FINAL VERSION, FALL 2015
GLHLTH 341
Ethics of Infectious Disease Control
Fall 2015, Duke Global Health Institute
Instructor:Kearsley A. Stewart, Ph.D.
Trent Hall, Room 239
919-681-8811
Teaching Assistant:Sydney Neeley, , 503-919-1007
Course time/location:Tues/Thur, 3:05–4:20 pm, Duke Hospital South, 3031, 3rd floor
Office hours:Stewart: Tues/Thurs 4:20 – 5:00 in Duke Hospital 3031
Wed 4:20 – 5:20 pm in Trent 239
And by appointment
Neeley: By appointment
Course Description:
Examination of the role of ethical decision-making when controlling infectious disease epidemics. Applies classic public health ethics of balancing individual liberty vs. public good to the new global health context of emerging infectious diseases such as HIV/AIDS, Ebola, plus re-emerging infectious diseases such as multidrug-resistant TB, polio, and cholera. Explores a variety of issues, such as: vaccination policies, surveillance-isolation-quarantine, control vs eradication, individual liberty vs national security vs humanitarian NGO responsibilities, consensus vs enforcement, duty to treat, resource allocation, mandatory or voluntary prevention measures, ethical obligations of health care workers vs. responsibilities of individuals, immigrant and refugee populations, responsible conduct of infectious disease research and research ethics, all in the context of a new global public health. Prior global health coursework recommended.
Course Objectives:
By the end of the course students will be able to:
(1) define the boundaries and overlapping areas between public health and global health and analyze in the context of a variety of specific infectious disease case studies
(2) recognize and clearly define ethical issues in a public/global health case study
(3) analyze the ethically right actions to take in a case study
(4) prioritize, according to your own ethical values, the right actions to take in a case study
(5) anticipate challenges to implementing your analysis and ethical behavior in a case study
Assignments:
1.)Four in-class exams@ 200, 100, 200, 200 pts each700
2.)Eight group slide sets @ 25 pts each200
3.)Assessment of your participation by your fellow study group members 50
4.)Critical reflection paper on November 3 special event (500 words)50
1000
Required Reading:
All required reading will be posted as .pdf files on our SAKAI course website. Readings are posted on SAKAI under “LESSONS” and then by weekly folders.
Explanation of reading load
I assign up to 75 pages of reading each week. I do not include bibliography, notes, index, etc in the volume calculations.
Class attendance policy:
This is a large lecture class, therefore I do not take attendance. However, the exams cover information that is presented only in class (films and lectures), so you need to attend class to be able to do your best on the exams. Also, there is class time allotted for study group interactions, and your fellow study group team members will be assessing you for 05% of your grade; therefore if you fail to come to study group during class, your study group grade will suffer.
OFFICIAL AUTHORIZED ABSENCES: Please contact me as soon as possible if you anticipate missing class due to athletic obligations or religious observances. It is essential that you alert me BEFORE any class absence; then we can work together to develop a strategy to make up the missed class and avoid any grade deductions.
ILLNESS RELATED ABSENCES: Please submit a “short-term illness notification form” BEFORE class, or a note from your academic dean after missing class. In illness or other extenuating cases, you must submit your weekly reading summary to me as soon as you are feeling better.
For the official Trinity policy regarding missed classes or work, please consult:
Study group participation policy:
Classtime is set aside for you to participate in your assigned study group. Five percent of your final grade comes from your fellow study group members assessing your participation in the group. Therefore, your active and informed participation in study group is a key component of your success in this course. At a minimum, you must complete all the assigned reading before class. However, excellence in participation means you are able to constructively analyze a variety of perspectives in the discussion, identify missing elements in the conversation, and introduce new, productive topics for discussion. The quality of your discussion, not the quantity, is the marker of an excellent discussion participant. I will distribute a short two-minute self-assessment form at the end of each class study group so your group can track participation.
Computer use during class: As we discussed in class, we all agreed on in-class internet guidelines: (1) no internet surfing during class unless it is related to class content(2) your fellow study group members will hold you accountable for this rule and will deduct points from your study group grade.
Cell phones during class: Please turn off your cell phones completely during class – that means no vibrate mode. If you have a specific need, on a specific day, to have your phone on, please let me know before class that your phone is on vibrate mode and you might have to step out of class to take a call.
