Core Curriculum Designation Proposal
Theological Understanding: Theological Explorations
TRS 142, “Medical Ethics”
SMC Core Curriculum Course Proposal Form
1. Name of Proposer: Tom Poundstone
2. Email address: tpoundst@stmarys-ca.edu
3. Department/Program of Proposer: Theology & Religious Studies
4. Name of Department/Program housing the course: Theology & Religious Studies
5. Name(s) of Program Director/Department Chair: Michael Barram
6. Course Acronym, Number and Title: TRS 142, “Medical Ethics”
7. Semester(s) in which course will be offered: Spring 2014 (probably)
8. How often is this course taught? Lately every other year, sometimes once a year
9. Course Prerequisites (if any): TRS 097, “The Bible & Its Interpretation”
10. Unit Value of Course: 1 course credit
11. Proper Audience for the course (delete those that don’t apply):
Freshmen
Sophomores
Juniors
Seniors
12. The Learning Goals for which the course is being submitted:
Theological Understanding:
Theological Explorations
Narrative
In TRS 142, the subfield of theology under consideration is applied moral theology, with the
specific application being healthcare, with a focus on the clinical encounter and the physicianpatient relationship. This course is taught in light of the Roman Catholic tradition, both from the
core understandings of the person integrally and adequately considered, and also with attention to
church teaching and contributions made to the moral debate by Catholic ethicists. Throughout
there is a dialogue between these Christian perspectives and the broader discipline of medical
ethics which has becoming increasingly secular in its approach.
This course explores the relation between moral values and the choices we as individuals
and as a society make about health care. Basic principles and methods of contemporary medical
ethics will be introduced. To test and explore the implications of those principles and methods, a
range of issues will be discussed, e.g., new reproductive technologies, the physician’s obligation to
treat, the patient’s right to refuse life-sustaining treatment, access to health care, quality of life, and
physician-assisted suicide. Throughout, we will aim at critically evaluating the arguments which
underlie the views presented. An attempt will be made to clarify why debates in medical ethics are
so contentious, assessing the strengths and weaknesses involved in various arguments, while
helping students sharpen their ability to reason about, develop, and cogently defend their own
view.
Students will be required to spend significant amounts of time reading both primary sources
and secondary texts, which will be the focus of lectures and discussions in the class. (For specifics
topics and readings, see the syllabus below.) The class format is a mixture of lecture, questions, and
discussion. Students are expected to be dialogue partners in the learning process, and they need to
be prepared to raise questions in response to the reading, engage in respectful dialogue and debate
with their classmates, and be prepared to respond to questions posed in class. Students are
frequently called upon to summarize the content of an article or chapter. Thus, for this and many
reasons careful reading of assigned materials is essential for success in this course.
Student learning is assessed through multiple means throughout the course. On a daily
basis, students are required to submit focused written reflections on the reading. More important
for assessment, two midterm examinations and a final examination will be administered. The
format of the exams will be a mixture of various types of questions: true-false, identification, shortanswer, and especially essays, all designed to assess mastery of the material covered. The exams
are comprehensive, incorporating both large concepts and themes and the small details which are
integral to true comprehension and crucial for building and assessing theories. The final exam is
cumulative. Also a final paper is required in which the student is asked to integrate and apply the
themes of the course to a particular topic in medical ethics.
SYLLABUS
Theology & Religious Studies 142
Medical Ethics
Course Description:
Ethics -- how we should live -- is at the core of medical practice. With the dramatic changes
in medical practice in recent decades, from new technologies, to changes in financing, to a changed
conception of patient rights, medical ethics has rapidly moved from obscurity to become one of the
most important areas of applied ethics.
