Philosophy 281Y


Winter 2007



1160 Bahen Centre                                                                                                      Professor Gopal Sreenivasan

MW 2-3                                                                                                                      215 Huron Street, Room 921



Reading Schedule



Distributive Justice and Health Care


Universality of Access  (continued)


January 8          Sreenivasan, “Health care and equality of opportunity,” Hastings Center Report (2007), forthcoming.


J 10                  Buchanan, “The Right to a Decent Minimum of Health Care,” Philosophy & Public Affairs 13 (1984): 



J 15                  R. Dworkin, Sovereign Virtue (2000), ch. 8. 


J 17                  No new reading.


J 22                  Reinhardt, “Reforming the Health Care System:  The Universal Dilemma,” American Journal of Law &

                                    Medicine (1993):  21-36.


What should a health care system cover?


J 24                  Emanuel, Ends of Human Life (1991), pp. 97-124.


J 29                  Emanuel, pp. 124-154.


J 31                  No new reading.


February 5       Brock, “Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization of Health Care

                                    Resources” in S. Anand et al. (eds.) Public Health, Equity, and Ethics (2004), ch. 10.


Rationing care


F 7                   Film.  “Transplant Tourism.”


F 12                 Radcliffe-Richards et al., “The case for allowing kidney sales,” Lancet 351 (1998): 1950-52.

Friedlaender, “The right to sell or buy a kidney:  are we failing our patients?,Lancet 359 (2002): 971-73.

Delmonico et al., “Ethical Incentives – Not Payment – For Organ Donation,” N. Engl. J. Medicine 346

            (2002): 2002-2004.

Matas et al., “Nondirected Donation of Kidneys from Living Donors,” N. Engl. J. Medicine 343 (2000):


Cronin et al., “Transplantation of Liver Grafts from Living Donors into Adults – Too Much, Too Soon,”

            N. Engl. J. Medicine 344 (2001): 1633-35.

Segre et al., “Partial Liver Transplantation from Living Donors,” Cambridge Quarterly of Healthcare Ethics

            4 (1992): 305-25.


F 14                 No class.


Spring Break.


F 26                 Daniels, “Rationing fairly,” in his Justice and Justification (1996), ch. 15.


F 28                 Mid-term examination.  In class.


March 5           Daniels, “The prudential life-span account of justice across generations,” in his Justice and Justification

                                    (1996), ch. 12.


M 7                  A. Williams, “Intergenerational equity: An exploration of the ‘fair innings’ argument,” Health Economics

                                    (1997):  117-32.



Research Ethics


M 12                Annas and Grodin (eds.) The Nazi Doctors and the Nuremburg Code (1992), ch. 5.

                        Beecher, “Ethics and Clinical Research,” N. Engl. J. Medicine 274 (1966): 224-246.

                        Brandt, “Racism and Research:  The case of the Tuskegee Syphilis Study,” Hastings Center Report 8

                                    (1978): 21-28.


M 14                Emanuel et al., “What makes clinical research ethical?,JAMA 283 (2000): 2701-2711.

The Nuremburg Code.

                        The Declaration of Helsinki.

                        Tri-Council Policy Statement.  (FYI only).

                        Second essay topics handed out.


M 19                Katz, “Human Experimentation and Human Rights,” St. Louis University Law Journal 38 (1993):  7-20.

                        Schafer, “The Ethics of the Randomized Clinical Trial,” N. Engl. J. Medicine 307 (1982): 719-724.

Hellman and Hellman, “Of Mice But Not Men:  Problems of the Randomized Clinical Trial,” N. Engl. J.

            Med. 324 (1991): 1585-89.


M 21                Freedman, “Equipoise and the Ethics of Clinical Research,” N. Engl. J. Medicine 317 (1987): 141-145.

                        Passamani, “Clinical Trials – Are They Ethical?,” N. Engl. J. Medicine 324 (1991): 1589-1592.

