Fall 2020– Tu/Th 11:30-12:50 p.m., via Zoom
https://washington.zoom.us/j/97948741821
Meeting ID: 979 4874 1821
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Instructor: Sara Goering
Office: Savery 386
Email: sgoering@uw.edu
Office hrs: Tu/Th 1:30 -2:30 p.m. and by appointment
Zoom for office hours: https://washington.zoom.us/j/92915461219
TAs: Elina Castellano Tejada and Nicolai Wohns
Brief description: We are in the midst of a global pandemic! This course will cover related areas of medical ethics, including fair distribution of medical goods, legacies of racism in medicine, autonomy, informed consent, and the right to refuse treatment; and end of life care (advance directives and assisted suicide). Philosophical and legal texts, journal articles from the medical humanities, ethics and medicine, and in-depth case studies will be used to raise and examine these issues. Every week will include a video clip, podcast, or film to help paint a more robust picture of some of the difficulties medical workers, patients and families face.
Students will learn to apply the distinct forms of reasoning from major moral theories to issues in medicine, to recognize moral problems in health care and medical decision making, to formulate their own solutions to such problems, and to critique the work of peers and others in the field. This course requires students to question their own moral positions and to think critically about the views of others.
We recognize that the global pandemic, remote learning and ongoing protests of racialized brutality may make this a very difficult and trying time for many of our students. We aim to make the course as flexible as possible to help accommodate issues as they arise. Please do not hesitate to get in touch with the instructor or TAs if you face significant challenges in getting the work completed.
Course readings available on UW Canvas.
Requirements:
8 reading responses (1/week; none when paper is due or during Thanksgiving week)
1 short paper (4-5 pages)
1 longer paper (6-7 pages)
Discussion board participation on video/film/podcasts (1/week)
2 Four sentence papers
2 musical selections (different weeks)
Participation in section every Monday
Lectures:
Asynchronous short lectures will be posted on Canvas by Monday and Wednesday afternoon of each week. If at all possible, please watch them prior to the following day’s synchronous lecture.
Synchronous sessions will take place each Tu/Th at lecture time (11:30 a.m.) via Zoom. The instructor will briefly touch on themes from the readings and asynchronous lecture, and then facilitate a large group discussion (sometimes with short periods in breakout rooms) to deepen student understanding of the material.
Sections:
Discussion sections are set up to meet M/W. In place of the Wednesday section, we are asking you to watch/listen to a video/film/podcast each week and post your comments on the discussion board by Friday of that week. Monday sections will occur as scheduled, by Zoom, and will provide an opportunity for TA-led small group discussion of course materials and paper assignments, and provide opportunities to earn the participation grade.
Explanation of assignments:
Reading responses will take different forms in different parts of the quarter (details below). All reading responses should be submitted to Canvas before the start of the synchronous lecture (e.g. by 11:30 a.m.) for which the reading is assigned. Reading responses will be graded credit/no-credit; they must meet the criteria – outlined below -- to receive credit.
Week 1 (first full week): summarize in your own words, in bold, the thesis of one of the papers/chapters for the week and then write a summary of the main argument (<250 words).
Week 2: raise and develop an objection to the main argument in one of the readings for the week (<250 words)
Week 3: raise an objection to the main argument of one of the papers for the week, and show how the author might respond to that objection (<300 words).
Week 4: no reading response due – just the paper!
Week 5 and beyond: briefly summarize the main argument in one of the assigned papers (~75 words) and then respond to the argument (raising an objection, exploring a further implication, drawing an interesting connection to an earlier paper or something in the news, etc.)(~200 words).
NO RR due in week 8 – Happy Thanksgiving!
Students should not expect to get comments on the reading responses; they will be used to formulate discussion topics for sections, and to ensure students are reading promptly and carefully.
Short and longer papers allow students to build their own arguments in response to readings for the course. The instructor will distribute potential paper topics, or students can make their own in consultation with the instructor or TA.
Discussion board: Each week includes an assigned video, podcast or film; please watch/listen to it during the week, and post a comment on the discussion board. Comments should highlight at least one thing the student found interesting and/or valuable, and one thing that raised concerns or further questions. Where possible, reference specific parts of the video/film/podcast.
Four sentence papers: The two “4 sentence papers” will be due prior to the short and longer papers, as a way to start organizing students thinking. More details will be shared on Canvas in advance of these due dates.
Musical selections: Music is sometimes said to be medicine for the soul – and we could all use some of that right now! Two times in the quarter (in two different weeks), you should choose and submit a link to a song that you think reflects the readings/topic for the week. Send a link and a short explanation of how you see it reflecting the material, before the lecture starts (e.g., by 10 a.m.). I will choose one or two of them to play at the start of each synchronous lecture session.
Section participation: We hope that you will attend section every Wednesday if possible; this part of your grade will be based on your participation in the section discussions and activities, or on alternative options provided by the TA in cases where that is necessary. Please do your very best to attend and participation in sections. Philosophy is best done in dialogue!
Given the length and number of writing assignments, all students who successfully complete the writing assignments and pass the course will receive W credit.
Students with disabilities should contact Disabled Student Services at (206) 543-8924/V, (206) 543-8925/TTY,
(206) 616-8379/FAX or email uwdss@u.washington.edu. If you have a disability or need academic accommodation for any reason, please discuss this with the instructor early in the term.
