Hello everyone. Welcome to Ethical Issues in Healthcare. I'm your professor, Dr. Jada Tweet Strabing. You can call me Professor Strabing or Dr. Strabing.
There are two TAs in this course, Dominic Colaluca and Lian Raz. The three of us are here to help you in any way that we can. We want you to do well in this course, so if you have any questions or concerns at all, please do not hesitate to reach out to us.
If you have any questions about grading or about the course canvas side or something didn't work with a reading quiz or something like that, Dom and Lean are your first points of contact. If you want to talk about the course material, the readings, the posted lectures, please feel free to reach out to any of us on those issues. And if you need an extension or if you're going through a difficult time and it's impacting your work in the course, please feel free to reach out to any of us as well, whoever you would feel most comfortable talking with.
Again, we are here to help you. in any way that we can, so please do not hesitate to reach out to us. In this introductory lecture, I'm going to start by going over some very basic material like what is philosophy, more specifically what is moral philosophy, what applied ethics is. This course is a course in applied ethics and specifically it's a course in medical ethics. So after I go over that introductory material, I'm then going to talk about some tips for reading philosophy.
Philosophy is hard and likely you haven't been exposed to philosophy before, so I want to equip you as well as possible for reading philosophy articles. After that, I'll talk about the Mets article that you read, How Philosophy Bears on COVID-19, and finally at the end of this lecture, I'll go over syllabus highlights. What do you think of when you think of philosophy? When I ask questions like this, I really wish that I was with you in person so that I could hear your responses to this question. What do you think of when you think of philosophy?
I think it's natural to, when you think of philosophy, to think about particular philosophers. So you might have instantly thought of Socrates or Plato or Aristotle or maybe Descartes or Immanuel Kant. You might think of famous philosophers from throughout history.
But the question is, what do these philosophers do when they do philosophy? What is the nature of philosophy? It's actually hard to say what philosophy is. Philosophers themselves disagree about what philosophy exactly is.
They disagree about the nature of the discipline. But just because there's disagreement about what philosophy is doesn't mean we can't say some things about philosophy. So there are going to be certain things that all philosophers will say about philosophy.
Philosophy is an activity. It's an activity that people engage in when they seek answers to fundamental questions about themselves and the world. in a systematic, rigorous way. So you probably, when you think of philosophy, think about philosophy as asking and trying to answer fundamental questions.
It's also important that philosophy does this in a systematic, rigorous way. And by that I mean, in doing philosophy, you support your ideas, you support your beliefs, with reasons and arguments. You give reasons, you give arguments, you don't just give your opinion. Or you don't just state what your belief is.
So in doing philosophy, it's not enough to say something like, well, I think abortion is wrong. You have to give reasons why, if that's what you hold in doing philosophy, you have to give reasons why you think abortion is wrong. You have to give arguments for the wrongness of abortion. You can't just simply say, well, that's my opinion.
In doing philosophy then, you can't just say something like, well, here's my opinion. I have my opinion. You have your opinion. Let's just agree to disagree.
In doing philosophy, we're seeking truth, and we think that the truth will be supported by good reasons and good arguments. So if you hold a particular belief about something, and someone else holds a different belief about it, you need to think, well, what are the reasons for my belief? What good arguments can I give for thinking that I'm right and the other person is wrong? But you also need to consider what the other person's beliefs are and whether they have good reasons for their beliefs, whether they can give good arguments for it. It could be that the other side gives a good argument and then you'll have to think about, well, I think it's wrong.
So where can I find a problem in that argument? It looks good, but if it's really, if they're really wrong, there must be something wrong with that argument. We're going to talk more next class about philosophical arguments. Now, I want to point out one more thing, which is that you can philosophize about any subject, really.
There's philosophy of science in which you ask questions about the nature of science. Does science really get at the truth? Does it really get at objective truth?
What are scientific theories and what are they trying to show? You can also philosophize about knowledge itself. You can ask the question, what is knowledge?
Now knowledge definitely seems if you have knowledge you have not just beliefs but you have true beliefs. But it's not just enough to have a true belief to have knowledge. It seems like you can have a true belief completely by accident, by luck, and that can't be knowledge. So what more is needed to add to knowledge besides having a true belief? You can also philosophize about the nature of reality.
Is reality just physical or can there be sort of an immaterial or spiritual reality? Does God exist? If so, what good arguments can we give for the existence of God? We can also do philosophy about morality.