This course will explore the relation between moral values and the choices we as individuals
and as a society make about health care. Basic principles and methods of contemporary medical
ethics will be introduced. To test and explore the implications of those principles and methods, a
range of issues will be discussed, e.g., new reproductive technologies, the use of fetal tissue in
research and therapy, court-ordered cesarean sections, the physician’s obligation to treat, the
patient’s right to refuse life-sustaining treatment, access to health care, quality of life, and
physician-assisted suicide. Throughout, we will aim at critically evaluating the arguments which
underlie the views presented. An attempt will be made to clarify why debates in medical ethics are
so contentious, assessing the strengths and weaknesses involved in various arguments, while
helping students sharpen their ability to reason about, develop, and cogently defend their own
view.
Learning Outcomes for the Core Curriculum Theological Understanding Learning Goal:
At the end of this course students will …
a. demonstrate an understanding of one or more aspects of Christian tradition and/or another
religious tradition or traditions, acquired through focused study in a sub-field of theology or
religious studies;
b. demonstrate an ability to explore religious questions from a believer’s point of reference and
from the critical perspective of the academy.
Learning Outcomes for the major or minor in Theology & Religious Studies:
Major Content: At the end of this course students will…
a. Demonstrate an understanding of the Christian theological tradition through an exploration of
specific topics in theology and the Bible;
b. Demonstrate an understanding of how Christian thought and/or practice has developed in a
specific historical period;
c. Demonstrate an understanding of the implications of the Catholic concept of the fundamental
dignity of the human person.
Major Skills: At the end of this course students will…
a. Demonstrate an ability to employ contemporary theories and methods of theology and/or
religious studies in analyzing religious beliefs, texts, and/or practices;
b. Demonstrate an ability to explain, analyze, and evaluate multiple informed perspectives in
contemporary debates about theological and ethical issues;
c. Demonstrate an ability to evaluate the interplay between religion and social, cultural, and/or
political phenomena.
Readings and Topic Schedule
1. INTRODUCTION: ETHICS & MORALITY, NORMATIVE & DESCRIPTIVE ETHICS
Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, third edition (1989): p.
23, fn. 16.
Tom Poundstone, “Locating ‘Medical Ethics’ in the Discipline of Ethics”
2. MEDICAL ETHICS & CHRISTIAN ETHICS
Gilbert Meilaender, “Introduction” & “Christian Vision” Bioethics: A Primer for Christians (1996):
pp. ix-xi, 1-10.
Nigel M. de S. Cameron, “A Theological Mandate for Medicine,” in The Changing Face of Health Care,
pp. 35-44.
Edmund Pellegrino and David Thomasma, Helping and Healing: Religious Commitment in Health
Care, pp. 6-10.
Lisa Cahill, Theological Bioethics, pp. 1-19.
Tom Poundstone, “Is This a Work of Christian Ethics?” Court-Ordered Cesarean Sections: A Case
Study in Medical Ethics and Moral Theology (2000)
Richard McCormick, “Surrogacy: A Catholic Perspective” Corrective Vision: Explorations in Moral
Theology (Sheed and Ward, 1994): pp. 208-209.
3. MEDICAL ETHICS & CHRISTIAN ETHICS (CONTINUED)
Richard A. McCormick, “Does Christianity Make a Difference?” Christian Bioethics (1995), volume 1,
pp. 97-101.
Poundstone, “Corrective Vision”
4. THE DOMAIN OF ETHICS
The Doctor
Robert Coles, “Intellect and Character,” The Chronicle of Higher Education, September 22, 1995
Richard M. Gula, “Sensitivity,” Reason Informed by Faith: Foundations of Catholic Morality (New
York: Paulist Press, 1989).
James Rest, “The Major Components of Morality”, from William M. Kurtines and Jacob L. Gewirtz,
eds., Morality, Moral Behavior, and Moral Development (New York: Wiley, 1984): pp. 24-36.
Richard A. McCormick, “Does Religious Faith Add to Ethical Perception?”
5. ETHICAL THEORIES
Case Study: A Potential Kidney Transplant
Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, fifth edition (Oxford,
2001): pp. 337-383.
Tom Poundstone, “John Rawls”
Ethics Committee of the American Fertility Society, “Ethical Considerations of the New
Reproductive Technologies,” Fertility and Sterility, vol. 53, no. 6, sup. 2 (June 1990): p. 1S.
