Course Description
This seminar is designed for students in the health professions and related disciplines who are seeking to develop skills and a working knowledge of health ethics and how to respond when confronted by ethical dilemmas in the clinical and organizational setting. A seminar and discussion format will be used to introduce rigorous thinking and discussion about both theoretical and applied aspects of ethics within multiple professions concerned with health care.  This experience will serve to enable the learner to respond to a broad range of interrelated ethical issues that are confronted within modern health care systems by the application of practical reasoning to real world issues and problems. Through readings, discussion, independent research, and shared experiences students will develop a thorough overview of ethical theory, the historical development of bioethics as a discipline, and the application of health ethics in professional life.  Selected sessions will also deal with interrelated areas of law and health policy that are informed by ethical debate. Following this learning experience, students will have a working knowledge of ethics in the health care setting and the process by which each individual may participate as a professional in deliberations that will impact the health and welfare of others. Critical thinking, writing, and group discussion will be encouraged.

Course Credit
Three credit hours

Prerequisites

• Graduate standing

Day, Time, and Location
Wednesdays, 1:00-3:30 pm, CE 705

Office Hours
Phillips: Mondays and Wednesdays, 9:15-10:00 am or contact the instructor to schedule an appointment. You are welcome to stop by at other times and if you see my door open I would be glad to talk to you about the course or other related matters.

Required Reading

• Thomas Mappes and David DeGrazia, editors, Biomedical Ethics, 6th edition, McGraw Hill, 2006.  (In assigned readings below this is referred to as “text.”)
• Frankie Perry, The Tracks We Leave, Ethics in Healthcare Management, Health Administration Press, 2002.

• There may be other articles or handouts that will be made available on the course Web site (hmi.missouri.edu).

Summary of Course Grading
Grading criteria to be determined.

Course Objectives

Upon completion of the course, participants will be able to:
1. Describe the ethical underpinnings of health care, health related research, and health care systems and how they relate within society.
2. Understand the historical and sociocultural context in which the discipline of bioethics has evolved and developed over the last 30 years.
3. Analyze and formulate different ethical responses when confronted with moral dilemmas related to the care of patients, the workings of healthcare systems, and to the welfare of individuals and groups of individuals within society.
4. Articulate and defend moral arguments pertaining to ethical issues in today’s health care environment and how these discussions can inform institutional and social policy.

Evaluation of Performance
Course Assignments and Due Dates

Course exams, papers, and presentations to be determined.

Schedule of Topics and Readings

Please see the course Website at hmi.missouri.edu for access and links to the course readings other than the textbook.  Students should bring a copy of the class-day’s readings to class (either online version via laptop or printed copy).

Week 1: Introduction to Ethics

1. “General Introduction,” text pages 1-53.

 
Week 2: The Physician-Patient Relationship

1. “Introduction,” etc. text pages 59-70.
2. “The Hippocratic Oath,” text pages 70-71.
3. Council on Ethical and Judicial Affairs, AMA, “Fundamental Elements of the Patient-Physician Relationship,” text pages 71-72.
4. Edmund D. Pellegrino, “The Virtuous Physician and the Ethics of Medicine,” text pages 72-76.
5. James F. Childress and Mark Siegler, “Metaphors and Models of Doctor-Patient Relationships: Their Implications for Autonomy,” text pages 76-84.
6. Terence F. Ackerman, “Why Doctors Should Intervene,” text pages 85-89.

Week 3: Truth Telling and Informed Consent

1. Higgs, Roger, “On Telling Patients the Truth,” text pages 90-95.
2. Benjamin Freedman, “Offering Truth: One Ethical Approach to the Uninformed Cancer Patient,” text pages 95-102.
3. Spotswood W. Robinson III, “Opinion in Canterbury v. Spence,” text pages 102-105.
4. President’s Commission, “The Values Underlying Informed Consent,” text pages 106-111.
5. Howard Brody, “Transparency: Informed Consent in Primary Care,” text pages 112-118.

Viewing of Dax video (in class)

Week 4: Hospitals, Nurses, Families, and Medical Confidentiality

1. “Introduction,” etc. text pages 162-169.
2. AHA, “The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities,” text pages 170-172.
3. ANA, “Code of Ethics for Nurses,” text page 172.
4. Lisa H. Newtown, “In Defense of the Traditional Nurse,” text pages 173-180.
5. Helga Kuhse, “Advocacy or Subservience for the Sake of Patients?” text pages 180-188.
6. Amy M. Haddad, “The Nurse/Physician Relationship and Ethical Decision Making,” text pages 188-192.
7. Matthew O. Tobriner, “Majority Opinion in Tarasoff v. Regents of the University of California,” text pages 211-215.
8. William P. Clark, “Dissenting Opinion in Tarasoff v. Regents of the University of California,” text pages 215-218.
9. “Please Don’t Tell: A Case About HIV and Confidentiality,” text pages 218-221.

Week 5: Human and Animal Research

1. “Introduction,” etc., text pages 224-233.
2. “The Nuremburg Code,” text pages 234-235.
3. World Medical Association, “Declaration of Helsinki,” text pages 235-239.
4. Council for International Organizations of Medical Sciences, “International Guiding Principles for Biomedical Research Involving Animals,” text pages 239-240.
5. Barry F. Brown, “Proxy Consent for Research on the Incompetent Elderly,” text pages 240-247.
6. Samuel Hellman and Deborah S. Hellman, “Of Mice but Not Men: Problems of the Randomized Clinical Trial,” text pages 257-262.
7. Don Marquis, “How to Resolve an Ethical Dilemma Concerning Randomized Clinical Trials,” text pages 262-265.

Viewing of video on Tuskegee Syphilis research study (in class)

Week 6: Death and Decisions Regarding Life-Sustaining Treatment

1. “Introduction,” etc., text pages 302-309.
2. President’s Commission, “Why “Update Death?”,” text pages 309-312.
3. Council on Ethical and Judicial Affairs, AMA, “Withholding and Withdrawing Life-Sustaining Treatment,” text pages 327-329.
4. Tia Powell and Bruce Lowenstein, “Refusing Life-Sustaining Treatment After Catastrophic Injury: Ethical Implications,” text pages 330-334.
5. Vicki Michel, “Suicide by Persons with Disabilities Disguised as the Refusal of Life-Sustaining Treatment,” text pages 335-340.
6. Mark R. Wicclair, “Medical Futility: A Conceptual and Ethical Analysis,” text pages 345-349.
7. Thomas Mappes, “Some Reflections on Advance Directives,” text pages 350-356.

Week 7: Suicide, Physician-Assisted Suicide, and Active Euthanasia

1. “Introduction,” etc., text pages 377-384.
2. R.B. Brandt, “The Morality and Rationality of Suicide,” text pages 388-395.
3. James Rachels, “Active and Passive Euthanasia,” text pages 395-399.
4. Daniel Callahan, “Killing and Allowing to Die,” text pages 399-401.
5. Dan W. Brock, “Voluntary Active Euthanasia,” text pages 401-403.
6. David Orentlicher, “The Supreme Court and Physician-Assisted Suicide: Rejecting Assisted Suicide but Embracing Euthanasia,” text pages 414-417.

Week 8: Abortion and Research on Embryonic Stem Cells

1. “Introduction,” text pages 448-457.
2. Pope John Paul II, “The Unspeakable Crime of Abortion,” text pages 457-459.
3. Mary Anne Warren, “On the Moral and Legal Status of Abortion,” text pages 459-466.
4. Don Marquis, “Why Abortion is Immoral,” text pages 466-471.
5. Margaret Olivia Little, “The Morality of Abortion,” text pages 479-483.
6. National Institutes of Health, “Stem Cells: A Primer,” text pages 493-498.
7. Bonnie Steinbock, “What Does “Respect for Embryos” Mean in the Context of Stem Cell Research?” text pages 498-501.

Week 9: Genetics and Human Reproduction

1. “Introduction,” etc., text page 511-521.
2. Leon R. Kass, “Implications of Prenatal Diagnosis for the Human Right to Life,” text pages 521-525.
3. Laura M. Purdy, “Genetics and Reproductive Risk: Can Having Children Be Immoral?” text pages 526-532.
4. Leon R. Kass, “Cloning of Human Beings,” text pages 565-568.
5. Robert Wachbroit, “Genetic Encores: The Ethics of Human Cloning,” text pages 571-577.
6. Leroy Walters and Julie Gage Palmer, “Germ-Line Gene Therapy,” text pages 594-601.
7. Walter Glannon, “Genetic Enhancement,” text pages 601-606.
8. Dan W. Brock, “Genetic Engineering,” text pages 606-612.

Week 10: Issues in Healthcare Management

1. “Introduction” in Perry, pages xix-xxiii.
2. “Medical Errors: Paradise Hills Medical Center,” in Perry, pages 1-15.
3. Joan McIver Gibson, “Deciding Values,” in Perry, pages 17-30.
4. “Conflicting Moral Demands: Qual Plus HMO,” in Perry, page 31-50.
5. “Gender Discrimination: Rolling Meadows Community Hospital,” in Perry, pages 87-104.

Week 11: Issues in Healthcare Management (continued)

1. “Physician Impairment: University Hospital,” in Perry, pages 105-112.
2. Glenn A. Fosdick, “Workforce Reduction: Hillside County Medical Center,” in Perry, pags 125-142.
3. Walter P. Griffin, “Legal Perspectives,” in Perry, pages 143-149.
4. “The Ethics of Managing People,” in Perry, pages 151-158.

Week 12: Social Justice and Health-care Policy

1. Richard H. Rubin, “Ethical Issues in Managed Care,” in Perry, pages 51-69.
2. “Introduction,” etc., text pages 615-628.
3. Allen Buchanan, “Justice: A Philosophical Review,” text pages 628-639.
4. Kai Nielsen, “Autonomy, Equality and a Just Health Care System,” text pages 639-645.
5. Allen Buchanan, “Managed Care: Rationing Without Justice, But Not Unjustly,” text pages 652-660.

Week 13: Hospice Foundation of America
Attend teleconference on campus

Week 14: Student presentations
Students present term papers in class.  Please bring PowerPoint slides and give oral presentation of 15 minutes.

Week 15: Student presentations
Students present term papers in class.  Please bring PowerPoint slides and give oral presentation of 15 minutes.

Policies and Expectations

Expectations for Professional Conduct

• Attendance: Students are expected to attend each class session. Students who must miss a session for any reason should make every effort to notify the instructor prior to the class meeting.
• Punctuality: Students are expected to arrive and be seated prior to the start of each class session.
• Behavior: Classroom interaction will be conducted in a spirited manner, but always while displaying professional courtesy and personal respect.
• Preparation: Students are expected to complete the readings, case preparations and other assignments prior to each class session and be prepared to actively participate in class discussion.
• Distractions:
• Exiting and Entering: Students are expected to remain in the classroom for the duration of the class session unless an urgent need arises or prior arrangements have been made with the professor.
• Laptop or PDA Usage: Students are expected to use laptops or PDAs only with the instructors consent and for activities directly related to the class session. Unapproved accessing of e-mail or the Internet during class is not permitted.
• Cell Phone Usage: Students are expected to keep their cell phones and pagers turned off or have them set on silent/vibrate during class. Answering phones or pagers, or sending or receiving text messages while class is in session is not permitted.

Late assignments. Unexcused late papers and exams will be accepted but will be assessed a lateness deduction.

Completion of all course requirements. All stated assignments must be completed to pass the course.

Statement on Academic Integrity

Academic integrity is fundamental to the activities and principles of a university. All members of the academic community must be confident that each person's work has been responsibly and honorably acquired, developed, and presented. Any effort to gain an advantage not given to all students is dishonest whether or not the effort is successful. The academic community regards breaches of the academic integrity rules as extremely serious matters. Sanctions for such a breach may include academic sanctions from the instructor, including failing the course for any violation, to disciplinary sanctions ranging from probation to expulsion. When in doubt about plagiarism, paraphrasing, quoting, collaboration, or any other form of cheating, consult the course instructor.

Academic Dishonesty includes, but is not necessarily limited to, the following:

• Cheating or knowingly assisting another student in committing an act of cheating or other academic dishonesty.
• Plagiarism, which includes, but is not necessarily limited to, submitting examinations, themes, reports, drawings, laboratory notes, or other material as one’s own work when such work has been prepared by another person or copied from another person.
• Unauthorized possession of examinations or reserve library materials, or laboratory materials or experiments, or any other similar actions.
• Unauthorized changing of grades or markings on an examination or in an instructor’s grade book, or such change of any grade report.

The University has specific academic dishonesty administrative procedures.  Although policy states that cases of academic dishonesty must be reported to the Office of the Provost for possible action, the instructor may assign a failing grade for the assignment or a failing grade for the course, or may adjust the grade as deemed appropriate.  The instructor also may require the student to repeat the assignment or to perform additional assignments. Office of the Provost, April 11, 1994
Students will be expected to abide by the Student Conduct Code as set forth in the HMI Student Handbook and the Rules and Regulations of the University of Missouri-Columbia, (M-Book Online: http://web.missouri.edu/~umcstudentlifeweb/docs/M-Book2007-2008.pdf. The policy states, “All forms of dishonesty destroy the trust and integrity on which the academic community of the University is built”. Dishonesty includes cheating and plagiarism, defined as:

1. The term cheating includes but is not limited to: (i) use of any unauthorized assistance in taking quizzes, tests, or examinations; (ii) dependence upon the aid of sources beyond those authorized by the instructor in writing papers, preparing reports, solving problems, or carrying out other assignments; (iii) acquisition or possession without permission of tests or other academic material belonging to a member of the University faculty or staff; or (iv) knowingly providing any unauthorized assistance to another student on quizzes, tests, or examinations.
2. The term plagiarism includes, but is not limited to: (i) use by paraphrase or direct quotation of the published or unpublished work of another person without fully and properly crediting the author with footnotes, citations or bibliographical reference; (ii) unacknowledged use of materials prepared by another person or agency engaged in the selling of term papers or other academic materials; or (iii) unacknowledged use of original work/material that has been produced through collaboration with others without release in writing from collaborators.
3. All forms of academic dishonesty will be reported to the HMI faculty and the Dean of the Graduate School for appropriate university action.

Statement of Nondiscrimination
The University of Missouri does not discriminate on the basis of race, color, religion, national origin, ancestry, sex, age, disability, or status as a disabled veteran, or veteran of the Vietnam era.  For more information, please see the University of Missouri official Statement of Nondiscrimination (http://www.missouri.edu/eeo-aa.php).

ADA Accommodations Statement
If you need accommodations because of a disability, if you have emergency medical information to share with the instructor, or if you need special arrangements in case the building must be evacuated, please inform the instructor immediately.
To request academic accommodations (for example, a notetaker), students must also register with the Office of Disability Services, (http://disabilityservices.missouri.edu), S5 Memorial Union, 882-4696. It is the campus office responsible for reviewing documentation provided by students requesting academic accommodations, and for accommodations planning in cooperation with students and instructors, as needed and consistent with course requirements. For other MU resources for students with disabilities, click on "Disability Resources" on the MU homepage.

Statement on Intellectual Pluralism
The University community welcomes intellectual diversity and respects student rights. Students who have questions concerning the quality of instruction in this class may address concerns to either the Departmental Chair or Divisional leader or Director of the Office of Students Rights and Responsibilities (http://osrr.missouri.edu/). All students will have the opportunity to submit an anonymous evaluation of the instructor(s) at the end of the course.