Syllabus PH 452/652 Ethics of Health Care / Boston University/ Spring 2007
Dr. Corine Pelluchon
Office: Room 418 STH, 745 Commonwealth Avenue.
Office Hours: TU 1:30-3; THR 11-12: 30. Email: corinep@bu.edu
Tel. 617. 358. 3622
Class meetings: TU 3:30-5, THR 3:30-5.
A. Course Description
This course will explore the conceptions or the assumptions which underlie the current ethical
and political standards of health care. We will present the prevailing principles and norms that
are referred to in medical and biomedical ethics and in the allocation of health care by
highlighting the conception of man and society which supports them. We will focus on the
procedural ethics and on the conception of justice in Rawls : is the priority of Justice over the
Good sufficient to introduce a reflection on the common Good in a democracy, that is to say
in a pluralistic secularized society, or does it betray an atomistic conception of man and a
misunderstanding of autonomy ? Does a content-less bioethics, whose key-principle is that of
permission, enable us to face the moral and political dilemmas we encounter, such as liberal
eugenics or any version of Huxley’s Brave New world where man’s nature can be changed
through genetic engineering ? These questions will lead us to reassess some conceptions ( of
man, on natural right, on science) which come from modern Enlightenment and its project of
mastery which has been supporting the use of technology and the exercise of human will but
which may become irrelevant today. Such inquiry will invite us to examine the Philosophy of
Human Rights : what is wrong with negative freedom ? Can we continue to draw rights from
man as a moral agent or do we need another foundation of ethics and justice? Is the reference
to man as a species relevant? The core of the problem is the understanding of selfhood : what
“image of man” can be opposed to that of science in a secularized world? Is Intersubjectivity
the - only - answer to such question which stresses the necessary reference to ontology in
ethics of health care and in politics?
B. Course Schedule
1. I. Ethics of Health Care and Political Philosophy
1. The current ethical and political standards of health care ( 5 Meetings : JANV 16-30)
- Decision making in a pluralistic society and the problem of relativism
- The priority of Justice over the Good in the procedural ethics : J. Rawls.
- The application of procedural ethics in Health Care : Engelhardt’s content-less
bioethics and the principle of permission
2. What conception of man supports such ethics of health care ? ( 5 Meetings : FEV 115)
-
The critique of the atomistic self ( M. Sandel and A. MacIntyre)
The concerns of the debates between liberals and communautarians in the
health care policies
Virtue ethics ( its philosophical roots and its current application in Pellegrino)
3. Health Care and Human Rights ( 5 Meetings : FEV 20-MARCH 6)
- The declarations and the reference to human rights in Health care
- The modern conception of man and natural right from T. Hobbes ; the critique
of the Enlightenment’s project of mastery of man and nature and the fact-value
distinction ( L. Strauss)
-
The problem of negative freedom ( and of the Philosophy of Human Rights)
Reflections on happiness ( from J. Locke and the Declaration of Jefferson till
A. Huxley’s Brave New World)
II. Ontology and Politics
1. The critique of procedural ethics and the overcoming of post-modernism ( 6 Meetings
: MARCH 8-AVRIL 3)
- The new foundation of ethics in The imperative of Responsibility of Jonas ( the
critique of the former ethics and the responsibility toward the subsequent
generations and toward nature; the problems of Jonas’s Philosophy of Organism
and the political problems of the heuristic of fear) ( 2 Meetings)
- Some recent texts of Habermas on the (biological) conditions of freedom and
rights ; the reference to man as a species and the change of paradigm ( 2
Meetings)
- Which “image of man” in a pluralistic secularized society? Theology and
Bioethics, Religion and Philosophy, toward a pluralistic reason. Readings of
some extracts of The Sickness unto Death ( Kierkegaard) ( 2 Meetings)
2. Another definition of Selfhood? ( 6 Meetings : AVRIL 5-26)
- The critique of Heidegger’s Dasein. Bezeugung, Selbstheit, Selbst-Ständigkeit,
Sorge and In-der-Welt-Sein. ( 2 Meetings)
- From Rosenzweig to Lévinas : the breach of autonomy and the transcendence
of the Other ( 2 Meetings)
- L’ipséité et le cogito brisé in Oneself as Another ( Ricoeur) ( 2 Meetings)
Summarizing Reflections ( 1 Meeting : May 1)
B. Texts
REQUIRED:
Recommended :
