UNC GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH EXECUTIVE DOCTORAL PROGRAM IN HEALTH LEADERSHIP (DrPH)

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1 UNC GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH EXECUTIVE DOCTORAL PROGRAM IN HEALTH LEADERSHIP (DrPH) SYLLABUS AND COURSE SCHEDULE HPM 821 (HARRIS)---SPRING 2013 Title of Course: Current Topics in Health Leadership Professor: Dean M. Harris, J.D. 1104A McGavran-Greenberg Hall Department of Health Policy and Management UNC Gillings School of Global Public Health CB # 7411 Chapel Hill, N.C Phone: (919) Dean_Harris@unc.edu Teaching Assistant: Mona Kilany mkilany@live.unc.edu Class Times: The first class will be held in person on January 8, 2013 in Chapel Hill. The remaining classes will be held online at the dates and times set forth below. All of the times listed below are local time in Chapel Hill. Course Description: In the Spring semester of 2013, this course will focus on the ethical issues of health leadership in global perspective. This global perspective is both comparative and trans-national. Thus, we will compare the ethical approaches to health issues in various countries, such as the different perspectives on informed consent, refusal of treatment, and reproductive health. The course will address global perspectives on the ethical issues in rationing of care and allocation of resources; ethical issues of corruption in health systems; and ethical aspects of research with human subjects in both developing and developed countries. In addition, we will consider the cross-border issues that arise from movement of patients and healthcare professionals across national borders, such as providing care for undocumented aliens and the brain drain of health care personnel from developing countries. Readings and Other Assignments: This course will include readings, class discussions, activities, and one 3-page paper at the end of the course. The text for this course is: Harris, DM. Ethics in Health Services and Policy: A Global Approach, (Jossey-Bass/John Wiley & Sons, Inc., San Francisco, CA, 2011). Other reading assignments will be posted on Sakai, identified on the internet, or otherwise available to all UNC students on the E-Journal Finder of UNC Libraries at Grading: Grades in this course will be based on class participation (50%) and one 3- page reflection paper which is due by 12:00 noon (Chapel Hill time) on Monday, April 15, 2013 (50%). The assignment for this paper is to explain how you will use what you learned in this course for your leadership in public health. There are no examinations in this course. 1

2 Course Learning Objectives, Competency Domains, and Specific Competencies: Learning Objective No. 1: Identify the ethical issues in a given state of facts, analyze those issues in global perspective, and explain the analysis Competency Domain: Advocacy Specific Competencies: A1. Present positions on health issues, law, and policy A4. Analyze the impact of legislation, judicial opinions, regulations, and policies on population health Competency Domain: Professionalism and Ethics Specific Competencies: G2. Differentiate among the administrative, legal, ethical, and quality assurance dimensions of research and practice. Learning Objective No. 2: Understand how to use regulation as a tool to address ethical problems and reform health systems Competency Domain: Management Specific Competencies: F4. Align policies and procedures with regulatory and statutory requirements. Learning Objective No. 3: Use ethical principles and global perspectives to promote health policy values and goals Competency Domain: Professionalism and Ethics Specific Competencies: G2. Differentiate among the administrative, legal, ethical, and quality assurance dimensions of research and practice. G3. Design strategies for resolving ethical concerns in research, law, and regulations. Competency Domain: Advocacy Specific Competencies: A1. Present positions on health issues, law, and policy A2. Influence health policy and program decision-making based on scientific evidence A7. Develop evidence-based strategies for changing health law and policy 2

