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HEALTH CARE

ETHICS

(CRN 46634)

RELS 300:10

(CRN 48090)

NURS 330:10

(6 credits)

September 2015

to

April 2016

Florence Nightingale and her medical and nursing colleagues http://aurorae-australis-borealis.blogspot.ca/2012_06_01_archive.html

BIOETHICS IN CANADA: A PHILOSOPHICAL INTRODUCTION

(2nd edition)

by Carol Collier and Rachel Haliburton

(Canadian Scholars’ Press, Toronto: 2015);

available at the Campus Book Store

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1st TERM 9 September: Introduction to Health Care Ethics and

Overview of Course 10 to 24 September: UNIT 1: Ethical Theory; Bioethics in

Canada [BC], Ch.1 (1-43)

30 September: In-class QUIZ 1 to 15 October: UNIT 2: Medical Research; BC, Ch.4 (95-

124)

21 to 28 October: UNIT 3: The Health Care Professional-Patient Relationship; BC, Ch.3 (63-93)

29 October to 2 December: UNIT 4: Intro. To Ethical issues in Reproduction; (A) Reproductive Technologies, BC Ch.5 (125-171); (B) Prenatal Genetic Testing, BC Ch.6, excerpts (165-171)

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2nd TERM 6 to 7 January: UNIT 5: Genetic testing and therapy; BC,

Ch. 6 (155-165)

13 to 27 January: UNIT 6: Abortion and Maternal-Fetal Conflicts, BC, Ch. 7 (187-212)

3 February to 10 March: UNIT 7: Death & Dying; BC, Ch.8 (213-241)

16 to 31 March: UNIT 8: Organs and Tissues: Procurement and Transplantation; BC, Ch. 9 (243-270)

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Student Evaluation, 1st TERM

30 September – In-class QUIZ on moral theory

= 20% of 1st term mark

Reflective Journal = 15% of 1st term mark• 6 weekly entries, in class• Summative reflection – due 2 December

• Reflections on moral agency, personal values, and self-assessment of learning

Group portfolio on an issue in reproductive technologies OR prenatal testing = 20%

Attendance = 5%

1st TERM EXAM = 30%

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Student Evaluation, 2nd TERM

Research Essay OR Portfolio of 4 items (may work with a partner) OR Service Learning Project

= 30% of term mark• Essay proposal due 4 Feb• Essay OR Portfolio due on or before 24 March• Service Learning Project due 30 March

Narrative Reflection: 5 in-class entries + summative reflection on one complete narrative = 20%

• Due 3 March

Group portfolio & presentation on an issue in organ & tissue transplantation & procurement = 20%

• Due on or before 23/24 March, 30/31 March as scheduled

2nd TERM EXAM = 30%

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COURSE OBJECTIVES

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• At the conclusion of this course, students will be able to demonstrate and exercise ethical skills and competence, especially with regard to issues encountered in health care settings

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1. Knowledge and conceptual competence will be assessed according to each student’s ability to:

a) demonstrate moral literacy with regard to:i. moral theories;

ii. moral principles and concepts;

iii. case study analysis;

iv. moral decision making frameworks;

v. moral duties, responsibilities and grounds for choices; and,

vi. the origins and history of contemporary bioethics.

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2. Competence in moral consciousness, perception and perspectives will be assessed according to each student’s ability to:

a) demonstrate moral literacy with regard to:i. multiple value perspectives within a moral situation;

ii. values, goals and choices within particular religious and cultural communities;

iii. respecting the choices of others;

iv. taking a whole person perspective that allows for personal definitions of well-being;

v. collaborating with others in finding consensus;

vi. demonstrating attentiveness to experiences of suffering, illness and healing; and,

vii. empathetic capacity to care and advocate.

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3. Competence in the process of making moral decisions and mobilizing moral values will be assessed according to each student’s ability to:

a) demonstrate moral insight and accountability with regard to:i. one’s ability to make informed decisions and articulate the

reasons for making one’s choices;

ii. generalizations, biases, or lack of empathy;

iii. moral values and actions of oneself and others;

iv. contributing to moral decision-making within a group setting;

v. independent self-appraisal and the development of one’s moral character; and,

vi. self-conscious reflection concerning experiences of moral uncertainty, ambiguity, and transformative responses to moral dissent and distress.

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Any questions or concerns?

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Take a sheet of paperand answer each question:

1. Are you a morning or night person?

2. If you were an animal, what would you be and why?

3. If you could visit any place in the world, where would you choose to go and why

4. If you had to describe yourself using three words, they would be…

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Form groups of 3 or 4 people;

Introduce yourselves to one another and

Share your answers in your group

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READ BIOETHICS IN CANADA [BC] CH. 1 (pages 1-43)

UNIT 1: Ethical Theory9 to 23 September

INTRODUCTION TO MORAL THEORY

17

MORAL THEORIES

provide a viewing framework highlight some elements, obscure others objects/dilemmas look different from different perspectives some perspectives are more complete than others

2 main categories of moral theories relativism

universalism or objectivism

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RELATIVISM: 2 FORMS

ETHICAL RELATIVISM:

Whatever is culturally acceptable in your society is right.