Tentative schedule:
Th Oct. 1 Introduction to the course/introduction to ethical theory and principles of bioethics (Beauchamp and Walters)
Week 1 Racism and racial inequities in the clinic and beyond
Tu Oct. 6 Medical ethics in context: legacies and realities of racism in medicine and medical research (Danis and Wilson et al. 2016; Harper 2020)
W Oct. 7 Video: Democracy Now “…History of Medical Apartheid Sows Mistrust” (13 minutes) https://www.democracynow.org/2020/9/10/vaccine_trials_black_participants_medical_ethics
Th Oct. 8 Race and racism: COVID-19 and racial distrust in medicine (Chowkwanyun & Reed Jr. 2020 and Egede & Walker 2020)
Week 2 Ableism and disability injustices in the clinic and beyond
Tu Oct. 13 Medical ethics in context: legacies and realities of ableism in medicine (Reynolds 2018)
W Oct. 14 Video: Stella Young TED talk (9 mins); I'm not your inspiration, thank you very much | Stella Young
Th Oct. 15 Disability: COVID-19 and crisis standards of care (Guidry-Grimes et al. 2020, Mukherjee 2020)
Week 3 Justice, trust and the allocation of medical resources
Tu Oct. 20 Allocation of scarce resources: who gets COVID drugs and vaccines (Webb et al. 2020)
W Oct 21 Podcast: Radiolab: “Playing God” https://www.wnycstudios.org/podcasts/radiolab/episodes/playing-god-broadcast (1hr)
Th Oct. 22 Distrust and COVID-19 vaccine (Jefferson 2020); listen to The Daily “The vaccine trust problem” https://www.nytimes.com/2020/07/21/podcasts/the-daily/coronavirus-vaccine.html
(29 minutes)
F Oct. 23 Four sentence paper due on Canvas by 5 p.m.
Week 4 Caring for patients, caring for health care workers: empathy and burnout
Tu. Oct. 27 Physician empathy vs. detached concern (Campelia & Tate 2019)
W Oct. 28 Podcast: This American Life “The Reprieve”
Th. Oct. 29 Burnout and moral injury (Talbot and Dean: https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/ and Koch & Jones; also Hartzband and Groopman https://www.nejm.org/doi/full/10.1056/NEJMp2003149)
Week 5 Cultural and structural competency in medicine
M Nov. 2 First paper due on Canvas by 11:59 p.m.
Tu Nov. 3 VOTE – Cultural differences/cultural competency in medical care? Kuczewski et al.)
Nov. 4 Podcast: This American Life “In Defense of Ignorance” (medical uncertainty) – Act I
Th Nov. 5 Cultural competency/structural competency (Metzl and Roberts; see also, story of “Lucky” and the “root doctor” from Neurology; retraction and responses: https://in-training.org/lessons-to-learn-from-reggie-the-importance-of-medical-humanities-18684
https://n.neurology.org/content/92/22/1029.long)
Week 6 Refusing treatment and the end of life for conscious competent patients
Tu Nov. 10 Right to refuse treatment (Cowart and Burt; Gawande -- “Whose body is it?”)
Nov. 11 Video: Frontline with Atul Gawande on Being Mortal (X min); and Podcast: https://www.wnycstudios.org/podcasts/radiolab/articles/dispatch-3-shared-immunity (last part)
Th Nov. 12 Uncertainty and accepting death (Gawande “Letting Go” and Childers & Arnold 2019)
Week 7 Advance directives
Tu Nov. 17 Precedent autonomy: Refusing treatment by advance directive (Steinbock and Menzel 2018; Walsh 2020)
Nov. 18 Podcast: Living will for Alzheimer’s disease? https://www.wbur.org/onpoint/2018/02/04/a-living-will-for-alzheimers
Th Nov. 19 Stopping eating and drinking by AD? (Cantor 2018; Wright et al. 2019; recommended: Dresser 2018).
Week 8 Physician-assisted Suicide
Tu Nov. 24 Intro to physician assisted suicide (Quill and Wolf)
Nov. 25 Film: How to Die in Oregon
Th Nov. 26 THANKSGIVING
Week 9 When is a wish to die “rational”?
Tu Dec. 1 Medically assisted dying vs. assisted suicide (Friesen 2020)
Dec. 2 Video: A Right to Die, a Will to Live? (NY Times: https://www.nytimes.com/video/magazine/100000002339935/a-right-to-die-a-will-to-live.html )
Th Dec. 3 Psychiatric suicide and PAS (Kious & Battin 2019)
F Dec. 4 Four sentence paper due on Canvas by 5 p.m.
Week 10 Physician-assisted Suicide and Disability critiques
Tu Dec. 8 PAS and disability moral psychology (Stramondo) http://dx.doi.org/10.1093/acprof:oso/9780199969104.003.0015)
Dec. 9 Podcast: NPR’s All Things Considered: http://www.npr.org/templates/story/story.php?storyId=4866181
Th. Dec. 10 PAS and “completed life” (Wijngaarden et al 2015); Course wrap-up
W Dec. 16 Final paper due on Canvas by 5 p.m.