Richard A. McCormick, “If I Had Ten Things to Share with Physicians”
6. PROFESSIONALS’ OBLIGATIONS AND PATIENTS’ RIGHTS
The Hippocratic Oath
World Medical Association, “Declaration of Geneva” (1948)
American Medical Association, “Principles of Medical Ethics” (1980)
American Medical Association, “Fundamental Elements of the Patient-Physician Relationship”
(1994)
Ralph Crawshaw, et al., “Patient-Physician Covenant” (1995)
Edmund Pellegrino, “The Virtuous Physician and the Ethics of Medicine”
Norman Daniels, “The Ideal Advocate and Limited Resources”
7. COMPETING MODELS OF THE PHYSICIAN-PATIENT RELATIONSHIP
Edmund Pellegrino, “Altruism, Self-Interest, and Medical Ethics”
Robert Veatch, from “Medical Ethics: Professional or Universal?”
William F. May, “Code and Covenant or Philanthropy and Contract?”
Robert Veatch, “Models for Ethical Medicine in a Revolutionary Age”
David Thomasma, “Beyond Medical Paternalism and Patient Autonomy: A Model of Physician
Conscience for the Physician-Patient Relationship”
James Childress and Mark Siegler, “Metaphors and Models of Doctor-Patient Relationships”
8. INFORMED CONSENT
United States Court of Appeals, Canterbury v. Spence (1969) x 2
Jay Katz, “Physicians and Patients, “A History of Silence”
Ruth Faden and Tom Beauchamp, “The Concept of Informed Consent”
Robet J. Levine, “Informed Consent: Some Challenges to the Universal Validity of the Western
Model”
Terrance Ackerman, “Why Doctors Should Intervene”
Case Study: “Proxy Consent for a Medical Gamble”
9. CONFIDENTIALITY AND CONFLICTS OF RESPONSIBILITY
Tarasoff v. Regents of the University of California (1976)
“Some details behind the Tarasoff case”
“Concerning the Tarasoff Case: letters to Dear Abby”
Reisner v. Regents of the University of California (1995)
Mark Seigler, “Confidentiality in Medicine -- A Decrepit Concept”
Morten E. Winston, “AIDS, Confidentiality, and the Right to Know”
Barron Lerner, “When a Docor Stumbles on a Family Secret,” New York Times, September 16, 2003
Leonard Fleck and Marcia Angell, “Please Don’t Tell: A Case about HIV and Confidentiality”
Case Study: “AIDS and a Duty to Protect”
Case Study: “A Duty to Warn, an Uncertain Danger”
10. FIRST MID-TERM
11. HUMAN EXPERIMENTATION
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research,
The Belmont Report
“The Nuremberg Code” (1949)
World Medical Association, “Declaration of Helsinki”
Robert J. Levine, “Selection of Subjects,” and “Deception,” Ethics and Regulation of Clinical Research,
second edition (Yale, 1986).
