TH298 Law, Medicine & Ethics

Fall Term, 2001
Tuesday & Thursday 9:00 - 10:15, Gasson 204
Office: Carney 403
Tel: 552-8434 (W)
       552-8237 (H)
John.Paris@BC.edu
www2.bc.edu/~parisj/
John J. Paris, S.J.
 

Office Hours: 
Wednesday 10:30-12:00 
or by appointment

BIOETHICS SITES FOR SEMINAR PAPER:
 http://ethics.acusd.edu
 http://www.upenn.edu/bioethics/
 http://bioethics.georgetown.edu (Access to Medline and Bioethics Line)
 Lexis/Nexis (O’Neil Library)
 Medline (O’Neil Library)

Text:
1.   Ronald Munson, Intervention and Reflection:  Basic Issues in Medical Ethics, 6th ed. (1999).
2.   Packet of Xeroxed materials.

Position Papers:
Write a one to two page position paper articulating the ethical stance you believe should govern the issue under discussion.  The purpose of the paper is to have you reflect on and take a preliminary position on the ethical issue under consideration.

 The papers, which will be read but not graded, are due BY 4:30 PM on the DAY BEFORE THE CLASS.

Term Paper:
A six-eight page paper is due THURSDAY, NOVEMBER 15TH @  9:00 AM (Two Copies).

Grading:
1.  Mid-Term Exam 25%
2. Term Paper  25%
3. Final Exam  40%
4. Class Participation 10%

Assignments:

 Thursday, September 6:  MORAL PRINCIPLES

1. Text:

a..  Ethical Theories and Moral Principles I, pp. 1-25 (Read quickly for an overview).
2. Packet:  Role of Ethics
a.   "Five Questions of Ethics," pp. 1-8.
b.   Richard McCormick, “Bioethics: A Moral Vacuum?” America, May 1, 1999, pp. 9-13.
c.   "When Doctors Play God," Newsweek, August 31, 1981, pp. 15-20.
d. "Painful Decisions:  The Role of The Medical Ethicist,"  New York Times Aug. 5, 1990, pp. 21-25.
e. “Last Rights,” Newsweek, August 26, 1996, pp. 26-31.
3. Position Paper #1:  (Due Wednesday at 4:30 p.m.)
What Would You Do?

CASE #1: A 47-year-old man suffers a brain aneurysm and is comatose.  After three years in a persistent vegetative state his wife abandons hope he will recover and asks the doctor to remove the feeding tube that supplies his nutrition and fluids.

CASE #2: A child is born with Down Syndrome and duodenal atresia (a blockage in his intestines that prevents his ability to digest food).  His parents ask the doctor to forgo surgery and let him die.

CASE #3:  Bill Shea, a 27 year old needs a kidney transplant.  All the family members are tested for tissue match.  Only his brother Jim matches.  When told, Jim, fearful of risking his own life, informs the surgeon he does not want to donate his kidney but does not want Bill or the family to know of his refusal.  Bill asks the surgeon, “Did anyone match?”  Should the doctor tell Bill the truth?

CASE #4:  An infertile married couple decides to have children by in vitro fertilization.  Multiple eggs are fertilized and two were implanted.  Seven other fertilized eggs were frozen.  The marriage failed and the couple divorced.  Now the woman wants to have some of the frozen embryos implanted so she can bear children.  The husband objects.  What should be done with the seven frozen embryos?  (What are they?  Whose are they?)

CASE #5: Mary and Jodie, conjoined twins of a family from the remote island of Gozo are born joined at the pelvis at St. Mary’s Hospital in Manchester, England.  Mary has a premature brain, malformed heart and non-functioning lungs.  She shares a common aorta with Jodie on whom she depends to survive.  Without surgery both will die within months.  Surgery will immediately result in Mary’s death.  Jodie has an 85% chance of survival.  The parents object to “killing one child to save the other.”  They refuse permission for the surgery.  The physicians want to save Jodie and petition the High Court for authorization to perform the surgery.  What would you do if you were the judge?
Tuesday, September 11:  DECISION MAKING

