Ethics of End-of-Life Issues 3800-EKZ26-BE-S-OG
The course is focused on the main moral problems of end of life and provides a
relevant ethical knowledge (concepts, theories, principles, rules and arguments)
as a general framework for interpreting and analysing moral issues arising in
terminal care as well as teaches methods of case analysis. The course aims at
making students aware of the normative aspects of medical decisions made in
terminal care, clarifying the most important philosophical approaches to
medico-moral reflection, that is the philosophical context of ethical theories and
their practical application as well as normative positions in end-of-life ethics.
The course aims at developing the students’ skills in recognizing the moral
dimensions of end of life and their ability to think critically about moral issues
arising in terminal care. The course develops students’ ability to analyze
critically moral arguments, making them able to formulate and support with
clear reasoning their medico-moral judgments concerning terminal care.
To sum up: The course aims at: (a) giving students a relevant ethical knowledge
of main problems and discussions in terminal care; (b) stimulating their
analytical skills and reasoning abilities; (c) enhancing their intellectual
sensibility and awareness of the needs of dying patients; (d) enhancing their
skills in construction arguments; (e) developing their habit of critical thinking;
(f) developing their linguistic skills (B2+level).
Content: Problem of death in analytical philosophy and phenomenology.
Evolution of the definition and criteria of death. Dying: changes in the attitudes
to death and dying in Western culture according to Ph. Ariès. Is cultural
thanatology just the science fiction to the Past? Michel Vovelle analyses of
cultural thanatology. The phenomenon of medicalization of death. The dilemma
of immortality and the transhumanist project. The concept of terminal stage and
terminal phase. Ethical foundations of medical thanatology. The rule of
informed consent, principle of proportionate and disproportionate means. The
notion of medical futility. Futile treatment - definitional difficulties. The
problem of the adequacy of the principle of double effect as an ethical
justification for effective terminal analgesia. Palliative sedation. Ethical
analyses of commissions and omissions, withholding and withdrawal. Ethical
aspects of artificial feeding and hydrating in terminal care. Advance directives
(living will, durable power of attorney, DNI/DNR). Ethical controversies
concerning persistent vegetative state (PVS). Quality of life: theories and
methods of assessment. Ethical and legal issues concerning euthanasia and
physician assisted suicide: evolution of the argumentation. Palliative care and
terminal care. Hospice movement: development of forms of hospice care.
Course coordinators
Type of course
Mode
Learning outcomes
At the end of the seminar, the student has knowledge of and understanding of:
K_W02 - the role of ethics and bioethics in the practice and development of
end-of-life medicine, palliative care and terminal medicine;
K_W03 - advanced, multi- and interdisciplinary terminology used in ethics of
end-of-life issues;
K_W12 - the issues and problems of end-of-life ethics and the current state of
discussion and research in that area at a level that leads to specialization.
At the end of the seminar, the student is able to:
K_U01 - identify ethical problems and conflicts that arise in the practice and
development of end-of-life medicine, palliative care and terminal medicine;
K_U02 - critically analyze oral and written statements by other authors in the
field of end-of-life ethics, including reconstructing theses, identifying factual
and normative assumptions, and critically evaluating the correctness and
strength of arguments;
K_U13 - prepare a short written paper on a topic related to end-of-life ethics in
accordance with the rules for writing papers of this type;
K_U14 - prepare and deliver an oral presentation on a topic related to end-of-
life ethics;
K_U15 (seminar in English) use English at the B2+ CEFR level, as well as the
specialized terminology used in end-of-life ethics.
At the end of the seminar, the student is able to:
K_K01 - critically evaluate their knowledge, acquired information, and received
content;
K_K02 - recognize the importance of knowledge in the fields of ethics,
bioethics, medical law, sociology, and medical anthropology in solving
problems arising from the practice and development of of end-of-life medicine,
palliative care and terminal medicine and seek expert advice when encountering
difficulties in solving these problems independently;
K_K05 - develop bioethics, especially ethics of end-of-life issues, reliably and
responsibly as a theoretical field and social practice;
K_K06 - recognize ethical, legal, and sociocultural problems and challenges
related to their own research and professional work, in particular, to comply
with, develop, and promote ethical standards for healthcare ethics consultants
and members of various bioethics and ethics committees.