We can ask questions about the nature of morality and what's right and wrong and things like that. And that's what we're going to be doing in this course. We're going to be doing a particular course in moral philosophy. What is moral philosophy?
Let's delve into that question. In moral philosophy, We bring philosophical reasoning to bear on questions related to morality. There are three main branches of moral philosophy.
Metaethics asks questions about morality itself. So some of the questions it asks are, say, about the meaning of moral terms. So a question in metaethics is, what is good? What does good even mean? It also asks questions about the nature of morality.
Is morality objective? Is it mind independent? or is it mind dependent?
Does it say depend upon human psychology or human emotions? Is morality dependent upon on human culture? It also asks questions about how to justify moral judgments. If you think something is morally right or wrong, how do you know you're right about that? How do you know your moral judgments are correct or not?
Another branch of moral philosophy is normative ethics. It raises questions such as what makes an action right or wrong? or what makes a person morally good or morally bad. In asking what makes an action right or wrong, there are different theories that attempt to say what makes an action right or wrong. For example, consequentialism claims that what makes an action right or wrong depends only upon its consequences.
You might have heard of a particularly famous kind of consequentialism called utilitarianism. According to utilitarianism, what makes an action right is that it maximizes happiness. What makes an action wrong is that it fails to maximize happiness. We'll talk more about consequentialism and utilitarianism later in the course. There are, of course, other normative ethical theories as well.
Deontological views in normative ethics are duty-based views, and they claim that what makes an action right or wrong depends upon whether you have a duty to do it or not. Immanuel Kant has a famous deontological view. where he says that what's right is, an action is right if and only if it conforms to the categorical imperative. And one version of the categorical imperative, which we'll talk about later in this course, has to do with whether you're treating humanity as an end in itself, or whether you're treating humanity as a mere means. You're acting wrongly if you're treating someone as a mere means to your own end.
A third branch of moral philosophy is applied ethics. And applied ethics asks what you should do in a particular case. So should you have an abortion or not? Or should you have a particular medical procedure? Should you get a particular vaccine or something like that?
This course is a course in applied ethics. We'll do a little normative ethics too. As just mentioned, we'll talk some about consequentialism, utilitarianism, Kantian deontology, and maybe a couple of other normative ethical theories as well.
But we'll focus specifically on applied ethical issues in healthcare. We'll talk about whether, in the context of healthcare, certain actions are right or wrong. Here are some of the topics that we'll be discussing in no particular order. Abortion, euthanasia, genetic modification, informed consent, whether doctors should tell patients the truth, medical research ethics, and ethical issues related to the coronavirus pandemic.
I wanted to mention this last one. It's actually broken up under two different topics on the syllabus, under the race and medical ethics section, and then under the healthcare justice section. And we wanted to include something like this topic related to the coronavirus pandemic because it's, you know, the COVID is still affecting our lives and obviously affected our lives in really significant ways not too long ago.
Let me say at the outset that philosophy is hard. Professional philosophers think that philosophy is hard. After all, philosophy is asking these deep fundamental questions, and so we should expect philosophy to be hard.
In this class in particular, we're asking questions about ethical issues in health care, and some of these issues are really controversial. We should expect it to be hard to give good reasons and good arguments for these controversial positions, and it can be hard to understand people's reasons and arguments for these controversial positions. So please, don't be discouraged if you don't understand everything that we read. I don't expect you to.
My hope is that these lectures will really help to clarify the readings. But of course, I really want you to do your best in reading these articles. And I do think that if you put in effort, you'll be able to understand at least a fair amount of what we read.
And to help you to help facilitate your understanding, I highly recommend that you read each article twice. The first time you read an article, read it just to get the big picture. Don't get bogged down by what you don't understand.
So if you don't understand something in the article the first time you read it, just move on. The point is to get the big picture of the article to really understand what the author is arguing for even if you don't understand all the details of that argument. The second time through, read more slowly and get more details.
Fill out that big picture. As you're reading, ask yourself what is the author's thesis or the author's main point? Why did the author write this article? What are they trying to prove to you?
Now there are signposts when you're reading an article to be able to figure that out. Philosophy is not like, reading philosophy is not like reading a mystery novel. The author is not trying to keep you in suspense or trying to get you to read until the end to figure out what they're arguing for.
A good philosophy paper, as all the papers that we'll be reading in this class are good philosophy papers, they're going to tell you up front what they're arguing for. The author will say flat out, Things like, I am arguing for this position. I'm going to argue that abortion is permissible in these cases, morally permissible. I'm going to argue that euthanasia is wrong for these reasons. So at the beginning of the article, you should be able to see what the author is arguing for.