Final Course Grading:
A+980-1000 ptsC+780-799 pts
A940-979 ptsC740-779 pts
A-900-939 ptsC-700-739 pts
B+880-899 ptsD+680-699 pts
B840-879 ptsD600-679 pts
B-800-839 ptsF599 and below
Duke Honor Code(
Duke University is a community dedicated to scholarship, leadership, and service and to theprinciples of honesty, fairness, respect, and accountability. Citizens of this community commit toreflect upon and uphold these principles in all academic and non-academic endeavors, and toprotect and promote a culture of integrity.
To uphold the Duke Community
I will not lie, cheat, or steal in my academic endeavors.
I will conduct myself honorably in all my endeavors.
I will act if the Standard is compromised.
IMPORTANT NOTES
(1) Our full syllabus is available on the course website. It includes:
(1) Complete reading list
(2)Full description of the one individual writing assignment
(3)Full description of study group work assignments
(4)Grading rubrics for class participation, group work, and written work
(2) This syllabus is approximate and may change. These changes may include additional readings.
1
FINAL VERSION, FALL 2015
GLHLTH 341Ethics of Infectious Disease ControlProfessor Kearsley Stewart
Fall 2015TUES/THUR 3:05 – 4:20 pm; (Duke South “Original Hospital”, Purple Elevator, 3rd Floor, 3031)
Week / Day / Theme / Class agenda / Study GroupPresentations
1 / Aug 25 / Introductions
Aug 27 / History of Ethics; Codes of Ethics / LECTURE: The Road from Bioethics, to Public Health Ethics, to Global Health Ethics
STUDY GROUP ASSIGNMENT: Each student brings in a code of ethics from their discipline
MODULE #1: Principlism and Research Ethics
2 / Sept 1 / KURU in Papua New Guinea / 3:05 – 3:30 LECTURE: Principlism
3:30 – 4:20 FILM: Kuru: Science and Sorcery, 2010, 52 mins
Sept 3 / KURU in Papua New Guinea / 3:05 – 3:30 LECTURE: Principlism, Autonomy, and Kuru in Papua New Guinea
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS / 2 groups present
Slide Set #1
3 / Sept 8 / HIV/AIDS Research in Kenya / 3:05 – 3:30 LECTURE: Informed Consent and Justice in Research in Developing Countries
3:30 – 4:20 FILM: Searching for Hawa’s Secret, 2000, 47 mins
Sept 10 / HIV/AIDS Research in Kenya / 3:05 – 3:20 LECTURE: Researchers’ Responsibilities (Duty to Relieve Oppression; Benefits sharing)
3:20 – 3:45 STUDY GROUP
3:45 – 4:00 GROUP PRESENTATIONS / 2 groups present
Slide Set #2
4 / Sept 15 / HIV/AIDS Research in South Africa / 3:05 – 3:45 LECTURE: Community Consent and Global Health Research Partnerships
3:45 – 4:20 FILM: Good Neighbours? The Africa Centre and the Local Community, 2000, 29 mins
Sept 17 / HIV/AIDS Research in South Africa / 3:05 – 3:30 LECTURE: Community Engagement and Global Health Research Partnerships
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS / 2 groups present
Slide Set #3
5 / Sept 22 / EXAM #1
200 points / Be sure to download “Respondus Lockdown Browser” before the exam
MODULE #2: Ethics ofHumanitarian Aid and Interventions
Sept 24 / CHOLERA in HAITI / 3:05 – 3:45 LECTURE: Ethics of humanitarian aid and interventions in Haiti
3:45 – 4:20 FILM: Faultlines: Haiti in a Time of Cholera, 2014, 25 minutes
6 / Sept 29 / CHOLERA in HAITI / 3:05 – 3:30 LECTURE: Ethics of humanitarian aid and interventions in Haiti
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS / 2 groups present
Slide Set #4
Oct 1 / POLIO in NIGERIA / 3:05 – 3:30 LECTURE: Ethics of humanitarian aid related to Polio eradication
3:30 – 4:20 FILM: Every Last Child, (Pakistan, Middle East), 2014, 85 mins(watch select clips 43 mins)
7 / Oct 6 / POLIO in NIGERIA / 3:05 – 3:30 LECTURE: Ethics of humanitarian aid related to Polio eradication
3:30 – 4:00 Study group break out discussion exercise, then class discussion
4:00 – 4:20 MID-TERM COURSE EVALUATION – BRING YOUR LAPTOPS TO CLASS!
