POLITICAL SCIENCE 322 -- POLITICS AND THE LIFE SCIENCES 

Fall 2005                                                                                             

Andrea Bonnicksen, Zulauf 401, 753-7059, albcorn@niu.edu

                                       

This semester we will examine policy and ethical issues arising from selected biomedical technologies. Innovative technologies are frequently debated in everyday news, and they affect us personally if we have to make decisions about genetic testing, organ donation, assisted conception, and end-of-life medical treatments. Issues related to these technologies can be contentious, and an introduction to the science, ethics, and policies of each will contribute to informed discussion about policy.

 

During the semester we will look at issues in biomedical ethics and policy with two overarching questions. First, what is and what should be the role of medical technology in today’s society? We tend to assume that medical technologies will benefit us, but it is important to ask what ends we want from medical innovation, whether these ends are being met, and whether innovation in itself might introduce new challenges. Second, how should we resolve tensions between private choice and public control? Medicine has traditionally been regulated only minimally in this country. State governments oversee licensing, enable malpractice claims, and enact various regulations, but professional associations and other private sector organizations traditionally oversee the practice of medicine. Periodically, however, legislatures and courts become involved in medical research and practice, which leads to discussions about when and under what conditions government involvement is appropriate. Our exploration of these issues will help shape perspectives about future medical innovations and about the values that guide medical research and practice.

 

REQUIRED READINGS 

Carol Levine, Clashing Views on Controversial Bioethical Issues. Dubuque, IA:

            McGraw-Hill/Dushkin, 2006. Eleventh Edition.

CP: readings indicated as CP below are in the course packet, which is required and is available for sale in the university bookstore.

DL: readings indicated as DL below can be downloaded from the internet.

Other class materials occasionally will be placed on NIU’s Blackboard system.

Some general websites are:

            http://bioethics.georgetown.edu (search for articles and books)

            www.mcw.edu/bioethics/news.html

            www.bioethics.gov (President’s Council on Bioethics)

            http://thomas.loc.gov (primary government documents)

 

I. INTRODUCTION (AUG. 23, 25)

What is meant by biomedical policy? What is meant by biomedical ethics? What principles guide biomedical ethics? Who makes biomedical policy? What are and what should be goals of biomedical innovation?

 

Levine, “Medicine and Moral Arguments,” in Levine, pp. xvi-xxvi

Amy Gutmann and Dennis Thompson, “Deliberating About Bioethics.” Hastings Center

            Report 27:38-41 (May/June 1997). CP

President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of

            Happiness. 2003. Chapter 1 (“Biotechnology and the Pursuit of Happiness: An

            Introduction”). CP  

Daniel Callahan, What Price Better Health? Hazards of the Research Imperative.

            Berkeley: University of California Press, 2003, Chapter 1, pp. 1-8. Available at

            http://bioethicsprint.bioethics.gov/background/callahan_intro.html  CP

 

II. REPRODUCTIVE TECHNOLOGIES (AUG. 30, SEPT. 1, 6)

What are assisted reproductive technologies (ARTs) and why are they practiced?  How should decisions be made about compensating egg donors for their services? Should ARTs be regulated more closely?  

 

TREATMENTS   

Browse through www.cdc.gov/reproductivehealth/art.htm 

President’s Council on Bioethics, Reproduction and Responsibility: The Regulation of

            New Biotechnologies. 2004. Chapter 2 (“Assisted Reproduction”). CP

 

COMPENSATION FOR GAMETE DONATION    

Ethics Committee, American Society for Reproductive Medicine, “Financial Incentives

            in the Recruitment of Oocyte Donors.” Fertility and Sterility 74(2):216-20

            (August 2000) CP

Rebecca Mead, “Eggs for Sale.” The New Yorker, August 9, 1999, pp. 56-65.

 

FERTILITY PRESERVATION

Ethics Committee, American Society for Reproduction Medicine, “Fertility Preservation

            and Reproduction in Cancer Patients.” Fertility and Sterility 83(6):1622-1628

            (June 2005). CP

 

ART REGULATION 

President’s Council on Bioethics, Reproduction and Reponsibility: The Regulation of

            New Biotechnologies. 2004. “Executive Summary.” CP

Kathy Hudson, “Something Old and Something New.” Hastings Center Report 34(4):14-

            15 (July/August 2004). CP

 

III. EMBRYONIC STEM CELL RESEARCH (SEPT. 8, 13, 15)

What ethical and policy issues are raised by embryonic stem (ES) cell research? Should the federal government expand funding for this research? What is the impact of ES cell legislation by California, New Jersey, and other states?

