Ethical Issues in Primary Care
M.Cl.Sc. 512
Course Instructors: Dr. Brian Hennen, Dr. Joseph Morrissy
Course Description
Participants in this course will address fundamental ethical issues that arise for health care professionals in the context of primary care. The course is designed to stimulate dialogue from a variety of disciplinary points of view in a small group format, and to promote the analysis of ethical issues and dilemmas that are commonly encountered in primary health care settings today. The central theme of the course will be understanding and applying a patient-centred model of care. Specific issues to be examined in light of this model include controlling information, resolving conflicts of values, intervening in patients' lifestyles, allocating scarce resources, and dealing with mistakes. Case vignettes, role-playing exercises, and videotapes will be used to complement readings drawn from the medical, nursing, and bioethics literatures.
Format
Participants will meet for four half-day sessions during the autumn's on-site sessions. Subsequently distance learning format will involve six assignments on topics agreed upon during the on site-meetings. Core reading and other published materials will be circulated as part of the course program materials. Each student participant will provide discussion leadership (on the Caucus Internet site) on one of the topics, including setting, constructively critiquing and grading the assignments for that topic. The assignments, critiques and grades will be forwarded to the faculty. Faculty will direct any unassigned discussions, assignments etc. New topic discussions will occur every two weeks. Assignments will be due at the two week interval following the introduction of the topic.
Requirements
1. A substantial essay (2,000 words) on an ethical issue or dilemma from a primary care setting. An outline of the topic, with references, will be discussed and approved with the faculty by mid term. The essay is due by the end of the twelfth week of the semester. The essay will be worth 50% of the final mark for the course.
2. Participation in discussions, direct and on Caucus, will be worth 25% of the final mark.
3. Presentation of one of the topics, leadership of e-mail discussion, evaluation of assignments will be rated by the faculty for the remaining 25% of the final mark.
Objectives
1. To become familiar with the academic literature that discusses the ethical issues of primary health care.
2. To become aware of different views about the nature of ethics, of medical ethics and of nursing ethics.
3. To appreciate how values are embedded in the disciplines of Family Medicine and Nursing and how those values give rise to ethical issues.
4. To become cognizant of how value issues intrude into the process of clinical problem solving and caring and to develop a strategy for explicitly incorporating value issues into clinical problem solving.
5. To demonstrate skill in applying ethical principles in everyday clinical situations with patients and colleagues.
6. To become aware of how one's personal values impinge upon the resolution of ethical problems in clinical situations, and to demonstrate the ability to recognize potential conflicts between one's personal and professional values.
7. To develop strategies for the teaching of ethics to undergraduate and senior clinical students in Family Medicine and Nursing.
8. To identify the ethical requirements governing.
Topic Areas
1. The Nature of Ethics for Primary Care Professionals
2. Ethical Dimensions of a patient-Centred Model of Care
3. Autonomy and Paternalism
4. Competence and Consent
5. Control of Information and Confidentiality
6. Decisions at the End of Life
7. Intervening in Lifestyle
8. Conflicting Values
9. Divided Loyalties
10. The Ethics of Teamwork
11. Allocation of Scarce Resources
12. Dealing with Mistakes and Whistle-Blowing
Reading Lists
Required:
Duplicated articles and materials from the medical, nursing and bioethics literatures compiled into "The Ethics of Patient-Centred Care Course Book".
Recommended:
Harmon L. Smith and Larry R. Churchill, Professional Ethics and Primary Care Medicine, Duke University Press, 1986.
Ronald J. Christie and C. Barry Hoffmaster, Ethical Issues in Family Medicine, Oxford University Press, 1986.
David Hilfiker, Healing the Wounds, Penguin Books, 1985 (out of print).
Anne J. Davis and Mila A. Aroskar, Ethical Dilemmas and Nursing Practice, 3rd Edition, Appleton and Lange, 1991.