And in the conclusion or near the end of the article, they'll often summarize their position. and they summarize their argument for it. So you can really find the author's main point at the beginning.
You should be able to see it at the end. So ask yourself, what is the author's thesis? Also ask yourself, what is the author's argument in support of that main point? Again, you'll often find signposting that can help you in an article to figure out what the author's argument is in support of their thesis. So for example, you might see something in an article that says something like, in sum, I have argued for this position but on the grounds that blah blah blah or here's a summary of my argument or you might find something before the argument is stated and here's my main argument.
Look for signposts that tell you that you found the author's argument and ask for help if you need it on discussion boards, over email, or during office hours. We are here to help you to help make sure that you understand. So again, just a reminder, philosophy is hard. Don't be discouraged. Read the articles twice, first for the big picture, second more slowly and get the details.
And it's okay if you still don't have a solid grasp. My hope is that these lectures will help a lot. And if you need more help, don't hesitate to reach out for help. We totally get it.
Philosophy is hard and we are here to help you. For this lecture, I asked you to read a short one-page article by Thaddeus Metz called How Philosophy Bears on COVID-19. I asked you to read this article just so you can see that philosophy does indeed have a bearing on issues that are central to our lives.
At the beginning of the article, Metz defines philosophy. He says that philosophy is rational inquiry that addresses fundamental matters of human life and that transcends science in some way. Let me read that again.
It says, philosophy is rational inquiry that addresses fundamental matters of human life and that transcends science in some way. So that's Metz's understanding of philosophy. And notice that it's very similar to what I said at the beginning of the lecture, when I said that philosophy is an activity that seeks to answer fundamental questions of human life in a systematic and rigorous way.
In particular, it seeks to answer these fundamental questions using rationality and rational arguments. And that's... different from how science operates that tends to be empirical type questions. Philosophy is seeking to address fundamental matters that are not scientific questions, but are instead kind of deep fundamental questions that really only ration. rationality and reasons and arguments can answer.
So Metz, after he defines what philosophy is, he talks about how philosophy bears on COVID-19 by pointing out there are important philosophical questions that are relevant to COVID-19. So here's one that he addresses. How should we allocate scarce resources like ventilators?
Now this is a philosophical question. It's not a scientific question. It's not a question that biology can answer. It's not a question that chemistry can answer. It's not a question that medicine can answer.
Doctors, of course, have to grapple with the question, and medical ethicists have to grapple with, how should we allocate scarce resources like ventilators? But when doctors grapple with such a question, they're not grappling with a medical question, but instead of philosophical question. Medical questions have to do with things like, what kind of treatment would be effective in a particular case?
Or with a particular disease, how does the disease progress? They don't answer the kind of what we call normative questions or should questions, like how should we allocate scarce resources? That's an ethical question, a philosophical question. And Metz actually discusses this question a bit.
He's a South African philosopher. And in Africa, there's a much higher proportion of young people compared to old people. So then he says, you know, what if we only have one ventilator and we have to choose whether to give it to one person or give it to the young person? or give it to the old person. What do we do?
Well, on the one hand, we could say something like, well, human life has equal dignity. So each person, the young person and the old person, they should have an equal chance at the ventilator. So we should do something like flip a coin. But that's not the only way that someone could answer a question like this. Someone could say something like, actually, the old person should get the ventilator because they've contributed more to the healthcare system or they, um, They have wisdom that we need to make sure can be passed down to the younger generation.
Or someone could say, no, actually we should give it to the younger person because the younger person has a lot more life in front of them and haven't really lived their life, whereas an elderly person has lived a full life already. So there are different ways in which this question can be answered. In the U.S., you know, there's other factors that we would naturally want to think about. Age, of course, is a factor too, and we're actually going to address this question.
in a future lecture. And so age is going to be one of the relevant factors, but there are other factors that we want to think about as well. For example, how long a person might live after receiving the ventilator, which is actually a separate question from age because that could involve the person's prior health status. There's also the issue of something like systemic racism.