 

STEM CELL SCIENCE

National Institutes of Health. “Pluripotent Stem Cells: A Primer.” CP

President’s Council on Bioethics, Monitoring Stem Cell Research. 2004. “Introduction”

            CP 

Rick Weiss, “The Power to Divide.” National Geographic, July 2005, pp. 3+. CP

 

FUNDING ES CELL RESEARCH

Levine, pp. 210-219, “Should the Federal Government Fund Embryonic Stem Cell

            Research?”

            YES: Baltimore, “Don’t Impede Medical Research”

            NO:  Bush, “Remarks by George W. Bush on Stem Cell Research”

Susan Okie, “Stem-Cell Research – Signposts and Roadblocks.” New England Journal of

            Medicine 353(1):1-5 (July 7, 2005). CP

Gretchen Vogel, “Ready or Not? Human ES Cells Head Toward the Clinic.” Science

            308:1534-38 (June 10, 2005). CP

H.R. 810 “Stem Cell Research Enhancement Act of 2005” (passed by House) CP

“Executive Order Creating the Illinois Regenerative Institute for Stem Cell Research.”

July 12, 2005. CP

 

IV. HUMAN REPRODUCTIVE CLONING (SEPT. 20)

What issues are associated with reproductive cloning? Should it be made illegal?

 

Dan W. Brock, “Cloning Human Beings: An Assessment of the Ethical Issues Pro and

            Con.” In National Bioethics Advisory Commission, Cloning Human Beings,

            Volume II, Commissioned Papers, June 1997, pp. E1-E23. CP

Martha C. Nussbaum, “Little C.” In Martha C. Nussbaum and Cass R. Sunstein, eds.

            Clones and Clones. New York: W.W. Norton & Co., 1998, pp. 338-346.

 

V. GENETICS AND SOCIETY (SEPT. 22, 27, 29)

What medical goals are envisioned for genetic research? How does genetic information affect reproductive decisions? Should policy makers be thinking about how to respond to the potential use of inheritable genetic modifications (IGMs) with humans? Can genetic information harm individuals?

 

GENETICS AND REPRODUCTION

Genetics and Public Policy Center, Johns Hopkins University. Reproductive Genetic

Testing: Issues and Options for Policymakers. 2004. Available at http://tools-content.labvelocity.com/pdfs/5/66755.pdf  DL

 

INHERITABLE GENETIC MODIFICATIONS

American Association for the Advancement of Science, Human Inheritable Genetic

Modifications. 2000. Available at http://www.aaas.org/spp/sfrl/projects/germline/report.pdf DL

Eric T. Juengst, “Germ-Line Gene Therapy: Back to Basics.” Journal of Medicine and

            Philosophy 16(6):587-592 (December 1991). CP

Lee Silver, Remaking Eden. New York: Avon Books, Inc., 1997, pp. 1-13, 281-93. CP

 

GENETICS AND DISCRIMINATION

Levine, pp. 220-233, “Will Genetic Testing Lead to Denial of Insurance and

            Employment?”

            YES: Markham, “Genetic Discrimination Arising from Cancer Risk Assessments:

            A Societal Dilemma”

            NO: Fisher, “Genetic Testing and Health Insurance: Can They Coexist?”

 

PAPER TOPICS DUE IN WRITING (SEPTEMBER 27)

 

EXAMINATION # 1 (OCTOBER 4)

 

VI. RESEARCH WITH HUMAN PARTICIPANTS  (OCT. 6, 11, 13)

What policy governs research using human participants today? What is meant by the Common Rule? What are current issues raised by research using human participants?

 

CURRENT POLICY

National Institutes of Health, “What is a Clinical Trial?” CP

Timothy Murphy, “Oversight and Study Design.” In Timothy F. Murphy, Case Studies in

            Biomedical Research Ethics. Cambridge MA: MIT Press, 2004, pp. 1-11. CP

Common Rule (Google search of “45 CFR 46”) (skim)

 

ISSUES RAISED BY PLACEBO STUDIES

Levine, pp. 254-272, “Is Sham Surgery Ethically Acceptable in Clinical Research?”

            YES:  Freeman, “Use of Placebo Surgery in Controlled Trials of a Cellular-Based

            Therapy for Parkinson’s Disease”

            NO:  Macklin, “Ethical Problems with Sham Surgery in Clinical Research”

 

INCENTIVES FOR RESEARCH PARTICIPANTS

Neil Dickert and Christine Grady, “What’s the Price of a Research Subject?” New

            England Journal of Medicine 341(3:198-203 (July 15, 1999). CP

 

VII. RESEARCH USING ANIMALS (OCT. 18, 20)

What is current policy on animal research? Is there an ethics of animal research? What challenges are posed by interspecies research?

