UNIVERSITY OF FLORIDA



UNIVERSITY OF FLORIDA

COLLEGE OF NURSING

COURSE SYLLABUS

FALL 2011

COURSE NUMBER NGR 7882

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

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

Office hours: By appointment

DEPARTMENT CHAIR M. Josephine Snider, EdD, RN

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

Office hours: By appointment only

JACKSONVILLE CAMPUS DIRECTOR Andrea Gregg, DSN, RN

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

Office hours: By appointment only

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.

COURSE OBJECTIVES (continued)

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

8428 Tuesday 8:30am-11:30am G114 GVL

8604 Alumni JAX

Sakai is the course management system that you will use for this course. Sakai is accessed by using your Gatorlink account name and password at . There are several tutorials and student help links on the Sakai 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 wide information and the course Sakai site for announcements and notifications.

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

ATTENDANCE

Students are expected to be present for all scheduled classes, other learning experiences, and examinations. Students who have extraordinary circumstances preventing attendance should explain these circumstances to the course instructor prior to the scheduled class or as soon as possible thereafter. Instructors will then make an effort to accommodate reasonable requests. A grade penalty may be assigned for late assignments, including tests. Students are responsible for responding to online assignments as part of their attendance. Make-up exams may not be available in all courses.

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

Lecture, class discussion, written assignments, presentations, and readings.

LEARNING ACTIVITIES

Participation in discussion; readings; group work; papers

EVALUATION METHODS/COURSE GRADE CALCULATION

Written assignments and class participation.

Issues paper I 25%

Issues paper II 25%

Personhood paper 25%

Preparation & Participation in class 25%

TOTAL 100%

Assignments/Papers will be returned within 2 weeks.

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

REQUIRED TEXT

Beauchamp, T.L., Walters, L. Kahn, J.P. & Mastroianni, A.C. (2008). Contemporary issues in

Bioethics. (7th ed.). Belmont, CA: Wadworth, Cengage Learning.

Shamoo, A., & Resnick, D. (2009). Responsible conduct of research (2nd ed.). Oxford: University

Press.

RECOMMENDED TEXT

Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). Oxford:

University Press.

Skloot, R. (2011). The immortal life of Henrietta Lacks. New York, NY. Random House, Inc.

ISBN (paperback): 978-1-4000-5218-9.

WEEKLY CLASS SCHEDULE

|DATE |TOPIC/EVALUATION |ASSIGNMENTS/READINGS |

|August 23 |Introduction to course; overview |Read Shamoo & Resnick, intro and chapter 1 & 2; |

| |Of course requirements; theoretical adequacy |Read Beauchamp & Walters, Ch. 1 |

| |Professional values; axiology; |Selected readings: Arras & Fenton |

| |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? |

|August 30 |Introduction to ethical models and ethical theory: |Read B & W, Ch. 1 |

|and |Rights-based |Read Shamoo, Ch. 2 |

|September 6 |Utilitarian, Deontology | |

| |Virtue, Feminist, Caring Communitarian | |

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

|September 13 |The history of informed consent; |Read B & W, Ch. 2 |

|and |vulnerable groups; clinical equipoise; |Read Shamoo, Ch. 8,12,13 |

|September 20 | |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? |

|September 27 |Bioethical principles from Beauchamp |Consider paternalism; consider the historical transition |

|and |& Childress (principlism) |from a beneficence model to autonomy model |

|October 4 |Autonomy Justice, Beneficence and 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 |

|DATE |TOPIC/EVALUATION |ASSIGNMENTS/READINGS |

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

|manner? |

|October 11 |Application of ethical models to |Read reports of each of these exemplars; discuss the |

|and |Schiavo |principles embedded in each; in a perfect |

|October 18 |Cruzan |ethical world, argue |

| |Dax Cowart |outcomes |

| |Angela Carder |Read Shamoo, Ch. 11,12 |

| |Stem cells for Huntington’s |Read B & W, Ch. 3 |

| |Gennarelli’s baboon head experiments | |

| |Military experimentation | |

|October 25 |The particulars of research misconduct |Read Shamoo, Ch.8 |

|and |Begin discussion of Henrietta Lacks |Read an account of the David |

|November 1 | |Baltimore case |

| | |Read an account of Pernkopf’s atlas |

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

|November 8 |Passing On; how many ways to say it |Read Ulrich |

|and | |Read Wolf |

|November 15 | |Read Battin |

| | |Consider compassion |

|November 22 |Issues presentations | |

|November 29 |Issues presentations | |

|December 6 |Issues presentations and summary | |

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: Access 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.

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