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TOPICS IN HEALTH POLICY (PHIL 6250)
Thursday 6:10-8:00 p.m., Phillips 413
Spring 2014
D. D. DeGrazia, Professor, Department of Philosophy, GWU (and Senior Research
Fellow, Department of Bioethics, NIH)
Rome 456, 994-6913, ddd@gwu.edu
http://departments.columbian.gwu.edu/philosophy/people/130
Office Hours: Th 4-5 and by appointment
Intended for graduate students but occasionally open to undergraduates with the
instructor’s prior permission, this course addresses the following topics in health policy
from an ethical and philosophical perspective: (1) human and animal research; (2) the
enhancement of human traits; and (3) health care allocation. After introducing the
subject matter, clarifying expectations, and reviewing some key ideas in ethical theory,
the course will examine specific issues organized under the themes listed in (1) – (3)
above. In examining each specific issue, the class will (a) confront ethical and
philosophical issues (e.g., moral status, personal identity, distributive justice) and (b)
analyze policy dimensions, focusing on relevant laws and regulations as well as proposals
for change.
Learning Objectives
1. to comprehend several leading approaches to moral reasoning, their similarities
and differences, and some of their chief strengths and weaknesses
2. to become familiar with several central topics in health policy from an ethical and
philosophical perspective, the major positions taken with respect to them, their
strengths and weaknesses, the empirical facts that bear on them, and their policy
dimensions
3. to become familiar with several contemporary readings on each of the central
issues addressed in the class
4. to engage leading approaches to moral reasoning in analyzing and addressing
these issues
5. to develop the ability to do the same (as in 4) in addressing an issue in health
policy (or biomedical ethics more broadly) that is not covered in class: the term
paper topic
6. to develop expertise on the term paper topic, as reflected in an independently
researched, well-written term paper and an oral presentation on one’s findings
Texts
 DeGrazia, Mappes, and Brand-Ballard (eds.), Biomedical Ethics, 7th ed. (New
York: McGraw-Hill, 2011) [BE]
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Presidential Commission for the Study of Bioethical Issues, Safeguarding
Children (PCSBI, 2013) (http://bioethics.gov/sites/default/files/PCSBI_PediatricMCM508.pdf) [SC]
President’s Council on Bioethics (PCB), Human Cloning and Human Dignity
(Washington, DC: PCB, 2002) [HC] (this and other PCB reports available
through http://bioethics.georgetown.edu/pcbe/ )
PCB, Beyond Therapy (Washington, DC: PCB, 2003) [BT]
PCB, Reproduction & Responsibility (Washington, DC: PCB, 2004) [RR]
Institute of Medicine, Chimpanzees in Biomedical and Behavioral Research
(Washington, DC: National Academies of Science, 2011) [CBBR] (available
through http://iom.edu/Reports/2011/Chimpanzees-in-Biomedical-andBehavioral-Research-Assessing-the-Necessity.aspx).
several articles available on Blackboard
Structure of Course by Date, Topic, and Assignment
INTRODUCTION
1/16 Review of Major Ethical Theories and Key Concepts
Reading: BE, chap. 1 (“General Introduction”).
HUMAN AND ANIMAL RESEARCH:
WHAT MEANS SHOULD WE TAKE TOWARD LAUDABLE ENDS?
1/23 The Permissibility of Using Human Subjects and the Issue of Placebo Controls
Readings from BE: Introduction to Chapter 4; “The Nuremberg Code”; “Declaration of
Helsinki”; Hellman and Hellman, “Of Mice but Not Men”; Marquis, “How to Resolve an
Ethical Dilemma Concerning Randomized Clinical Trials”; Litton and Miller, “A
Normative Justification for Distinguishing the Ethics of Clinical Research from the
Ethics of Medical Care.” Optional reading available at
http://www.hhs.gov/ohrp/policy/belmont.html: The Belmont Report.
1/30 Placebo-Controlled AZT (and other) Trials in Developing Countries
Readings from BE: Glantz et al., “Research in Developing Countries”; Brody, “Ethical
Issues in Clinical Trials in Developing Countries”; Participants in the 2001 Conference
on the Ethical Aspects of Research in Developing Countries, “Fair Benefits for Research
in Developing Countries.” Reading available on Blackboard: “Case Studies: The Havrix
and Surfaxin Trials.”
2/6 The Use of Children in Research
Reading: SC. Readings available on Blackboard: Gutmann, “Safeguarding Children—
Pediatric Research on Medical Countermeasures”; Wendler, “A New Justification for
Pediatric Research without the Potential for Clinical Benefit.”
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2/13 Cloning-for-Biomedical-Research and Embryonic Stem Cell Research
Readings from BE: NIH, “Stem Cell Basics”; McMahan, “Killing Embryos for Stem Cell
Research”; PCB, “The Moral Case against Cloning-for-Biomedical-Research.” Readings
from HC: “Executive Summary,” chap. 4 (“Scientific Background”), chap. 8 (“Policy
Recommendations”).