 

ETHICAL ISSUES

Levine, pp. 236-253, “Should Animal Experimentation Be Permitted?”

            YES:  Loeb, “Human vs. Animal Rights: In Defense of Animal Research”

            NO:  Regan, “Ill-Gotten Gains”

 

CURRENT POLICY

Elizabeth Heitman, “The Humane Care and Use of Animals in Research.” In Ruth Bulger

            et al., eds, The Ethical Dimensions of the Biological and Health Sciences. 2nd ed.

            New York: Cambridge University Press, pp. 183-91. CP

Timothy Murphy, “Use of Animals.” In Timothy F. Murphy, Case Studies in Biomedical

            Research Ethics. Cambridge MA: MIT Press, 2004, pp. 249-52 CP

Timothy Murphy, “Expanding the Animal Welfare Act.” In Timothy F. Murphy, Case

            Studies in Biomedical  Research Ethics. Cambridge MA: MIT Press, 2004, pp.

            269-70. CP

 

INTERSPECIES RESEARCH

Julian Savulescu, “Human-Animal Transgenesis and Chimeras Might Be an Expression

            of Our Humanity.” American Journal of Bioethics 3(3):22-25 (2003). CP

Mark Greene, et al., “Moral Issues of Human-Non-Human Primate Neural Grafting.”

            Science 309(5733):385-86 (July 15, 2005). CP

 

VIII. END-OF-LIFE DECISION MAKING (OCT. 25, 27, NOV. 1)

How is medical technology both a benefit and burden at the end-of-life? What are the purposes of advance directives? Should adolescents make their own end-of-life decisions? Should autonomy include physician-assisted suicide? Should physicians refuse to provide treatment they regard as futile?

 

ADVANCE DIRECTIVES

Levine, pp. 61-70, “Are Some Advance Directives too Risky for Patients?”

            YES: Ryan, “Betting Your Life: An Argument Against Certain Advance

            Directives”

            NO:  Luttrell and Sommerville, “Limiting Risks by Curtailing Rights: A Response

            to Dr. Ryan”

 

ADOLESCENTS AND END-OF-LIFE DECISIONS           

Levine, pp. 176-190, “Should Adolescents Make Their Own Life-and-Death Decisions?”

            YES: Weir and Peters, “Affirming the Decisions Adolescents Make About Life

            and Death”

            NO:   Ross, “Health Care Decisionmaking by Children”

 

PHYSICIAN-ASSISTED SUICIDE

Timothy E. Quill, “Death and Dignity: A Case of Individualized Decision Making.” New

            England Journal of Medicine 324(10):691-694 (March 7, 1991). CP

Levine, pp. 80-99, “Should Physicians Be Allowed to Assist in Patient Suicide?”

            YES: Angell, “The Supreme Court and Physician-Assisted Suicide—The

            Ultimate Right”

            NO:  Foley, “Competent Care for the Dying Instead of Physician-Assisted

            Suicide”

“Oregon’s Death with Dignity Act” CP

Katrina Hedberg, “Five Years of Legal Physician-Assisted Suicide in Oregon.” New

            England Journal of Medicine 348:961-64 (March 6, 2003). CP

Kate Christensen, “Kate Christensen Speaks with Pat Matheny, A Recipient of Lethal

            Medication under Oregon’s Death with Dignity Act.” Cambridge Quarterly of

            Healthcare Ethics 8(4):564-568 (1999). CP

 

ALTERNATIVE END-OF-LIFE OPTIONS

David M. Eddy, “A Conversation with My Mother.” NEJM      272(3):179-181. CP

Timothy E. Quill, “Dying and Decision Making – Evolution of End-of-Life Options.”

            New England Journal of Medicine 350(20):2029-32 (May 13, 2004). CP

Barry Yeoman, “Going Home.” AARP Magazine 48:62+ (January/February 2005).

 

TREATMENT DEEMED FUTILE BY PHYSICIANS

Levine, pp. 121-132, “Should Doctors Be Able to Refuse Demands for ‘Futile’

            Treatment?”

            YES: Miles, “Informed Demand for ‘Non-Beneficial’ Medical Treatment”

            NO:  Ackerman, “The Significance of a Wish”

 

EXAMINATION # 2  (NOVEMBER 3)

 

IX. ENHANCEMENT TECHNOLOGIES (NOV. 8, 10)

What is meant by enhancement technologies? What ethical issues do they raise?

 

ENHANCEMENT TECHNOLOGIES IN SPORTS

Levine, pp. 303-312, “Should Performance-Enhancing Drugs Be Banned from Sports?”