1. The Nicomachean Ethics, Aristotle, Books II and IV, Translated by H.
Rackham, Harvard Univ. Press, 1926, ( USBN-0-6749908)
2. The Foundations of Bioethics, T. H Engelhardt, Oxford Univ. Press, 1996, (USBN-0195036085)
3. The imperative of Responsibility, Hans Jonas, University of Chicago Press, 1985,
(ISBN-02-2640597-4)
4. Groundwork of the Metaphysic of Morals, in Kant, Pratical Philosophy, trans. M. J.
Gregor, 49-108, Cambridge Univ. Press, (IBSN-0-1987518-X)
5. Outside the Subject, Emmanuel Lévinas, Standford Univ. Press, 1993, ( USBN-080472198-8) and Totality and Infinity : An Essay on Interiority, Kluwer Academic
Publisher, 1980, 4 th edition, ( USBN-9-0247228-8)
6. After Virtue, Alasdair MacIntyre, University of Notre Dame, Second edition,1984, (
ISBN-0-268-00610-5)
7. Utilitarism, John Stuart Mill, Hackett, ( USBN-0-87220-606-8)
8. Theory of Justice, John Rawls, Belknap Press, New edition, 2005, ( ISBN-0674017722) and Political Liberalism, Columbia Univ. Press, expanded edition, 2005,
( USBN-0-231130899)
9. Oneself as Another, Paul Ricoeur, Univ. of Chicago Press, Nex edition, 1995, (USBN0-226713296) and “The three levels of medical judgement”, In The Just, translated by
D. Pellauer, Univ. of Chicago Press, (ISBN-0-22671340)
10. Liberalism and the Limits of Justice, Michael Sandel, Cambridge Univ. Press, 1982, (
USBN-0-521-562988)
11. “Reflections on liberty”, in The View from Afar, Claude Lévi-Strauss, transl. J.
Neugroschel, Univ. of Chicago Press, 1992, ( USBN-0-226474747)
12. The Sources of the Self, Charles Taylor, Cambridge, MA, Harvard Univ. Press, 1989, (
USBN-0-674824261)
13. Patient Autonomy and the Ethics of Responsibility, Alfred I. Tauber, MIT Press,
2005, (ISBN- 0-262-70112-X)
C. Course Requirements
Regular punctual attendance of all students is required. More than four unexcused absences
will result in a reduction of the final grade by 1/3 of a letter grade for each class missed in
excess of four (e.g., a student with a “B” average and with six unexcused absences will
receive a final grade of “C+”). There will be three papers due ( 4-7 pages each), a final exam (
comprehensive), and a component of informed participation. In the papers, you are required to
articulate and evaluate a particular issue from the readings and critically consider relevant
arguments and counter arguments. The final examination will take place at the date time, and
place specified in the course schedule. It will be “comprehensive”: you are responsible for all
the readings, assignments, and class discussion.
D. Grades
Final grades will be averaged as follows: Papers 3/5, Final Exam 1/5, Informed Participation
1/5. As should be expected, earning high grades will be challenging and require exceptional
commitment, informed arguments, clear critical focus and balanced judgment on the part of
the student.
E. Plagarism and Academic Conduct
University rules governing plagiarism will be maintained. Suspected academic misconduct
will initiate consultation with the Dean. If the course professor and the Dean judge that
misconduct has occurred, an “F” grade will be assigned to the paper. Similar considerations
apply to in-class written work. Students are encouraged to review the CAS Academic
Conduct Code (copies available in room 105 of CAS).