Course Description and Rationale
This 3 credit course examines and explores the legal and ethical principles and applications as they pertain to clinical nursing practice. This course provides the opportunity for in-depth discussion and analysis of ethical and legal principles related to nursing and health care. The information from this course is applied in concurrent and successive clinical courses and provides a basis for beginning ethical and legal professional nursing practice. This course uses clinical situations, case analyses, and content gleaned in both clinical nursing and medical courses.
Expectations
Active participation in discussions (electronic and face-to-face); attendance at on-campus lectures; reasonable decorum and demeanor.
The student is expected to read the required lessons, reading assignments and other sources (such as lecture audiofiles and podcasts) to supplement these. The nature of the content is such that almost any recent journal has appropriate references or editorials.
Course Goals
Upon completion of 4200 course, the student will be able to:

1. Understand the nature of moral reasoning and how ethical decision making is distinguished from clinical problem solving and clinical decision making.
2. Describe theories of moral development and the history of the bioethics movement and how they influence clinical-ethical behavior.
3. Discuss the four ethical principles that underpin bioethics.
4. Identify the relationship among nursing ethics, medical ethics, and bioethics.
5. Explore personal values that influence ethical decision making.
6. Analyze major ethical issues which arise at various life stages within the framework of selected ethical theories.
7. Discuss the meaning of personhood under the law.
8. Examine ethical and legal dimensions of nursing and of health care delivery regarding access, affordability, and quality.
9. Describe the sources of law, and types of law that impact upon nursing practice.
10. Evaluate professional liability in nursing practice.
11. Discuss the legal parameters of patient/provider relationships.
12. Discuss the advent of defensive medicine, and how it pertains to both medical and nursing care in various health care settings.
13. Examine ethical concerns related to distributive justice and allocation of scare healthcare resources.

Methods of Instruction

• Syllabus lesson content
• Assigned readings (text, lessons, and other print and web resources)
• Discussion (postings to discussion list, hosted live online chat sessions)
• large/small group exercises (either on-line or on Seminar Day)
• Live lectures with core/guest faculty
• Accessing audiofiles / podcasts
• Application of an Ethical Decision Making Model

Modes of Evaluation
Course grade will be based on online quizzes, written assignments (for Writing Intensive students) as well as quality of online participation. Live attendance at the Pellegrino Lectureship and Annual MU Health Ethics Conference.
References
Required Textbooks

• Paul, R. & Elder, L. (2004). The Miniature Guide to Critical Thinking (4th ed.). Foundation for Critical Thinking, Dillon Beach.
• Pozgar, G.D.  (2005) Legal and Ethical Issues for Health Professionals, Jones & Bartlett, Mass.
• Butts & Rich, Nursing Ethics (all these texts are available via MU online bookstore under N4200)

WATCH THIS BLOG: http://lawprofessors.typepad.com/healthlawprof_blog/
As part of the reading for this course, I encourage you visit this blogspot regularly, as well as using the following excellent resources for your literature searches:
Ethics and Law Journals

• American Journal of Law & Medicine
• Journal of Legal Medicine
• Journal of Medical Ethics
• Journal of Clinical Ethics
• Nursing Ethics
• Journal of Law, Medicine and Ethics
• BMC Medical Ethics
• Bioethics (Journal of the International Association of Bioethics)
• Cambridge Quarterly of Healthcare Ethics
• JONA's Healthcare Law, Ethics, and Regulation
• Kennedy Institute of Ethics Journal
• Hastings Center Report
• Journal of Medical Humanities
• Theoretical Medicine and Bioethics
• Annals of Health Law
• Medicine and Law

