When you enter the room of a psychiatric patient on your med/surg floor, he throws his emesis bas... more When you enter the room of a psychiatric patient on your med/surg floor, he throws his emesis basin at you and knocks you against the wall. Two days later, during a staffing crunch, you're assigned to care for this patient, who's now in restraints. You worry that you won't be able to treat him like your other patients. What would you do?
A patient's son, who is her designated decision maker, refuses to let his terminally ill, sem... more A patient's son, who is her designated decision maker, refuses to let his terminally ill, semiconscious mother receive narcotics to manage her pain.
Background and Purpose. Teachers strive for understanding that survives beyond the end of a cours... more Background and Purpose. Teachers strive for understanding that survives beyond the end of a course, semester, or professional program. The purpose of this paper is to explore teaching for enduring understandings in ethics using the 4 filters proposed by Wiggins and McTighe to determine what is worth understanding, regardless of the discipline or content. Performance or learning by doing is described in the context of a required ethics course. Professionals not only possess knowledge and how to appropriately use it in novel contexts, they also have the ability to reflect on their actions and the relevance of knowledge to practice. Therefore, self‐reflection brings together understanding and doing through the personal development of the student. Position and Rationale. The specific design of learning experiences in a required ethics course to promote critical self‐reflection is described. In‐depth interviews were conducted with 9 students immediately following the ethics course and with 5 of the original 9 students 1 year later. Evidence of findings of students' reflective discourse regarding enduring understanding is presented. Discussion and Conclusion. Overall, students' explanations of what they retained from the ethics course and how they have used the skills learned in class changed from the first interview to the second becoming more elaborate, complex, and critical. Personal growth and development as a health professional emerged as a key factor in the second interview.
In this special issue of the Journal of Physical Therapy Education we discuss, expand, and explor... more In this special issue of the Journal of Physical Therapy Education we discuss, expand, and explore the scholarship of teaching and learning (SoTL) in physical therapist education. For the majority of papers, we have linked physical therapist educators with faculty members from other disciplines engaged in SoTL, and who have participated in the Carnegie Fellow program of the Carnegie Academy for the Scholarship of Teaching and Learning (CASTL). This allows us to focus on the emergence and development of SoTL in general, and in physical therapist education in particular. The first assumption of this special issue is that different disciplines will approach SoTL in different ways, ask different questions, and differ in their views of what counts as argument and evidence. The distinction between general observations about SoTL and the specific focus on physical therapy is an important one. We want to focus on the discipline of physical therapy and the way it organizes thinking about teaching and learning and how physical therapist educators approach critical inquiry into pedagogy. The discipline of physical therapy has its own history, agreements, and disputes about subject matter and methods that influence what is taught, to whom, when, where, how, and why.1 Contributors from the discipline of physical therapy will report on what has been going on in SoTL and answer the following broad questions: How do physical therapists talk about teaching and learning issues in their field? Is physical therapy concerned about advancing the practice and profession of teaching? Does physical therapy recognize SoTL as having the same intrinsic value as other forms of scholarship? The second major assumption we make is that, even though SoTL may be "domainspecific," there is great richness in working across disciplines and finding common language or new ways to approach problems and reach resolutions. This special issue will be a sort of "trading zone" as described by Shulman,2 where scholars of teaching and learning seek advice, collaborate, discuss references and methods, and fill in the gaps in the discipline of physical therapy. We established partnerships between physical therapists and members of the Carnegie Academy for the Scholarship of Teaching and Learning (CASTL), who hail from a variety of disciplines such as mathematics, American literature, psychology, women's studies, psychiatry, and education, in the hope that it will broaden our inquiry, provide perspective, and, in the long run, contribute to enhanced student understanding. The partners were not randomly assigned, as we looked for areas of mutual interest in teaching and learning as a starting point for discussion and inquiry. The first 3 articles herein provide a background and overview of the basic components in SoTL applied to physical therapist education and practice. Ellen Spake, PT, PhD, and Anita Salem, MS, provide both an overview of the general characteristics of scholarly inquiry into teaching and learning, along with evidence of how this work is viewed by physical therapist educators. In their paper, "Setting the Stage: Scholarship of Teaching and Learning." Martha Hinman, PT, PhD, and Alix Darden, PhD, examine the role of SoTL in physical therapist education more specifically in "Beyond Scholarly Teaching: Opportunities for Engaging in the Scholarship of Teaching and Learning in Physical Therapist Education." They provide examples of how faculty scholarship in teaching and learning fits with faculty expectations in the accreditation criteria from the Commission on Accreditation in Physical Therapy Education (CAPTE). In addition, they describe opportunities for implementing SoTL in education programs. In the third paper, Cathy Peterson, PT, EdD, and Judith Haymore Sandholtz, PhD, focus on strategies for supporting and promoting SoTL with new faculty. The authors make a strong case by including examples of how to blur the boundaries between teaching and research. …
Speak too loudly, stink from sweat and beer. Thrown together like strings of Christmas lights jam... more Speak too loudly, stink from sweat and beer. Thrown together like strings of Christmas lights jammed in a bin where some work and some don't. Jessamyn's mine, the mother explains. Lonnie's ours. Families like this carry pocket knives in their overalls. Use one to cut their boy down from the swing set, where he hung in the rain. Lay his body on the slide, wait for the squad. It was raining that day or we wouldn't never had looked out the window, never would've found him at all. It was raining. They repeat the story to the flock in the waiting room. Families like this are wary and watchful, agree to every test and treatment. Never ask the health team questions, only nod. Families like this worship before the heart monitor, spy miracles in each muscle twitch or sigh from the ventilator. But, this family doesn't believe in our religion. This family watches their son, their backs to the heart rate skimming across the screen not taken in by this false god. After only two days in the ICU, the mother tells the team he is gone. Stolid, clear-eyed this family has drawn a line. Too soon for us, the team fights for him. He is so young. We shift to high code to murmur about their survivor guilt, premature closure. The family circles the bed. His stringy black hair stark against the pillow, his teenage whiskers dust. They wait for the team to get it. Willing us to stop. Not what we expect from families like this. Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Families Like This," by A. Haddad.
