Sociology 222 - Course Requirements and Outline

Course Requirements and Outline

READINGS:

Each student should purchase a copy of the following:

Mark R. Wicclair, ETHICS AND THE ELDERLY (New York: Oxford University Press, 1993).

Timothy E. Quill, A MIDWIFE THROUGH THE DYING PROCESS: STORIES OF HEALING AND HARD CHOICES AT THE END OF LIFE (Baltimore: Johns Hopkins University Press, 1996).

Daniel Callahan, SETTING LIMITS: MEDICAL GOALS IN AN AGING SOCIETY (Washington, DC: Georgetown University Press, 1995).

*AGING AND ETHICAL ISSUES STUDENT GUIDE (Fall, 2001).

ASSIGNMENTS AND REQUIREMENTS:

Aside from regular attendance and active participation, major assignments and requirements for the course can be grouped into three categories:

2. There will be one exam given in the course. The exam is tentatively scheduled for Wednesday, October 24. It will cover readings, presentations, and discussions up to that point in the course. Details will be given later, but it is most likely to be an essay exam, lasting about 90 minutes, with ample choice among questions provided prior to the exam. Methods for administering the exam to distance learning students will be discussed prior to the exam.

3. The final assignment is a written paper on some topic consistent with the general themes of the course: i.e., aging and ethical issues. The paper should be typed (double-spaced) and no less than 12 pages in length, excluding references, bibliography, etc. Papers must be handed in to me or postmarked no later than 4:00 p.m. Friday, December 7.

Listed below are a number of examples of possible topics you might want to consider. Most will have to be narrowed down when you begin to work on them, and I encourage you to propose other topics. Either way, I would like to see or speak with each of you fairly early in the semester to discuss topics for the paper.

Is it permissible to use age as a criterion in the allocation of scarce health-care resources?

Aging, competence, and informed consent: are special procedures needed in securing consent from the elderly?

Assessing competence in the aged.

Rules of precedence: who decides when the wishes of the elderly, their families, and professionals clash?

The institutionalized elderly: ethical issues in treatment or in research.

The elderly and the use of life-sustaining technology.

Ethical issues in the withdrawal of artificial nutrition and/or hydration.

Should categorically special ethical guidelines be developed for and/or applied to the elderly as research subjects in the same way as they have been for other groups (e.g., fetuses, children, prisoners, the mentally infirm)?

Physician/nurse relationships and the elderly.

Living wills and durable powers of attorney.

Nursing homes as teaching institutions: legal and ethical issues.

Barriers to effective communication between physicians and elderly patients and their implications for treatment and/or research.

Ethical issues in elder abuse or in self-neglect among elders.

Euthanasia.

Ethical issues in withholding benefits from elderly members of control groups in experimental studies.

Transfer trauma: legal, ethical, and health issues.

Ethical and policy implications of increasing life expectancy and decreasing morbidity.

Issues in the use of "No Code" and "DNR" orders.

Issues regarding filial responsibility laws.

Intergenerational obligations, rights, and responsibilities.

Theories of justice.

Providing health care to veterans.

Ethical issues in case management and/or discharge planning.

Ethical issues and the role of emergency medical technicians.

Ethical perspectives on physician-assisted suicide.

Ethical issues arising from the human genome project.

Ethical issues in genetic testing.

Ethical (and legal) analyses of selected case studies.

The Patient Self-Determination Act and its consequences

Comparative and cultural contexts of health care decision-making.

For the references in the paper, feel free to use any style with which you are familiar as long as the format is consistent and complete. Material used in the paper which is drawn from the work of others must be acknowledged as such. Direct quotations from the work of others must be placed in quotation marks and the page number(s) of the original source must be provided. Slight paraphrasing does not absolve you of this responsibility. If you have any questions about proper procedures for acknowledging sources, please see me and/or consult one of the several "manuals of style" available at the UVM Bookstore or in the library.

