UNIVERSITY OF FLORIDA



UNIVERSITY OF FLORIDA

COLLEGE OF NURSING

COURSE SYLLABUS

Fall 2012

COURSE NUMBER NGR 7882, Section 3459

COURSE TITLE Ethical Theories and Rational Decision Making in Health Care

CREDITS 3

PLACEMENT Variable: Required Core Course

PREREQUISITES Admission to Doctoral Program or permission of instructor

FACULTY M. Josephine Snider, EdD, RN

Associate Professor

HPNP 4221 snidemj@ufl.edu

Office hours: By appointment

DEPARTMENT CHAIR M. Josephine Snider, EdD, RN

snidemj@ufl.edu (352) 273-6359 HPNP 4221

Office hours: By appointment

JACKSONVILLE CAMPUS DIRECTOR Andrea Gregg, DSN, RN

greggac@ufl.edu. (904) 244-5172 Jacksonville Campus

Office hours: By appointment

COURSE DESCRIPTION This course provides the student with the opportunity to analyze ethical theories, and evaluate the applicability of theories to nursing, health care systems, and health care policies. Emphasis is on reasoned considerations of contemporary theoretical perspectives in bioethics. The focus is on theories related to rational systems of bioethical problem solving in a culturally pluralistic society.

COURSE OBJECTIVES Upon completion of this course, the student will be able to:

1. Evaluate the conditions of adequacy of ethical theories from which to assess the deficits and strengths of theories.

2. Critique selected contemporary and post-modern ethical theories using methods of moral justification and philosophical reasoning in a culturally pluralistic society.

3. Evaluate recurrent ethical issues having relevance for national and international health policy decisions.

4. Evaluate the effects of cultural pluralism on ethical decision making processes regarding wellness and illness.

5. Analyze nursing and health related literature for selected epistemic, metaphysical, and axiological themes related to health and illness.

COURSE SCHEDULE

Section Day Time Room

3459 Tuesday 830-1130 G112

E-learning in Sakai is the course management system that you will use for this course.

E-Learning in Sakai is accessed by using your Gatorlink account name and password at

. There are several tutorials and student help links on the E-learning login site.

If you have technical questions call the UF Computer Help Desk at 352-392-HELP or send email

to helpdesk@ufl.edu .

It is important that you regularly check your Gatorlink account email for college and University

generated information and the course E-Learning site for announcements and notifications.

Course websites are generally made available on the Friday before the first day of classes. Course

materials should be available at that time.

CLASS TIME AND PREPARATION

This is a 3 credit hour theory course. In order to be successful, it is expected that students will need

to spend at least 3 hours weekly preparing for each hour of academic credit, which translate to weekly

preparation time of 9 hours.

ATTENDANCE. Students are expected to participate in the activities and discussions as listed in the course syllabus and in course materials. Instructors will make an effort to accommodate reasonable requests for absences and late assignments. A grade penalty may be assigned for late assignments.

ACCOMMODATIONS DUE TO DISABILITY

Each semester, students are responsible for requesting a memorandum from the Disability Resource Center to notify faculty of their requested individual accommodations. This should be done at the start of the semester.

STUDENT HANDBOOK

Students are to refer to the College of Nursing Student Handbook for information about College of Nursing policies, honor code, and professional behavior.

TOPICAL OUTLINE

1. Conditions of theoretical adequacy

2. Respect for autonomy as related to theoretical value systems in health care

3. Justice and the platonic ideal in modern society

4. Responsive interaction and moral principles in a culturally pluralistic society

5. Rights-based theories; duty and obligation in health care

6. Communitarianism; the community and the individual as moral agents

7. Contractarianism; the absence of arbitrary inequalities

8. Moral injunctions and the health care professional; theory of virtue

9. Rational problem-solving and ethical issues

TEACHING METHODS

Seminar discussion, assigned readings, and case analysis

LEARNING ACTIVITIES

Scholarly discourse, case analysis, case presentation, written papers

EVALUATION METHODS/COURSE GRADE CALCULATION

Issues 30%

Personhood/lacks 40%

Preparation & Participation 30%

GRADING SCALE/QUALITY POINTS

A 95-100 (4.0) C 74-79* (2.0)

A- 93-94 (3.67) C- 72-73 (1.67)

B+ 91- 92 (3.33) D+ 70-71 (1.33)

B 84-90 (3.0) D 64-69 (1.0)

B- 82-83 (2.67) D- 62-63 (0.67)

C+ 80-81 (2.33) E 61 or below (0.0)

* 74 is the minimal passing grade

WEEKLY CLASS SCHEDULE

|DATE |TOPIC/EVALUATION |ASSIGNMENTS/READINGS |

|August 28 |Introduction to course; overview of course |Read Beauchamp & Walters, Ch. 1 |

| |requirements; theoretical adequacy Professional |Selected readings: arras & Fenton |

| |values; axiology; Codes of ethics; conscientious | |

| |Objections in practice & research | |

|QUERY 1: To what extent is it ethical to put one’s own values in a superior position to the needs of the patient or the rigor of the |

|research study? |

|DATE |TOPIC/EVALUATION |ASSIGNMENTS/READINGS |

|September 4, 11 & 18 |Introduction to ethical models and ethical theory: |Read B & W, Ch. 1 |

| |Rights-based, Utilitarian, Deontology Virtue, | |

| |Feminist, Communitarian, Casuistry | |

|QUERY 2: Can one’s use of a particular model or theory change one’s approach to an ethical dilemma? How so? |

|September 25 & |The history of informed consent; vulnerable groups; |Read B 7 W, Ch. 2 |