This chapter explores the basic ethical principle of autonomy and the related principles of verac... more This chapter explores the basic ethical principle of autonomy and the related principles of veracity, fidelity, and avoidance of killing. The pharmacist’s role in recognizing and respecting the individual patient’s moral interests is discussed. The chapter addresses the psychological and moral meanings of the principle of autonomy and delineates the elements of a substantially autonomous decision. Circumstances are discussed when it would be morally justifiable to override the actions of a substantially autonomous person. Cases highlight the issues that arise in determining whether a person is substantially autonomous for health care purposes, those posed by external constraints on autonomy, and those that arise in consideration of overriding patient autonomy.
This chapter is concerned with one of the major ethical issues in contemporary health care practi... more This chapter is concerned with one of the major ethical issues in contemporary health care practice: informed or valid consent. The chapter defines the elements of informed consent—that is, the types of information that need to be transmitted for consent to be adequately informed. The second section looks at cases involving questions of the standards of consent, referring to the question of what standard of reference should be used in determining whether a sufficient amount of a particular type of information has been transmitted: the professional standard, the reasonable person standard, or the subjective standard. The third section examines questions of whether the information transmitted is comprehended and whether the consent is adequately voluntary. Finally, the fourth section addresses whether incompetent patients can be expected to consent and what role parents, guardians, and other surrogates can play in giving approval for medical treatments for those who are legally incomp...
Avoidance of killing is a moral consideration that arises in health care controversies involving ... more Avoidance of killing is a moral consideration that arises in health care controversies involving the notions that human life is sacred or that killing is morally wrong. Pharmacists may find themselves in positions where they must reconcile the idea that generally killing is a harm to be avoided based on the principle of nonmaleficence with the idea that death might be perceived by a particular patient as a beneficial outcome. This chapter explores the principle of avoidance of killing, highlights differences between active, merciful killing and decisions to forgo treatment, and discusses the concept of proportionality. The cases presented involve topics such as withholding treatment and withdrawing treatment and direct versus indirect killing.
This chapter examines ethical issues in research involving human subjects. The Nuremberg trials, ... more This chapter examines ethical issues in research involving human subjects. The Nuremberg trials, which exposed to all humankind the outrageous things that could be done in the name of medical science, led to the Nuremberg Code, the first international document from public sources setting out an ethic for research on human subjects. Basic differences are outlined between the goals of therapy for the good of a patient and those of research that focus on attainment of knowledge and the good of society. To protect the interests of human subjects who take part in research, guidelines such as the Declaration of Helsinki have been established for assessing risks and benefits, voluntary consent, protection of privacy and confidentiality, and equity in subject selection. The chapter focuses on the difficulty in calculating harms and benefits to subjects and challenges of obtaining informed consent for participation in research.
This chapter focuses on the purpose of formularies and the potential ethical problems or issues t... more This chapter focuses on the purpose of formularies and the potential ethical problems or issues that formularies raise. Pharmacists will increasingly find themselves on committees, such as Pharmacy and Therapeutics Committees, that set the standards for formularies used by health system pharmacies and insurers responsible for paying for the cost of pharmaceuticals. Some ethical principles that are relevant to decisions on setting limits on prescribing and dispensing practices include justice, beneficence, and nonmaleficence. Reducing costs overall, which may serve the principle of justice, may threaten the well-being or limit the autonomy of a few. Cases in this chapter deal with these issues as well as the ethical justification for overriding formulary decisions.