Oct 8 / EXAM #2
100 points / SPECIAL TIME 3:05 – 3:50
Be sure to download “Respondus Lockdown Browser” before the exam
8 / Oct 13 / No class, Duke Fall Recess
15 / No class
MODULE #3: Ethics of Quarantine
9 / Oct 20 / QUARANTINE:
EBOLA LIBERIA / 3:05 – 3:30 LECTURE: Ethics of quarantine in Liberia
3:30 – 4:00 FILM: The Search for a Cure, 2014, edited to 30 mins for our class
4:00 – 4:20 STUDY GROUP
Oct 22 / QUARANTINE: EBOLA NIGERIA / 3:05 – 3:30 FILM: In the Shadow of Ebola, 2014, 25 minutes
3:30 – 4:00 LECTURE: Sulzhan Bali, PhD, Guest lecture: Business Ethics, Corporate Responsibility and Ebola in Nigeria
4:00 – 4:20 STUDY GROUP
10 / Oct 27 / QUARANTINE:
EBOLA USA / 3:05 – 3:30 LECTURE: Ethics of quarantine in theUSA
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS / 2 groups present
Slide Set #5
Oct 29 / QUARANTINE:
HIV/AIDS CUBA / 3:05 – 3:30 LECTURE: Cuban health system
3:30 – 4:20 FILM: Search for Answers: Cuba/Capetown Connection, 2002, 52 mins
11 / Nov 3 / SPECIAL TIME 3:00 – 5:00
SPECIAL LOCATION
Rubenstein 153 / Alvan Ikoku, MD, PhD, Guest Faculty
Asst Prof, Department of Comparative Literature, and School of Medicine, Stanford University,
Randall Packard, PhD, Guest Faculty
Prof, Institute for the History of Medicine, School of Medicine, Johns Hopkins University,
Nov 5 / QUARANTINE:
HIV/AIDS CUBA / 3:05 – 3:30 LECTURE: Ethics of HIV/AIDS quarantine in Cuba
3:30 – 4:00 STUDY GROUP:
4:00 – 4:20 GROUP PRESENTATIONS / 2 groups present
Slide Set #6
12 / Nov 10 / Exam #3
200 points / Be sure to download “Respondus Lockdown Browser” before the exam
MODULE #4: Ethics of Resource Allocation and the Duty to Care; Responsible Conduct of Research
Nov 12 / EBOLA / 3:05 – 3:30 LECTURE: Ethics of resource allocation: ZMapp for Who?
3:30 – 4:00 FILM: The Search for a Cure, 2014, edited to 30 mins for our class
13 / Nov 17 / EBOLA / 3:05 – 3:30 LECTURE: : Responsible conduct of research during Ebola treatment and vaccine trials: What is ethical?
3:30 – 4:20 FILM: The Search for a Cure, 2014, second half of film.
Nov 19 / EBOLA / 3:05 – 3:40 Is it ethically permissible to provide unproven therapies to Ebola patients outside research context? If yes, then how do we decided who gets limit supply?
3:40 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS / 2 groups present
Slide Set #7
14 / Nov 24 / No class
26 / No class, Duke Thanksgiving Recess
15 / Dec 1 / TBD / 3:05 - 3:35LECTURE: Ethics of the duty to care: Who must care for the sick and why?
3:35 - 4:20FILM: Ebola War: Nurses of Gulu, 2002, 46 minutes
4:20End
Dec 3 / TBD / 3:05 – 3:15 COURSE EVALUATION – BRING YOUR LAPTOPS TO CLASS!
3:15 - 3:45 Lecture: Lessons Learned in the West African Ebola Epidemic: Where are the ethics?
3:45 – 4:10 STUDY GROUP for slide set 7/8
4:10 – 4:20 GROUP PRESENTATION / 2 groups present
Slide Set #8
16 / Dec 8 / EXAM #4
200 points / TUESDAY DECEMBER 8, 7:00 pm
Be sure to download “Respondus Lockdown Browser” before the exam
1
FINAL VERSION, FALL 2015
Week 1:
Introductions;
The Road from Bioethics to Public Health Ethics to Global Health Ethics
53 pages
TUESDAY, August 25
Introductions
THURSDAY, August 27
STUDY GROUP EXERCISE: Choose your disciplinary code of ethics and bring to THURSDAY class for study group discussion. For example:
for engineers, there is a code of ethics from the National Society of Professional Engineers
for psychologists, there is a code of ethics from the APA
for anthropologists, there is a code of ethics from the AAA
for chemists, there is a code of ethics from American Institute of Chemists
for biologists, there is a code of ethics from the American Society for Biochemistry and Molecular Biology
etc….
