The Plague

1. In England in 1500 children sang a rhyme and played a game called "Ring around the Rosies." In Canada in the 1940s, children still held hands in a circle and chanted: Ring around the rosies A pocketful of posies Ashes, ashes We all fall down.

The rhyme originated from the flulike symptoms, skin discoloration, and mortality caused by bubonic plague. Discuss how the meaning was that life could be both unimaginably beautiful and horrible.

2. Study and report on the romanticization of tuberculosis in the nineteenth century, especially focusing on famous cases such as the poet John Keats.

3. Report on the science of immunology. What is a vaccine and how does this agent in the war on disease work in the immune system? Define the terms antibodies, pathogens, antigens, macrophages and dendrites, T cells, cytokines, white blood cells, and lymph nodes. What are the pros and cons of administering vaccines? See the National Vaccine Information Center,

4. Study Dark Winter, a 2001 exercise simulating a covert smallpox attack in the United States. How have the senior-level policy makers met the challenge of containing the outbreaks of this highly contagious disease? The scenario is available at the University of Pittsburgh Medical Center, Center for Biosecurity, dark_winter/dark_winter.html.

5. Discuss the 1997 U.S. Supreme Court decision on assisted suicide and its Fourteenth Amendment view that there is no constitutional right to die. Review ongoing federal legislation, specifically the Assisted Suicide Funding Restriction Act prohibiting federal money to support physician-assisted suicide. House and Senate bills were introduced in 1999 to revoke a doctor's license for prescribing federally controlled drugs used in an assisted suicide. If these laws pass, Oregon doctors would be subject to federal sanction.

6. Compare Dr. Jack Kevorkian, who advocated complete patient autonomy with an in-your-face defiance of the suicide law, to Dr. Haiselden's 1915 actions as described in The Black Stork.

7. Reflect on the Pope Pius XII controversy following World War II, when he, as a moral leader, was accused of falling culpably silent in the face of known Nazi crimes against the Jews.

8. A small Texas boy, Audie Murphy, was the most decorated soldier of World War II. He epitomized American heroism and in 1945 received the Medal of Honor. Learn about Murphy's heroic activities and the Medal of Honor to discuss courage and heroism. Place Murphy on Aristotle's Golden Mean of courage, in which an excess of courage is rashness; the mean is courage; and a deficiency is cowardice. See Aristotle, Ethics (London: Penguin Classics, 1976).

Miss Evers' Boys

1. How did Alexander Fleming's "accidental" discovery, penicillin, take so long for widespread use?

2. Explain the need to monitor ethical standards, such as those 1) leading to the disastrous 1950-60s use of thalidomide in pregnant women; 2) leading to the 2001 tragic death at Johns Hopkins of a healthy 24-year-old woman who inhaled hexamethonium; and 3) leading to the placebo-controlled African AZT trial for preventing maternal-to-fetal transmission of HIV. How are colleges monitored in treating student volunteers to keep the public trust from eroding?

3. Some surviving Tuskegee Syphilis Study (TSS) investigators argue the study was ethical. Analyze their arguments and compare them to the study's majority condemnation.

4. Describe Negro Health Week, established in 1915 by Tuskegee Institute founder Booker T. Washington, and discuss how by 1932 it provided a positive national context for public health work in black communities and contributed to the TSS.

5. There are many examples of research abuse like the TSS, including: 1) Nazi concentration camps; 2) Willowbrook State School hepatitis experiments on mentally retarded children; 3) elderly patients injected with cancer cells without consent at the Jewish Chronic Disease Hospital; and 4) the 1950-60s human radiation experiments in the United States at the Nevada Test Site. What Nuremberg Code principles were broken that an institutional review board would stop today?

6. Harvard University philosopher John Rawls devised the Rawls Test to highlight questions of right and wrong. For him an ideal society includes the principle relationship that asks, would the best-off people accept the arrangements if they believed that they might at any moment find themselves in the place of the worst off? How in good faith would you answer this role reversal question about 1) slavery, 2) Nazi concentration camp inmates, and 3) the TSS?

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