Truog, “Randomized Controlled Trials:  Lessons from ECMO,” Clinical Research 40 (1992):  519-527.


M 26                Freedman, “Placebo-Controlled Trials and the Logic of Clinical Purpose,” IRB 12 (1990):  1-6.

                        Rothman and Michels, “The Continuing Unethical Use of Placebo Controls,” N. Engl. J. Medicine 331

                                    (1994): 394-398.


M 28               Temple and Ellenberg, “Placebo-Controlled Trials and Active-Control Trials in the Evaluation of New

                                    Treatments:  Ethical and Scientific Issues,” Annals of Internal Medicine 133 (2000):  455-463.

Miller and Emanuel, “The Ethics of Placebo-Controlled Trials – A Middle Ground,” N. Engl. J. Medicine

            345 (2001): 915-919.

                        Second essay due in class.


April 2              Appelbaum et al., “False Hopes and Best Data:  Consent to Research and the Therapeutic Misconception,”

                                     Hastings Center Report (1987): 20-23.

                        Miller and Rosenstein, “The Therapeutic Orientation to Clinical Trials,” N. Engl. J. Medicine 348 (2003):


                        Miller and Brody, “A Critique of Clinical Equipoise,” Hastings Center Report 33 (2003):  19-28.


A 4                  Levine, “Informed Consent in Research and Practice,” Archives of Internal Medicine 143 (1983): 1229-31.

                        Nelson and Merz, “Voluntariness of Consent for Research:  An Empirical and Conceptual Review,” Medical

                                    Care 40 (2002); V69-V80.


A 9                  Joffe et al., “Quality of informed consent in cancer clinical trials:  a cross-sectional survey,” Lancet 358

                                    (2001):  1772-77.

                        Sreenivasan, “Does informed consent to research require comprehension?Lancet 362 (2003): 2016-18.                       


A 11                No new reading.


End of lectures.


Final examination in Spring examination period.





Course packages are available at the U of T Bookstore on College.  The final package will be available toward the end of February.




There will be four examinations and two essays (2000 words) over the course of the whole year, an essay and two examinations in each term.  Each term there will be an in-class mid-term and an examination during the finals period.


The assignments will carry the following weights:


            Essays:                                                 20 % each.

            Fall mid-term:                                         5 %.

            Fall end-term examination:                    17 %.

            Spring mid-term:                                     5 %.

            Final examination:                                 33 %.




There will be a weekly tutorial in this course with a TA.  Tutorials are offered on Mondays from 3-4 (right after class), on Wednesdays from 1-2 (right before class), and also from 3-4 (right after class again).


Please check the webpage for your specific tutorial assignment (e.g., the room).


Office hours


Sreenivasan                  Wednesdays 3-5.  Room 921, 215 Huron Street.  I will also hold office hours by appointment.


TAs                              Daniel Bader, Katherine Browne, Leanne Garvie, Alex Sinha.

Office hours to be announced.




Please do not e-mail your TA for anything.  E-mail should be directed to the instructor, who will try to reply in a reasonable time.  He is not, however, an e-mail machine.


Late penalties


Essays submitted after the due date will be penalised one increment of a grade (e.g., from B to B-).  Essays submitted a week or more late will be penalised a further increment for each week late.




Plagiarism is a serious academic offence.  It comes in various forms, all of which carry grave penalties.  If in doubt about what constitutes plagiarism, ask.  You should consult the Philosophy Department’s statement on plagiarism.


Students agree that by taking this course all required papers may be subject to submission for textual similarity review to for the detection of plagiarism. All submitted papers will be included as source documents in the reference database solely for the purpose of detecting plagiarism of such papers. The terms that apply to the University’s use of the service are described on the web site.


Writing help


Help in writing is available from the Philosophy Department’s essay clinic.  You are also encouraged to consult the Department’s guide to writing a philosophy essay.





1 April 2007