            YES: Murray, “Drugs, Sports, and Ethics”

            NO:  Savulescu, et al., “Why We Should Allow Performance Enhancing Drugs in

            Sport”

President’s Council on Bioethics, Beyond Therapy:Biotechnology and the Pursuit of

Happiness. 2003. Chapter 3 (“Superior Performance”).  Available at http://bioethicsprint.bioethics.gov/reports/beyondtherapy/chapter3.htmlDL

 

AGE EXTENSION

President’s Council on Bioethics, Beyond Therapy:Biotechnology and the Pursuit of

Happiness. 2003. Chapter 4 (“Ageless Bodies”). Available at http://bioethicsprint.bioethics.gov/reports/beyondtherapy/chapter4.htmlDL

 

PAPERS DUE (NOVEMBER 15)

 

X. BIOETHICS AND ISSUES OF SECURITY (NOV. 15)

What issues are posed for the medical profession when national security is in question? What tensions arise between private liberties and public health?  

 

BIOETHICS IN TIME OF WAR

Levine, pp. 288-302, “Does Military Necessity Override Medical Ethics?

            YES: Gross, “Bioethics and Armed Conflict”

            NO:   Bloche and Marks, “When Doctors Go to War”

Case Study, “Dialysis for a Prisoner of War.” Hastings Center Report 34(6):11-12

            (November-December 2004). CP

 

PUBLIC HEALTH AND BIOTERRORISM

Levine, pp. 350-363, “Should Public Health Be Given Sweeping Powers Over Individual Liberty in a Bioterrorist Threat?”

            YES: Gostin, “Law and Ethics in a Public Health Emergency”

            NO:   Annas, “Bioterrorism, Public Health, and Human Rights”

 

XI. ALLOCATION OF HEALTH CARE RESOURCES (NOV. 17)

What are features of health care reimbursement in the U.S. today? How can resources be more equitably distributed?

 

CURRENT SYSTEM OF HEALTH INSURANCE

Levine, pp. 276-287, “Should Health Insurance Be Based on Employment?”

            YES: Custer et al., “Why We Should Keep the Employment-Based Health

            Insurance System”

            NO:  Reinhardt, “Employer-Based Health Insurance: A Balance Sheet”

Robert J. Blendon et al., “Health Care in the 2004 Presidential Election.” New England

            Journal of Medicine 351(13):1314-22 (September 23, 2004). CP

 

XII. ORGAN AND TISSUE TRANSPLANTATION (NOV. 22, 29)

Fifty years after the first successful organ transplant, what issues remain? How can organ donation rates for cadavers be increased? What should be done to protect living donors?

 

Browse through www.giftofhope.org and www.livingdonorsonline.org.

Levine, pp. 313-330, “Should There Be a Market in Body Parts?”

            YES: Radcliffe-Richards et al., “Case for Allowing Kidney Sales”

NO:  Rothman, “International Organ Traffic”

Francis L. Delmonico, et al., “Ethical Incentives – Not Payment – for Organ Donation.”

            New England Journal of Medicine 346(25):2002-05 (June 20, 2002). CP

Robert Steinbrook, “Public Solicitation of Organ Donors.” New England Journal of

            Medicine 353(5):441-444 (August 4, 2005). CP

Robert Truog, “The Ethics of Organ Donation by Living Donors.” New England Journal

            of Medicine 353(5):444-446 (August 4, 2005). CP

Julie R. Ingelfinger, “Risks and Benefits to the Living Donor.” New England Journal of

            Medicine 353(5):447-449 (August 4, 2005). CP

 

XIII. INFORMED CONSENT (DEC. 1)

What is meant by informed consent? Why is informed consent a cornerstone of autonomy? What are problems in securing informed consent? What should be the role of family interests in making medical decisions?

 

INFORMED CONSENT IN MEDICAL PRACTICE

Levine, pp. 1-20, “Is Informed Consent Still Central to Medical Ethics?”

            YES: Arnold and Lidz, “Clinical Aspects of Consent in Health Care”

            NO:  O’Neill, “Gaining Autonomy and Losing Trust?”

 

WHOSE AUTONOMY OUGHT TO PREVAIL?

Levine, pp. 21-44, “Can Family Interests Ethically Outweigh Patient Autonomy?”

            YES: Hardwig, “What About the Family?”

