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Institute
for Ethics
in Health Care
Miami-Dade Community College
Medical Center Campus
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A
secretary, unable to read a doctor’s prescription, asks another
doctor to interpret the handwriting. In doing so, does she breach
patient confidentiality?
What
is the ethical responsibility of the health care provider to further
investigate a client’s claim that he is HIV positive?
And,
given what little we know about coma patients, how conscious,
after all, is conscious?
These
are the kinds of questions raised and discussed on Miami-Dade
Community College’s (M-DCC) Institute
for Ethics in Health Care website. Launched in 2001 by faculty
on the college’s Medical Center Campus, the site includes information
about the institute’s activities, provides links to other health
care-related home pages, and serves as a resource to apprise the
community of upcoming ethics-oriented conferences.
The
website is an outgrowth of M-DCC’s commitment to the incorporation
of ethics throughout the curriculum. The Medical Center Campus
offers 16 associate-degree and 12 short-term certificate programs
in nursing and allied health. The Institute for Ethics in Health
Care was developed to help support college values and to help
faculty teach health care-related ethical concepts to the student
population. These values include the respect for individuals from
a variety of cultural backgrounds, the provision of role models,
the offering of interdisciplinary educational programs, and the
teaching of students about the cultural, economic, political,
and social environments in which they live. Funding from the Department
of Education Fund for the Improvement of Post-Secondary Education
(FIPSE) and the Hugoton Foundation supports the institute’s activities.
The
Medical Center Campus is one of six campuses of Miami-Dade Community
College, one of the largest multicampus community colleges in
the United States. In the academic year 2002-2003, 1,167 students
were graduated from the Medical Center Campus. Committed to their
health care professions and to their community, 95 percent of
the graduates stayed and are employed in the South Florida area.
The
Medical Center Campus student population is cultural diversity
of the region. More than 52 percent of the student body is Hispanic,
and more than 30 percent is African American. Students come from
virtually every South and Central American country and the Caribbean
Islands. Over half of the students speak Spanish or French as
a primary language, and many speak their primary language at home.
These students bring with them a variety of cultural and ethical
experiences and values, and sometimes those values clash with
the professional ideals of health care providers practicing in
the United States.
Institute
activities are designed to help students identify and understand
professional ethical practice and standards and to provide them
with the knowledge and skills necessary to practice ethically
in their work environments. Faculty provide within their curriculum
and classwork the knowledge and skills necessary to practice professional
ethics within the health care arena.
Through
the institute, faculty and students address contemporary ethical
challenges in health care. In its second year, approximately 40,500
visitors viewed the site. M-DCC’s Medical Center Campus is also
collaborating with Plattsburgh State University/SUNY and Utah
State College in the development of case studies and analyses
for eventual dissemination to faculty who can use them in the
classroom. A serial format with layers was designed so that faculty
could use the case briefly or extensively, depending on the course
objectives and educational level of the student.
One
case study is titled “Confidentiality vs. the Duty to Warn.” It
is an exercise in applied bioethics, and the case evolves as students
ask questions and learn about the situation. As the case progresses,
the ethical questions that arise become increasingly complex.
The same situation may have different meanings and promote different
levels of discussion for students in community colleges and universities.
The
institute and its partners have also developed an evaluation framework
for assessing student responses to cases, as well as an evaluative
matrix for making judgments about the student responses
The
concept of the institute grew out of the work of Frances Aronovitz,
director of the School of Nursing; Susan Kass, professor and program
coordinator in Dental Hygiene; and Carol Petrozella, professor
in the School of Nursing and Medical Center Campus training and
development coordinator. An advisory committee sets the direction
for institute activities through strategic planning and evaluates
the programs it provides. The committee is composed of members
of the community and college faculty from across disciplines and
campuses. Philosophy faculty from other campuses teach a required
Associate in Science degree core course called Critical Thinking/Ethics.