Content of Course

• Critical thinking, ethics and law: What do they have in common?
• What is critical thinking in nursing?
• Critical thinking activities
• Critical thinking - reasoning
• The role of critical thinking in resolving controversial issues
• Discussion of controversial issues
• Decision making models and examples: Clinical, legal, and ethical
• Sources of Law
• Types of Law
• The Legal Landscape
• Legal parameters of nursing
• State Nurse Practice Acts
• Missouri State Board of Nursing
• Disciplinary actions
• Substance abuse
• Unsafe working conditions
• Advance practice nursing
• Informed consent
• Treatment decisions
• Confidentiality and privacy
• Documentation of patient care
• Common sources of liability
• Risks of specific nursing practices
• Ethical theory & principles
• The character of the nurse-virtues, compassion
• Types of ethical problems, ethical decision-making
• Professional roles
• ANA Code of Ethics
• Health care team
• Confidentiality
• Truth-telling
• End-of-life Issues
• Special challenges
• Distributive justice
• Compensatory justice
• Health care organizations
• Summary: What do critical thinking, law, and ethics have in common?
• Course evaluation

Library Resources and ERes
Access to the library will be critical to your academic success. This course used resources and materials accessible via the Electronic Reserve System (ERes): http://eres.missouri.edu. You may also access the University of Missouri-Columbia Library Distance Education Support Service page at: http://mulibraries.missouri.edu/distance/.
Evaluated Assignments

General Guidelines for Written Assignments (For WI students)
Those students undertaking N4200 as a 4 credit hour Writing Intensive Course will need to make contact with Dr Breier at their earliest convenience to receive instructions. The Writing Intensive component of this course will include a 500-word article summary, revised during the first 3 weeks of the semester. Students will ‘dissect’ and concisely analyze a pertinent and timely legal/ethical article. Their summaries will be written in a scholarly yet discursive fashion. Worth 5% of their overall course grade.
Discussion paper: Writing Intensive students will also write a 3000-word discussion paper, revised on autonomy and informed consent. A draft will be submitted at mid-semester for review, and the final version due at the end of semester. Dr Breier will conference individually with the students on topic selection, paper direction, and writing throughout the semester. Worth 25% of the course grade.
Assignments are to be submitted electronically, but this does not relieve you of appropriate formatting and making sure the paper looks good. Utilize your APA Manual, 5th edition for hints on writing, formatting, and references.
I expect at minimum:

• One inch margins all around
• 10-12 point type
• double spaced
• cover page
• page number in upper right corner with header
• references appropriately cited

Note: Written assignments are subjective, and therefore it is not like a math test where you can score 100%. Rarely do students receive full points for a written assignment in this course. The grading guidelines are just that...guidelines. Points are not necessarily deducted for mistakes, rather they are earned for content, quality and rigor. Please contact Dr Breier should you have concerns or queries about the grading in this course. 
Assignments and Grading Criteria
Preamble: A high level of analysis, breadth and depth of reasoning and critical analysis, appropriate referencing, thorough and relevant addressing of points and scholarly structure is necessary for consideration of 'A' grades in the written assignments in this course. Please contact Dr. Breier-Mackie if you have concerns regarding the expectations of these assignments.
Class Participation - As an online course, your participation in this course will not only be very important to the success of the course and your 'law & ethics' experience, it will also be well-documented. Students are expected to make valid contributions each lesson to the discussion board. It is though the sharing of thoughts and ideas that the course content really comes to life to be a part of it and engage!!! Discussion questions will be posted by the instructor prior to each new week.
Volume on the BB will not necessarily be the primary consideration in evaluating class participation. Quality of comments and issues raised will be of greater importance. The value of discussion will be enhanced immeasurably by good prior preparation; students should thoroughly review the readings before the period for which they are assigned (this will help in the completion of your quizzes too).
Finally, 'netiquette' is imperative. Respect for one's peers and instructors, and courtesy in discourse will be expected at all times. Please refer to the MU Direct Code of Conduct regarding netiquette if you are unsure.
Grades and Grievances: I make every attempt to grade each assessment with utmost fairness and honesty, however every once in a while a student in this course (if not in all courses) will be disappointed with their grade. That is why I try to make these grading information/guidelines as detailed as possible so as to provide as much up-front guidance as to what is expected. Although I am happy to discuss grades and provide guidance as to how a student may be able to improve in his/her performance, I am not in a position to adjust grades in accordance with a student's wishes, grievance, or pressure. Once final grades for this course are posted in the grade book, no further correspondence will be entered into. Should you wish to contest your grade, please refer to page 23 of your undergraduate student handbook regarding the appeals process.
Help Available
If you are having any technical difficulties (e.g., logging in, accessing the discussion board) please email helpdesk@missouri.edu or contact the IATS Help Desk at 882-5000 (for out-of-area MU Direct students, toll-free at 866/241-5619).
If you have questions regarding academic advising, please contact Jenette Hough (hough@missouri.edu) or Laura Anderson (andersonla@health.missouri.edu).
Online Class Netiquette
Your instructor and fellow students wish to foster a safe on-line learning environment. All opinions and experiences, no matter how different or controversial they may be perceived, must be respected in the tolerant spirit of academic discourse. You are encouraged to comment, question, or critique an idea but you are not to attack an individual.
Our differences, some of which are outlined in the University's nondiscrimination statement below, will add richness to this learning experience. Please consider that sarcasm and humor can be misconstrued in online interactions and generate unintended disruptions. Working as a community of learners, we can build a polite and respectful course ambience.
Academic Integrity Policy
Academic honesty 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 academic dishonesty as an extremely serious matter, with serious consequences that range from probation to expulsion. When in doubt about plagiarism, paraphrasing, quoting, or collaboration, consult the course instructor.
Academic Dishonesty includes but is not necessarily limited to the following:

1. Cheating or knowingly assisting another student in committing an act of cheating or other academic dishonesty.
2. 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.
3. Unauthorized possession of examinations or reserve library materials, or laboratory materials or experiments, or any other similar actions.
4. Unauthorized changing of grades or markings on an examination or in an instructor's grade book or such change of any grade report.

Academic Integrity Pledge: "I strive to uphold the University values of respect, responsibility, discovery, and excellence. On my honor, I pledge that I have neither given nor received unauthorized assistance on this work." Students are expected to adhere to this pledge on all graded work whether or not they are explicitly asked in advance to do so.
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. In instances where academic integrity is in question, faculty, staff and students should refer to Article VI of the Faculty Handbook. Article VI is also available in the M-Book. Article VI provides further information regarding the process by which violations are handled and sets forth a standard of excellence in our community.
University of Missouri-Columbia Notice of Nondiscrimination
The University of Missouri System is an Equal Opportunity/ Affirmative Action institution and is nondiscriminatory relative to race, religion, color, national origin, sex, sexual orientation, age, disability or status as a Vietnam-era veteran. Any person having inquiries concerning the University of Missouri-Columbia's compliance with implementing Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Americans With Disabilities Act of 1990, or other civil rights laws should contact the Assistant Vice Chancellor, Human Resource Services, University of Missouri-Columbia, 130 Heinkel Building, Columbia, Mo. 65211, (573) 882-4256, or the Assistant Secretary for Civil Rights, U.S. Department of Education.
Sinclair School Of Nursing Nondiscrimination Statement
Faculty and staff at the Sinclair School of Nursing are committed to cultural diversity and nondiscrimination toward all people with regards to race, color, religion, national origin, ancestry, gender, age, all veterans, and sexual orientation.
ADA Statement
If you need accommodations because of a disability, if you have emergency medical information to share with me, or if you need special arrangements in case the building must be evacuated, please inform me immediately. Please see me privately after class or at my office.
To request academic accommodations (for example, a note taker), students must also register with the Office of Disability Services, AO38 Brady Commons, 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. Another resource, MU’s Adaptive Computing Technology Center, 884-2828, is available to provide computing assistance to students with disabilities.
Grievance Policy

Information concerning student grade appeal procedures and non-academic grievances and appeals may be found in the Student Handbook.

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