REQUIRED READINGS
Jonsen, AR. 2014. Bioethics: A History of. In Bruce Jennings, ed, Bioethics, 4th edition. Macmillan Reference USA/Gale Cengage Learning: Farmington Hills, MI. pp 331-336.
Childress, JF and RG Bernheim. 2015. Introduction: A Framework for Public Health Ethics. Chapter 1 in Bernheim, et al, eds, Essentials of Public Health Ethics. Jones and Bartlett Learning: Burlington, MA. pp 3-19.
Pinto, AD, A-E Birn, and REG Upshur. 2013. The Context of Global Health Ethics. Chapter 1 in Pinto and Upshur, eds, An Introduction to Global Health Ethics. Routledge: London. pp 3-15.
Upshur, REG, S Benatar, and AD Pinto. 2013. Ethics and Global Health. Chapter 2 in Pinto and Upshur, eds, An Introduction to Global Health Ethics. Routledge: London. pp 16-35.
Thomas, JC and RG Bernheim. 2008. Codes of Ethics for Public Health. In Stella Quah and Kristian Heggenhougen (ed.),International Encyclopedia of Public Health, Elsevier, San Diego CA, pp. 754-759.
Week 2
Module #1: Principlism and Research Ethics
Case Study: Kuru in Papua New Guinea
40 pages
TUESDAY, September 1
3:05 – 3:30 LECTURE: Principlism
3:30 – 4:20 FILM: Kuru: Science and Sorcery, 2010, 52 mins
REQUIRED READINGS
Ainslie, DC. 2014. Principlism. In Bruce Jennings, ed, Bioethics, 4th edition. Macmillan Reference USA/Gale Cengage Learning: Farmington Hills, MI. pp 2485-2489.
Philpot, S. 2014. Research Unethical. In Bruce Jennings, ed, Bioethics, 4th edition. Macmillan Reference USA/Gale Cengage Learning: Farmington Hills, MI. pp 2795-2798.
THURSDAY, September 3
3:05 – 3:30 LECTURE: Principlism, Autonomy, and Kuru in Papua New Guinea
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS; SLIDE SET #1 DUE IN CLASS
REQUIRED READINGS
Bechtel, K. and MD Geschwind. 2013. Ethics in Prion Disease. Progress in Neurobiology 110:29-44. Focus your reading on the ethics discussions.
Lindenbaum, S. 2001. Kuru, Prions, and Human Affairs. Annual Review of Anthropology v30:363-385. Focus on 363-371.
Lindenbaum, S. 2015. An Annotated History of Kuru. Medical Anthropology Theory v2, n1:95-126. Focus on 95-110.
Week 3
Module #1: Issues in Research Ethics:
Informed Consent, Justice, Researchers’ Responsibilities
Case Study: HIV/AIDS Research in Kenya
50 pages
TUESDAY, September 8
3:05 – 3:30 LECTURE: Informed Consent and Justice in Research in Developing Countries
3:30 – 4:20 FILM: Searching for Hawa’s Secret, 2000, 47 mins
REQUIRED READINGS
Levine, R. Consent Issues in Human Research. In Bruce Jennings, ed, Bioethics, 4th edition. Macmillan Reference USA/Gale Cengage Learning: Farmington Hills, MI. pp 1687-1697.
London, A. 2011. Justice and Research in Developing Countries. In Benatar and Brock, eds, Global Health and Global Health Ethics. Cambridge: Cambridge University Press. pp293-303.
THURSDAY, September 10
3:05 – 3:20 LECTURE: Researchers’ Responsibilities (Duty to Relieve Oppression; Benefits sharing)
3:20 – 3:45 STUDY GROUP
3:45 – 4:00 GROUP PRESENTATIONS: SLIDE SET #2 DUE IN CLASS
REQUIRED READINGS
Nolan, S.2006.Sex Slaves for Science?Globe and Mail.(Jan 7)
Lavery, J., et al.2010.‘Relief of Oppression’: An Organizing Principle for Researchers’ Obligations to Participants in Observational Studies in the Developing World.BMC Public Health 10:384-391.
Lucas, JC, et al. 2013. Donating Human Samples: Who Benefits? Cases from Iceland, Kenya, and Indonesia. Chapter 5 In Doris Schroeder and Julie Cook Lucas, eds., Benefit Sharing: From Biodiversity to Human Genetics, READ ONLY pp:104-115.