When you enter the room of a psychiatric patient on your med/surg floor, he throws his emesis bas... more When you enter the room of a psychiatric patient on your med/surg floor, he throws his emesis basin at you and knocks you against the wall. Two days later, during a staffing crunch, you're assigned to care for this patient, who's now in restraints. You worry that you won't be able to treat him like your other patients. What would you do?
A patient's son, who is her designated decision maker, refuses to let his terminally ill, sem... more A patient's son, who is her designated decision maker, refuses to let his terminally ill, semiconscious mother receive narcotics to manage her pain.
Background and Purpose. Teachers strive for understanding that survives beyond the end of a cours... more Background and Purpose. Teachers strive for understanding that survives beyond the end of a course, semester, or professional program. The purpose of this paper is to explore teaching for enduring understandings in ethics using the 4 filters proposed by Wiggins and McTighe to determine what is worth understanding, regardless of the discipline or content. Performance or learning by doing is described in the context of a required ethics course. Professionals not only possess knowledge and how to appropriately use it in novel contexts, they also have the ability to reflect on their actions and the relevance of knowledge to practice. Therefore, self‐reflection brings together understanding and doing through the personal development of the student. Position and Rationale. The specific design of learning experiences in a required ethics course to promote critical self‐reflection is described. In‐depth interviews were conducted with 9 students immediately following the ethics course and with 5 of the original 9 students 1 year later. Evidence of findings of students' reflective discourse regarding enduring understanding is presented. Discussion and Conclusion. Overall, students' explanations of what they retained from the ethics course and how they have used the skills learned in class changed from the first interview to the second becoming more elaborate, complex, and critical. Personal growth and development as a health professional emerged as a key factor in the second interview.
In this special issue of the Journal of Physical Therapy Education we discuss, expand, and explor... more In this special issue of the Journal of Physical Therapy Education we discuss, expand, and explore the scholarship of teaching and learning (SoTL) in physical therapist education. For the majority of papers, we have linked physical therapist educators with faculty members from other disciplines engaged in SoTL, and who have participated in the Carnegie Fellow program of the Carnegie Academy for the Scholarship of Teaching and Learning (CASTL). This allows us to focus on the emergence and development of SoTL in general, and in physical therapist education in particular. The first assumption of this special issue is that different disciplines will approach SoTL in different ways, ask different questions, and differ in their views of what counts as argument and evidence. The distinction between general observations about SoTL and the specific focus on physical therapy is an important one. We want to focus on the discipline of physical therapy and the way it organizes thinking about teaching and learning and how physical therapist educators approach critical inquiry into pedagogy. The discipline of physical therapy has its own history, agreements, and disputes about subject matter and methods that influence what is taught, to whom, when, where, how, and why.1 Contributors from the discipline of physical therapy will report on what has been going on in SoTL and answer the following broad questions: How do physical therapists talk about teaching and learning issues in their field? Is physical therapy concerned about advancing the practice and profession of teaching? Does physical therapy recognize SoTL as having the same intrinsic value as other forms of scholarship? The second major assumption we make is that, even though SoTL may be "domainspecific," there is great richness in working across disciplines and finding common language or new ways to approach problems and reach resolutions. This special issue will be a sort of "trading zone" as described by Shulman,2 where scholars of teaching and learning seek advice, collaborate, discuss references and methods, and fill in the gaps in the discipline of physical therapy. We established partnerships between physical therapists and members of the Carnegie Academy for the Scholarship of Teaching and Learning (CASTL), who hail from a variety of disciplines such as mathematics, American literature, psychology, women's studies, psychiatry, and education, in the hope that it will broaden our inquiry, provide perspective, and, in the long run, contribute to enhanced student understanding. The partners were not randomly assigned, as we looked for areas of mutual interest in teaching and learning as a starting point for discussion and inquiry. The first 3 articles herein provide a background and overview of the basic components in SoTL applied to physical therapist education and practice. Ellen Spake, PT, PhD, and Anita Salem, MS, provide both an overview of the general characteristics of scholarly inquiry into teaching and learning, along with evidence of how this work is viewed by physical therapist educators. In their paper, "Setting the Stage: Scholarship of Teaching and Learning." Martha Hinman, PT, PhD, and Alix Darden, PhD, examine the role of SoTL in physical therapist education more specifically in "Beyond Scholarly Teaching: Opportunities for Engaging in the Scholarship of Teaching and Learning in Physical Therapist Education." They provide examples of how faculty scholarship in teaching and learning fits with faculty expectations in the accreditation criteria from the Commission on Accreditation in Physical Therapy Education (CAPTE). In addition, they describe opportunities for implementing SoTL in education programs. In the third paper, Cathy Peterson, PT, EdD, and Judith Haymore Sandholtz, PhD, focus on strategies for supporting and promoting SoTL with new faculty. The authors make a strong case by including examples of how to blur the boundaries between teaching and research. …
Speak too loudly, stink from sweat and beer. Thrown together like strings of Christmas lights jam... more Speak too loudly, stink from sweat and beer. Thrown together like strings of Christmas lights jammed in a bin where some work and some don't. Jessamyn's mine, the mother explains. Lonnie's ours. Families like this carry pocket knives in their overalls. Use one to cut their boy down from the swing set, where he hung in the rain. Lay his body on the slide, wait for the squad. It was raining that day or we wouldn't never had looked out the window, never would've found him at all. It was raining. They repeat the story to the flock in the waiting room. Families like this are wary and watchful, agree to every test and treatment. Never ask the health team questions, only nod. Families like this worship before the heart monitor, spy miracles in each muscle twitch or sigh from the ventilator. But, this family doesn't believe in our religion. This family watches their son, their backs to the heart rate skimming across the screen not taken in by this false god. After only two days in the ICU, the mother tells the team he is gone. Stolid, clear-eyed this family has drawn a line. Too soon for us, the team fights for him. He is so young. We shift to high code to murmur about their survivor guilt, premature closure. The family circles the bed. His stringy black hair stark against the pillow, his teenage whiskers dust. They wait for the team to get it. Willing us to stop. Not what we expect from families like this. Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Families Like This," by A. Haddad.
