MODERN MEDICINE AND PERSONAL AUTONOMY - INTRODUCTION TO THE MEDICAL LAW AND ETHICS
Judit Sandor
Term: Fall 1994
Department of Political Science, Budapest
CENTRAL EUROPEAN UNIVERSITY



Course Summary:

Physical inviolability and personal integrity as an inherent part of individual autonomy has long been respected by law and ethics. Still for long centuries it did not seem to be evident that medical treatment without the patient's consent is an injury and constitutes a battery. During the last decades the preliminary question of informed consent has been followed by many other new challenges; end of life decisions, refusal of medical treatment, transplantation, experimentation on human subjects, assisted procreation, genetic testing and therapy, human cloning.

The aim of the course is to provide an introduction to the different moral and legal concepts of individual autonomy in the field of health care. The course focuses on a comparative approach of readings and cases with the intent to identify the scope and limits of individual autonomy and compelling state interest.

Each modul includes lectures elaborating the themes and discussions based on reading materials and lecture. Every second lecture is a case analysis.
Syllabus:

1. Introduction
Required Readings:
Michel Foucault: The Birth of the Clinic An Archaeology of Medical Perception Routledge l973 pp.3.-21
Shapiro, Michael H. 1981 Cases Materials and Problems on Bioethics and Law , Chapter Three Managing Dilemmas: ethical theories pp.72-92

2. Moral Principles in Medical Ethics and Law
Required Readings:
Dworkin G, 1988, Theory and Practice of Autonomy, CUP pp.100-121.
Raanan Gillon, 1985 Philosophical Medical Ethics, Autonomy and the principle of respect for autonomy
Raanan Gillon, 1985 Philosophical Medical Ethics, Justice and Medical Ethics pp.86.-91.
Raanan Gillon, Philosophical Medical Ethics,Utilitarianism pp.21.-27.

3. Concept of Privacy in Medicine
Required Readings:
Brandeis, J.1890, The right to Privacy, Harvard Law Review Vol.IV. December 15,1890. No5. pp.193- 215.
Richards, 1986. Toleration and the Constitution The Jurisprudence of Constitutional privacy pp 255.-281.
Griswold v. Connecticut 381 U.S. 479 (1965)

4. Concept of dignity
Required Readings:
Kommers, D.P. 1989, Constitutional jurisprudence of the Federal Republic of Germany. Human Dignity and Personhood pp.305-366 Duke University Press
Merrils, J.G.1988. The development of international law by the European Court of Human Rights Manchester University Press Chapter 3. The Court's conception of the Strasbourg system pp. 40- 62. Chapter 10. Ideology and international human rights law pp. 207- 219.

5.Principle of autonomy in the medical decision-making Informed consent
David W. Meyers,The Human body and the Law l990.Consent to medical treatment pp 22.-149.
Dworkin G, 1988, Theory and Practice of Autonomy, CUP pp 85.-99.
Origins of the Informed Consent Doctrine in: Furrow,Barry R. Johnson,Sandra H. Jost,Timothy S. Schwartz,Robert L.l991 West Publishing Co. St. Paul, Minn.,l991 :Health Law cases, Materials and Problems Second Edition pp.321.-323.
The Cantebury rule
Canterbury v. Spence (United States Court of Appeals, District of Columbia Circuit,1972.564 F.2d 772.)

6. Right to life v. human dignity
Required Readings:
Judith Jarvis Thomson: A defense of abortion in; Biomedical ethics and the Law 2nd edition ed.. James M. Humber and Robert Almeder Plenum Press New York 1979. pp.57-72.
J. Finnis, The Rights and Wrongs of Abortion: A Reply to Judith Thomson in The Philosphy of Law ed. R.M. Dworkin Oxford University Press pp.129.-152.
Legal recognition of the beginning of human life in: Furrow,Barry R. Johnson,Sandra H. Jost,Timothy S. Schwartz,Robert L.l991 West Publishing Co. St. Paul, Minn.,l991 :Health Law cases, Materials and Problems Second Edition ,Organizing Health Care Delivery,pp.893.-898
Roe v. Wade (410 U.S.113,93 S Ct 705,35 L.Ed.2d 147(1973)
State v. Merrill Supreme Court of Minnesota ,1990 450 N.W.2d 318.
Planned Parenthood of Southeastern Pennsylvania, et al. v. Casey

7. Reproductive freedom
Required Readings:
Matter of Baby M Supreme Court of New Jersey, 1988 109 N.J. 396,537 A2d 1227
Matter of Grady Superior Court of New jersey, Chancery Division, 1979 170 N.J.Super.98 405 A2d851
Doctors, Patients and the Law Edited by: Clare Dyer Chapter 5. Reproductive Medicine pp 89-106 Sheila McLean