2/20 Animal Research
Readings from BE: CIOMS, “International Guiding Principles for Biomedical Research
Involving Animals”; Cohen, “The Case for the Use of Animals in Biomedical Research”;
Hettinger, “The Responsible Use of Animals in Biomedical Research”; DeGrazia, “On
the Ethics of Animal Research.” Additional readings available on Blackboard: Brody,
“Defending Animal Research”; Engel, “The Commonsense Case Against Animal
Experimentation”; Rowan, “Debating the Value of Animal Research.” Reading from
CBBR: pp. 1 – 7 (“Summary”).
THE ENHANCEMENT OF HUMAN TRAITS WITH BIOTECHNOLOGIES:
WHAT SORT OF PEOPLE SHOULD WE BE?
2/27 Enhancement with Biotechnology: Overview and the Enhancement of Cognitive and
Psychological Traits
Readings from BT: chap. 1 (“Biotechnology and the Pursuit of Happiness”), chap. 5
(“Happy Souls”), chap. 6 (“’Beyond Therapy’: General Reflections”). Readings from
BE: Kramer, “Makeover”; Freedman, “Aspirin for the Mind?”; Mills, “One Pill Makes
You Smarter.” Reading available on Blackboard: DeGrazia, “Enhancement
Technologies and Human Identity.”
3/6 Genetic Enhancement
Readings from BE: PCB, “Selecting Embryos for Desired Traits”; Walters and Palmer,
“Germ-Line Gene Therapy”; Michael Sandel, “Mastery and Gift”; Brock, “Genetic
Engineering.” Reading from RR: chap. 4 (“Modification of Traits and Characteristics”).
Optional readings available on Blackboard: Buchanan, “Human Enhancement and Moral
Status” and DeGrazia, “Genetic Enhancement, Post-Persons, and Moral Status: A Reply
to Buchanan.”
3/20 Moral Bioenhancement
Readings available on Blackboard: Douglas, “Moral Enhancement”; Faust, “Should We
Select for Genetic Moral Enhancement?”; Persson and Savulescu, “The Perils of
Cognitive Enhancement and the Urgent Imperative to Enhance the Moral Character of
Humanity”; Harris, “Moral Enhancement and Freedom”; DeGrazia, “Moral
Enhancement, Freedom, and What We (Should) Value in Moral Behaviour”
JUSTICE AND HEALTH CARE ALLOCATION:
WHAT SORT OF NATION SHOULD WE BE?
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3/27 Distributive Justice
Readings from BE: Introduction to Chapter 9; Buchanan, “Justice: A Philosophical
Review”; Nielsen, “Autonomy, Equality, and a Just Health Care System.” Reading
available on Blackboard: “Persad et al., “Principles for Allocation of Scarce Medical
Interventions.”
4/3 International Models and Perspectives
Deber, “Health Care Reform: Lessons from Canada”; Light, “Universal Health Care:
Lessons from the British Experience”; Altenstetter, “Insights from Health Care in
Germany”; Rodwin and Le Pen, “Health Care Reform in France—the Birth of State-Led
Managed Care”
4/10 The Affordable Care Act and Other Reform Proposals for the U.S.
Readings from BE: Palmisano et al., “Expanding Insurance Coverage Through Tax
Credits, Consumer Choice, and Market Enhancements”; Himmelstein and Woodhandler,
“National Health Insurance or Incremental Reform: Aim High, or at Our Feet?”;
Emanuel, “The Problem with Single-Payer Plans”; Emanuel and Fuchs, “Vouchsafe”;
DeGrazia, “Single Payer Meets Managed Competition.”
4/17 Student Presentations
4/24 Student Presentations
Requirements and Grading
 Attendance of every class (missed classes counting heavily in your class
contribution grade; penalty can be mitigated by notifying professor in advance
and arranging for reading notes to be submitted prior to class)
 Quality, quantity, and constructiveness of contributions to class discussions (20%)
 Presentation (20%)
 Research progress as determined by two office visits in which student presents
research plan (first visit) and outline, bibliography, and draft of introduction to
term paper (second visit) (10%)
 Term paper of 20-25 pages (50%)
Academic Integrity
The GW Code of Academic Integrity defines plagiarism as “intentionally representing
the words, ideas, or sequence of ideas of another as one’s own in any academic exercise;
failure to attribute any of the following: quotations, paraphrases, or borrowed
information,” (article I, sect. b). The penalty for plagiarism ranges from failure of the
assignment to expulsion from the university. Please avoid this grave error and bring any
questions about appropriate attribution to me.
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Support of Students Outside the Classroom
 Disability Support Services (DSS). Any student who may need an
accommodation based on the potential impact of a disability should contact the
DSS office (Marvin Center 242) at 4-8250 to establish eligibility and coordinate
reasonable accommodations. For further information refer to
gwired.gwu.edu/dss/.
 University Counseling Center (UCC). The UCC (4-5300) offers assistance and
referral to address students’ personal, social, and study skills problems. For
further information refer to gwired.gwu.ed/counsel.
Security
In the case of an emergency, the class should shelter in place if at all possible.