ADDITIONAL EDUCATIONAL EFFECTS FOR DOCTORAL STUDENTS
At the end of the seminar, the PhD student:
(a) has as knowledge and understanding of:
- methodology of scientific research in the field of end-of-life ethics;
- ethical and philosophical aspects of fundamental dilemmas brought about by
the advances in end-of-life medicine, terminal medicine and palliative care;
(b) is able to:
- use knowledge from various fields in the humanities to identify, formulate and
solve - in an innovative way - complex ethical problems brought about by the
advances in end-of-life medicine
- critically analyze and evaluate results of scientific research, opinions of
experts, and views of other scholars regarding ethical problems of end-of-life
medicine;
- participate in or initiate scientific discussions and debates on procreative
ethics;
(c) is ready to:
- critically evaluate one's own contribution to the development of end-of-life
ethics; and to participate in discussions, formulate arguments, and express one’s
own opinions in a manner respectful to others, their views, and to diversity of
methods and approaches employed in the humanities;
- recognize the priority of knowledge in solving scientific, theoretical, and
practical problems in end-of-life ethics; and to respect standards of good
research practice.
Assessment criteria
Active participation in the seminars (attendance, preparation, participation in
discussions) – 40%
Preparation & oral delivery of presentation – 30%
Critique of a book/paper concerning seminar subject or the case study or
problem analysis (argumentative essay) in writing – 30%
Final assignment requirements: 3600 – 5400 characters with spaces (2-3
standard pages), the Student’s name given as a title of the file, sent via email, in
Word format. Proper references are required.
A written study providing an in-depth analysis of a selected end-of-life issue,
covering theoretical background and medical/social practice
(4-5 stron standardowych/ 4-5 standard pages)
Number of absences allowed per semester: 2
Bibliography
Ad Hoc Committee of the Harvard Medical School to Examine the
Definition of Brain Death (1968).
A. Alichniewicz, Terapia daremna – problem definicyjne, Przegląd Prawa
Medycznego, 3 (2024), 16, s. 5-32, DOI: 10.70537/p196w724
Ph. Ariès, Człowiek i śmierć, PIW, Warszawa 1989.
G.S Belkin, Death before Dying, Oxford University Press, Oxford – New
York 2014.
M.J. Cholbi (ed.), Euthanasia and Assisted Suicide, Praeger, Santa
Barbara-Denver 2017.
P. Lee, Total Brain Death and the Integration of the Body Required of a
Human Being. Journal of Medicine and Philosophy, 2016,41, 300 – 314.
doi:10.1093/jmp/jhw005
J.P. Lizza, Defining death: beyond biology. Diametros 2018, 55, 1–19.
DOI: 10.13153/diam.1172
P. Łuków (red. nauk.), Zrozumieć śmierć człowieka , Polskie
Stowarzyszenie Koordynatorów Transplantacyjnych 2015
F. G. Miller, R.D. Truog, Death, Dying, and Organ Transplantation.
Reconstructing Medical Ethics at the End of Life. Oxford University
Press, Oxford – New York 2012.
President’s Commission for the Study of Ethical Problems in Medicine
and Biomedical and Behavioral Research (1981). Defining Death.
https://repository.library.georgetown.edu/bitstream/handle/10822/559345
/defining_death.pdf?sequence=1&isAllowed=y
President’s Council of Bioethics. (2008). Controversies in the
Determination of Death. A White Paper.
https://repository.library.georgetown.edu/bitstream/handle/10822/559343
/Controversies%20in%20the%20Determination%20of%20Death%20for
%20the%20Web.pdf?sequence=1&isAllowed=y
J. Różyńska, W. Chańska (red), Bioetyka, Wolters Kluwer, Warszawa
2013.
Literatura dodatkowa
J. M. Fischer (red.), The Metaphysics of Death, Stanford University
Press, Stanford 1993.
McMahan, The Ethics of Killing: Problems at the Margins of Life,
Oxford University Press 2003.
M. Vovelle, Śmierć w cywilizacji Zachodu. Od roku 1300 po
współczesność, Słowo/Obraz Terytoria, Gdańsk 2005.
M. Warnock, E. Macdonald, Easeful Death, Oxford University Press,
Oxford 2009
S.J. Youngner, G.K. Kimsma, Physician-Assisted Death in Perspective.
Assessing the Dutch Experience, Cambridge University Press, Cambridge
2012.
I. Ziemiński, Zagadnienie śmierci w filozofii analitycznej, TN KUL
Lublin 1999;
I. Ziemiński Metafizyka śmierci, Wydawnictwo WAM, Kraków 2010.