NURS 660/PHIL 510 Seminar in the Ethics of Health Care (3) Fall 1995 section 001 Robinson B, 105 Tuesday, 4:30 pm -7:10 pm MARY SILVA, RN, Ph.D Office: Rob. I, A373 Phone: 993-1909 (0) 425-6136 (H) Fall Semester 1995 #:1491 $3.15
Course Number: NURS 660/PHIL 510 Course Title: Seminar in the Ethics of Health Care (3) Placement in Curriculum: Faculty: Elective Mary Silva, RN, Ph.D Course Description: An examination of the moral dilemmas within the health care profession, with special emphasis on patients' rights, professional obligations to other professional, and issues of social justice in health care. Methods of rational moral deliberation based on ethical theories and principles, as well as caring and virtue theories, will be applied to ethical dilemmas in health care. Course Objectives: At the completion of this course, the student will be able to: 1. Discuss ethical theories, principles, and decision- making frameworks. 2. Analyze methods of moral deliberation by applying the preceding theories, principles, and frameworks to health care issues. 3. Discuss major concerns related to select bioethical issues in health care. 4. Evaluate the effects of bioethical issues on future trends within the health care profession. Topical Outline: 1. Historical background of modern biomedical ethics 2. Definition of key terms and classical ethical theories 3. Major ethical principles, caring, virtue ethics, and moral development. 4. Codes of ethics and ethics decision-making frameworks 5. Professional and ethical obligations to society 6. Professional and ethical obligations to clients/patients 7. Professional and ethical obligations to other professionals 8. Future bioethical issues and trends Page 2
Teaching strategies: 1. Lecture - discussion 2. Seminars 3. Guest speakers 4. Use of audiovisuals 5. Incorporation of the arts and humanities Week Topic Presenter(s) 1. Introduction to Course; Key Ethical Terms; Facultv Ethical Codes 2. Moral Justification; Classical Ethical Faculty Theories and Principles 3. Ethical Decision-Making Frameworks; Faculty Theories of Moral Development 4. Feminist Ethics and the Ethics of Care Faculty 5. Ethical Issues in Peer and Colleague Relationships 6. Ethical Issues and Testing, screening, and Technological Advances in science 7. Ethical Issues and Abortion and New Methods of Reproduction 8. Ethical Issues and Cultural Diversity 9. Ethical Issues and Organ Donations and Transplants 10. Ethical Issues and Death and Dying 11. Ethical Issues and Scarce Resource Allocation 12. Ethical Issues in Health Care Research (Ethics Issue Paper Due). 13. Ethical Issues and Genetic Experimentation 14. Future Bioethical Issues and Trends; Page 3
Evaluation Methods: 1. Seminar Presentation 40% 2. Seminar preparation/ 30% participation 3. Ethics issue paper 30% Required Readings: American Nurses Association. (1985). Code for nurses with interpretive statements. Kansas City: MO. American Psychological Association. (1994). Publication manual of the American Psychological Association (4th ed.). Washington, DC: Author Beauchamp, T..L., & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press. Garrett, T. M., Baillie, H. W., & Garrett, R. M. (1993). Health care ethics: Principles and Problems (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall. White, G. B. (Ed.). (1992). Ethical dilemmas in contemporary nursing practice. Washington, DC: American Nurses Association. Suqgested Readinqs: rd Benjamin, M., & Curtis, J. (1992). Ethics in nursing (3 ed.). New York: Oxford University Press. Silva, M. C. (1990). Ethical decision making in nursing administration. Norwalk, CT: Appleton & Lange. Page 4
Purpose Apply moral justification and ethical decision making to contemporary bioethical issues in health care. Directions Purpose 1. You are free to plan the seminar in any manner you desire as long as you discuss a contemporary bioethical issue in health care identified in this syllabus and propose viable ethical choices for its potential resolution. 2. It is advisable for you to review the seminar evaluation form before preparing your seminar so that you are aware of the specific areas in which you will be evaluated. 3. The richness of the seminar is the group interaction and discussion. Although the presenters have the responsibility for providing the framework and organizing the seminar, each participant is responsible for preparing and contributing to the seminar. 4. Please provide your colleagues with objectives, an outline, learner activities, and a reading list related to your seminar content one week in advance of your presentation so that they may prepare adequately for your seminar. 5. Arrange for in advance and be sure all audiovisual equipment is working prior to the seminar presentation. Seminar Preparation and Participation To ensure adequate preparation and participation of colleagues for each seminar so substantive knowledge is learned and critiqued. Criteria 1. Grading criteria for seminar preparation are as follows and will be self reported as a percent: A (90-99%) --Student has carefully and thoughtfully read all required readings, plus several additional or recommended readings. B (80-89%)-- Student had carefully and thoughtfully read all required readings. Page 5
