BIOETHICAL DECISION MAKING IN HEALTH CARE: A SYMPHONOLOGICAL APPROACH

COURSE DESCRIPTION:

Medical technology has brought forth an array of notoriously difficult ethical dilemmas. Because of a rapid expansion of knowledge and technology, these dilemmas are far too complex to be dealt with effectively through intuition, good intentions, or cultural catch phrases. Health care professionals cannot escape awareness of the need for a sound theoretical basis to guide ethical decision making. This program presents a symphonological (agreement-based) bioethical theory to guide the ethical decision making process. This theory provides guidance to health care professionals and is easy to understand and to use. The theory arises from the nature of the health care setting, the dynamics of the relationship between health care professionals and patients, and the importance of context in bioethical decision making. Its use is demonstrated through the analysis of cases elicited from the audience or from cases studies.

OBJECTIVES:

Examine the vital importance of contextual awareness in resolving bioethical dilemmas. Discuss the appropriateness of the traditional and contemporary ethical systems to a patient's well-being. Explain the nature of a Symphonological bioethical approach. Given a variety of case studies, utilize a Symphonological approach to resolving bioethical dilemmas. Apply knowlwdge of the PSDA and advance directives to effective ethical interactions wiht individual patients and/or their families. Analyze immediate areas of bioethical concern (as elicited from individuals in the audience).

OUTLINE

Examine the vital importance of contextual awareness in resolving bioethical dilemmas.

1. The Ethical Power of Context
   1. Importance of Contextual Consistency
   2. Aspects of the Context
      1. The context of the situation
      2. The context of knowledge
   3. Contextual Justification
      1. Interweaving of both aspects
      2. Sorting the ethically relevant information from the non-relevant information
   4. Ethical Certainty and Context
      1. Absolute certainty versus contextual certainty
      2. Use of context in resolving bioethical dilemmas
      3. Attention to the dynamic nature of the context

II. The Traditional and Contemporary Ethical Systems
1. Deontology
   1. Duties determine the ethical
   2. Relevance to patient's well-being
2. Utilitarianism
   1. The greatest good for the greatest number determine the ethical
      
   2. Relevance to patient's well-being
3. Emotivism
   1. Feelings determine the ethical
   2. Relevance to patient's well-being
4. Relativism
   1. Beliefs of culture, religion, or society determine the ethical
   2. Relevance to patient's well-being
      

III. Symphonology as a Practice-Based Bioethic

1. Nature of a practice-based bioethic
   1. Definition of a practice-based bioethic
   2. The necessity of a practice-based bioethic
2. Symphonology as a practice-based bioethic
   1. Meaning of Symphonology
      1. The nature of agreements
   2. The nature of a professional agreement
      1. The role of the health care professional as the agent of the patient
      2. The patient as the center of the health care professional's activity
3. The bioethical standards as an integral part of a practice-based ethic
   1. Autonomy
   2. Freedom
   3. Objectivity
   4. Self-assertion
   5. Baneficence
   6. Fidelity
4. The bioethical standards as preconditions of the agreement
5. The bioethical standards as lenses

IV. The Importance of Experience to Bioethical Decision Making
1. The relationship of practice to skill attainment
2. Utilizing the theory
   1. Using cases provided in the hand-out or cases from the audience analyze them from a symphonological perspective
   2. Audience participation in doing the analysis

V. The Agreement Behind the Agreements
1. The necessity of an agreement before interaction can occur
   1. Informed consent
   2. Substituted judgement
   3. Best interest standard
2. The ethical intent of the PSDA
3. Forms of advance directives
4. Problems in drafting an advance directive
5. Barriers to implementation of a patient's advance directive
6. Symphonology as a guide
   1. Execution
   2. Activation

Analyze immediate areas of bioethical concern (as elicited from participants).

VI. Cases and Question from the Audience

(This would have been an ongoing process but this time is set aside for any further cases members in the audience wish to have discussed or any further questions they wish addressed. Following the presentation, the presenters will be available to answer any further questions from participants.)

• The direct teaching strategies that will be used in each and every section are lecture/discussion, case presentations, and questioning. The indirect teaching strategies that will be used are hand-outs and overheads. (The hand-outs are extensive and enable the participants to follow the discussion without having to take voluminous notes.)
  
  
• The conference/seminar is tailored for each group. Other areas of interest can be added as requested such as: Children and bioethical dilemmas, Futile care; Suspension of the DNR order in the operating room, The psychiatric patient. [Objectives will be added accordingly.]
  
  
• Conference presenters - Gladys and Jim Husted or Barbara A. Brown
  
  Barbara A. Brown, RN, PhD is a Professor of Humanities and Health Sciences at Community College of Allegheny County where she teaches both nursing and philosophy courses. She also is an adjunct faculty member at Carlow College where she teaches pharmacology on-line. Her areas of expertise are in ethics - with a special emphasis on advance directives (the focus of her dissertation) - and critical care nursing. She has studied with the Husteds' and tested a piece of their theory in her dissertation.
  

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The URL for this page is: http://www.nursing.duq.edu/faculty/husted/bioworktext.html
Revised Tuesday, 18-Sep-2007 11:26:34 EDT