If it is culturally unacceptable, then it is immoral or wrong.

ETHICAL SUBJECTIVISM:

If you feel good and right about something,

then it is a moral act.

If you feel bad

about something,

then it is immoral

or wrong

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Cultural Relativism• There is NO ideal culture against which any other culture can be

measured or judged; cultural practices and beliefs are geographically, linguistically and socially unique

• Every culture has patterns of socially approved behaviours, habits and ideals

In societies where time is perceived to be restricted and limited, punctuality becomes a virtue. It is insulting to waste someone's time, and the ability to do that and get away with it is an indication of superior status.

In cultures where time is regarded as plentiful, circular, and constantly regenerated, no disrespect is intended when people wait all day, and then are told to come back the next day. (see http://www.analytictech.com/mb021/cultural.htm)

Actions which conform with cultural norms are regarded as morally good

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SUBJECTIVISM says:

There is no way to resolve a moral dilemma when different people disagree.

People make their own decisions according to what they feel or believe to be right or wrong.

Everybody creates their own morality.

If you believe something is wrong, don’t do it.

If you feel OK about doing something, then it must be right for you.

We all have to make our own decisions and live with them.

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SUBJECTIVISM asks:

What will be best for me?What do I prefer to do?What action best represents my lifestyle and principles?

What choice feels right for me?Which decision corresponds with my beliefs?Why would I try to convince someone else to make the same choice I have made when their beliefs and preferences are different?

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Cultural relativism and circumcision

• In some cultures, infant male circumcision is practiced.

• In other cultures, infant male circumcision is regarded as abusive.

• Some cultures practice female circumcision.• Other cultures regard female circumcision as abusive and discriminatory.

Is circumcision a moral practice?Is circumcision an immoral and abusive act of mutilation?

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Cultural spectrumAmong Bantu speaking peoples of sub-equatorial Africa, circumcision is an adolescent rite of passage which represents the initiation of males into a warrior status

In the US, the primary determinant of male circumcision is religion – almost all Muslim and Jewish males are circumcised. Muslim boys may be circumcised at any age between birth and puberty. A Jewish male infant is circumcised on his eighth day.

Medical studies show that circumcision status is not directly correlated with either sexual function or dysfunction • In Canada, the infant circumcision

rate in Canada has fallen from roughly half in the 1970s to its present value of 13%; only Manitoba publicly funds circumcision procedures.

• Male circumcision may be performed as a medical procedure by a health care professional, or by a religious leader in a ritual ceremony

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Female Circumcision• Female circumcision may

ensure the virginity of a bride on her wedding day.

• Studies show that female circumcision reduces sexual pleasure and contributes to sexual dysfunction.

• In areas of Africa & the Middle East, circumcision is seen as “women’s business”; circumcised women are seen as clean, civilized, wise and mature.

• Female circumcision is performed for cultural and social reasons.

• Parts of the clitoris and the labia may be removed, and the vaginal opening may be sewn smaller; typically, no anesthetic is used.

• Female circumcision is a cultural practice that is found among all religious groups in certain geographical settings.

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When medical ethics confronts cultural values

NEJM Volume 22, Number 18, Pages 1312-1315,“The Question Of Routine Neonatal Circumcision” by Ronald L. Poland, http://www.cirp.org/library/general/poland/

CMAJ Volume 148, Number 2: Pages 288-289, ”Female circumcision: When medical ethics confronts cultural values” by Eike-Henner Kluge

“Late Complications of Childhood Female Genital Mutilation” by Aseel Hamoudi & Michael Shier, http://www.sogc.org/jogc/abstracts/full/201006_CaseReport_1.pdf

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What do you think?

Should Canadian pediatricians perform circumcision on infant boys or girls?

Definitely YES because …

Definitely NO because …

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Is circumcision a moral cultural practice, or an immoral and abusive act of mutilation?

Cultural relativism asks if circumcision is an approved and habitually practised social norm.

Subjectivism asks if circumcision conforms with my personal beliefs and seems acceptable or preferable to me.

According to our text (p.5), “Ethical [and/or cultural] relativism and subjectivism are inadequate

approaches to morality.”What 3 reasons do they give for this statement?

How would this apply to our consideration of circumcision?

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What are the alternatives to

Ethical relativism and subjectivism

OR

Cultural relativism and subjectivism?

For centuries, philosophers, theologians and politicians have put forward more objective ethical

theories and formulated universal moral rules.

Our first UNIT of study

will focus on some of these.

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What moral theoriesdo I need to understand?

Utilitarianism / Consequentialism Kantianism: Duty / Deontology Virtue ethics

Natural law: Teleology & Rationality

Feminist ethics / Ethics of care / nursing ethics

Each of these will be discussed in class.

For next class, finish reading p.1-43

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Student Questionnaire

Please complete the student questionnaire.

This is only to help me get to know you better.

If there is anything you feel uncomfortable answering, please just leave it blank.

If you wish to provide me with any additional information or concerns, please write on the back of the sheet.

Thank you!

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