3 UNC Honor Code The principles of academic honesty, integrity, and responsible citizenship govern the performance of all academic work and student conduct at the University as they have during the long life of this institution. Your acceptance of enrollment in the University presupposes a commitment to the principles embodied in the Code of Student Conduct and a respect for this most significant Carolina tradition. Your reward is in the practice of these principles. Your participation in this course comes with the expectation that your work will be completed in full observance of the Honor Code. Academic dishonesty in any form is unacceptable, because any breach in academic integrity, however small, strikes destructively at the University's life and work. If you have any questions about your responsibility or the responsibility of faculty members under the Honor Code, please consult with someone in either the Office of the Student Attorney General ( ) or the Office of the Dean of Students ( ). Read The Instrument of Student Judicial Governance ( Recognizing, Valuing, and Encouraging Diversity The importance of diversity is recognized in the mission statement of HPM. In the classroom, diversity strengthens the products, enriches the learning, and broadens the perspectives of all in the class. Diversity requires an atmosphere of inclusion and tolerance, which oftentimes challenges our own closely-held ideas, as well as our personal comfort zones. The results, however, create a sense of community and promote excellence in the learning environment. This class will follow principles of inclusion, respect, tolerance, and acceptance that support the values of diversity. Diversity includes consideration of: (1) life experiences, including type, variety, uniqueness, duration, personal values, political viewpoints, and intensity; and (2) factors related to diversity of presence, including, among others, age, economic circumstances, ethnic identification, family educational attainment, disability, gender, geographic origin, maturity, race, religion, sexual orientation, social position, and veteran status. Course Evaluation HPM participates in the UNC-CH s online course evaluation system, enabled at the end of each semester by DigitalMeasures. Your responses will be anonymous, with feedback provided in the aggregate. Open-ended comments will be shared with instructors, but not identified with individual students. Your participation in course evaluation is an expectation, since providing constructive feedback is a professional obligation. Feedback is critical, moreover, to improving the quality of our courses, as well as for instructor assessment. 3

4 CLASS SCHEDULE AND ASSIGNMENTS Note: The topics, assignments, and schedule of classes are subject to change by the professor, by posting an announcement on this course s web site on Sakai. Unless otherwise stated, all chapter references are to the text. Class 1 -- January 8: In-person session to launch this course (introduction and overview) Text, Chapter 1. A. Preview of issues B. Housekeeping matters C. Ethical theories and approaches to decision-making Brock, D, Broadening the Bioethics Agenda, Kennedy Institute of Ethics Journal, (2000) 10(1): Hedayat, K and R Pirzadeh, Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician, Pediatrics, (October 4, 2001) 108(4): Jafarey, A and F Moazam, Indigenizing Bioethics: The First Center for Bioethics in Pakistan, Cambridge Quarterly of Healthcare Ethics, (2010) 19(3):

5 Class 2 January 15 (6:35-8:00 pm): Ethical issues in the movement of patients across national borders A. Ethical issues in providing healthcare services to undocumented aliens B. Ethical aspects of providing care to patients who are unable to communicate effectively in the language of the host country C. Activity about developing a hospital policy on undocumented aliens Text, Chapter 10 Preston, J, Texas Hospitals Reflect Debate on Immigration, New York Times, (July 18, 2006), at < Sontag, D, Immigrants Facing Deportation by U.S. Hospitals, New York Times, (August 3, 2008), at < Class 3 January 22 (5:00-6:25 pm): Ethical issues in the movement of healthcare professionals across national borders A. Brain drain and the movement of health workers B. Ethical issues in recruiting health workers from developing countries Text, Chapter 11 Recommended reading for this class: Dwyer, J. What s Wrong with the Global Migration of Health Care Professionals? Individual Rights and International Justice. Hastings Center Report, (2007) 37(5):

6 Class 4 January 29 (6:35-8:00 pm): Global Perspectives on Informed Consent and Refusal of Treatment A. Global perspectives on autonomy and informed consent B. Different approaches to refusal or withdrawal of treatment C. Activity about informed consent at a rural health facility in a developing country Required readings for this class: Text, Chapters 2 and 3. Akabayashi, A and B Slingsby, Informed Consent Revisited: Japan and the U.S., American Journal of Bioethics, (2006) 6(1): Blackhall, L, et al, Bioethics in a Different Tongue: The Case of Truth-Telling, Journal of Urban Health, (March 2001) 78(1): Del Pozo, P and J Fins, Islam and Informed Consent: Notes from Doha, Cambridge Quarterly of Healthcare Ethics (2008) 17: Iqbal, S, et al, Different Moral Worlds, Bioethics Links (June 2010) 6(1): 2-6, available on the website of the Centre of Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation, at (Click on Newsletter and then Past Issues to find volume 6, issue no. 1. Then, click on that volume and issue number. ) 6