C (70-79%)-- Student has been inconsistent in preparing for class, and all required readings are read less than 75% of the time. 2. Grading criteria for seminar participation are as follows and will be self reported as a percent. A (90-99%)-- Student participates in at least 12 seminars in a constructive and thoughtful manner. B (80-89%)-- Student participates in at least 10 seminars in a constructive and thoughtful manner. C (70-79%)- Student participates in seminars in a sporadic and superficial manner, or student is excessively talkative or quiet. Notes: Students are expected to attend all classes because of their participatory nature. The Honor Code is in effect during self-evaluation of seminar participation and preparation. Since an ethical issue discussed may be personal and distressing, students may leave the classroom to regain their composure, returning when feeling comfortable to do so. Page 6
NURS 660/PHIL 510 Seminar in the Ethics of Health Care Seminar Presentation Evaluation Form Topics Presented: Presenter(s) : Date: Possible Points I. Orqanization 25 Earned Points A. Demonstrated logical development 5 of ideas B. Used handouts and/or audio-visual 5 aids of high quality C. Assigned class readings to group 5 one week prior to seminar D. Supported group participation 10 II. Level of Scholarship 60 A. Presented accurate information and 15 supported generalizations B. Included relevant content related to 15 ethical issues(s), as well as morally justified resolutions C. Discussed application of the 15 ethical issue and its resolution in nursing practice D. Demonstrated critical thinking in 15 presentation and critique III. Presentation Style 15 A. Used time appropriately and adhered 5 to time limit B. Demonstrated originality and 10 creativity Total 100 Constructive Comments: Evaluators Page 7
NURS 660/PHIL 510 Seminar in the Ethics of Health Care Health Care Ethics Issue Paper Objectives/Criteria tor Health Care Ethics Paper Points 1. Describe a specific ethical dilemma in health. (5) 2. Select a position of the above dilemma to defend. (5) 3. Defend your position with reasoned arguments (30) using ethical theories and principles, facts, research and/or case examples 4. Examine critically potential objections to your (20) position based on opposing commentary in the literature (counter arguments and defense). 5. Based on the preceding two positions, state the (20) implications for nursing practice and health care policy. 6. Use APA format, correct grammar and spelling, (20) and demonstrate logical, concise organization of content. Total points/grade for paper 100 Guidelines tor Paper: 1. Excluding the cover page, abstract, references, and appendices, the paper is to be no more than eight pages, using standard size type and 8 1/2 x 11" paper. 2. The 4th edition of the AEA manual must be followed. 3. The Honor Code is in effect during the writing of this paper. 4. The paper is due by class time on week 12. Evaluation: The paper will be graded by the instructor according to the criteria implicit in its six objectives. 90-99% = A 80-89% = B 70-79% = C Page 8
NURS 660/PHIL 510 Seminar in the Ethics of Health Evaluation of Ethics Issue Paper Student: Instructor: Date: A. Objectives/Criteria for Health Care Ethics paper Points 1. Describe a specific ethical dilemma in health care (5) 2. Select a position of the above dilemma to defend. (5) 3. Defend your position with reasoned arguments using (30) ethical theories and principles, facts, research and/or case examples 4. Examine critically potential objections to your (20) position based on opposing commentary in the literature (counter arguments and defense). 5. Based on the preceding two positions, state the (20) implications for nursing practice and health care policy. 6. Use APA format, correct grammar and spelling, and (20) demonstrate logical, concise organization of content. Total points/grade for paper; 1/3 of final grade 100 Page 9
Seminar Tips 1. Use current references, unless classics in the field. 2. Arrange required readings in logical order, not alphabetically. 3. Include at least one research article in your required readings. 4. Make sure all reproduced articles and handouts are legible and contain the complete citation. 5. Do not repeat material in class unless you have a specific purpose for doing so. 6. On the other hand, make sure every required reading is mentioned in class so that its relevance to the seminar is clear. 7. Collate all required readings for each student prior to class; do not use class time for this. Place a copy of the seminar evaluation form in each packet for peers and instructors. 8. Regarding teaching-learning activities, be creative. Pull from history, art, music, literature, poetry, games, videos, and your imagination.. 9. Analyze the length of time each part of the seminar will take so you do not feel pressured for time. 10. Do a rehearsal of the seminar before your presentation, including testing all equipment. 11. The seminar must be at the highest level of professionalism; please dress appropriately and address your fellow students as colleagues. 12. Handouts, overheads, and so forth must be typed, not handwritten. 13. Begin the seminar on time. Do not wait for tardy students to arrive. Finish the seminar on time. 14. Make your topic interesting and creative. Your classmates will appreciate your efforts. 15. Remember to meet with your instructor at least one time prior to your seminar presentation. Page 10
