ETHICAL ISSUES IN PUBLIC HEALTH

HS 249L
Winter Quarter - 1998
Tuesdays and Thursdays, 4-6 PM
Room 41-235
Instructors: Emily Abel, PhD, Patricia Ganz, MD, and Ruth Roemer, JD
Purpose: The aims of this course are (1) to acquaint students with ethical aspects of public health
and management of health services, as distinguished from the ethical aspects of the
individual doctor-patient relationship; (2) to explore the impact of legislation and
judicial decisions on the scope of ethical decision-making; and (3) to develop the ability
of students to analyze ethical issues in support of public health policies.
Methods: The course will be conducted through a combination of lecture, student participation,
and class discussion.
Tues. I. Framework for ethical issues and public health Ruth Roemer, JD
Jan 13
Thurs. II. History of medical and public health ethics Milton I.. Roemer, MD
Jan 15
Tues. III. Management of medical and public health information. Patricia Ganz, MD
Jan 20 Tension between confidentiality and public health.
Reporting requirements. Research needs.
Thurs IV. Ethical-legal issues in use of pharmaceuticals Michael Wilkes, MD
Jan 22
Tues. V. Economic support and access to care. David Carlisle, MD,
Jan 27 PhD
Thurs. VI. Ethical issues in administration of health services. Miriam Cotler, PhD
Jan 29 Dilemmas in managed care.
Tues. VII. Ethical problems in welfare, Medicaid, and E. Richard Brown,
Feb 3 impacts on vulnerable populations. PhD
Thurs. VIII. Patient rights. Ethical aspects of reproductive health. Ruth Roemer, JD
Feb 5
Tues. IX. The ethics of prevention and health education. William J. McCarthy,
Feb 10 PhD
Thurs. X. Ethical issues in measurement of health outcomes. Dean Jamison, PhD
Feb 12
Tues. XI. Communication responsibilities of public Robert Valdez, PhD
Feb 17 health professionals.
Thurs. XII. Ethical aspects of the genetics revolution. Leslie Rothenberg, JD
Feb 19
Tues. XIII. Rationing health care to the elderly - Roberta Malmgren,
Feb 24 an epidemiologist's perspective. PhD
Thurs. XIV. Ethical-legal issues in the AIDS epidemic. David I. Schulman, JD
Feb 26
Tues. XV. Aging and ethics Emily Abel, PhD
March 3
Thurs. XVI. Quality of life. Patient and/or provider determination. Patricia Ganz, MD
March 5
Tues. XVII. The future of Social Security William Shonick, PhD
March 10
Thurs. XVIII. End of life decision-making. Right to die, assisted Leslie Rothenberg, JD
March 12 suicide, advance directives, durable power of attorney.
Tues. XIX. Discrimination on the basis of race, gender, or disability. Christine Littleton, JD
March 17
Thurs. XX. Presentation of student papers.
March 19
March 27 FINAL EXAMINATION, 3 -6 PM
Required: Issue Paper (8-10 pages) on an ethical issue in health care, setting forth an ethical
problem in health policy, differing points of view, options for solution, and your
recommendation and reasons, including references. Due February 17. 1998.
Required Texts: Tom L. Beauchamp and LeRoy Walters, Contemgorarv Issues in Bioethics, 4th
ed., Wadsworth Publishing Company, Belmont, CA 1994.
Steven S. Coughlin, Colin L. Soskoline, and Kenneth W. Goodman, Case
Studies in Public Health Ethics, American Public Health Association,
Washington, D.C., 1997.
Optional Texts: Kurt Darr, Ethics in Health Services Management, 2nd ed., Health Professions
Press, Towson, MD 21204, 1994.
Cynthia R. Daniels, At Womens Expense: State Power and the Politics of Fetal
Rights. Harvard University Press, Cambridge, MA 1993.
Nancy S. Jecker, Aging and Ethics, Philosophical Problems in Gerontology,
Humana Press, Clifton NJ, 1991.
2
ASSIGNMENTS
ETHICAL ISSUES IN PUBLIC HEALTH. .
HS 249L
Winter Quarter - 1998
Tues. Framework for ethical issues and public health.
Jan 13 Beauchamp & Walters, Ch.1, Ethical Theory and Bioethics, especially
pp.22-34.
Case Studies, Ch. 1 Case Analysis and Moral Reasoning.
Thurs. History of medical and public health ethics.
Jan 15 Case Studies, Ch. 2, Case 2 a, Case 2 c.
Tues. Management of medical and public health information. Tension between
Jan 20 confidentiality and public health. Reporting requirements. Research needs.
Beauchamp & Walters, Ch. 3 Management of Medical Information.
Case Studies, Ch. 4, Case 4 c, Ch. 7, Case 7 c.
Thurs. Ethical-legal issues in use of pharmaceuticals.
Jan22
Tues. Economic support and access to care.
Jan 27 Beauchamp & Walters, Ch. 10, Justice in the Distribution of Health Care.
Case Studies, Ch. 16, Case 16 c.
Thurs. Ethical issues in administration of health services. Dilemmas in managed care.
Jan 29 Beauchamp & Walters, Ch. 10, justice in the Distribution of Health Care.
Case Studies, Ch. 16, Case 16 a.
Tues. Ethical problems in welfare, Medicaid, and impacts on vulnerable populations.
Feb 3 Beauchamp & Walters, Ch. 10.
Case Studies, Ch. 16, Case 16 b.
Thurs. Patient rights. Ethical aspects of reproductive health.
Feb 5 Beauchamp & Walters, Ch. 4, Reproductive Technologies and Surrogate
Parenting Arrangements; Ch. 5, Abortion and Maternal-Fetal Relations.
Case Studies, Ch. 3, Case 3 c.
Tues. The ethics of prevention and health education.
Feb 10 Case Studies, Ch. 11, Case 11 a, Case 11 c.
Thurs. Ethical issues in measurement of health outcomes.
Feb 12 Case Studies, Ch. 13, Case 13 b.
Tues. Communication responsibilities of public health professionals.
Feb 17 Beauchamp & Walters, Ch. 2, Professional Relationships to Patients and
Subjects; Rights and Responsibilities.
Case Studies, Ch. 10, Case 10 e, Case 10 f.
3
Thurs. Ethical aspects of the genetics revolution.
Feb 19 Beauchamp & Walters, Ch. 9, Eugenics and Human Genetics.
Case Studies, Ch. 14, Case 14 a, Case 14b.
Tues. Rationing health care to the elderly - an epidemiologist's perspective.
Feb 24 Beauchamp & Walters, Ch. 10, pp. 734-745.
Case Studies, Ch. 12, Case 12 a.
Thurs. Ethical-legal issues in the AIDS epidemic.
Feb 26 Beauchamp & Walters, Ch. 8, The Global Epidemic.
Case Studies, Ch. 15, Case 15 a. Case 15 b.
Tues. Aging and ethics.
March 3
Thurs. Quality of life. Patient and/or provider determination.
March 5
Tues. The future of Social Security.
March 10
Thurs. End of life decision-making. Right to die, assisted suicide, advance directives,
March 12 durable power of attorney.
Beauchamp & Walters, Ch. 6, The Right to Die and Ch. 7, Active
Euthanasia and Assisted Suicide.
Tues. Discrimination on the basis of race, gender, or disability.
March 17
4