COVID-19 has disproportionately affected people of color due to the lack of access to public health services. systemic racism and so it's it's there's an argument to be made that a person of color should have a greater chance at receiving a ventilator than a white person so that's something we're going to talk about in the lecture in future lectures as well Mets also addresses or brings up another philosophical question relevant to COVID-19 and that's the question of whether the government is justified in issuing lockdowns and other rules and should we obey the government's rules That's not a question that we're going to talk about in this particular course, but it is a philosophical question related to COVID-19. And finally, who should we believe about COVID-19? There has been a lot of misinformation about COVID-19, and there's an important question about who we should believe. Who counts as an expert?
What makes someone an expert? And then what do we do when experts disagree? These are all philosophical questions. and they're important questions. They're not ones that we're gonna take up in this course, but they are philosophical questions.
And so Matt here is really trying to point out the relevance of philosophical questions to our everyday lives by pointing out how they're relevant to COVID-19. And again, we will address the first question, not the second two, but if you're interested in those other questions, feel free to come and talk to me about it. We're now at the last part of this introductory lecture where I want to go over the syllabus. So please go ahead and get the syllabus out.
It will be much more helpful during this next slide if you're looking at the syllabus while I'm talking. So please get out the syllabus now. I'll now go over syllabus highlights.
Hopefully you've already familiarized yourself with the syllabus. You've taken the syllabus quiz. I also sent out a video of myself going over syllabus highlights in an announcement. So if you haven't taken a look at that, please do. That video is meant to be a kind of way to introduce myself to you as well.
But in this introductory lecture, I wanted to go over some syllabus highlights again, kind of solidify everything in your mind. So first, there is no requirement. required textbook.
I put PDFs of all the articles up on Canvas. If you'd like to buy the textbook, I do list what the textbook is in the syllabus. So if you would like the textbook, feel free to buy it. I will say that the PDFs on Canvas, they're not all, you know, pristine.
They're not all super clear, but they're all legible. So if you want something even better, feel free to get the textbook. But otherwise, hopefully it's helpful to you to have the PDFs on Canvas. Next, reading quizzes. You'll have two articles, roughly, typically two articles each week, and each article will have an associated reading quiz.
You have a week to read the articles and then take the associated quizzes that are due Sunday at midnight. After the reading quizzes close for a particular article, the lecture for that article will open up. So it opens up basically Monday morning, midnight, like right when it passes from Sunday to Monday, your reading quizzes do, and then the lectures open up. So please watch the lectures. The lectures are going to be just crucial for studying for the exam because I base the exams on the lectures.
For the connection here between reading quizzes and lectures, there's also another part of that, and that's once the lectures open up, I give you a chance to watch the lectures and then redo the reading quizzes. So you may wonder, why do the lectures come out after the reading quizzes? Well, the idea is this. The reading quizzes serve as checks that you've done the reading. They basically give you points for doing the reading.
And then once the reading quiz is closed, the lectures open up, and then you can use the lectures to redo the quiz. And then you'll use the lectures to study for the exams. So once you do the reading quizzes, you can really focus on the lectures after that.
with regard to your exam preparation. With regard to redoing the reading quiz, you have one week to redo the reading quiz. So hopefully you'll watch those lectures, redo the reading quiz, and get all of that solidified in your mind so you're not scrambling before the exam to study and watch all the lectures. Evaluation and grade breakdown.
There are four parts of your grade, all of them worth 25 percent. Midterm exam, final exam, reading quizzes, and discussion board posts. I do drop your three lowest reading quizzes and I drop your lowest discussion board post. So you could just skip three reading quizzes if you want or you could do all of them and then I just drop your three lowest however you would like to do that.
Regarding the exam specifically, again there's a midterm and a final. They are not cumulative and they're based on the lectures. In addition, there'll be two parts to each of those exams. So the midterm exam and the final exam each have two parts.
multiple choice section of 30 questions, and an essay section. And in the essay section, you will get the essay options in advance, so you will not be surprised about any of the questions. So you'll get more options than you have to write, so you won't know exactly which question you'll get, but you'll know what the pool of essay questions is. Finally, discussion board posts. You will have this due not weekly, like the reading quizzes, but rather for each topic.
I think it averages out to roughly every other week. You'll have a discussion board post due. And for the discussion board posts, you'll need to write an original post, typically on a case study of a couple paragraphs.
And then once you do that and you submit that, then you write a reply post to another student's post. And the reply post has to be to a different case study. So that's basically what I have with respect to syllabus highlights, a quick overview.
Again, hopefully that just helps solidify what you've already seen from the syllabus and my video announcement. But again, please familiarize yourself with the syllabus and let us know if you have any questions. Once again, welcome to the course.
I'm excited to be teaching you this semester.