Introduction

students are required to complete four workbook exercises.  Two are compulsory (Module 1 ‘Introduction to Ethics’ and Module 3 ‘Developing and writing a research paper’).  Students must complete two other exercises from the remaining modules (you can choose which two). Workbook responses should address the issue raised succinctly and within the word limit set (where applicable). Students should reference material relied upon in their responses in the usual way. It should be noted that these exercises are in place of group discussion which internal students conduct during seminar time.  The purpose of the workbook exercises is for students to show their critical engagement with the module material and literature.

Please note:

• No independent research is required other than as directed below. Use the readings and the lecture material to assist you in answering the workbook exercises.
• Save this document and insert your answers into it at relevant points.

 

Module 1: Introduction to Ethics – Compulsory

 

• Apply each of the ethical frameworks discussed in the lecture to the following scenario using the space provided in the table below (do not go above 1500 words).

 

A surgeon was approached by a political science lecturer who requested that the surgeon amputate the lecturer’s healthy leg.  The lecturer had the support of his wife in making this request.  He was a member of a small on-line community of persons who shared his desires who called themselves ‘wannabes’ (i.e. want to be amputees).  The lecturer told the surgeon “my left leg is not part of me” and that his desire to be an amputee was so intense and all-consuming it was ruining his life to the extent that he was considering either suicide or performing a self-amputation if the surgeon would not undertake the surgery. The lecturer was assessed by a psychiatrist as being competent to make decisions and had received counselling. Does each ethical theory suggest that the surgeon should or should not operate?

 

(Further optional reading on the topic of the scenario C Elliott, “A New Way to Be Mad” http://www.theatlantic.com/past/issues/2000/12/elliott.htm)

 

Theory	Application
Utilitarianism
Deontology
Principles
Virtue Ethics
Justice based approaches
Feminist Bioethics
Casuistry
Rights based approaches

 

 

Module 2: No Workbook exercise

 

Module 3 – Workshop (compulsory)

 

• Read the following papers and answer the questions that follow in the table:
  1. G. Cohen, “How to regulate medical tourism (and why it matters for bioethics)” (2012) 12:1 Developing World Bioethics 9; and
  2. S Allan, ‘Psycho-social, ethical and legal arguments for and against the retrospective release of information about donors to donor-conceived individuals in Australia’ (2011) 19 Journal of Law and Medicine

 

	Cohen’s paper(max 200 words per entry)	Allan’s paper(max 200 words per entry)
Consider the introduction to the paper: did it sufficiently explain the paper’s substantive content and the approach to be used? If not, why not?
Do you think the paper ‘flowed well’ or was ‘disjointed’? Explain why you think this was?
In considering the issues or concepts raised in the paper, were these well explained? Identify areas of each paper which you thought were well explained or poorly explained (and if any reason was provided by the author for this).
How was law and ethics integrated into the paper’s discussion?
Consider the conclusion to the paper: was the conclusion reached justifiable and linked to the arguments in the paper?

 

• Overall, which paper do you consider to be better written and why? (Word limit 300 words)

 

Module 4: Disability (optional)

 

Consider the case of a couple seeking to select an embryo for implantation with a ‘disability’ (e.g. deafness or dwarfism). In the context of your readings, discuss the arguments for and against ‘future’ parents having such a choice. (Word limit 1000 words)

Arguments in favour	Arguments against

 

 

Module 5: Organ and Tissue Donation (optional)

 

• Read A Ghods and S Savaj, ‘Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation’ (2006) 1(6) Clin J Am Soc Nephrol

 

The authors of this article describe the ‘Iranian Model’ of kidney.  If such a model were adopted in Australia, what regulatory issues would this raise and do you think it would succeed in increasing donation rates? Explain why you think it would, or would not, be successful. (Word limit 1000 words)

 

Module 6: End-of-life (optional)

Consider the following scenario (which is based on a person described by a medical student, Andrew Firlick, in his article ‘Margo’s Logo’ in the Journal of the American Medical Association 265 (1991): 201). (This scenario is extracted from an article by Rebecca Dresser, ‘Dworkin on dementia: Elegant theory, questionable policy’ The Hastings Center Report (Nov 1995): 32-8.)