7 Class 5 February 5 (5:00-6:25 pm): Ethical Issues in Human Reproduction A. Abortion in different times, places, and cultures B. Ethical issues of abortion C. Ethical issues of emergency contraception D. Conscience clauses and the refusal to provide particular healthcare services on ethical grounds E. Ethics of imposing conditions on government or private funding F. Activity about the ethics of emergency contraception in Gouanastan Text, Chapter 4. American College of Obstetricians and Gynecologists (ACOG), Committee on Ethics, The Limits of Conscientious Refusal in Reproductive Medicine, ACOG Committee Opinion No. 385 (November 2007), Obstetrics & Gynecology (2007) 110 (5): Cantor, J, Conscientious Objection Gone Awry Restoring Selfless Professionalism in Medicine, New England Journal of Medicine (2009) 360(15): World Medical Association, Declaration on Therapeutic Abortion, (2006), at 7

8 Class 6 February 12 (6:35-8:00 pm): Ethical issues of research with human subjects in both developing and developed countries A. Introduction (history of research with human subjects, and basic ethical principles in the Belmont Report) B. Autonomy and voluntary informed consent (including issues of undue influence over potential research subjects, and obtaining informed consent from potential subjects in different cultures) C. Beneficence and cost-benefit analysis D. Justice and fairness in selecting the subjects of research and allocating the benefits and burdens (including issues of research in countries unable to obtain the drug being tested, use of placebo controls, and duty of researchers after completion) E. Activity on the use of prisoners as subjects of research Required readings for this class: Text, Chapter 6. World Medical Association, Declaration of Helsinki, available at Brandt, A, Racism and Research: The Case of the Tuskegee Syphilis Study, Hastings Center Report (1978) 8(6): Frimpong-Mansoh, A, Culture and Voluntary Informed Consent in African Health Care Systems, Developing World Bioethics, (2008) 8(2): Shapiro, H, and E Meslin, Ethical Issues in the Design and Conduct of Clinical Trials in Developing Countries, New England Journal of Medicine, (2001) 345(2):

9 Class 7 February 19 (6:35-8:00 pm): Rationing and allocation of resources Text, Chapter 8. A. Levels of allocating resources B. Methods of rationing health resources C. Comparative effectiveness research (CER) and cost effectiveness analysis (CEA) D. Activity about cost-effectiveness analysis in a country with universal health care coverage Chalkidou, K et al, Comparative Effectiveness Research and Evidence-Based Health Policy: Experience from Four Countries, Milbank Quarterly (2009) 87(2): Kilner, J. Who Shall Be Saved? An African Answer, Hastings Center Report (June 1984) 14(3): Persad, G et al, Principles for Allocation of Scarce Medical Interventions, Lancet (January 31, 2009) 373(9661): Class 8 March 26 (5:00-6:25 pm): Values of health systems, plus the ethical issues of financing and health reform A. Fundamental values of health systems B. Ethical issues in financing health services and designing fair systems of health insurance C. Activity about establishing a system of health coverage in a developing country Required readings for this class: Text, Chapters 7 and 9. 9

10 Frenk, J and O, Gomez-Dantes, Ideas and Ideals: Ethical Basis of Health Reform in Mexico, Lancet (2009) 373(9673): Jecker, N, Can an Employer-based Health Insurance System Be Just? Journal of Health Politics, Policy and Law (1993) 18(3): Priester, R, A Values Framework for Health System Reform, Health Affairs (Spring 1992) 11(1): Class 9 April 2 (5:00-6:25 pm): Corruption in health systems A. Payment of informal fees by patients and their families B. The relationship between governance and health C. Activity about developing a hospital plan to stop collection of informal fees from patients in a developing country Text, Chapter 12. Barber, S et al, Formalizing Under-the-Table Payments to Control Out-of-Pocket Hospital Expenditures in Cambodia, Health Policy and Planning, (2004) 19(4): Ensor, T and A Duran-Moreno, "Chapter 5: Corruption as a Challenge to Effective Regulation in the Health Sector" in R Saltman, et al, Regulating Entrepreneurial Behavior in European Health Care Systems (WHO 2002), available online from the website of the European Observatory on Health Care Systems at < 10

11 Class 10 April 9 (5:00-6:25 pm): Last Class (Topic to be announced) NOTE: As stated above, each student is required to write and submit one 3- page reflection paper which is due by 12:00 noon (Chapel Hill time) on Monday, April 15, By noon on that date, please submit your paper to the Sakai site for this course. The assignment for this paper is to explain how you will use what you learned in this course for your leadership in public health. DrPH Syllabus-HPM 821-Spring 2013.doc 11