EVALUATION:

Regular attendance, active and thoughtful participation in the course, completing required readings, and meeting due dates are all expected. Clearly, performance on the exam and the quality of the term paper will be major factors in the final grade for the course. With these considerations in mind, a rough approximation of the basis for determining grades is as follows:

AUDITING:

If you are enrolling in this course as an auditor, please speak with me no later than the end of the first week of classes to discuss my requirements for receiving audit credit.

POLICY REGARDING LATE ASSIGNMENTS:

As a matter of equity and fairness to all students in the course, it is imperative that all assignments be submitted on the due date and by the indicated time. Assignments which are turned in late will be penalized one grade for any part of a 24-hour period that they are overdue. An A paper turned in or postmarked at 5:30 p.m. on Friday, December 7 will receive a grade of A-; the same paper turned in or postmarked at 5:00 p.m. on Saturday, December 8 will receive a grade of B+. In no case will late assignments be accepted after graded papers have been returned to other students. The only exceptions to these policies will be where there is a signed medical excuse, an officially authorized incomplete, or in other unusually extenuating circumstances which have been cleared with me well in advance of the due date.

COURSE OUTLINE | Course Calendar

August 29:Introductions and Introduction

--to the participants

--to the course

--to aging and the aged

--to the issues

Readings: "Helga Wanglie’s Ventilator," HASTINGS CENTER REPORT, Vol. 21 (July-August, 1991), pp. 23-24.*

Administration on Aging,"Profile of Older Americans: 2000," available at www.aoa.dhhs.gov/aoa/stats/profile/default.htm.

"The Demography of Aging: Tables and Charts."*

Note: All readings noted by an * for this and subsequent sessions may be found in the STUDENT GUIDE.

September 5:Overview of Ethical Theories and Issues

Readings:Wicclair, ETHICS AND THE ELDERLY, preface.

R. Hunt and J. Arras, ETHICAL ISSUES IN MODERN MEDICINE. Palo Alto: Mayfield, 1977, pp. 1-48.*

Capron, A. M., "In Re Helga Wanglie," HASTINGS CENTER REPORT, Vol. 21 (September/October, 1991), pp. 26-28.*

Case 1A.*

September 12-19:Autonomy

Readings:

Wicclair, ETHICS AND THE ELDERLY, Chaps. 1-2.

Quill, A MIDWIFE THROUGH THE DYING PROCESS, Introduction (pp. 1-5) and Chaps. 1-6 (pp. 6-139).

"Taking Steps: To Plan for Critical Health Care Decisions," Montpelier: Vermont Ethics Network, 1992.*

Joan M. Teno et al., "Do Advance Directives Provide Instructions that Direct Care?" JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, Vol. 45 (1997), pp. 508-512.*

E. Bradley, L. Walker, B. Blechner, and T. Wetle, "Assessing Capacity to Participate in Discussions of Advance Directives in Nursing Homes: Findings from a Study of the Patient Self Determination Act," JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, Vol. 45 (1997), pp. 79-83.*

Cases 2A-F.*

September 26:Beneficence and Paternalism

Film: PBS Frontline documentary on the Nancy Cruzan case.

Readings:

Wicclair, ETHICS AND THE ELDERLY, Chap. 4.

Quill, A MIDWIFE THROUGH THE DYING PROCESS, Chaps. 7-10 (pp. 140-228).

R. A. Kane and C. A. Levin, "Who’s Safe? Who’s Sorry? The Duty to Protect the Safety of Clients in Home- and Community-Based Care," GENERATIONS, Vol. 22 (Fall, 1998), pp. 76-81.*

S. H. Miles and A. August, "Courts, Gender, and 'The Right to Die,'" LAW, MEDICINE & HEALTH CARE, Vol. 18 (Spring-Summer, 1990), pp. 85-95.*

Cruzan v. Director, Missouri Health Department available at http://web.utk.edu/~scheb/cruzan.html

Cases 3A-C.*

October 3:(A) Beneficence and Paternalism (cont.)