1. Packet:

a. Joel Feinberg, "Rights," pp. 32-37.
b. Inglefinger, "Arrogance," NEJM, December 25, 1980, pp. 38-42.
c. Responsibility for the Decisions, pp. 43-44.
d. Case 6, "The Dying Infant and the Needs of Others," pp. 44-47. N.B.  Be prepared to assess and evaluate the positions of the various participants in this case.
e. Case 8:  Family Conflict Over Leg Amputation, pp. 47-50.
f. Nemser Case, pp. 51-54.
Thursday, September 13:  SERIOUSLY ILL NEWBORNS

1. Text:

a.   Dilemma of Extreme Prematurity, pp. 136-150.
b. John A. Robertson, "Examinations of Arguments in Favor of Withholding Ordinary Medical Care from Defective Infants, Stanford Law Review, pp. 151-157.
c. Tristam Englehardt, Jr., "Ethical Issues in Aiding in the Death of Young Children,"  pp. 158-163.
2. Packet:
a.   Johns Hopkins Case, p. 55.
b.   Maine Medical Center v. Baby Boy Houle, pp. 56-57.
c. Baby L, p. 58.
d. Baby Q

Baby Q was born on July 15, 2001 in a small community hospital in Northern California.  She was born without hands or feet.  Her elbows were permanently splayed outward. She had significant respiratory problems that are probably reversible.  She is now on a ventilator.  A CAT Scan did not reveal any brain damage. (An MRI is a more expensive but more accurate test.)  Baby Q was transferred to USCF Medical Center for treatment.

If the ventilator is removed while she still has respiratory insufficiency, she will die.  When appraised of her medical condition late Friday evening by the resident, the mom asked the doctors to end all treatment.

3. In-Class  Video:   Baby K

4. Position Paper  #2:  (Due Wednesday at 4:30 p.m.)
 

Write a 1-2 paragraph position paper on:

a.  Who should decide?

b. What should be done in:  1) Johns Hopkins,  2) Baby Houle, 3) Baby L and 4) Baby Q?  (Do each case separately!)

Tuesday, September 18: SERIOUSLY ILL NEWBORNS (CONT.)

1. Packet:

a. Singer, “Furor Follows Princeton Philosopher,” Boston Globe, July 27, 1999, pp. 59-62.
b.   Gustafson, "Mongolism, Parental Desires and the Right to Life." Perspectives in Biology and Medicine, Summer, 1973, pp. 63-76.
c.   Duff and Campbell, "Moral and Ethical Dilemmas in Special Care Nursery,"NEJM, pp. 77-81.
     (And Duff "Letter" on p. 82).
d. Richard McCormick, "To Save or Let Die," JAMA (1974), pp. 83-87.
e. Michael Tooley, "Abortion and Infanticide," pp. 88-104.
f. Stinson, "On the Death of a Baby," pp. 105-111.
Thursday, September 20:  PATIENTS' RIGHTS AND PROFESSIONAL RESPONSIBILITY

1. Text:

a. Principles of Nuremberg Code, p. 515.
b. Gerald Dworkin, Paternalism, pp. 402-410.
2. Packet:  Autonomy
a. Schloendoroff v. Soc of NY Hosp, 211 N.Y. 125 (1914), pp. 112-115.
b. Kessler and Gilmore, "Contracts," pp. 116-117.
c. John Stewart Mill, "On Liberty," p. 117.
d. Patrick Devlin, "The Enforcement of Morals," pp. 117-121.
e. Isaiah Berlin, "Two Concepts of Liberty," pp. 121-124.
f.  Pius XII, "Moral Limits of Medical Research," pp. 124-126
g. Dostoveysky, "The Grand Inquisitor," pp. 126-128.
h. John Rawls, "A Theory of Justice," pp. 129-143.
Tuesday, September 25: PATIENTS' RIGHTS AND PROFESSIONAL RESPONSIBILITY (CONT.)

1. Packet:

a. Peter Marzuk, "The Right Kind of Paternalism," NEJM, December 5, 1985, pp. 144-146.
b. Robert Nozick, "Anarchy, State and Utopia," pp. 147-157.
c. Lisa Belkin, “The Made to Order Savior,” NY Times Magazine, July 1, 2001, pp. 158-169.
d. Marian Damewood, “Ethical Implications of Preimplementation Diagnosis,” JAMA, June 27, 2001, pp. 170-171.
e. Barry Maron,  “Competitive Athletes with Cardiovascular Disease—The Case of Nicholas Knapp,” NEJM, November 26, 1998, pp. 588-591.
2. Position Paper #3:  (Due Monday at 4:30 p.m.)
 
1) Northwestern University appealed the federal district court ruling in the Knapp case.  Write a memorandum for the Court of Appeals on the ethical issues to be considered in the case.  Should he be allowed to take the risk of playing basketball?

2) What, if any, limits should there be on a mother’s attempt to create a perfectly matched sibling for a Fanconi anemia child?

Thursday, September 27: INFORMED CONSENT AND AUTONOMY: JEHOVAH'S WITNESS CASES

1.   Packet:

a. Canterbury v. Spence, 464 F.2d 772 (1972), pp. 182-187.
    (N.B.  Two exceptions to the need for consent.)
b. Shine v. Vega, 709 N.E. 2d58 (1999), pp. 188A-188B.
c. Application of President and Directors of Georgetown College, 331 F. 2d 1000 (D.C. Cir.1964), pp.172-176.
    (N.B. Judge Warren Burger's dissent.)
d. In re Brooks Estate, 32 111 2d 361 C 1965, pp. 178-179.
e. Powell v. Columbia Presbyterian Medical Center, (NY Dec. 24, 1965), pp. 180-181.
3. Position Paper #4: (Due Wednesday at 4:30 p.m.)
Write a one paragraph opinion for the SJC in the Shine v. Vega case (packet pp. 188A-188B).
Tuesday, October 2: INFORMED CONSENT AND AUTONOMY: JEHOVAH'S WITNESS CASES (CONT.)

1. Packet:

a. Heglund, "Unauthorized Rendition of Life Saving Medical Treatment," pp. 189-193.
b. "She Refused Blood and Died," Boston Globe, September 19, 1979, p. 194.
c. John Figgis Jewett, "Total Exsanguination," NEJM,  November 12, 1981, pp. 195-197.
d. Prestigiacomo v. Campbell, pp. 198-199.
e. Position papers on Jehovah's Witnesses, pp. 203-204.
2. Position Paper #5:  (Due Monday at 4:30 p.m.)
Write a position paper on what should be the public policy in the Prestigiacomo v. Campbell case (pp. 198-199).
Thursday, October 4: REPRODUCTIVE RIGHTS AND MATERNAL-FETAL CONFLICT

1.   Text:

a.   Roe v. Wade (1973), pp. 109-113.
2.   Packet:
a. Griswold v. Connecticut, 310 U3, 479 (1965), pp. 205-211.
b. Jefferson v. Griffin Spaulding Hospital 274 S.E. 2d 457 (1981), pp.  212-216.
c. In re A.C. 533 A. 2d 611 (1987), pp. 217-220.
d. In re A.C. - A2d - (D.C. 1990) pp. 221-227.
Tuesday, October 9: MATERNAL-FETAL CONFLICT

1. Packet:

a. Robertson, "Procreative Liberty and the Control of Conception, Pregnancy and Childbirth," pp. 228-231.
b. Helene Cole, "Legal Intervention During Pregnancy," JAMA 244: 2663-2670, pp. 232-239.
c. Berkowitz, "Selective Reduction of Multifetal Pregnancies," NEJM  (1988) 318, pp. 242-245.
d. Greenhouse, "Hospital Sets Policy on Pregnant Patients' Rights," NY Times, Nov. 24,  1990, p. 246.
e. Chervenak and McCullough, "Justified Limits on Refusing Intervention," Hastings Center Report, March 1991, p. 247.
f. David Abel, “Pregnant Sect Member in State Custody,” Boston Globe, September 1, 2000, pp. 248.
g. Ellen Goodman, “Just How Far Can the State Go in Protecting an ‘Unborn’ Child?” Boston Globe, Sept. 10, 2000, pp. 249-250.
h. George Annas, “Testing Poor Pregnant Women for Cocaine?Physicians as Police Investigators,” NEJM, May 31, 2001, pp. 251-254.
3. Position Paper #6:  (Due Monday at 4:30 p.m.)
1) Chervenak and McCullough's essay (p. 247)  "Justified Limits on Refusing Intervention," Hastings Center Report, March 1991, challenges the policy announced by George Washington University Medical Center (Greenhouse article in NY Times, Nov. 29, 1990 (p. 246)  Write a position paper on what you believe should be the public policy with regard to a woman presenting at term with complete placenta previa who refuses a C-section.

2) Discuss the ethical issues in the Rebecca Corneau case (packet pp. 248-250).

Thursday, October 11:  NO CLASS.  THIS CLASS WILL BE MADE UP WITH AN EVENING CLASS ON THURSDAY EVENING, NOVEMBER 1ST AT 7:00 PM, HIGGINS 310.

Tuesday, October 16: TRUTH TELLING AND CONFIDENTIALITY

1.   Text:

a. Tarasoff v. Regents of Univ. of California, 131 Cal R 14 (1976), pp. 445-451.
2. Packet:
a. "Harvard Defends Role in Dean's Resignation," Boston Globe, July 3, 1999, pp. 256-257.
b. Joseph Collins, "Should Doctors Tell the Truth?", Harpers, 1927, pp. 285-289.
c. Blackhall et al., "Ethnicity and Attitudes Toward Patient Autonomy," JAMA. 1995;274:820-825, pp. 290-295.
d. Carrese and Rhodes, "Western Bioethics on the Navajo Reservation," JAMA, 1995;274:826-829, pp. 296-299.
e. Matthew Wynia, “Physician Manipulation of Reimbursement Rules for Patients,” JAMA, April 12, 2001, pp. 300-303.
f. Victor Freeman, “Lying for Patients,” Archives of Internal Medicine, Oct. 25, 1999, pp. 304.
g.  Stephen Gillers, “A Duty to Warn,” NY Times, July 26, 2001, p. 305.
3. In Class Video:    Fred Friendly on Confidentiality

4. Position Paper #7:  (Due Monday at 4:30 p.m.)

a. Bill Shea, a 26 year old is in end stage renal failure and without a kidney transplant will die.  Of all the family members tested only his brother Jim is a match.  When told, Jim, fearful of risking his own life by donating a kidney, informs the surgeon that he does not want to donate.  Jim does not want Bill or the family to know of his refusal.  Bill asks the surgeon, “Did anyone match?”  Should the doctor tell Bill the truth?

b.   Lawyer–Client Confidentiality

In the course of discussing his problem Jim Lockland tells his attorney, James Neill, that last year in the midst of a robbery he shot and killed a store clerk.  Michael Brown was incorrectly convicted of that murder and is scheduled to be executed.  What are Mr. Neal's obligations:
   1) Toward his client?
   2) To Michael Brown?
   3) To society?

What are the public policy implications of the attorney breaching the confidentiality?

Thursday, October 18: STERILIZATION

1.   Packet:

a. Ruby v. Massey, pp. 311-327.
b. Buck v. Bell, 247 US 200 (1927), pp. 328-329.
c. Skinner v. Oklahoma, 316 US 535 (1942), pp. 330-332.
d. Stump v. Sparkman, 431 US 349 (1967), pp. 333-334.
e. Gilmore, Ages of American Law, pp. 335-338.
f. Gaylord, "The Sterilization of Carrie Buck," pp. 339-346.
g. George Annas, "Sterilization of the Mentally Retarded: Lee Ann Grady,” pp. 347-348.
h. HEW Rules, pp. 349-353.  (Read quickly to determine the “rule” on sterilization.)
i. Downs v. Sawtelle, 574 F. 2d (1978), pp. 354-357.
j. Elizabeth Rosenthal, “China’s Sterlization Law,” NY Times, August 1, 1998, pp. 306-308.
k. Carl Honore, “They Took Away My Dignity—100 Sterilized Canadians Sue,” Houston Chronicle, March 8, 1998, pp. 309-310A.
Tuesday, October 23: DEATH AND DYING

1.   Text:

a. Introduction, pp. 203-211.
b. Karen Quinlan, pp. 190-192.
c. James Rachels, "Active and Passive Euthanasia," pp. 212-215.
2.   Packet:
a.    President's Commission, Deciding to Forego Life-Sustaining Treatment, pp. 358-373.
b. Neuhaus, "The Gospel of Life," Wall Street Journal, April 3, 1995, pp. 374.
c. Vatican 1980 Declaration on Euthanasia, pp. 375-378. (N.B. Section IV.)
3.  Bring a written outline of the Vatican Declaration on Euthanasia to class.

Thursday, October 25: SUICIDE/ACTIVE EUTHANASIA

1. Text:

a. Dr. Kevorkian, pp. 199-201.
b. Dan Brock, “Voluntary Active Euthanasia,” pp. 215-222.
c. Daniel Callahan, “When Self-determination Runs Amok,” p. 225.
d. Oregon’s Physician Assisted suicide Law, pp. 192-196.
2.   Packet:
a. “It’s Over, Debbie,” JAMA, Jan. 8, 1988, pp. 379.
b. Timothy Quill, "Death and Dignity:  A Case of Individualized Decision Making," NEJM, March 7, 1991, pp. 380-383.
c. Marcia Angell, “The Supreme Court and Assisted Suicide—The Ultimate Right,” NEJM 1997;336:50-53, pp. 389-392.
d. George Annas, “The Bell Tolls for a Constitutional Right to PAS,” NEJM 1997;337:1098-1104, pp. 393-398.
e. Arthur Chin, “Legalized Physician Assisted suicide in Oregon?The First Year Experience,” NEJM 1999, pp. 384-386.
f. Johanna Groenewoud, “Clinical Problems with PAS in Netherlands,” NEJM Feb. 24, 2000, pp. 387-388.
3. In Class Video: 60 Minutes—Dr. Kevorkian

4. Position Paper #8:  (Due Wednesday at 4:30 p.m.)

a. Dr. John Smith, a professor of medicine at Dartmouth Medical School, gave a Grand Rounds lecture on physician assisted suicide. In the course of his lecture Dr. Smith described three cases of physician assisted suicide in his own practice. In each of the cases, the patient had end stage terminal cancer and had requested assistance in dying. Dr. Smith gave the patients instructions on lethal dosages of medication and a prescription for a sufficient number of pills to end life. All took pills and died. In one case Dr. Smith had to help the patient swallow the pills by pushing them down the patient's throat. The New Hampshire Attorney General is informed of the lecture and after an investigation seeks an indictment against Dr. Smith.

Peter Mosseau, a BC Law graduate and former Acting Attorney General of New Hampshire, represents Dr. Smith. He asks you to provide him with guidance on the ethical/legal aspects of this case.

Tuesday, October 30: INCOMPETENT PATIENT

1. Text:

a.   In Re Quinlan, pp. 230-232.
2.   Packet:
a. In re Helga Wanglie, NY Times, Jan. 10, 1990, pp. 405-407.
b. Field & Romanus, "18 Year Decerebrate," pp. 408-410.
c. Belchertown v. Saikewicz, 370 N.E. 2d 417 (Probate Court) (1977), pp. 413-417.
d. Superintendent of Belchertown v. Saikewicz (Supreme Judicial Court) (1977), pp. 417A-417F.
e. In re Storar, 420 N.E. 2d  64 (1981), pp. 418-420.
f. In re Conroy, 98 NJ 321, 486 A. 2d 1209 (1985), pp. 421-427.
g. Joseph Quinlan, Karen Ann, pp. 428-438.
3.  In Class Video:  Earle Spring

4. Position Paper #9: (Due Monday at 4:30 p.m.)

Write a position paper on the guidelines you would propose for the Brigham & Women's Hospital for cases such as that described by Field and Romulus in the 18 Year Decerebrate case (packet pp. 408-410).
Thursday, November 1: WITHDRAWAL OF TREATMENT FROM INCOMPETENT PATIENTS

1. Packet:

a. Barber v. Superior Ct., 195 Cal. Rptr. 484 (1983), pp. 439-442.
b. AMA Statement (1986), p. 443.
c. Brophy v. N.E. Sinai Hospital, 398 Mass. 417 (1986), pp. 444-447.
   (N.B.  The description of how patients deprived of nutrition and fluids will die in Footnote 2 of Justice Nolan's dissent.)
d. Cruzan v. Director, Missouri Department of Health,  US, (1989), pp. 448-454.
* * *

SPECIAL EVENING CLASS, HIGGINS 310 @ 7:00 PM:  (Yes, two classes in one day!)

Atty. Frank Reardon, who represented the Brophy family, and Mrs. Patricia Brophy will speak on the medical-legal issues in the Brophy case.
In Class Video:  20/20 Edition on Paul Brophy case
* * *

Tuesday, November 6:  NO CLASS.  PREPARE TERM PAPER.

Thursday, November 8:  NO CLASS.  PREPARE TERM PAPER.

Tuesday, November 13:  NO CLASS.  PREPARE TERM PAPER.

THURSDAY, NOVEMBER 15:  TERM PAPER DUE @ 9:00 AM.

There will be a 15-minute grace period.
There is a five (5) point a day penalty for late papers.
If there is any delay in the computer printing room you may bring a completed disk to class at 9:00 AM.  Then bring the two hard copies to my office by 3:00 PM without any late penalty.

Tuesday, November 20: ECONOMICS OF HEALTH CARE DELIVERY

1. Packet:

a. "Preventing Patient Dumping," pp. 455-456..
b. Wrenn, "No Insurance, No Admission," NEJM 1985;312:373, pp. 457-458.
c. Taylor, "U.S. Health Care:  Built for Waste," NY Times, April 17, 1990, p. 459.
d. Enthoven, "The History and Principles of Managed Competition," Health Affair 1993, pp. 460-462.
e. Himmelstein, "A National Health Program for the US:  A Physicians Proposal," NEJM 1989;320:102, pp. 463-468.
f. Iglehart, John, "Rapid Changes for Academic Medical Centers," NEJM 1994;331;1391-1395, pp. 469-473.
g. Rogers, "Cultural and Organizational Implication for Academic Managed Care Networks," NEJM 1994;331:1374-1377, pp. 474-477.
h. Eileen McNamara, “Boys Last Hope,” Boston Globe, September 15, 2000, p. 478.
2. Position Paper #10: (Due Monday at 4:30 p.m.)
Write a memorandum for the Massachusetts Medicaid Review Board on the ethical issues involved in the care of David Stewart (p. 478).
Thursday, November 22: ECONOMICS OF HEALTH CARE DELIVERY (CONT.)

1. Packet:

a. AMA Council on Judicial Affairs, "Ethical Issues in Managed Care," JAMA 1995;273:330-335, pp. 479-484.
b. Darragh M, McCarrick PM, “Managed Health Care:  New Ethical Issues for All,” Kennedy Institute of Ethics Journal 1996;6:189-207, pp. 485-486.
c. Social Security Act?COBRA (1985), pp. 487-488.
d. Pegram v. Herdrich, 120 S.ct.2143 (2000), pp. 489-490.
e. Paris and Moore, “Controlling the Costs: The Use of Financial Incentives in Managed Care,” America, July 16-23, 2001, pp. 491-494.
f. David Blumenthal, “Controlling Health Care Expenditures,” NEJM, March 8, 2001, pp. 495-498.
g. James C. Robinson, “The End of Managed Care,” JAMA, May 23, 2001, pp. 499-505.
h. Marcia Angell, “Patients’ Bills of Rights and Other Futile Gestures,” NEJM, June 1, 2000, pp. 506-507.
Tuesday, November 27: INFORMED CONSENT AND RESEARCH ON HUMAN SUBJECTS

1. Text:

a. “Social Context of Research: Tuskegee, Willowbrook and Radiation and Baby Fae Experiments,” pp. 463-473.
b. Introduction, pp. 473-492.
c. Nancy Kass, “Trust: The Fragile Foundation of Biomedical Research,” pp. 495-499.
d. Paul Ramsey, “Judgement on Willowbrook,” pp. 511-514.
e. Principles of the Nuremberg Code, p. 515.
2. Packet:
a. Marc E. Lippman, “High-Dose Chemotherapy Plus Autologous Bone Marrow Transplantation for Metastatic Breast Cancer,” NEJM, April 13, 2000, pp. 508-509.
b. Gina Kolata, “Hope for Sale,” NY Times, Oct. 3, 1999(p1), pp. 510-517.
c. Ellen Goodman, “A Sad Lesson about Breast Cancer,” Boston Globe, Feb. 20, 2000, pp. 518.
Thursday, November 29: INFORMED CONSENT AND RESEARCH ON HUMAN SUBJECTS (CONT.)

1. Packet:

a. Troyen Brennan, “Proposed Revisions of the Declaration of Helsinki?Will They Weaken the Ethical Principal Underlying Human Research?” NEJM, Aug. 12, 1999, pp. 519-522.
b. Ruth Macklin, “The Ethical Problems with Sham Surgery in Clinical Research,” NEJM, Sept. 23, 1999, pp. 523-526.
c. Gerald Fischbach, “Cell Therapy for Parkinson’s Disease,” NEJM, March 8, 2001, pp. 527-529.
d. George Annas, “Ulysses and the Fate of Frozen Embryos,” NEJM, Aug. 3, 2000, pp. 530.
e. Susan Klock, “The Disposition of Unused Frozen Embryos,” NEJM, July 5, 2001, pp. 531.
f. Denise Grady, “Baby Conceived to Provide Cell Transplant for His Dying Sister,” NY Times, Oct. 4, 2000, p 532.
g. “Cellular Divide,” Newsweek, July 9, 2001, pp. 533-537.
h. Kenneth Woodward,” A Question of Life or Death,” Newsweek, July 9, 2001, p. 538.
i. Sheryl Stolberg, “Company Using Cloning to Yield Stem Cells,” NY Times, July 13, 2001, p. 539.
2. Position Paper #11: (Due Wednesday at 4:30 p.m.)
 
Write a letter to your Senator on the ethical issues in federal support for stem cell research and what you believe should be the public policy of the US government on stem cell research.
Tuesday, December 4: NEW FORMS OF REPRODUCTION

1. Text:
a. “Hello Dolly:  Advent of Cloning,” pp. 647-650.
b. Louise Brown:  First Test Tube Baby, pp. 650-651.
c. “Septutlets:  The Perils of Multiple Pregnancies,” pp. 651-653.
d. “Post Menopausal Motherhood,” pp. 653-654.
e. "Embryos in Court,” Davis and Nahamani Cases, pp. 654-656.
f. “Father Shopping:  Sperm by Mail,” p. 656.
g.   "Baby M,” pp. 656-658.
h. “Calvert Case:  Gestational Mother Changer Her Mind,” pp. 658-659.
i. Introduction, pp. 659-673.  (Read Quickly)
j. “Vatican Congregation for the Doctrine of the Faith, “Instruction on Respect for Human Life,” pp. 674-681.  (Somewhat difficult text to read.  Focus on the major arguments.)

Thursday, December 6: NEW FORMS OF REPRODUCTION (CONT.)

1. Packet:

a. Michael Lemonick, “Making Babies,” Time, December 1, 1997, pp. 540-545.
b.   George Annas, "Crazy Making:  Embryos and Gestational Mothers," Hastings Center Report, February, 1991, pp. 546-549.
c. People v. Sorensen, 437 P.2d 495 (1968), pp. 550-553.
d. C.M. v. C.C., 337 A.2d 821 (1977), pp. 553-555.
e. Karen T. v. Michael T., 127 Misc. 2d, 14, 484, N.Y.S. 2d 780 (1985), pp. 556-561.
f. Davis v. Davis, Supreme Court of Tenn (1992), pp. 562-567.
g. Notes, p. 567.
h. Berkowitz, “Selective Reduction of Multifetal Pregnancies,” NEJM 1988;318:1093-1097, pp. 568-571.
i. “Gay Sperm Donor Father of Lesbians’ Child,” Chicago Tribune, November 20, 1994, p. 572.      (Assignment continued on next page.)
j. Gina Kolata, “Uncertain Area for Doctors:  Saving Sperm of Dead Men,” NY Times, May 30, 1997, p. 573.
k. Lisa Belkin, “Pregnant With Complications:  Post-Menopausal Pregnancy,” NY Times Magazine, October 26, 1997, pp. 574-582.
l. George Annas, “The Shadowlands—Secrets, Lies, and Assisted Reproduction,” NEJM, September 24, 1998, pp. 583-586.
m. Ralph Randalli, “A Victory for Gay Mothers,” Boston Globe, Aug. 11, 2000, p. 587.
2. Position Paper #12: (Due Wednesday at 4:30 p.m.)
What should be the public policy with regard to:
a. Frozen embryos? (Compare Davis v. Davis and Kass v. Kass (In Notes after Davis).
b. Post-menopausal pregnancy?
c. Selective reduction?
d. Post-mortem fatherhood?
e. Fetal ovary transplant?


One of the latest advances in reproductive technology brings to the fore the question of fetal ovary transplants.  A female fetus in the first trimester of pregnancy already has nearly its full complement of eggs.  If an ovary from a fetus aborted at this stage is transplanted into a woman with no ovaries (or whose ovaries are nonfunctional, as in natural menopause), the ovary may continue to develop and mature to the point where ovulation occurs in a natural manner without any additional medical intervention.  Consequently it would be possible for a woman to conceive and bear a child whose genetic mother is the aborted fetus from which the ovary was removed.