Transcript class notes

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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 (95124)
 21 to 28 October: UNIT 3: The Health Care ProfessionalPatient 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.
ii.
iii.
iv.
v.
vi.
moral theories;
moral principles and concepts;
case study analysis;
moral decision making frameworks;
moral duties, responsibilities and grounds for choices; and,
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:
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.
i.
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3.
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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 paper
and 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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UNIT 1: Ethical Theory
9 to 23 September
READ BIOETHICS IN CANADA
[BC] CH. 1 (pages 1-43)
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INTRODUCTION TO
MORAL THEORY
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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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Among 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.
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Cultural spectrum
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 theories
do 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
and review p.1-14 on UTILITARIANISM
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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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