Fall 2011

Justice and Health Care

This course will examine ethical issues in the distribution, financing, and delivery of health care in the United States. We will focus in particular on central issues raised by the recent U.S. health care reform debate and resulting legislation. Readings are drawn from political philosophy, health care economics, behavioral economics, nonprofit thinktank white papers, Congressional testimony, news articles, and blog posts. The first third of the class explores key issues in U.S. health policy and forms the empirical foundation for the rest of the class. The second third explores ongoing debates in moral and political philosophy over putative rights to health and health care. The last third investigates the nature, justifiability, and methods of health care rationing—including bedside rationing by doctors—and the myriad issues implicated by the near-universally shared goal of health care cost containment.

Summer Intersession 2011

Ethics and Health Inequality (3 credits)

Medical History & Bioethics 559-001 (class #88096)

May 23-June 10, 2011, MTWTF 9:00 AM – 12:00 PM, Van Hise 494

When is an inequality in health status an inequity or injustice? What is the value of equality? Should equality be construed more as a desirable feature of distributions (e.g. of income or health statuses) or as a virtue of social relations (as in a “society of equals”)? Does the specific cause of an inequality affect its moral urgency? Might the goal of health equity ever conflict with the goal of making everyone healthier? The first week of this 3-week intercession course will survey several ethical approaches to understanding the nature, value, and importance of equality. The second week brings ethical analysis to bear on recent work in social epidemiology and health economics on the social determinants of population health. The third week will focus on international health inequalities and will ask whether and why citizens in rich countries have urgent duties to aid those who suffer ill health in developing countries.

Spring 2011

Public Health Ethics

Medical History & Bioethics 559-2, Philosophy 305-1

This course focuses on ethical issues distinctive of a population-level approach to disease prevention and health promotion. Students will explore prominent theoretical approaches to public health ethics and will engage with several ethical tensions. Special topics for the Spring 2011 semester include climate change and the social determinants of health. Other issues we will discuss include: the use of coercive or intrusive public health interventions that restrict individual freedom, infringe upon individual privacy, and/or invite individual harm (or risks of harm); the justification of paternalistic measures in societies or sub-populations that seemingly indulge in pleasurable yet unhealthy behaviors; the extent to which societies should hold individuals responsible for their health conditions; the need to decide who receives life-saving treatment or vaccination when not all can; the need to choose between the identifiable victims we can save with expensive measures here and now and the more numerous unidentifiable victims we could save in the future with the same monetary investment; the trade-offs between maximizing aggregate health benefits and addressing the special needs of vulnerable social sub-groups and individuals; and the need to establish reasonable limits to public health demands in a world where health outcomes are profoundly influenced by policies in other domains (such as transportation, housing, unemployment, and education) that generate their own ethical problems and imperatives.

Fall 2010

Justice and Health Care

Medical History & Bioethics 559 (Class #83150)

This course will examine ethical issues in the distribution, financing, and delivery of health care in the United States. We will focus in particular on central issues raised by the recent U.S. health care reform debate and resulting legislation. Readings will be drawn from political philosophy, health care economics, behavioral economics, nonprofit thinktank reports, Congressional testimony, news articles, and blog posts. The first half of the class will consist of units exploring the philosophical and economic bases underlying currently dominant perspectives on putative entitlements to health care. We will seek to understand health economists’ concern to promote the “efficiency” of health resource allocation while constraining the “moral hazard” they detect when individuals use “too much” health care.  In this context we will strive to identify values that may either compete with or override concerns with efficiency, so construed. The second half of the class will consist of units investigating the nature, justifiability, and methods of health care rationing—including bedside rationing by doctors—and the myriad issues implicated by the near-universally shared goal of health care cost containment. If time allows, we will consider a question rarely (if ever) asked during the recent health care reform debate: Are there ethically defensible alternatives to the current patent regime for pharmaceutical development that could reduce drug costs while offering adequate or even enhanced levels of innovation?

Spring 2010

1. Public Health Ethics

Medical History & Bioethics 559-2, Philosophy 305-1

This course focuses on ethical issues distinctive of a population-level approach to disease prevention and health promotion. Students will explore prominent theoretical approaches to public health ethics and will engage with several ethical tensions, including: the use of coercive or intrusive public health interventions that restrict individual freedom, infringe upon individual privacy, and/or invite individual harm (or risks of harm); the justification of paternalistic measures in societies or sub-populations that seemingly indulge in pleasurable yet unhealthy behaviors; the extent to which societies should hold individuals responsible for their health conditions; the need to decide who receives life-saving treatment or vaccination when not all can; the need to choose between the identifiable victims we can save with expensive measures here and now and the more numerous unidentifiable victims we could save in the future with the same monetary investment; the trade-offs between maximizing aggregate health benefits and addressing the special needs of vulnerable social sub-groups and individuals; and the need to establish reasonable limits to public health demands in a world where health outcomes are profoundly influenced by policies in other domains (such as transportation, housing, unemployment, and education) that generate their own ethical problems and imperatives.

2. Health, Disability, and Social Justice

Medical History & Bioethics 559-3, Philosophy 305-2

This course will focus on the question: What do we owe each other healthwise? Ever since John Rawls ducked this question in his influential work, A Theory of Justice, many others have offered philosophical frameworks that address it head on. With a primary focus on the domestic context, we will investigate the bases on which various frameworks found political duties to address health needs. Special attention will be paid both to the ways in which the demandingness of candidate duties shapes the content and scope of bona fide social obligations, and to the special features of the domestic political context that might generate health-related responsibilities of citizenship. We will also ask how a just society will respond to the presence of disability in the populace; this will force us to address the fact that many forms of disability appear to be the result of an interplay between biomedical impairment and the wider built and social environment. When disabilities can be eliminated or alleviated through social accommodation and environmental change, how should the burdens of accommodation be distributed? Are there some disabilities that ought always to be addressed via social accommodation, even if more individualized measures (surgery or special wheelchairs, e.g.) are less expensive or less socially disruptive? Finally, we will take up the question of justice for persons with profound cognitive disabilities, which is still largely neglected by philosophers concerned with justice in health and health care.