|October 2 |clinical equipoise; |Consider Harlow’s research in this context; consider |

| | |military exemptions; consider subjects with |

| | |psychiatric disorders; consider prisoners; research |

| | |in other lands |

| | |Read Brudney |

| | |Read Streiffer |

|QUERY 3: What does the literature say about these issues and, when supported, what is the basis for the support? |

|October 9 & 16 |Bioethical principles from Beauchamp & Childress |Consider paternalism; consider the historical |

| |(principlism) Autonomy, Justice, Beneficence and |transition from a beneficence model to autonomy model|

| |Nonmaleficence |Consider the history of artificial hearts, liver |

| | |transplant; consider the justice model and the death |

| | |penalty |

| | |Read Ulrich |

| | |Read Miller & Wertheimer |

| | |Read B & W, Ch. 7 |

|QUERY 4: What, if any, use may be made of scientific materials produced in an unethical manner? |

|October 23 & 30 |Application of ethical models to Schiavo |Read reports of each of these exemplars; discuss the |

| |Cruzan |principles embedded in each; in a perfect ethical |

| |Dax Cowart |world, argue outcomes |

| |Angela Carder |Read B & W, Ch. 3 |

| |Stem cells for Huntington’s Gennarelli’s baboon head|Student selected Readings |

| |experiments | |

| |Military experimentation | |

|DATE |TOPIC/EVALUATION |ASSIGNMENTS/READINGS |

|November 6 & 13 |The particulars of research misconduct; Begin |Read an account of the David Baltimore case |

| |discussion of Henrietta Lacks |Read an account of Pernkopf’s atlas |

| | |Read B & W, Ch. 4 & 5 |

|November 20 & 27 |Passing On Issues Related to Death with Dignity |Read Ulrich |

| | |Read Wolf |

| | |Read Battin |

| | |Consider compassion |

|December 4 |Issues presentations | |

|December 11 |Issues presentations | |

Approved: Academic Affairs Committee: 10/97, 03/07

Faculty: 12/97, 04/07

UF Curriculum: 06/98, 05/07

Additional Readings

Arras, J. & Fenton, E. (2009). Bioethics and human rights: Accessing to health-related goods.

HCR, 39, (5), 27-38.

Battin, M. (2008). Terminal sedation: Pulling the sheet over our eyes. HCT, 38, (5), 27-30.

Brudney, D. (2007). Are alcoholics less deserving of liver transplants? HCR, 37, (1), 41-47.

Miller, F. & Wertheimer, A. (2007). Facing up to paternalism in research ethics. HCR, 37, (3), 24-34

Streiffer, R. (2008). Informed consent and federal funding for stem cell research. HCR, 38, (3), 40-47

Ulrich, C., Hamric, A. & Grady, C. (2010). Moral distress: A growing problem in the health

profession? HCR, 40, (1), 20-22.

Wolf, S. (2008). Confronting physician-assisted suicide and euthanasia: My father’s death.

HCR, 38, (5), 23-26.

Preparation for Assignments

For each ethical theory, organize our work & discussion with regard for the following:

a. The major players

b. The history of the model

c. The central principles, propositions, hypotheses

d. Arguments in opposition to the relevance of the model to contemporary ethical thinking

e. Examples of application to cases, events, situations that imply the presence of one or more ethical dilemmas

Assignments for Course

Class and Seminar: Participation in and preparation for class are essential elements of this course. Preparation should be enhanced by not only reading the prescribed requirements for the day but also by reading from the bibliography provided. You are encouraged to read extensively and beyond the small number of resources tendered. Some of the references are starters for your presentations. The items marked with * are available from my personal library as these are probably unavailable from the e-resources of the university library. You will notice that the topics of the day are quite broad and support choices for readings. It is important for you to learn the language of ethics rapidly as the teaching methods used in this course are Socratic and only rarely didactic. So if you have not prepared, you cannot engage in discourse, and if you cannot engage in discourse you cannot meet the course objectives. Therefore, it is critical that your behavior supports learning for everyone. This means: no sidebars, no inattention, and a professional persona.

The following papers are required for this section of the course:

1. Personhood and Henrietta lacks

a. Define the construct personhood from several points of view.

b. Note the sources of variability in the definitions provided for the construct

c. Speculate about the points of view regarding the personhood of Henrietta Lacks

d. Argue both for and against the position that racism played a part in the decisions reflected

in the lacks situation

e. Present an affirmative argument for the premise that the Lacks case is more significant for

personhood than it is for informed consent.

f. Argue for or against the premise that Lacks teaches us that personhood is the central hub

from which the ethical practice of research extends.

2. Issues paper

a. Select an issue that reflects an ethical dilemma in nursing research. Provide a brief one page outline describing the issue.

b. In the paper, begin with an introduction that clearly states the issue to be addressed in some detail. Provide an explication of your position.

c. Clarify terms as you progress through the paper and use an appropriate theoretical model from the ethics literature in which you support your position.

d. Investigate the positions reflected in the ethics literature with particular attention to balance regarding your issue.

e. Identify the major counterarguments to your own position and explain why these have or have not been persuasive in your changing original position to this issue.

f. End the paper with a clear summary that includes a brief reiteration of the issue and the arguments you have made.

g. Use APA throughout the ten page paper. References should be adequate to the task in number and quality.

Near the end of the term, each of you will be asked to present your paper to the class. You will need to state your issue, the arguments, the theoretical model used in support of your position. Questions and comments from the group should be elicited and welcomed upon completion of your report. Please note that dictionaries and Wikipedia are unacceptable sources for definitions in your papers in this course. Use ethics texts or other ethics literature resources for definitions and discussion.

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