Film: "Mr. Nobody"

(B) Justice

Readings:Wicclair, ETHICS AND THE ELDERLY, Chaps. 3, 6.

Callahan, SETTING LIMITS: MEDICAL GOALS IN AN AGING SOCIETY.

Nancy R. Zweibel, Christine K. Cassel, and Theodore Karrison, "Public Attitudes About the Use of Chronological Age as a Criterion for Allocating Health Care Resources," THE GERONTOLOGIST, Vol. 33 (February, 1993), pp. 74-80.*

Cases 4A-C.*

Assignment:CALLAHAN REVIEW DUE

October 10:Issues in Research with Elders

Readings:Wicclair, ETHICS AND THE ELDERLY, Chap. 5.

Dallas M. High, "Research with Alzheimer's Disease Subjects: Informed Consent and Proxy Decision Making," JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, Vol. 40 (Sept., 1992), pp. 950-957.*

ASSIGNMENT: Complete the tutorial on the protection of human subjects in research that is available at the following web site:

http://www.uvm.edu/~reshmpg/test2/protecting_human_subjcets_16/index.htm

October 17: Summary: The Case of Physician-Assisted Suicide

Film: "On Our Own Terms, Moyers on Dying in America: A Death of One's Own."

Readings:

J. Biskupic, "Unanimous Decision Points to Tradition of Valuing Life," Washington Post, June 27, 1997, p. A01; available at http://www.washingtonpost.com/wp-srv/national/longterm/supcourt/stories/die.htm

Department of Human Services, Oregon Health Division, Center for Disease Prevention and Epidemiology,"Oregon's Death with Dignity Act: Three Years of Legalized Physician-Assisted Suicide," February, 2001, available at http://www.ohd.hr.state.or.us/chs/pas/ar-index.htm or http://www.ohd.hr.state.or.us/chs/pas/00paspt.pdf

A. Meisel, L. Snyder, and T. Quill, "Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth," JAMA, Vol. 284 (No.19), November 15, 2000, pp. 2495-2501, available at http://jama.ama-assn.org/issues/v284n19/rfull/jlm00010.html#a1 or http://jama.ama-assn.org/issues/v284n19/rfull/jlm00010.pdf

October 24:EXAMINATION

October 31- December 5: ETHICAL AND LEGAL ISSUES IN PRACTICE

October 31: Anne Dilley, Case Management Supervisor

Champlain Valley Agency on Aging

November 7:Gilbert Myers, Esq.

Essex Jct. and Middlebury

November 14:NO CLASS - Gerontological Society of American Annual Meeting

November 21:NO CLASS - Thanksgiving break

November 28:Dr. Joseph Haddock

Thomas Chittenden Health Center

December 5:John Campbell, Director

Vermont Ethics Network

December 7: PAPERS ARE DUE (OR TO BE POSTMARKED) BY 4:00 p.m.

RELATED EVENTS:

Though not required, you are strongly encouraged to attend the Forum on Aging lecture (cosponsored by several other groups) on Thursday evening, November 1. Dr. Timothy Quill, whose work we will be studying this semester, will be speaking at the Sheraton Hotel on Williston Road in Burlington. Perhaps more than anyone, Dr, Quill has facilitated rational and thoughtful discourse on end-of-life treatment, care, and issues, and this is the general topic he will address in his presentation. Further information will follow.

BIBLIOGRAPHIC INFORMATION:

Included on the course Web site is a lengthy (60+ pages), though not exhaustive bibliography of works on ethics and/or aging that should be of use to you in preparing the term paper. Organized by general subject areas, the bibliography can be searched easily by specific topic or author with most browsers. Feel free also to print the bibliography, either in whole or in part, if having a hard copy better meets your needs.

Principal journals in the fields of gerontology and ethics include: