Return to Distance Education - Bioethics

Jesuit Distance Education Network

Center for Online Bioethics Education

Final Performance Report

Grant Number P116Z040012

1. National Need for the Center

Bioethics is a burgeoning field. The growth of interest in bioethics is fueled by the need for information, analysis and consultation by policy makers, health-care professionals, and healthcare institutions. Ethical issues related to scientific research and health care have gained much attention in recent years. On the clinical level, every health-care institution has need of stafftrained in clinical ethics in order to operate a quality ethics committee and provide case consultation to clinicians. These needs, in turn, generate significant demand for bioethics education, especially when it is accessible to health-care professionals who cannot leave their place of work for extended periods of time.

Secured at the request of  Congressman Alan Mollohan (D-WV), the Association of Jesuit Colleges and Universities (AJCU) Center for Online Bioethics Center received a $248,525 FY2004 Congressional Grant from the U.S. Department of Education. With these funds, the Center--led by AJCU staff at the Jesuit Distance Education Network (JesuitNET)--worked with the outstanding bioethics programs and faculty at nine Jesuit campuses to facilitate and help meet some underserved educational and training needs. Grounded in a 460-year ethics-centered academic tradition, Jesuit bioethics education is characterized by two core values--respect for the dignity of the person, and justice in the allocation, administration and delivery of health-care services.

These values guided all aspects of the Center's curriculum development. For instance, the value of respect for the dignity of the person inspires conceptual and empirical training related to ethical issues in aging, disability, end-of-life care, and genetic therapies. Similarly, the value of justice will be incorporated into course topics covering health care access, biomedical research involving vulnerable and stigmatized patient populations, organizational ethics, cultural

competency and health-care reform.

The Federal policy of supporting quality patient care is enhanced when health care practitioners are sensitive to the ethical dimension of their work, and are trained in clinical ethics to operate quality ethics committees and provide case consultation to clinicians. Nine participating Jesuit university bioethics organizations provided the Center's courses and

students with an unparalleled reservoir of faculty expertise, academic resources and learning opportunities.

The Center began working in early 2004  with bioethics programs at Creighton, Fairfield, Fordham, Loyola Marymount, Loyola Chicago, Regis, Santa Clara, Saint Louis, and Wheeling Jesuit universities to identify priorities for the development of new online courses. Using a new AJCUBIOETH listserv, the program directors identified and discussed descriptions of 30 on-campus and 12 online bioethics courses. Detailed analyses of course content were conducted to identify Center curriculum development priorities for the January  2004 - June 2005 project period.

In working with the nine bioethics organizations at Jesuit campuses, the Center identified online courses to facilitate and help meet some underserved educational and training needs. Among the online offerings that were proposed for development and delivery were the following:

·         Noncredit courses and workshops for health care practitioners throughout the Nation

·         Graduate courses for existing AJCU degree and certificate programs

·         Undergraduate courses as minors or electives for students at AJCU colleges and universities

·         Special courses and offerings for Jesuit university alumni and the general public

The 28 Jesuit colleges and universities alone provide a large potential market for online bioethics course offerings. The Jesuit schools enroll 122,000 undergraduate students, 53,000 graduate students and 17,000 professional students. In addition, there are 1.5 million Jesuit university alumni and tens of thousands of noncredit and short-course enrollments each year.

The Center surveyed academic deans across the undergraduate, graduate, professional, and continuing education program spectrum of the 28 U.S. Jesuit colleges and universities. Similar contacts were made with the schools' alumni directors. These investigations ascertained the priority interests in online bioethics instruction across these various audiences, and served to align these with the curriculum development and teaching resources at the nine AJCU bioethics institutes.

2. Center Bioethics Partners

The Center for Online Bioethics Education collaborated with and drew upon the resources of nine bioethics centers and programs at Jesuit universities. While all nine centers and programs provide significant research and clinical services, they also have extensive expertise and experience in offering a variety of undergraduate, graduate and professional courses and programs in health care ethics as summarized below.

Program in Applied Ethics - Fairfield University

The Program in Applied Ethics is an interdepartmental organization that offers eight undergraduate courses in heath care and related ethics topics.

Center for Ethics Education - Fordham University

The Center for Ethics Education was established in 1999 to promote high quality teaching, research, and service through intellectual appreciation of moral values and critical thinking about ethical practices. The Center offers nine undergraduate and graduate heath care ethics courses

The Bioethics Institute - Loyola Marymount University

The Bioethics Institute was founded in 2000, and offers four graduate and undergraduate bioethics and a wide range of Continuing Medical Education (CME) courses.

Neiswanger Institute for Bioethics and Health Policy - Loyola Chicago Medical School

The Neiswanger Institute for Bioethics and Health Policy was established in 2000, and offers an online M.A. Program in Clinical Bioethics and Health Policy. The program offers eleven online bioethics courses throughout the academic year.

Department of Health Care Ethics - Regis University

The Department of Health Care Ethics was created in 2004 to offer online courses in health care ethics and policy to students in nursing and related health fields.

Center for Health Care Ethics - Saint Louis University

The Center for Health Care Ethics was established in 1979, and offers a Ph.D. program in health care ethics. This program presents an interdisciplinary curriculum of eleven courses in health care ethics that is delivered in an integrated fashion.

Markkula Center for Applied Ethics - Santa Clara University

The Markkula Center for Applied Ethics was established in 1986 as a resource for people and organizations wanting to study and apply an ethical approach to the fields of health care ethics and biotechnology. It currently offers five undergraduate and graduate courses in bioethics.