8. Refusal of medical treatment
Required Readings:
Persels, Jim. 1993, Forcing the Issue of the Physician-Assisted Suicide Impact of the Kevorkian case on the Euthanasia in: Journal of Legal Medicine,14: pp93-124
Veatch, Robert M.Revised Edition Death, Dying and the Biological Revolution Yale University Press pp.ll8.-136.
Bouvia v. Superior Court Court of Appeal of California, Second District 986 179 CalApp 3d 1127, 225 Cal Rptr 297. In re: A.C533 A.2d 611(D.C.1987.)
Mills v. Rogers Supreme Court of the United States, 1982 457 U.S. 291., 102 S. Ct 2442 73 l.Ed2d 16.

9. End of life decisions
Required Readings:
Raanan Gillon,1985 Philosphical Medical Ethics, Acts and Omissins, killing and letting die, pp.l26-131.
Gervais, Karen Grandstrand, 1986, Redefining Death, Yale University Press, Chapter 4. pp.75.- 110. Moral arguments
Have, Henk A.M.J. ten 1992, Euthanasia: Normal Medical Practice? in: Hastings Center Report March-April 1992 pp. 34-38.
Cruzan v. Director, Missouri Department of Health (Supreme Court of the United States,1990. 492 U.S.-110 S. Ct.2841,111 L.Ed.2d 224.

10. Dignity after death, cadaver transplantation
Required Reading:
Barber v. Superior Court Court of Appeal, Second District,1983. 147 Cal App3d 1006,195 CalRptr.484.
Harmonisation of legislations of member states relating to removal, grafting and transplantation of human substances Resolution (78) 29 adopted by the Committee of Ministers of the Council of Europe on 11 May 1978 and Explanatory memorandum 1978

11. Experimentation on human subjects
Nuremberg Code, Helsinki Declaration
History of Research upon Human Subjects in the United States in:Furrow,Barry R. Johnson,Sandra H. Jost,Timothy S. Schwartz,Robert L. l991 West Publishing Co. St. Paul, Minn.,1991 :Health Law cases, Materials and Problems Second Edition p. 1197-1211.
Mack v. Califano United State ws District Court, District of Columbia 1978 447 F. Supp.668.
Moore v. Regents of the University of California Supreme Court of California 1990. Cal 3d 793 P2.d 479,271 Cal.Rptr 146.

12. Right to health Care-Justice in health care
Allan Buchanan Justice: A Philosophical Review p.3.-21.in: Justice and the Health Care e.Earl E. Shelp D. Reidel Publishing Company 1981.
Frederick S. Carney: Justice and Health Care: A Theological Review pp.37.49. in: Justice and the Health Care e.Earl E. Shelp D. Reidel Publishing Company 1981.
David Friedman, Should Medicine Be a Commodity? An Economist's Perspective in Rights to Health Care ed. Thomas Bole, William B Bondeson Kluwer Academic Publishers pp.259-307

13. Allocation of scarce resources
Required Readings:
David Meyers: Distribution and Rationing of Scarce Medical Resources pp.330-349 in:David W. Meyers, The Human body and the Law 1990
Furrow,Barry R. Johnson,Sandra H. Jost,Timothy S. Schwartz,Robert L.l991 West Publishing Co. St. Paul, Minn.,l991 :Health Law cases, Materials and Problems Second Edition ,Organizing Health Care Delivery,pp.457-458.
Thompson v. Sun City Community Hospital, Inc. (Supreme Court of Arizona,1984.141 Ariz,597,688 P.2d 605.)

14. Personal identity and autonomy in the moderm technology Genetic screening, gene therapy, human cloning
Required Reading:
John Locke: Of Identity and Diversity in :Personal Identity ed: John Perry University of California Press 1975 pp.33-52

Current materials shall be provided for this modul during the semester

Additional compulsory readings:

Annas, George J. 1993, Standard of Care, Oxford University Press the U.S. Constitution of Bioethics pp. l5.-115.
Bickel, Alexander M. The morality of consent Yale University Press pp.33.-54.
Feinberg, Joel, 1973: Social Philosophy, Prentice-Hall,Inc Englewood Cliff, New Jersey
Merrils, J.G. 1988. Development of international law by the European Court of Human Rights Chapter 3, Chapter 10.
Rosenfeld 1991. Affirmative action and justice, philosophical and constitutional inquiry Chapter 6. Constitutional Equality and the Equal Protection pp.l35.162.

Grading:
Activity on seminars: 25%
Mid-term essay: 25%
Final exam: 50%


Digitized version prepared by the Curriculum Resource Center (CRC)
CEU Budapest, Hungary
Revised: April, 1996

San_ModMedic.F94PS.v5


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