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課程資訊

課程名稱	臨床倫理諮詢理論與實務 Clinical Ethics Consultation: Theory and Practice
開課學期	100-1
授課對象	醫學院醫學系
授課教師	蔡甫昌
課號	Med5031
課程識別碼	401 U0660
班次
學分	2
全/半年	半年
必/選修	選修
上課時間	星期三8,9(15:30~17:20)
上課地點
備註	主要授課教師為客座教師雅齊可(George Agich),合授:蔡甫昌. 總人數上限：30人

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課程概述	Rationale Ethics committees in healthcare institutions and ethics consultation services first developed in United States in the 1980s and quickly spread internationally. Besides the public controversies that dominate the field of bioethics, the primary interaction with bioethics by the public and healthcare professionals is through involvement with ethics committees and ethics consultants in the course of addressing ethical problems arising in patient care. Because clinical ethics and ethics consultation have become an everyday part of healthcare for many patients, families, and health professionals, it is important to understand the function, limits, and theory underlying this field. This course will explore: 1. the development of the field of clinical ethics and ethics consultation; 2. the theoretical connection with bioethics and ethical theory; and, 3. the procedures and processes that comprise its practice. We will discuss questions affecting the field of clinical ethics such as 1. Can ethical theory can be applied and is clinical ethics consultation an applied ethics? 2. Should healthcare ethics committees and ethics consultants be “experts” in ethics in order to function legitimately? 3. What is nature of clinical ethics consultation as a practice? 4. How should clinical ethics consultation services and healthcare ethics committees be evaluated?
課程目標	At the completion of this module, the participant will be able to: 1. Make informed decisions about how to effectively use ethics consultation services in addressing specific ethical and communication problems arising in patient care. 2. Identify the clinical ethical needs and challenges involved in particular practice settings and healthcare institutions and devise effective strategies for meeting those needs and challenges. 3. Develop strategies to improve the education of clinical ethics consultants and clinical ethics services in particular healthcare institutions and practice settings.
課程要求	Written paper and attendance.
預期每週課後學習時數
Office Hours
指定閱讀
參考書目	Agich GJ. The Issue of Expertise in Clinical Ethics. Diametros 2009; 22(December):3-20. Agich GJ. The question of method in ethics consultation. Am J Bioeth 2001;1(4):31-41. American Society for Bioethics and Humanities. Core competencies for healthcare ethics consultation. American Society for Bioethics and Humanities, 1998. American Society for Bioethics and Humanities Clinical Ethics Task Force. Improving Competence in Clinical Ethics Consultation: A Learner's Guide . American Society for Bioethics and Humanities, 2008. Aulisio MP, Arnold RM, and Youngner SJ. Ethics Consultation: From Theory to Practice. Baltimore, John Hopkins University Press, 2003. Aulisio MP, Arnold RM, Youngner SJ. An Ongoing Conversation: The Task Force Report and Bioethics Consultation. The Journal of Clinical Ethics 1999;10(1):3-4. Aulisio MP, Arnold RM, Youngner SJ. Health care ethics consultation: nature, goals, and competencies. Ann Intern Med 2000;133(1):59-69. Bernal EW. Ethics consultation is not therapy. J Clin Ethics 1994;5(1):47-49. Cohen CB. Avoiding Cloudcuckooland in Ethics Committee Case Review: Matching Models to Issues and Concerns. Law, medicine & Health Care 1992;20(4):294-299. Drane JF. Methodologies for Clinical Ethics. Bulletin of the Pan American Health Organization 1990;24(4):394-404. Fletcher JC, Spencer E, Fry-Revere S, et al. Recommendations for guidelines on procedures and process and education and training to strengthen bioethics services in Virginia. 1996 Fox E, Arnold RM. Evaluation Outcomes in Ethics Consultation Research. The Journal of Clinical Ethics 1996;7(2):127-138. McGee G, Caplan AL, Spanogle JP, et al. A national study of ethics committees. AJOB 2001;1(4):60-64. McGee G, Spanogle JP, Caplan AL, et al. Successes and failures of hospital ethics committees: A national survey of ethics committee chairs. Cambridge Quarterly of Ethics 2002;(2):87-93. Pfafflin M, Kobert K, Reiter-Theil S. Evaluating clinical ethics consultation: a European perspective. Camb Q Healthc Ethics 2009;18(4):406-419. Reiter-Theil S. Ethics consultation on demand: concepts, practical experiences and a case study. Journal of Medical Ethics 2000;26:198-203. Spencer EM. A New Role for Institutional Ethics Committees: Organizational Ethics. The Journal of Clinical Ethics 1997;(Winter):372-376. Tulsky JA, Stocking CB. Obstacles and Opportunities in the Design of Ethics Consultation Evaluation. The Journal of Clinical Ethics 1996;7(2):139-145. West MB, Gibson JM. Facilitating Medical Ethics Case Review: What Ethics Committees Can Learn from Mediation and Facilitation Techniques. Cambridge Quarterly of Healthcare Ethics 1992;1:63-74. Wolf SM. Quality Assessment of Ethics in Health Care: The Accountability Revolution. American Journal Of Law & Medicine 1994;XX(1&2):105-128.
評量方式 (僅供參考)

課程進度

週次	日期	單元主題
第1週	9/14	Historical development of clinical ethics committees Impact of law on the development of clinical ethics Movement of ethics committees from fall policy development and education to clinical ethics consultation
第2週	9/21	Ethics committees and the functions of policy development, education, and ethics consultation Integrating clinical ethics services with ethics committees to support education and policy development
第3週	9/28	Discussion of ethics policy development and implementation, connection of policy development function with ethics consultation and education
第4週	10/05	Ethics policy continued: discussion of withholding/withdrawing care policies and protocols, Do Not Resuscitate orders and other limitation of treatment orders, withholding and withdrawing artificial nutrition and hydration
第5週	10/12	Models of ethics consultation and disputes over qualifications for doing clinical ethics consultation, including the issue of credentialing of ethics consultants and certification of programs that provide training in clinical ethics
第6週	10/19	Theories of clinical ethics and questions of methodology in ethics consultation. The relation of ethical theory, concepts, and principles to practice, casuistry, and applied pragmatic ethics.
第7週	10/26	Ethics consultation and ethics liaison practices, structural and procedural issues, reporting and documentation issues, access to consultation services
第8週	11/02	Ethics Consultation Cases: Applying Ethical Theory in Clinical Settings I This class and the following class will review clinical ethics cases including cases that have been the subject ethics consultation. Among the questions we will address are: How are the clinical data viewed differently from the perspective of clinical ethics than the perspective of health care? Are problems of ethics primarily obstructions or problems in communication or are there deeper value issues involved? If there are deeper value issues involved, how does clinical ethics resolve these issues in order to bring the clinical case to resolution?
第9週	11/09	Ethics Consultation Cases: Applying Ethical Theory in Clinical Settings II
第10週	11/16	Addressing Taiwanese clinical ethics issues and questions I This class and the following class will utilize cases in which ethical questions and conflicts have arisen within the Taiwan Health Care System. What similarities and differences distinguish these cases from the cases presented and discussed in previous session? Do the differences create problems for the field of clinical ethics?
第11週	11/23	Addressing Taiwanese clinical ethics issues and questions II
第12週	11/30	Clinical Ethics Consultation: Quality Improvement and Research. This class will discuss the challenges of research on clinical ethics and the processes that can be implemented to improve health care delivery by focusing on the ethical issues and concerns that arise in the course of patient care.
第13週	12/07	Future of Clinical Ethics and Course Summary