Bio-Medical Ethics
Hey there, people of the internet. Below you will find the bioethics course I created for my students during the fall and spring semesters of 2020-2021 at North Carolina State University. On this page, I have combined components of each semester, including several videos that my students created as part of their class project. I hope you enjoy exploring the course. Please let me know if you need help accessing any of the readings or want me to grade your paper. If you are currently taking the course through NCSU, please do not rely on the information you find here, as much of it is outdated.
Welcome
Hello and welcome!
I’m glad you’re taking this course. In this section you will find many course materials, including the syllabus, a link to submit your video introduction and view those posted by your classmates, information for using My Mediasite to upload your videos, a link to the Student Discussion Forum, and a link to our class Mediasite channel, where you can see all the video lectures in one place and post and read the comments for each video.
There are a few things to do this week, which begins January 19:
– Read the syllabus thoroughly.
– Watch this week’s video lecture.
– Find out what group you’re in for the group project and what that group’s project due dates are.
– Familiarize yourself with this Moodle page.
– Share your 1-2 minute video introduction.
In this week’s lecture, I’ll be providing a full orientation to the course, explaining the syllabus and all the course components, explaining how to use My Mediasite, and more, so be sure to tune in. As always, if you have any questions please let me know.
I have aimed for excellence in creating this course and communicating with you, so if you notice any errors or anything missing, broken links, videos not working, etc., please do let me know.
Take care of yourselves. Enjoy the class!
Returning to Campus
Hello Again.
This week we will be discussing one of the most central and important question of all of our lives at this moment: should we be returning to campus? Our lives may depend on the answer, and on NCSU’s answer, in particular. And yet, here you are.
There are three articles to read for this week, which begins on August 17:
1. “College Campuses Must Reopen in the Fall. Here’s How We Do It.” Paxson
2. “The Misguided Rush to Reopen Universities,” Mikhalevich and Powell
3. “The Hard Truth About the Fall,” Sorrell
The first article was written by Christina Paxson, the president of Brown University, and appeared in The New York Times. Paxson argues that returning to campus at this time is essential to the future of higher education. The other two articles argue against returning to campus.
Your assignment this week is to map an argument presented in one of the articles. Mapping an argument means symbolizing the argument to show how all of its different parts fit together. In this week’s lecture, I explain how to map an argument, and I map the argument presented in the first article for you. You can view my map below at the link titled “Sample Argument Map.” Take some time to study my sample map carefully. Then map one of the remaining arguments (NOT from the article I already did for you!) I will share the best argument maps you create anonymously with the class, so if you don’t want me to share yours, please let me know. Submit your map through the assignment link below (“Argument Map Assignment”) before 9pm on Sunday, 8/23.
This is a challenging assignment, and I go over all
the details in the video lecture, so please watch it carefully, and
prepare to take breaks as you watch.
As always, let me know if you have any questions by commenting on the video or emailing me. You can also ask your classmates your questions. They may have some good ideas or insights to share.
Be well.
Philosophical Foundations of Bioethics
We will spend two weeks discussing the philosophical foundations of bioethics. During the first week, which begins 2/1, please read the piece titled, “Introduction,” by Kuhse and Singer. Kuhse and Singer lead us on a fast-paced tour through the field of ethical theory. Be on the lookout for ways in which these theories show up in discussions of specific bioethical issues throughout the course. This introductory essay moves quickly through each of the theories, with only a couple of paragraphs devoted to each one. We could easily spend an entire semester working through this material more thoroughly, and if you take an introductory course in ethics, that is probably a lot of what you would be doing.
During the second week, beginning 2/8, we’ll be discussing “Ethics of Caring in Environmental Ethics: Indigenous and Feminist Philosophies.” This essay presents an important alternative framework for thinking about ethics and human wellbeing. Ethics of care challenges the standard conceptions of ethics that have dominated Western philosophy for many centuries, opening up new ways of thinking about ethics. The feminist and Indigenous philosophies we will read about center our interdependence with other humans and ecological systems, and our roles within the caring relationship-webs that make up our lives. These themes will repeatedly come into play as the semester progresses and we study specific issues within bioethics.
