APA Newsletters
Fall 1999
Volume 99, Number 1

Below you will find descriptions of sessions planned by the Committee for the coming Division meetings. Please note that two committee-sponsored sessions will be presented at the Eastern Division meetings this December.

APA Eastern Division, Boston, December 1999

Cosponsored by the APA Committee on Philosophy and Medicine and the APA Committee on Philosophy and Law

Title: "Citizens in Extended Medical Dependencies: Virtue, Obligation, and Federal Law"

Co-chairs:
Leonard Fleck, Michigan State University
Leslie Francis, University of Utah

Round Table Participants:
Eva Kittay, SUNY Stonybrook
Alisdair MacIntyre, Duke University
Mary Mahowald, University of Chicago School of Medicine
Thomas Pogge, Columbia University
Anita Silvers, San Franciso State University
David Wasserman, University of Maryland

APA Eastern Division, Boston, December 1999

Sponsored by the APA Committee on Philosophy and Medicine

Title: "Philosophical Challenges in Teaching Bioethics"
Chair: Laurence B. McCullough, Baylor College of Medicine

Speakers:
Robert B. Baker, Union College
"The Role of History in Teaching Biomedical Ethics"

Maureen Kelley, Baylor College of Medicine
"Profession-Relative Ethics and the Role of Moral Judgment: Teaching across the Health Professions"

Commentator: Rosamond Rhodes, Mount Sinai School of Medicine

Speakers:
Rosemarie Tong, University of North Carolina at Charlotte
"Teaching Bioethics in the New Millennium: Holding Theory(ies) Accountable to Actual Practices and Real People"

W. Richard Momeyer, Miami University of Ohio
"What Conception of Moral Truth is Communicable and Defensible in the Classroom?"

Commentator: Stephen E. Wear, State University of New York at Buffalo

APA Central Division, 2000

Sponsored by the APA Committee on Philosophy and Medicine

Topic: "Justice and the Ethics of International Research."
Organizer: John D. Arras, University of Virginia

APA Pacific Division Session, 2000

Sponsored by the APA Committee on Philosophy and Medicine

Title: "Health Risks and Health Responsibility: What are the Ethical Issues?"
Co-chairs: Rosemarie Tong and Leonard Fleck

There is more than a little rhetoric in the air these days about irresponsible choices people make with regard to their own health. In the late 1980s we debated the issue of whether or not alcoholics ought to be eligible for liver transplants, the argument was that they were responsible for destroying their livers, and therefore, it would be unjust to deny other individuals (whose liver failure was due to no fault of their own) access to such a scarce lifesaving good. Prominent in this debate was the fact that alcoholics (along with drug addicts and smokers) engaged in behaviors that were highly socially disfavored. A major concern in this debate was that such socially disfavored individuals would be denied access to needed health under the guise of moral principle when something substantially less noble actually determined the social judgment.

In this session we would like to explore a somewhat broader issue. We live in the era of managed care, the era of health care cost containment. This has come about because we, taxpayers and insurance premium payers, want to limit the demands that health care makes on our budgets. Advances in medical technology, especially life-prolonging medical technology, have created these costly demands more than anything else. The social rhetoric (as transliterated by a philosopher) is: "If everyone just took more responsibility for their health (watched what they ate, exercised regularly, reduced stress, moderated alcohol consumption), then there would be fewer heart attacks, fewer strokes, and fewer other chronic debilitative disorders, with the result that health care costs would stay in bounds and health care would only go to those with "just health care needs," needs that were not a product of irresponsible health behaviors."

Before going any further, we wish to be clear that we want nothing to do with health care police who would seek out perpetrators of unhealthy behavior. There are obvious moral and practical grounds for rejecting that notion. Instead, we want to ask ourselves when we (individually) should hold ourselves accountable, blameworthy, for unhealthy behaviors that make unjust demands on limited resources within our managed care plan. It might require something approximating a saintly moral disposition for an individual to forego expensive life-prolonging medical care as a result of an introspective judgment that they were really blameworthy for generating these excess health needs. We wish to put that issue aside. Instead, we just want to focus on the question of whether it is possible to come to fair (nondiscriminatory) rational agreement as to what sorts of unhealthy behaviors are morally irresponsible, i.e., make unjust demands on the health care system/our managed health plan.

APA Eastern Division, December 2000

Sponsored by the APA Committee on Philosophy and Medicine

Title: "Ethical Issues in the Banking of Umbilical Cord Blood Program"

Organizers:
Mark Sheldon, Indiana University Northwestern and Indiana School of Medicine
Rosamond Rhodes, Mount Sinai School of Medicine

Description: Stem cells from umbilical cord blood obtained at the time of delivery could be a valuable substitute for bone marrow in transplant procedures. First, it is possible that graft-vs-host disease will be significantly reduced. Second, since collecting umbilical cord does not involve the same difficulty associated with collecting bone marrow, it is likely that the availability of stem cells for transplant purposes will be much increased. However, the collection of umbilical cord blood raises a number of ethical issues. For example:

Should umbilical cord blood be banked for autologous use by for-profit corporations, as is presently done in some states? The technology is being sold to prospective parents who pay a fee for collection and then an annual fee for maintenance. The stem cells, presumably, will be available for the child should he or she ever develop an illness that could be treated by stem cell transplant. Should umbilical cord banking for profit be permitted, or should the umbilical cord blood be banked by the state or municipality with the idea that it will be available to anyone who needs it? What does justice require?

What is the status of the cord blood? Is it material that can simply be collected, without consent? Or is it a body part that belongs to the child? Should it be viewed as analogous to organ donation or blood donation? Does the mother stand in some special relationship to the umbilical cord blood so that her consent is required?

What weight should privacy concerns be given in light of the possible benefit that could result from banking umbilical cord blood? What special protections should be put in place because it involves a child, who is, by definition, particularly vulnerable, and who can be linked to the collected umbilical cord blood?