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Sample Proposal: Ethics

College of Liberal Arts

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E 324 Literature and Medicine

Department of English

Ethical Reasoning as Course Content: Courses that carry the Ethics Flag teach students to think ethically. Please describe course readings, assignments, and/or activities that require students to engage in ethical reasoning.

This course will explore literary representations of illness experiences, of health-provider (e.g., doctors, nurses) experiences, and of health care as a system made up of institutions, policies, and people. Rather than illustrating behavior that is easy to identify as either ethical or unethical, the chosen texts frame complex ethical questions that do not have easy answers. Some readings concentrate on the provider-patient relationship. For instance, William Carlos Williams’s short story “The Use of Force” depicts an early twentieth-century doctor trying to obtain a throat culture from a young girl in order to determine if she has diphtheria. The girl refuses to open her mouth and resists the doctor’s attempts even to touch her. The more she resists, the harder the doctor tries to force her to open her mouth. He tells himself that he needs to obtain the culture for the girl’s own good, but finds himself increasingly caught up in a power struggle that he is determined to win. In a moment that figuratively resembles a rape, he succeeds in sticking his instrument down her throat, which reveals that the girl does indeed have diphtheria and must be brought to the hospital for treatment. At the same time, the doctor becomes conscious of a sense of deep shame at the rage, even sadism, he experienced during the struggle. Students will receive a writing prompt, which will be followed up by discussion, asking whether the doctor’s action was ethical, unethical, or both at the same time. I hope to lead students to consider the paradox of unethical behavior (here, violation of the girl’s will and personal sense of bodily integrity) motivated by what the doctor, at least, views as an ethical goal (diagnosing a serious illness that might require medical treatment). I will also ask students to think about whether the doctor’s internal state (an increasingly emotional desire to exert his will over a resistant child) affects the ethics of his action in obtaining the throat culture. In other words, what happens when “ethical reasoning” becomes entangled with human passions? If Williams’s “The Use of Force” focuses on a single doctor and patient, Chang-Rae Lee’s speculative novel On Such a Full Sea raises broader questions about the system by which a society delivers health care. Lee’s novel imagines a future world in which the environment has become so toxic due to human-made pollutants that everyone, no matter their geographic location or social status, develops some form of cancer by the time they reach late middle-age and, in many cases, significantly earlier than that. Oversimplifying somewhat, the novel juxtaposes two societies, each of which has a different system for supplying health care to its population. The wealthy Charter Villages have a highly individualistic “free market” health care system, with no public or even private forms of health insurance, in which one receives only the type and amount of health care one can pay for. Highly expensive cutting edge treatments are available to the very rich—in some cases the treatments are even sold by auction. Such treatments can extend life but they have damaging side effects and require almost constant medical attention. Those without sufficient funds enter a zone outside the city walls in which they receive no care at all. By contrast, the more resource-constrained Production Settlements have a health care system controlled and funded by the government, requiring only small co-payments for access. Following a policy that echoes the imaginary “death panels” some claimed to see in the Affordable Care Act, citizens diagnosed as at a terminal stage of cancer are placed in palliative care, where one receives “steady visitations from one’s kin and closest friends” (65). Those who live in the Production Settlements appreciate that they “will never die alone, something that even Charters cannot say, what with how intent they are to outlive one another” (66). Lee’s novel asks readers to consider which health care system is ethically preferable—an entirely market-based system in which the wealthy receive what they consider medically superior care, including care that temporarily holds death at bay but decreases one’s quality of life, or a society in which health care is both cheaper and more equitably distributed, which increases communal solidarity but also means that no one receives medically possible but extremely costly life-extending treatments.

Ethics as an Explicit Component of the Course: The Ethics Flag indicates that students will learn practical ethics, so the connection between ethical content and real-life choices should be made concrete. Please describe how this course gives students the opportunity to apply ethical reasoning to issues relevant to their adult and professional lives.

In addition to exam questions focused on analyzing how specific literary works frame ethical questions and what answers, if any, the works seem to supply, I will also assign at-home writing prompts that ask students to explore at a more personal level some of the issues raised in our reading. For instance, after we have analyzed William Carlos Williams’s “The Use of Force” in its own terms, as described above, students will write about a situation—it can be one which they have already experienced or one they can imagine experiencing in their future lives or careers—in which a desire to do good involves specific actions that at the same time feel ethically wrong, whether at an emotional level or at the level of ethical reasoning. How did they, will they, or should they handle the situation? I am told that I can expect one-third to one-half of the students in the class to be pre-health professionals. A number of our majors also have majors in the College of Natural Sciences, as do at least some English majors likely to enroll in the course. Nathaniel Hawthorne’s short story “The Birthmark” tells of a brilliant scientist during the period of the American Enlightenment who becomes increasingly horrified by a red birthmark (in the shape of a human hand) on the face of his otherwise “perfect” wife Georgiana. He determines to find a way to remove the birthmark, which he perceives as the sole sign of imperfection in an otherwise ideal woman. By story’s end, he succeeds in creating a “potion” or oral medication that erases the birthmark. But quaffing the potion also eliminates Georgiana’s vital spark; in the very moment that the birthmark fades from her cheek, she dies. In 2002, the President’s Council on Bioethics devoted a full session of its national meeting to “Science and the Pursuit of Perfection: Discussion of Nathaniel Hawthorne’s Short Story, “The Birth-Mark.” Discussion at the session primarily focused on the ethics—and ethical hazards—of human genetic and genomic engineering, a topic that recent advances in CRISPR technology have made even more urgent today. Consideration both of the story and of selections from the 2002 bioethics transcripts will help prepare students for thoughtful, ethically informed participation, whether as future scientists or simply as citizens, in ongoing debates about the potential for science to “correct” perceived flaws in human beings. Hawthorne’s story also raises important issues about consent, not only in the provider-patient relationship but also in romantic relationships. Georgiana ultimately gives verbal consent to undergoing a procedure that she initially had no desire for, but she does so only in the face of intense pressure from her husband that produces feelings of guilt, shame, and a desire to please at any price. In that sense, the story also has clear relevance to current debates on the UT campus about how to define authentic consent in regards to sex.

Graded Content Based on Ethical Reasoning: To satisfy the requirements of the Ethics Flag, at least one-third of the course grade must be based on work in practical ethics. Please describe the course grading scheme, indicating how one-third of the course is based on ethical reasoning

Students will take three essay-based tests (50% of grade) and complete a series of short at-home writing assignments (15% of grade). The exams and writing assignments will require students to think critically and analytically about the course readings and the ethical issues they raise, and to offer their own well-reasoned opinions about them. (Models and examples of the intimate relation between course readings and ethical problems and choices are provided above.) The at-home writing assignments will ask students to relate the issues involved to their own personal experiences and choices. An additional 15% of students’ grades will be based on their active and thoughtful engagement in whole-class discussions and small-group work that focuses on the same texts and the issues.