History of Bioethics Syllabus

HSOC-140
History of Bioethics
Professor Beth Linker
Fall 2007
______________________________________________________________________________
Course Description: This course is an introduction to the history of human experimentation in
the United States, from the smallpox inoculation trials in colonial Boston to the injection of live
cancer cells into unknowing hospitalized patients during the 1960s. We will examine how and
why such practices took place, from the perspective of both the experimenter and the subjects
involved. We will also explore the history of moral reasoning used to justify and denounce the
practice of human experimentation. By the end the term students will come to appreciate the way
in which contemporary bioethical debates and restrictions on human experimentation emerged as
a result of historical processes.
Course Objectives: The focus of this course is on the conduct of medical researchers who use
human begins as subjects for experimentation. We will be studying various experiments that have
taken place in the United States from the colonial period up to the present time.
Our disciplinary tool for coming to understand better the theme of human experimentation will be
history. Historians seek to understand how and why change occurs over time within any given
society and culture. Some guiding questions for this course include:
How have the justifications for conducting human experimentation changed over time?
What populations of Americans are most likely to be the subjects of human
experimentation? Why? Does this change over time?
In what way (if at all) did Nazi medicine and the Nuremberg code affect U.S. research?
Which Americans oppose the practice of human experimentation? What arguments do
they use in their favor? Does this change over time?
How and why does experimentation become the centerpiece of U.S. medicine?
Course Assignments* and Grading:
Participation (20%): Participation will take many forms. Every class session will include
discussion of the readings, so you need to be prepared, both by having done the reading and by
coming up with questions or observations on which you would like to focus our discussions.
Some class sessions will include in-class writing or group work. Occasionally, you will be
responsible for an oral presentation in class, either individually or as part of a group.
Midterm Exam (20%): In-class bluebook exam. Format of exam: identification and essays, both
long and short. Friday October 12th.
Short writing assignment and in-class presentation (30%): Approx. 2,500 word essay that
historically interprets a work of fiction (short story) or film that focuses on a theme in medical
ethics. A list of stories along with more detailed instructions for writing the essay and due date(s)
will follow.
Final exam (30%) Blue-book exam. Format of exam: cumulative, identification and essays, both
long and short. Tuesday, December 18th, noon-2:00pm.
*Academic integrity policy: Students are expected to adhere to the universitys Code of
Academic Integrity (http://www.vpul.upenn.edu/osl/acadint.html) on all assignments. Students
who violate these policies risk failing the course.
Course Materials:
The following books* and course materials are required:
1. Susan Lederer, Subjected to Science: Human Experimentation in America before the Second
World War (Johns Hopkins University Press, 1995).
2. James Jones, Bad Blood: The Tuskegee Syphilis Experiment, 2nd ed. (Free Press, 1993)
3. David Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed
Medical Decision Making (Basic Books, 1991).
4. Coursepack readings posted on Blackboard: https://courseweb.library.upenn.edu/
*Books can be found at Penn Book Center, 130 S. 34th Street, 215-222-7600.
Readings and Assignment Schedule:
Week 1 Introduction to the course
W Sept 5
Introductions
F Sept 7
Charles E. Rosenberg, Meaning, Policies, and Medicine, Daedalus (Fall 1999):
27-47.
Week 2: The Boston Inoculation Controversy
M Sept 10
Roslyn Stone Wolman, A Tale of Two Colonial Cities: Inoculation Against
Smallpox in Philadelphia and in Boston, Transactions and Studies of the
College of Physicians of Philadelphia 45 (1978): 338-47.
John B. Blake, The Inoculation Controversy in Boston: 1721-1722, The New
England Quarterly 25 (1952): 489-506.
W Sept 12
Cotton Mather, An Account of the Method and Success of Inoculating the SmallPox, in Boston in New England (London: J.Pells, 1722): selections
William Douglass, Inoculation of the Small Pox as Practiced in Boston (Boston,
1722): selections.
Zabdiel Boylston, An Historical Account of the Small-Pox Inoculated in New
England (London, 1726): selections.
F Sept 14
Margot Minardi The Boston Inocluation Controversy of 1721-1722: An Incident
in the History of Race The William and Mary Quarterly 61(2004).
Week 3: Defining Experimental Medicine
M Sept 17
Claude Bernard, An Introduction to the Study of Experimental Medicine in
Medicine and Western Civilization, ed. David Rothman, et. al. (Rutgers
University Press, 1995): 314-318.
William Beaumont, Experiments and Observations on the Gastric Juice and the
Physiology of Digestion (Plattsburgh, 1833): 5-29 [Preface and Introduction].
W Sept 19
William Beaumont, Experiments and Observations on the Gastric Juice and the
Physiology of Digestion (Plattsburgh, 1833): 31-41; 103-116 [Sections I & VI].
F Sept 21
Ronald Numbers, William Beaumont and the Ethics of Human Experimentation
Journal of the History of Biology 12 (Spring 1979): 113-135.
Week 4: Dr. Sims, Hero or Villain?
M Sept 24
J. Marion Sims, The Story of my Life, 2nd ed. (New York, 1968 [original edition
published in 1884]): 222-250.
W Sept 26
Todd L Savitt, Medical Experimentation and Demonstration on Blacks in the
Old South, in Race and Medicine in Nineteenth and Early-Twentieth-Century
America (Kent State, 2007): 77-88.
F Sept 28
Barron Lerner, Scholars Argue Over Legacy of Surgeon The New York Times,
Oct 28, 2003, p. F7
Diana E. Axelsen, Women as Victims of Medical Experimentation: J. Marion
Simss Surgery on Slave Women, 1845-1850, Sage 2 (Fall 1985): 10-12.
LL Wall, The Medical Ethics of Dr. J. Marion Sims: a Fresh Look at the
Historical Record, Journal of Medical Ethics (August 2006): pp. 346-350.
Week 5: The Human Vivisection Controversy
M Oct 1
Human Vivisection (New York Anti-Vivisection Society), pp. 1-12.
Susan Lederer, Subjected to Science, Introduction (xiii-xvi); chapter 2 (pp. 2750).
W Oct 3
Lederer, Subjected to Science, chapter 3 (51-72)
F Oct 5
IN-CLASS Presentations
Week 6: Walter Reed and Yellow Jack
M Oct 1
W Oct 10
Lederer, chapter 6 (pp. 126-138).
F Oct 12
MIDTERM EXAMINATION
Week 7: The Democracy of Germs
M Oct 15
NO CLASS: Fall Break
W Oct 17
Jones, Bad Blood, Chpts. 1 & 2 (pp. 1-29)
F Oct 19
Jones, Chpts. 3 & 4 (pp.30-60)
Week 8: The Inequaltiy of Health
M Oct 22
Jones, chpt. 5 & 6 (61-90)
W Oct 24
Jones, chpt. 7& 8 (91-132)
F Oct 26
Week 9: Tuskegees Legacy
M Oct 29
Jones, Chpt. 9 & 10 (pp.132-170)
W Oct 31
Vanessa Northington Gamble, A Legacy of Distrust: African Americans and
Medical Research, American Journal of Preventive Medicine, 1993, Vol. 9, pp.
35-38.
F Nov 2
NO CLASS: CLASS CANCELLED

