizability is not the same as universality Kant's point is not that we would all agree on some rule if it is moral Instead, we must be able to will that it be made universal; the idea is very much like the golden rule --Do unto others as you would have them do unto you If you cannot will that everyone follow the same rule, your rule is not a moral one The second version of the categorical imperative given above emphasizes respect for persons Persons, unlike things, ought never to be merely used Their value is never merely instrumental; they are ends in themselves Of course, a person may be useful, but must always at the same time be treated with all the respect due to a person, ie, also as an end Deontological ethics is strongest in many of the areas where utilitarianism is weakest In an ethics of duty, the ends can never justify the means Individual human rights are acknowledged and inviolable We need not consider the satisfaction of harmful desires in our moral deliberations THE DOCTRINE OF DOUBLE EFFECT Definition THERE IS A MORALLY RELEVANT DIFFERENCE BETWEEN THE INTENDED EFFECT OF A PERSON S ACTION AND THE NON-INTENDED, THOUGH FORESEEN, EFFECTS OF THE ACTION FOUR CONDITIONS ALL FOUR CONDITIONS MUST BE SATISFIED FOR AN ACT WITH BOTH A GOOD AND BAD EFFECT TO BE JUSTIFIED BY APPLYING THE DOCTRINE OF DOUBLE EFFECT 1 THE ACT ITSELF MUST NOT BE INTRINSICALLY WRONG 2 THE AGENT MUST INTEND ONLY THE GOOD EFFECT AND NOT THE BAD EFFECT 3 THE BAD EFFECT MUST NOT BE A MEANS TO BRINGING ABOUT THE GOOD EFFECT 4 THE GOOD RESULT MUST OUTWEIGH THE HARM PERMITTED 12