This chapter explores the basic ethical principle of autonomy and the related principles of verac... more This chapter explores the basic ethical principle of autonomy and the related principles of veracity, fidelity, and avoidance of killing. The pharmacist’s role in recognizing and respecting the individual patient’s moral interests is discussed. The chapter addresses the psychological and moral meanings of the principle of autonomy and delineates the elements of a substantially autonomous decision. Circumstances are discussed when it would be morally justifiable to override the actions of a substantially autonomous person. Cases highlight the issues that arise in determining whether a person is substantially autonomous for health care purposes, those posed by external constraints on autonomy, and those that arise in consideration of overriding patient autonomy.
This chapter is concerned with one of the major ethical issues in contemporary health care practi... more This chapter is concerned with one of the major ethical issues in contemporary health care practice: informed or valid consent. The chapter defines the elements of informed consent—that is, the types of information that need to be transmitted for consent to be adequately informed. The second section looks at cases involving questions of the standards of consent, referring to the question of what standard of reference should be used in determining whether a sufficient amount of a particular type of information has been transmitted: the professional standard, the reasonable person standard, or the subjective standard. The third section examines questions of whether the information transmitted is comprehended and whether the consent is adequately voluntary. Finally, the fourth section addresses whether incompetent patients can be expected to consent and what role parents, guardians, and other surrogates can play in giving approval for medical treatments for those who are legally incomp...
Avoidance of killing is a moral consideration that arises in health care controversies involving ... more Avoidance of killing is a moral consideration that arises in health care controversies involving the notions that human life is sacred or that killing is morally wrong. Pharmacists may find themselves in positions where they must reconcile the idea that generally killing is a harm to be avoided based on the principle of nonmaleficence with the idea that death might be perceived by a particular patient as a beneficial outcome. This chapter explores the principle of avoidance of killing, highlights differences between active, merciful killing and decisions to forgo treatment, and discusses the concept of proportionality. The cases presented involve topics such as withholding treatment and withdrawing treatment and direct versus indirect killing.
This chapter examines ethical issues in research involving human subjects. The Nuremberg trials, ... more This chapter examines ethical issues in research involving human subjects. The Nuremberg trials, which exposed to all humankind the outrageous things that could be done in the name of medical science, led to the Nuremberg Code, the first international document from public sources setting out an ethic for research on human subjects. Basic differences are outlined between the goals of therapy for the good of a patient and those of research that focus on attainment of knowledge and the good of society. To protect the interests of human subjects who take part in research, guidelines such as the Declaration of Helsinki have been established for assessing risks and benefits, voluntary consent, protection of privacy and confidentiality, and equity in subject selection. The chapter focuses on the difficulty in calculating harms and benefits to subjects and challenges of obtaining informed consent for participation in research.
This chapter focuses on the purpose of formularies and the potential ethical problems or issues t... more This chapter focuses on the purpose of formularies and the potential ethical problems or issues that formularies raise. Pharmacists will increasingly find themselves on committees, such as Pharmacy and Therapeutics Committees, that set the standards for formularies used by health system pharmacies and insurers responsible for paying for the cost of pharmaceuticals. Some ethical principles that are relevant to decisions on setting limits on prescribing and dispensing practices include justice, beneficence, and nonmaleficence. Reducing costs overall, which may serve the principle of justice, may threaten the well-being or limit the autonomy of a few. Cases in this chapter deal with these issues as well as the ethical justification for overriding formulary decisions.
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