These
faculty have strong backgrounds in ethics and stimulate the discussions
at advisory committee meetings. The committee includes faculty
from other universities in the area. Community members include
an attorney who specializes in guardianship activities, an organ
procurement coordinator from the University of Miami School of
Medicine, and a physician who is well known for his philanthropic
activities in the community. Several members also belong to other
community health care ethics committees. One of the nurses, an
advanced registered nurse practitioner in private practice, worked
on the ethics component of the Human Genome Project. The director
of the University of Miami’s bioethics program is also a member
of the committee. Through collaborative relationships, the two
organizations compliment and support one another rather than compete.
The
Mission of the Institute for Ethics in Health Care is to
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Create
awareness in the community of ethical issues in health care;
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Impart to faculty and students the skills and background needed
to apply critical thinking and ethics in their disciplines;
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Promote a forum through which skills and decision making related
to ethical issues in health care can be addressed; and
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Promote collaboration among disciplines.
Institute
Director Petrozella has been granted partial release time for
her work on the website. The webmaster is also a college employee
who is paid separately for her work with the institute. A consultant
with expertise in bioethics assists in answering some of the questions
posed by students either on the website or in classes, and several
faculty have been given partial release time to develop special
projects.
Petrozella
is available to students, faculty, and the community for support.
She presents seminars for the college and the community on an
ongoing basis, and she makes presentations to classes across disciplines
regarding ethical decision making and increasing the awareness
of faculty and students on the current ethical issues in health
care. The goal of these presentations is to increase faculty and
student knowledge and awareness of current biomedical ethical
issues by facilitating classroom and clinical discussions.
The
director is responsible for maintaining and monitoring the interactive
website. It is a resource for the community, faculty, and students,
and it includes current links to other professional sites, examples
of course syllabi teaching strategies, the forum for questions
and discussion, and research papers that comprise abstracts of
theses and dissertations from colleagues in the community. Visitors
to the website can use an electronic comment card that can be
used for open discussion or sent directly to the director for
analysis. As director, Petrozella consults with advisory committee
members to develop responses to questions received on the site.
And the site has a counter for visitors, as well as e-mail access
to the webmaster for comments and questions.
The
website also serves as a resource for faculty to integrate technology
into the classroom. One of the current projects is the Ethics
Primer, a faculty-initiated project. This extensive PowerPoint
presentation is available on the website as a benefit to the community.
The aim of the primer is to give faculty a resource to teach health
care ethics across medical disciplines.
Brochures
describing the website were distributed throughout the local health
care community and other institutions, and the institute has collaborated
with several professional organizations in disseminating information
about the site. Included in these affiliations are the Florida
Nurses Association, the Florida Bioethics Network, and the South
Florida Bioethics and Health Law Working Group.
In
2002, the website launched a newsletter, The Ethical Times.
It features information about institute activities and conferences.
A nurse ethicist contributed an article titled “Ethics is in the
Eye of the Beholder,” and the article is linked to the M-DCC home
page, the campus home page, and the School of Nursing and School
of Allied Health home pages, respectively. The site also provides
an address book for those interested in obtaining copies of the
newsletter.
In
April of 2003, the Ethics Primer and website were presented
at the University of Miami’s Nova Ethics Law Working Group, and
the presentation was met with enthusiasm and accolades. In 2002,
a poster presentation was made at the FIPSE Project Directors’
meeting in San Diego. In the fall of 2003, the primer will be
presented during the Ethics Forum at the Florida Nurses Association
Convention.
Summary
and Lessons Learned
The
site continues to gain in number of hits, although Director Petrozella
has no way of identifying these visitors. The webmaster reported
a large group from Texas visiting the website in 2003, and institute
facilitators drew the assumption that a professor somewhere in
that state had assigned the website as a resource or curricular
tool.
The
site’s address book is offered so that visitors can sign in and
stay connected. Project teams are also exploring new avenues for
generating interest in the newsletter, The Ethical Times,
whose content and appearance on the site has won high praise.
M-DCC’s
Institute for Ethics in Health Care and its website represent
an ongoing commitment to promote ethics across curricula at M-DCC.
The website’s founders and facilitators continue to look for ways
to make it even more interactive. It is emerging as an outstanding
example of collaboration, imagination, and dedication to ethics
in the health care community at Miami-Dade.
For
comments, suggestions, or more information, contact:
Carol Petrozella
Director
Institute for Ethics in Health Care
Miami-Dade Community College