Nature
For our next unit, we will be discussing issues related to health, well being, and the natural world. Beginning the week of 2/15, we’ll read an article from The New York Times, “How Humanity Unleashed a Flood of New Diseases,” which examines how humanity’s lifestyle choices have resulted in the spread of disease. We’ll also read a short article about philosophical issues that arise when thinking about the health of our microbiome – these are the tiny organisms that live around and within us. In “Health, Ecology, and the Micrbiome,” we’ll consider a variety of perspectives on the relationship between these organisms and ourselves, and we’ll note how these perspectives connect to other issues we’ve discussed, including Covid-19, social inequalities, and feminist ethics of care. The following week, beginning 2/22, we’ll watch a full-length film about how climate change impacts coral reefs. The unifying theme of these two weeks is humanity’s connection to nature, and how this in turn affects our own health and well being.
Link to Chasing Coral
Age
Discussions of children and of age-related issues within bioethics will take us through the next two weeks. We will also now begin viewing student-created videos for each of the assigned readings. Be sure to view these videos created by your classmates, and post questions and comments you have in the comments section on each video.
During the first of these two weeks, which begins on 3/1, we will read a chapter of The Routledge Handbook of Philosophy of Childhood and Children, entitled “Children and Health.” This chapter is structured around three considerations that uniquely affect children who are ill: that they are embodied, enacted, and situated. Children are embodied in that they experience dynamic bodily changes constantly. Being enacted involves the choices and limitations that adults enact on children’s behalf, as well as children’s susceptibility to epistemic injustice (both testimonial and hermeneutical – make sure you know what these mean). And children are situated within families, which healthcare professionals often treat as a basic unit. These considerations make children’s vulnerabilities especially pronounced and give rise to demanding healthcare challenges when children become patients. There are a number of examples of ill children discussed throughout this piece. Consider how each example relates to one of the three points that frame the chapter overall. Also note what the authors point out at the outset: that children’s vulnerabilities do not entirely set them apart from the rest of us. We are all vulnerable, they write, and children’s “dependence on us is a more naked version of our own dependence, vulnerability and fragility.” If you’ve been ill yourself, or dependent on the healthcare system, in what ways did your age impact the care you received?
During the week beginning 3/8, we will read an article written by NCSU alum Cambray Smith. Smith argues that in most cases, parents are ethically required to vaccinate their children against HPV. Her conclusion is based on a collectivist approach to human health, which recognizes our interdependence and the extent to which our choices about vaccination affect one another. Smith is aware of the complexities of increasing the use of the HPV vaccine. For one, the vaccine is targeted to adolescents aged 11 and 12, since it is most effective before sexual activity begins. This raises several difficulties since parental consent is almost always required for 11- and 12-year-olds to receive the vaccine. Additionally, because HPV is only spread through sexual contact, parental decisions about whether to vaccinate are often based on the parents’ sexual values, which frequently do not align with those of their child, as well as the parents’ (often false) beliefs about their child’s future sexual conduct. Smith believes that parents ought to vaccinate their male and female children. This is because, although females face more adverse effects from acquiring HPV, vaccinating males can still help protect them against some dangerous health effects, boost the community’s immunity, protect the sexual partners of males, and work against existing stigmas regarding female sexuality.
Later in the paper, Smith turns her attention to additional contextual features of the issue of HPV vaccination. She writes, “medicine can never be separated from the social environment in which it exists.” She discusses the conflict between individual rights and public safety, the role of racism and economic differences in shaping people’s views towards vaccination, and the tension between a capitalist framework and a paternalistic one for thinking about human health. She ultimately advocates a “maternalistic” framework, rooted in feminist ethics of care. Her approach prioritizes open and honest dialogue among parents, adolescents, and physicians, and respects and elevates young people as competent and independent choice-makers.
Gender
For our unit on gender, which will span two weeks, we will begin with a discussion of abortion. During the week beginning 3/15, we will read two classic pieces on abortion: “A Defense of Abortion,” by Judith Jarvis Thomson and “Why Abortion is Immoral,” by Don Marquis. Thomson argues that abortion is not immoral in most cases, while Marquis argues that it is. Both essays proceed from a basic moral principle that relevantly similar cases ought to be treated alike. Both also agree that the wrongness of abortion cannot be established by arguing that a fetus is a person. For Thomson, this is because even if the fetus is a person, it may still be okay to end its life. She hopes to make this point by considering hypothetical scenarios that share relevant features with abortion. For Marquis, the personhood argument ultimately fails because it leaves those who argue for and those who argue against abortion at a standstill. For Marquis, both sides of the abortion debate are unable to defend their respective views of the fetus’ status. Marquis goes on to argue that ending the life of a fetus is as wrong as ending the life of an adult human because both types of killing share the feature that makes killing wrong: depriving something of a future-like-ours.