Firlik met Margo, who has Alzheimer’s disease, when he was enrolled in a gerontology elective. He began visiting her each day, and came to know something about her life with dementia. Upon arriving at Margo’s apartment (she lived at home with the help of an attendant), Firlik often found Margo reading; she told him she especially enjoyed mysteries, but he noticed that “her place in the book jumped randomly from day to day.” “For Margo,” Firlik wonders, “is reading always a mystery?” Margo never called her new friend by name, though she claimed she knew who he was and always seemed pleased to see him. She liked listening to music and was happy listening to the same song repeatedly, apparently relishing it as if hearing it for the first time. Whenever she heard a certain song, however, she smiled and told Firlik that it reminded her of her deceased husband. She painted, too, but like the other Alzheimer patients in her art therapy class, she created the same image day after day: “a drawing of four circles, in soft rosy colors, one inside the other.” The drawing enabled Firlik to understand something that previously had mystified him: Despite her illness, or maybe somehow because of it, Margo is undeniably one of the happiest people I have known.

 

In his classic work, Life’s Dominion, Ronald Dworkin poses the following additional information: years ago, when fully competent, Margo had executed a formal document directing that if she should develop Alzheimer’s disease she should not receive treatment for any other serious, life-threatening disease she might contract.

 

Assume Margo contracts pneumonia and needs medical treatment.  If she receives antibiotics, she will recover from pneumonia and continue to live as before.  Alternatively, Margo can be provided with comfort care and be allowed to die.

 

1. Assuming that it would be lawful either to provide or withhold the antibiotics, what ethical principles would be relevant in coming to a decision? (Word limit 1000 words)

 

 

 

 

Module 7: Health Tourism (optional)

 

Read the readings for this topic and consider the role for law in regulating this area. In a maximum of 1000 words evaluate the arguments for and against using law to regulate health tourism.

Arguments in favour	Arguments against

 

Module 8: Health and the Right to Health (optional)

 

• Consider how you characterise health
• We are asking you to draw a concept. Draw how you would design a system to maximise what your idea of ‘health’ is.  You can use symbols but not words or letters.  We will not be marking you on your artistic abilities (or lack thereof) so stick figures etc are fine.
• Scan and save your picture and submit as an attachment to your workbook or take a photo and attach as a jpg. You may insert a maximum 100 word caption in the space below to explain the relationships between parts of your diagram or its conceptual basis if you think an explanation is required.

 

Module 9: Resources and Rationing (optional)

 

• Rank the following in the order that you would give priority for funding – 1 highest priority and 13 lowest and provide your justification for its ranking.

 

Intervention	Ranking	Justification (max 200 words per entry)
Treatments for children with life threatening illnesses
Special care and pain relief for people who are dying
Preventive screening services and immunisations
Surgery, such as hip replacement, to help people carry out everyday tasks
District nursing and community services/care at home
Psychiatric services for people with mental illness
High technology surgery, organ transplants and procedures which treat life threatening conditions
Health promotion/education services to help people lead healthy lives
Intensive care for premature babies who weigh less than 680 g with only a slight chance of survival
Long stay hospital care for elderly people
Treatment for infertility
Treatment for people aged 75 and over with life threatening illness
Provision of public pools in remote indigenous communities

 

Adapted from A Bowling “Health Care Rationing: The Public’s Debate” BMJ 1996; 312: 670.

 

 

Module 10: Pluralism (optional)

 

• In a maximum of 1000 words critically argue whether Australian states and territories need to create a legal framework that confers a legal right to receive health services that are culturally appropriate or whether current law (anti-discrimination law) and practice is sufficient.

 

 

Module 11: Patient Safety and Open Disclosure (optional)

 

• After listening to the lecture for module 11 (Patient Safety and Open Disclosure) and considering the prescribed materials, read the following articles:
  10. A Wu et al “Disclosing Adverse Events to Patients: International Norms and Trends” Journal of Patient Safety 2014 [epub] http://dx.doi.org/10.1097/pts.0000000000000107;
  11. Quick O “Regulating and legislating safety: the case for candour” BMJ Qual Saf 2014; 23:614 – 618

 

• Consider the following:

Wu et al state that there is a “growing expectation in health systems around the world that patients will be fully informed when adverse events occur,” yet note that “current practices still fall short of this expectation.” The authors identified the challenges to disclosure and proposed potential solutions. In his article, Quick evaluates recommendations in the United Kingdom to reform the legal and regulatory landscape around patient safety, with a focus on the potential for a legal duty of candour to contribute to an improved safety culture in healthcare.

 

Does law help or hinder attempts to create a culture of open disclosure and promote safer healthcare? Should a statutory duty of candour be enacted in Australia? (Word limit 1,000 words)

 

Module 12: Research Ethics (optional)

 

• Watch 5 most evil Nazi Human Experiments available at: https://www.youtube.com/watch?v=KokEoBhkk3s

 

In a maximum of 1000 words address and justify, using ethical theories, whether and in what circumstances scientists should in their publications reference the results of Nazi research in which human subjects were killed or maimed.