Week 4
Module #1: Issues in Research Ethics:
Ethics of Community Engagement and Global Health Research Partnerships
Case Study: HIV/AIDS Research in South Africa
43 pages
TUESDAY, September 15
3:05 – 3:45 LECTURE: Community Consent and Global Health Research Partnerships
3:45 – 4:20 FILM: Good Neighbours? The Africa Centre and the Local Community, 2000, 29 mins
REQUIRED READINGS
Simwinga, M and C Kabero. 2014. Community Engagement. In History of Research Ethics Review in Africa. In M. Kruger, ed, Research Ethics in Africa: A Resource for Research Ethics Committees. Sun Press: Stellenbosch, South Africa. Pp143-151.
March, V., et al. 2013 Consent and Community Engagement in Diverse Research Contexts: Reviewing and Developing Reseearch and Practice. Journal of Empirical Research on Human Research Ethics, 8(4):1-18. (read pp 1-12)
Official Website, The Africa Centre, Mtubatuba, South Africa
News article on recent Africa Centre activities, May 2015
THURSDAY, September 17
3:05 – 3:30 LECTURE: Community Engagement and Global Health Research Partnerships
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS: SLIDE SET #3 DUE IN CLASS
REQUIRED READINGS
Murphy, J. et al. 2015. Making a Commitment to Ethics in Global Health Research Partnerships: A Practical Tool to Support Ethical Practices. Bioethical Inquiry 12:137-146.
MacQueen, K, et al. 2015. Evaluating community engagement in global health research: the need for metrics. BMC Medical Ethics 16:1-9.
Week 5
END OF MODULE #1:
Issues in Research Ethics
TUESDAY, September 22
3:05 – 4:20 EXAM #1, 200 points
(1) Bring your FULLY charged laptop to class
(2) Download RespondusLockdownBrowser to your laptop
(3) Read the RespondusLockdownBrowser instructions
(4) Take the practice test so you feel comfortable with the process
URL link here
Week 5
MODULE #2:
Ethics of Humanitarian Aid and Interventions
18 pages reading
THURSDAY, September 24
3:05 – 3:45 LECTURE: Ethics of Humanitarian Aid and Interventions in Haiti
3:45 – 4:20 FILM: Baseball in the Time of Cholera,2012, 30 mins, RYOT Films
OPTIONAL FILM: Faultlines: Haiti in a Time of Cholera, 2013, 25 minutes, AlJazeera Network
REQUIRED READINGS
Morris, JG. 2011. Cholera: Modern Pandemic Disease of Ancient Lineage. Emerging Infectious Diseases 17(11):2099-2104.
Kean, S. 2014. As Cholera Goes, So Goes Haiti. Science. 345(6202):1266-1268.
Hunt, M. 2014. Humanitarian Relief. In Bruce Jennings, ed, Bioethics, 4th edition. Macmillan Reference USA/Gale Cengage Learning: Farmington Hills, MI. pp 1618-1621.
Schwartz, L. et al. 2012. Models for Humanitarian Heath Care Ethics. Public Health Ethics 5(1):81-90.
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FINAL VERSION, FALL 2015
Week 6
MODULE #2:
Ethics of Humanitarian Aid and Interventions
6+ pages reading
TUESDAY, September 29
3:05 – 3:30 LECTURE: Ethics of humanitarian aid and interventions in Haiti
3:30 – 4:00 STUDY GROUP
4:00 – 4:20 GROUP PRESENTATIONS: SLIDE SET #4 DUE IN CLASS
REQUIRED READINGS
Transnational Development Clinic. 2013. Peacekeeping without Accountability: The United Nations' Responsibility for the Haitian Cholera Epidemic. (Focus on: Executive Summary, pp 1-6; skim rest of report for evidence for your slide set #4 assignment))
OPTIONAL RESOURCE
Want to learn more?
Week 6-7
MODULE #2:
Ethics of Polio Vaccination and Polio Eradication
37 pages reading
THURSDAY, October 1
3:05 – 3:30 LECTURE: Ethics of humanitarian aid related to Polio eradication
3:30 – 4:20 FILM: Every Last Child, (Pakistan, Middle East), 2014, 85 mins (we will watch clips totaling 43 minutes)
REQUIRED READINGS
Premji, A. et al. 2015. The Next Country to be Polio-Free: A Case Study of Nigeria’s Challenges, Success, and Lessons Learned for the Global Question to Eradicate Polio. Read entire case study, pp 4-21