Week 10: Nuremberg Comes to America?
M Nov 5
Rothman, intro. & chpt. 2
W Nov 7
George Annas and Michael Grodin, Introduction in The Nazi Doctors and the
Nuremberg Code (Oxford University Press, 1992): 3-11.
George Annas, The Nuremberg Code in U.S. Courts: Ethics vs. Expediency
The Nazi Doctors and the Nuremberg Code (Oxford University Press, 1992):
201-221.
Wolfgang U. Eckart and Hanna Vondra, Disregard for Human Life:
Hypothermia Experiments in the Dachau Concentration Camp, in Man,
Medicine, and the State: the Human Body as an Object of Government
Sponsored Medical Research in the 20th Century, Wolfgang Eckart, ed. (Stuttgart
2006): 157-166.
F Nov 9
Week 11: Research in an Atomic Age
M Nov 12
Final Report of the Advisory Committee on Human Radiation Experiments,
preface, Introduction, Chapter 2 (xxi-xxxii;1-13;74-96).
W Nov 14
Final Report of the Advisory Committee on Human Radiation Experiments,
Chapter 5 (pp. 139-171)
F Nov 16
Week 12: The Gilded Age of Research
M Nov 19
Rothman, chapter 3.
W Nov 21
Rothman, chapter 4.
F Nov 23
NO CLASS: Thanksgiving Break
Week 13: Distrust of the Doctor
M Nov 26
Rothman, chapter 5.
W Nov 28
Rothman, Chapter 6.
F Nov 30
Week 14: Outsourcing Experimentation
M Dec 3
W Dec 5
Rothman, Chapter 9.
Hearings before the Senate Subcommittee on Health: Quality of Health Care
Human Experimentation, 1973, in Medicine and Western Civilization, ed. David
Rothman, et. al. (Rutgers University Press, 1995): 330-340.
F Dec 7
David Rothman, Back to First Principles: First World Research in Third World
Countries, in Man, Medicine, and the State: the Human Body as an Object of
Government Sponsored Medical Research in the 20th Century, Wolfgang Eckart,

ed. (Stuttgart 2006): 279-288.
Harold T Shapiro and Eric Meslin,Ethical Issue in the Design and Conduct of
Clinical Trials in Developing Countries, New England Journal of Medicine
(July 2001): 139-141.
Final Examination:
T Dec 18: 12:00noon-2:00pm

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HSOC-140

NO CLASS: CLASS CANCELLED

Government Sponsored Medical Research in the 20th Century, Wolfgang Eckart,

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