Possible In Class Video: Obedience to Authority
Arthur L. Caplan, “The Intrusion of Evil: The Use of Data from Unethical Medical Experiments”
Case Study: “Willowbrook”
Case Study: “Publishing Unethical Research”
12. EXPERIMENTAL DESIGN AND RANDOM CLINICAL TRIALS
Leon Eisenberg, “The Social Imperatives of Medical Research”
Rob Stein, “Procedure on Women in Labor Adds Risk: Study Urges Halt to Episiotomies,”
Washington Post, May 4, 2005
Alex Berenson & Gardiner Harris, “Pfizer Says 1999 Trials Revealed Risks with Celebrex,” New York
Times, February 1, 2005
Benjamin Freedman, “Equipoise and the Ethics of Clinical Research”
Marcia Angell, “The Ethics of Clinical Research in the Third World”
Harold Varmus & David Satcher, “Ethical Complexities of Conducting Research in Developing
Countries”
Danstan Bagenda & Philippa Musoke-Mudido, “We’re Trying to Help Our Sickest People, Not Exploit
Them”
Peter Clark, “The Ethics of Placebo-Controlled Trials for Perinatal Transmission of HIV in
Developing Countries”
Robert Levine, “The ‘Best Proven Therapeutic Method’ Standard in Clinical Trials in Technologically
Developing Countries”
Donald G. McNeil Jr., “Two Cheap Drugs Combined Can Prevent H.I.V. in Newborns,” New York
Times, July 10, 2004
13. HANDICAPPED NEWBORN
Video in class: Who Shall Live? (The Johns Hopkins Case)
James Gustafson, “Mongolism, Prenatal Desires, and the Right to Life”
Stephen k Paulson, “Request to Play Football Spiked for 20-Year0Old with Down Syndrome,” Contra
Costa Times, September 13, 1996
Raymond S. Duff & A.G.M Campbell, “Moral and Ethical Dilemmas in the Special-Care Nursery,’ The
New England Journal of Medicine, 1973, pp. 890-894
Richard McCormick, “To Save or Let Die: The Dilemma of Modern Medicine”
Darrel W. Amundsen, “Medicine and the Birth of Defective Children: Approaches of the Ancient
World”
Baruch Brody & H. Tristram Englehardt, “Defective Newborns”
14. WITHDRAWAL OF TREATMENT
Joanne Lynn & James Childress, “Must Patients Always Be Given Food and Water?”
Supreme Court of New Jersey, In re Quinlan (1976)
United States Supreme Court, Cruzan v. Director, Missouri Department of Health (1990) (two sets of
excerpts: the first to establish the facts of the case and the medical condition, the second
about the legal ruling.)
Steven J. Miles, “Informed Demand for “Non-Beneficial” Medical Treatment”
Richard A. McCormick, S.J., “Moral Considerations Ill-Considered”
Congregation for the Doctrine of the Faith, “Responses to Certain Questions of the United States
Catholic Bishops Concerning Artificial Nutrition and Hydration”
15. REFUSAL OF TREATMENT
Video outside class: Dax’s Case
Dax Cowart and Robert Burt, “Confronting Death: Who Chooses, Who Controls?” Hastings Center
Report, January-February 1998
California Court of Appeals, Bouvia v. Superior Court
Gregory Pence, “Elizabeth Bouvia and Voluntary Death”
George J. Annas, “Elizabeth Bouvia: Whose Space Is This Anyway?”
Paul Longmore, excerpts from The Electric Edge
“Disability Rights Activists Cautiously Celebrate Supreme Court Victory -- Ready to Advocate
Against State Measures,” Not Dead Yet, June 26, 1997
Philip C. Hébert and Michael A. Weingarten, “The Ethics of Forced Feeding in Anorexia Nervosa,”
Canadian Medical Association Journal (1991): pp. 141-144.
Massachusetts Medical Society, “Total Exsanguination”
Plus two excerpts with background material on Jehovah’s Witnesses beliefs: “There is Life in the
Blood” & Ruth Macklin, “Consent, Coercion, and the Conflicts of Rights”
Gloria Maxson, “Whose Life is it, Anyway? Ours, That’s Whose!”
16. DEFINING DEATH
President’s Commission for the Study of Ethical Problems in Medicine, “Why ‘Update’ Death?”
Charles M. Culver & Bernard Gert, “The Definition and Criterion of Death”
Daniel Wicker, “The Definition of Death and Persistent Vegetative State”
Alexander Capron, “Anencephalic Donors: Separate the Dead from the Dying,” Hastings Center
Report, 1987 Feb; 17(1): 5-9.