The second part of the unit on gender, during the week beginning 3/22, will examine sex-based inequality. We’ll read Gloria Steinem’s famous essay, “If Men Could Menstruate.” Steinem claims that claims that “logic is in the eye of the logician,” and that oppressor groups will always seek to justify existing inequalities. She imagines a world in which men menstruate and women don’t, and claims that in such a world, menstruation would be viewed very differently. Rather than being treated as shameful and secretive, as it currently is, it would be seen as “enviable, boastworthy, and masculine.” What is your experience with menstruation? If you menstruate, have you ever felt shame or embarrassment related to menstruating? If you don’t menstruate, have you ever talked about it with someone who does? What are your opinions about it? What are your memories of learning about menstruation or times that the topic has come up? Do you think Steinem is correct in her assertions?
Steinem’s essay will be paired with another discussion of sex-based inequality, the UN’s policy brief concerning the impacts of Covid-19 on women. The policy brief details unique harms that women are experiencing as a result of the pandemic due to their lower economic status, disproportionate impacts on their health, their overrepresentation as unpaid care workers, their increased susceptibility to domestic violence, and the fact that all of these impacts are amplified in regions characterized by conflict and fragility. These impacts are complex and interconnected and the policy brief does a good job of outlining these complexities. It also insists on a global response to the pandemic that views the issue through a gender-based lens, includes women’s voices, and works for transformative change towards a more equitable future.
The interesting thing to ask about this week’s readings is how they intersect. How is Covid-19’s unique impact on women related to sexism and oppression, and to the way that power is distributed? Which aspects of the impact outlined in the UN’s policy brief are related to women’s inferior status in societies around the world? What sorts of transformative changes do you imagine could result from formulating an equitable response to the pandemic?
Race
We will begin this unit by considering indigenous people around the world and in the U.S. During the week that begins 3/29, we’ll read an article about Aboriginal bioethics, “Is There an Aboriginal Bioethic?” This article examines the health disparities faced by Aboriginal Australians and considers the ways that the healthcare system in Australia is shaped by white values. The authors argue that a greater effort should be made to understand the ethics and traditions of Aboriginal people in order to devise treatments and services that are more appropriate for these populations. Be sure to watch the accompanying video about the impacts of Covid-19 within the Navajo Nation in the U.S. One question to ask this week is how the U.S. response to Covid-19 within the Navajo Nation perpetuates the types of inequalities that are discussed in the longer essay.
We will begin the following week, which starts on 4/5, by reading “Differences from Somewhere: The Normativity of Whiteness in Bioethics in the United States.” This is the most academically challenging piece we will encounter throughout the semester, and those whose task is to present it in a video to the class certainly have their work cut out for them. The main idea is this: bioethicists, who are overwhelmingly white, need to notice that their whiteness shapes the dominant conversations (and concepts and values) within the field, and that this perpetuates the exclusion of other groups. The author also discusses the historical relevance of whiteness as a social category (she’s not talking about skin color!), and its relationship to Fox’s category of “American-ness.” She claims that many attempts to diversify bioethics fail to recognize the dominance of white language and culture, and therefore risk deepening cultural differences. Finally, she points to some specific suggestions for problematizing and decentering whiteness in bioethics in the ways that she advocates. My recommendation to the group that’s been assigned this piece is to present these main points clearly and then find a way to motivate your classmates to think more deeply about their own social position within the classroom and the university.
Finally, for this unit, we will consider the disparate maternal mortality rates faced by black women, by reading a New York Times article, ““Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis.” This article looks more deeply at the connection between racism and public health, specifically the health of black women. The article reveals vast racial disparities in how likely it is that someone will die due to pregnancy or childbirth: 3 to 4 times more likely for black women than white women. The author attributes these disparities to pervasive racial bias in health care, as well as “weathering” experienced by black women. Weathering is the effect, including toxic stress, of prolonged exposure to systemic racism in our culture. Alongside this article, we will explore a website devoted to tracking race and ethnicity data related to Covid-19.
The State
This week week we will be discussing whether health care is a human right. In “Is There a Right to Health Care and If So, What Does it Encompass,” Norman Daniels bases the right to health care on a right to equal opportunity. He argues that this framework is useful for addressing some of the complexities that arise when thinking about health care. The essay by Gawande in The New Yorker takes a different approach. Gawande shares a number of stories of individuals, their health challenges, and their beliefs about health care. Ultimately, he argues that progress on the health care front will require that we regain trust in our collective power to work towards the common good. I did not record this week’s video with the Powerpoint on the screen, so I recommend you pull up the Powerpoint below to follow along as you watch the lecture.