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 pubic 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.