Department of Philosophy - Wheeling Jesuit University

The Department of Philosophy offers on-campus courses in bioethics for nurses and other health care professionals, and launched its initial online bioethics course in 2004.

3. Accomplishment of Center Goals and Objectives

The Center was established to foster two primary goals for online bioethics education:

·            Realize the development of new online bioethics courses to reach new audiences

·            Support the collaborative sharing of online bioethics courses by Jesuit universities

The Center has successfully met these two goals, as described in the following sections.

3.1 Development of New Online Bioethics Courses

The Center utilized JesuitNET's proven Competency Assessment in Distributed Education (CADE) competency-based approach in the development of the new bioethics courses. The CADE approach focuses on the development of higher-level thinking skills--the processes and strategies used by learners to solve problems related to specific competencies. This approach informs the choice and design of the performance tasks that are embedded in each course so that they both reflect the desired course competencies and simultaneously reinforce the instruction. The Center's online bioethics courses utilized as appropriate software tools, animations and interactive elements to teach higher-level subject competencies.

The CADE design approach from competencies to evidence to tasks makes the assessment of student competency mastery within instructional tasks an explicit requirement of course development. The CADE process organizes curriculum design around three phases of development:

·         The first phase identifies the specific set of competencies for students to master--

            What do faculty want students to know, understand, or be able to do?

·         The second phase identifies the evidence needed to indicate student mastery--

                  How will faculty know if students have attained these competencies?

·         The third phase identifies the instructional tasks needed to reveal the evidence--

            How will faculty create an instructional environment in which students interact

       meaningfully with the content?         

Over 150 professors from 28 Jesuit universities have completed the CADE course design workshop, which requires ninety hours of participant time over a 6-week period. Each workshop participant prepares a 25-page portfolio consisting of design worksheets and supporting narratives that serve as a design document for developing and producing the online course. Faculty to both develop and teach the new online bioethics courses came from the nine participating bioethics centers and programs, and had academic backgrounds in such disciplines as medicine, law, health policy, and philosophy. Competency-based online course design workshops were made available to bioethics faculty during the fall 2004 and spring 2005 semesters.

The Center provided the participating bioethics organizations with key course production services, including planning course production, producing course content in appropriate multimedia formats, and managing these production projects from inception through completion. With each participating bioethics organization, the local and Center staffs worked on bioethics course production as an integral unit. Completed online bioethics courses were hosted by the home (credit-awarding) institution.

Figure 1. The Nursing Home Case Study


 

The video case posed two distinct tasks for students. First, in an appropriately sized group, each student was assigned one of the character roles from the video case. Each student worked within their group to try to reach an ethically appropriate resolution, bearing in mind personal interests and perspectives. Second, students considered how their approaches may have missed certain features of ethics cases. Questions included what might a feminist argue are key features that traditional moral theories miss but that feminist awareness bring to light?

A study of the principal ethical and legal norms that inform clinical ethics discussions. A range of theories and approaches will be studied, such as the role of virtues, principles, religion, and the law. An understanding of these areas is essential for understanding the disagreements that arise in clinical ethics cases and for analyzing such cases.

HCE.G502 Models of Clinical Consultation and Case Analysis

This course has two main purposes: first, to examine the main models for conducting clinical ethics consultations; second, to present a framework for analyzing cases which is suitable for writing up case studies. Each of these goals will be met by analyzing actual cases in clinical health care ethics.

HCE.G503 Foundations of Catholic Health Care Ethics*

This course examines the Ethical and Religious Directives for Catholic Health Care Services to offer a critical appraisal of the foundations of Catholic health care ethics.

HCE.G510 Informed Consent and Surrogate Decision Making

A study of informed consent and decision making on behalf of incompetent patients, including topics such as: the legal and ethical basis for informed consent, standards health professionals must meet in disclosing information, standards used by surrogate decision makers, and the role of advance directives.

HCE.G511 Death and Dying

This course surveys ethical issues and norms that pertain in healthcare for patients who are near the end of life, such as advance directives, palliative care, proxy decision making, and criteria of death germane to this domain of study.

HCE.G512 Ethical, Policy, and Social Issues in Pain Management and Palliative Care

A study of: empirical data concerning pain management and palliative care to identify major areas of concern relevant for ethicists in the clinical setting; the ethical framework for physicians and institutions in providing pain management and palliative care; legal norms regarding pain management, including statutes, cases, professional guidelines, and private accreditation.

HCE.G513 Patient Safety and Medical Error

This course examines the related ethical issues of patient safety and medical error, especially from the perspective of quality improvement in health care today.

HCE.G514 Organ Donation: Ethical Issues in Clinical Practice

A study of ethical and legal issues that arise in facilitating organ donation in the context of brain death, cardiac death, and living organ donation. Special attention will be given to common concerns of family members and clinical staff with current donation policies and practices.

HCE.G515 Perinatal and Pediatric Ethics

A study of ethical and legal issues that arise in the care of children and adolescents, such as genetic testing and counseling, parental refusals of and demands for treatment, care of critically ill newborns, adolescent decision making, intra-familial organ and tissue transplants, end of life decisions, and confidentiality. The legal and ethical standards for making health care decisions on behalf of children will be examined.

HCE.G589 Capstone Project: Ethical Case Analysis

A mentored project for participants completing the Certificate in Health Care Ethics. Participants will develop and analyze an ethics case based on their clinical experience and areas of interest. Participants will be responsible for integrating relevant health care ethics literature and a discussion of relevant legal, cultural, and/or religious issues into their analyses.

By the conclusion of the Congressional grant's funding period on June 30, 2005, the number of online bioethics courses offered by Center partners increased from 12 to 22 courses, as summarized in Table 1.