17. VOLUNTARY ACTIVE EUTHANASIA
James Rachels, “Active and Passive Euthanasia”
Tom L. Beauchamp and James F. Childress, “Rachels on Active and Passive Euthanasia”
Congregation for the Doctrine of the Faith, “Declaration on Euthanasia”
Vatican Condemns Dutch Euthanasia Vote
Anonymous, “Its Over Debbie” (with “Notes on Euthanasia”)
Timothy E. Quill, “Death and Dignity: A Case of Individualized Decision Making”
The Oregon Death With Dignity Act
Oregon Public Health Division, “Oregon’s Death with Dignity Act - 2011”
James F. Keenan, “The Case for Physician Assisted Suicide,” America, November 14, 1998, pp. 14-19
18. PHYSICIAN ASSISTED SUICIDE
American Medical Association, “Physician Assisted Suicide”
U.S. Supreme Court, Vacco v. Quill
U.S. Supreme Court, Washington v. Glucksberg
Richard McCormick, “Physician Assisted Suicide: Flight from Compassion”
James Breshnahan, “Palliative Care or Assisted Suicide?”
William F. May, “Some Skeptical Reflections on Active Euthanasia”
19. SECOND MID-TERM EXAMINATION
20. ABORTION: THE LEGAL ISSUE
Members of the Supreme Court: 1973, 1992, 2008
U.S. Supreme Court, Roe v. Wade (1973)
U.S. Supreme Court, Planned Parenthood v. Casey (1992)
Black’s Law Dictionary, “Stare Decisis”
Poundstone, “Supreme Court Jurisprudence and Prenatal Life”
Beauchamp & Childress, “Positive Rights and Negative Rights”
21. ABORTION: THE MORAL DEBATE
Pope John Paul II, from Evangelium Vitae (The Gospel of Life)
John Allen, “Under Vatican Ruling, Abortion Triggers Automatic Excommunication,” National
Catholic Reporter, January 17, 2003.
Judith Jarvis Thomson, “A Defense of Abortion”
Mary Anne Warren, “On the Moral and Legal Status of Abortion”
Richard A. McCormick, S.J., “Abortion: The Unexplored Middle Ground”
Daniel Callahan, “An Ethical Challenge to Prochoice Advocates”
22. PRE-NATAL DIAGNOSIS AND EMBRYO REDUCTION PROCEDURE
Leon R. Kass, “Implications of Prenatal Diagnosis for the Human Right to Life”
Ted Peters, “In Search of the Perfect Child: Genetic Testing & Selective Abortion”
Adofo Uribarren, et al., “Selective Embryo Reduction in a Sextuplet Pregnancy”
Case Study: “Selective Termination of Pregnancy”
23. EMBRYO EXPERIMENTATION, CLONING, & STEM CELL RESEARCH
Tom Poundstone, “A Catholic Response to Embryo Experimentation”
Plus much more….
24. JUSTICE AND HEALTH CARE
Robert M. Veatch, “Justice, the Basic Social Contract, and Health Care”
Allen E. Buchanan, “The Right to a Decent Minimum of Health Care”
H. Tristram Engelhardt, Jr. “Rights to Health Care, Social Justice, and Fairness in Health Care
Allocations: Frustrations in the Face of Finitude”
Paul Menzel & Donald Light, “A Conservative Case for Universal Access to Health Care”
James Dwyer, “Illegal Immigrants, Health Care, and Social Responsibility”
25. INTERNATIONAL MODELS AND DOMESTIC DEBATES ON HEALTH CARE REFORM
Michael Moore, Sicko
TBA
26. JUSTICE, RATIONING, AND THE ALLOCATION OF MEDICAL RESOURCES
George J. Annas, “The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ
Transplantation”
Carl Cohen, et al., “Alcoholics and Liver Transplantation”
Daniel Callahan, “Aging and the Ends of Medicine”
Norman Daniels, “Why Saying No to Patients in the United States is So Hard: Cost Containment,
Justice, and Provider Autonomy”
Marcia Angell, “The Doctor as Double Agent”
“Case Study: Allocating Livers”
27. FINAL EXAMINATION IN CLASS
FINAL PAPER DUE BY NOON ON FRIDAY IN EXAM WEEK