GEORGE MASON UNIVERS ITY NURS 660/PHIL 510 Seminar in the Ethics of Health Care Moral Justification Classical Ethical Theories and Principles Tuesday, September 5, 1995 Seminar Objectives 1. Discuss the components and levels of moral justification. 2. Compare and contrast ethical theories. 3. Compare and contrast basic ethical principles. I. Moral Justification A. Components and Definition B. Levels II. Classical Ethical Theories A. Utilitarian Theories B. Deontological Theories C. Virtue Theories D. Others III. Ethical Principles A. Respect for Autonomy B. Nonmaleficence C. Beneficence D. Justice Seminar Outline Teaching -Learning Activities Based on your readings for this class, select and defend what you believe to be your dominant ethical theory and principle in framing health care ethical issues. Required Readings Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University. (Please read pages 13-22; 47-50; 56-60; 62-68; 120-128; 189-194; 259-265; 326-334.) Page 11
Suggested Readings Garrett, T. M., BailIe, H. W., & Garrett, R. M. Health care ethics: principles and problems. Englewood Cliffs, NJ: Prentice Hall. (Read pages 28-29; 54-61; 79-85.) Silva, M. C. (1990). Ethical decision making in nursing administration. Norwalk, CT: Appleton & Lange. (Peruse Chapters 2 and 3.) Page 12
NURS 660/PHIL 510 Seminar in the Ethics of Health Care Ethical Decision Making Frameworks Theories of Moral Development Tuesday, September 12, 1995 Seminar Objectives 1. Discuss the purpose of ethical decision-making frameworks. 2. Compare and contrast two ethical decision-making frameworks. 3. Discuss the concepts of moral development and related discipline moral development theories. 4. Discuss a beginning nursing theory of moral development. I. Ethical Decision-Making Frameworks A. Purpose B. Curtin Framework C. Silva Framework D. Others II. Moral Development Theories A. Related Discipline Theories B. Beginning Nursing Theory Seminar Outline Teaching -Learning Activities List all the factors that you believe influence your ethical decision making. Prioritize the top three. Required Readings Silva, M. C. (1990). Ethical decision making in nursing administration. Norwalk, CT: Appleton & Lange. (Read pp.95-105; pp.l09-126). (Chapters are attached to syllabus.) Suggested Readings Gilligan, C. (1982). In a different voice: Psychological theory and women's development. Cambridge, MA: Harvard University Press. Gournic, J. L. (1994). Patient integration: Toward a theory of moral development of experienced clinical nurses. Unpublished doctoral dissertation, George Mason University, Fairfax, VA. (Doctoral Office) Page 13
Kohlberg, L. (1981). Essay on moral development: Vol 1. The philosophy of moral development: Moral states and the idea of justice (pp. 409-412). San Francisco: Harper & Row. Page 14
NURS 660/PHIL 510 Seminar in the Ethics of Health Care (3) Feminist Ethics and the Ethics of Care Tuesday, September, 19, 1995 Seminar Objectives 1. Discuss the moral dimensions of caring. 2. Compare and contrast different feminist perspectives on the ethics of care. 3. Critique the ethics of care. 4. Discuss a research study related to nursing students and faculty caring/noncaring behaviors. Seminar Outline I. Moral Dimensions of Caring A. Mutual Interdependence in Relationships B. Role for Emotions II. Feminist Perspectives on Caring A. Alison Jagger B. Joan C. Tronto III. Critique the Ethics of Care IV. Research study in Caring Teaching -Learning Activities Be prepared to share a personal experience that demonstrates a caring and a noncaring teacher behavior. Required Readings Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press. (Read pages 85-92). Jagger, A.M. (1990). Feminist ethics: Projects, problems, prospects. In C. Card (Ed.), Feminist ethics (pp. 78-104). Lawrence, KS: University Press of Kansas. (Article is attached to syllabus.). Page 15
Suggested Readings Benner, P. (1990). The moral dimensions of caring. In American Academy of Nursing, Knowledge about care and caring (pp. 5-17). Kansas City, MO: American Academy of Nursing. Manning, R. C. (1992). Speaking from the heart: A feminist perspective on ethics. Lanham, MD: Rowman & Littlefield. Pepin, J. I. (1992). Family caring and caring in nursing. IMAGE: Journal of Nursing Scholarship. 24, 127-166. Swanson, K. M. (1991). Empirical development of a middle range theory of caring. Nursing Research. 40, 161-166. Swanson, K. M. (1994). Nursing as informed caring for the well-being of others. IMAGE: Journal of Nursina Scholarship. 25, 352-357. Tronto, J. C. (1993). Moral boundaries: A Political argument for an ethic of care. New York: Routledge. Wolf, Z. R., Giardino, E. R., Osborne, P. A., & Ambrose, M. S. (1994). Dimensions of nursing care. IMAGE: Journal of Nursing Scholarship. 26, 107-111. B:NUR660 Fall 1995 Page 16