            NO:  Blustein, “The Family in Medical Decision-Making”

 

EXAMINATION  # 3 (Finals Week)

 

Grading policy:

Grades will be based on three exams worth 50 points each, one paper worth 50 points, and a participation and attendance grade worth 20 points:

            Exam 1                                                 50 points

            Exam 2                                                 50 points

            Exam 3                                                 50 points

            Paper                                                               50 points

            Attendance and participation                             20 points

            TOTAL POINTS POSSIBLE                        220 points

Grading scale: 198-220 = A; 176-197 = B; 154-175 = C; 132-153 = D; below 132 = F

 

Exams:

The exams will be short answer and essay. A portion of each may be take-home. Make-up exams will be given only for documented serious illness or a death in the family and only if you contact me AHEAD of the exam (753-7059 -- leave a message if necessary).

 

Participation:

All class members are expected to read the material before it is covered in class and participate in discussions based on the readings. To encourage careful reading and informed discussion based on the reading, 20 points will be allocated as follows.

18 – 20 points = regular, informed participation

                           regular attendance (3 or fewer absences)

16 – 17 points = occasional and thoughtful participation

                           attendance (4 or fewer absences)

14 – 15 points = attendance (5-6 absences)

12 – 13 points = infrequent attendance (7-8 absences)

10 – 11 points = rare attendance (9 absences)

5            points = 10 or more absences

To make all have a chance to contribute I will occasionally call on students. I also appeal to the grace of individuals who are more talkative to raise their hands to be recognized before speaking so that all students may be given the opportunity to contribute. I will also give occasional short optional internet assignments. Thoughtful written responses will count toward class participation.

 

Papers:

The paper will let you do independent research on a subject of interest to you. A written description of the topic will be due September 27 and the paper itself will be due November 15. Further information about the proposal and paper will be given later in the semester.

 

The paper is to be 8-10 typed double-spaced pages. It is to be thoughtful, carefully documented, and well written. It should relate to course topics but should not repeat specific issues covered in class. Reference all sources you use so I can repeat your research if necessary by putting the author’s name in parentheses in the text and then giving the full citation at the paper’s end (Smith 2004). The burden will lie on the student to show that he/she wrote the paper. This means handing in sources used and speaking knowledgeably about the paper after it is turned in. You are encouraged to submit a draft of the paper for feedback before turning in the final version.

 

Papers will give you experience in writing informative and balanced papers and in reaching reasoned conclusions. The topic should pose a question for which there is no clear answer. You will give some background about the issue, present differing views in response, and reach a reasonable conclusion. You must use subheadings (Issue, Background, Arguments I, Arguments II, Conclusion).  Here are some issues to illustrate:

 

Should organ recipients be told if their organs are of questionable quality?

Should organs from HIV positive donors be given to HIV positive recipients?

Should parents be notified when their minor daughters seek an abortion?

Should the medical use of marijuana be approved for patients with cancer?

Should reproductive cloning be made illegal by the U.S. Congress?

Should the law be amended to require publication of negative results in the development of pharmaceuticals? 

 

One way to find topics is to look at bills before the U.S. Congress. To find a recent bill in Congress go to http://thomas.loc.gov and do a search for a bill (proposed law) in the 106th, 107th, 108th , or 109th Congress related to a topic of interest. Select a bill that is manageable and understandable to you. You may also search for bills in the Illinois legislature. I will ask people to choose different topics if too many select the same topic.

 

Important dates:

October 4                    Exam 1

November 3                 Exam 2

December                    Exam 3

            Paper topic                   September 27

            Paper submission          November 15

 

Manners:

You are asked to arrive on time. Late arrivals are very disruptive. If lateness becomes a problem during the semester, I will close the door and post a note requesting no one to enter. If you have an appointment that requires you to leave early, let me know ahead of time and then sit in a chair near the door. Please turn off cell phones before class begins. Do not leave and then return after receiving a phone call. 

 

Other information:

CAAR.-- NIU is committed to making reasonable accommodations for students with documented disabilities. Students with disabilities that may have some impact on their coursework and for which they may need accommodation should contact the Center for Access-Ability Resources (CAAR) on the fourth floor of the Health Services Building during the first two weeks of the semester.

 

Paper awards.-- The Department of Political Science annually recognizes outstanding undergraduate papers written in conjunction with 300-400 level political science courses (all majors are welcome to compete). Winners are expected to attend the Department’s spring graduation ceremony where they will receive a certificate and $50.00. Submit three papers from any undergraduate political science class to a department secretary in Zulauf 315 by February 28. All copies should have two cover pages – one with the student’s name and one without. Only papers written in the previous calendar year (2005) can be considered for the 2006 award. However, papers completed in the current spring semester are eligible for the 2006 competition even if the author has graduated.

 

Website. -- You are encouraged to consult the Department of Political Science website (http://polisci.niu.edu) to help you contact faculty and staff, explore graduate programs and career options, and track department events and activities.