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(updated 8/5/2021)HCB 521 Clinical Ethics PracticumCourse Director Phyllis Migdal MD, MA will attend sessions throughoutCore Supplemental Faculty: Robyn McKeefrey RN, MASession Faculty: Maria Basile MD, Jules Cohen MD, Kathleen Culver DNP, RN, CPNP,MA, Laureen Diot ANP-C, WCC, ACHPN, Rina Meyer MD, Clare Whitney PhD, MBE,RN, Kevin Zacharoff, MDSemester: Fall 2021Schedule: Thursday, 6-8:30 pmClinical ethics is an interdisciplinary activity to identify, analyze, and resolve ethical problemsthat arise in the care of particular patients. While a theoretical understanding of ethical issues isessential, the details of actual clinical practice are often more complex and contextual thanabstract principles would have one believe. Medical considerations, ethical and legal dimensions,comparisons with similar cases (casuistry), cultural factors, psychological conditions, familialcircumstances, “stakeholders,” time constraints, heightened emotions, communication barriers,and a host of other dimensions make clinical ethics a matter of getting to plausibly “good”outcomes.Readings – required text (can be purchased on Amazon. AbeBooks, or eBooks)AR Jonson, M Siegler, WJ Winslade, Clinical Ethics, 8th Edition: A Practical Approach toEthical Decisions in Clinical Medicine (New York: McGraw-Hill, 2015).This is “the” classic manual that is commonly used by clinician and the most successful “how to”book in the field.Otherwise, articles will be emailed to you weekly.Course StructureThe first several weeks of the course are introductory with regard to the nature and function ofethics committees and clinical ethical consultations, including background and essentialdocuments. The course will then turn to an array of clinical areas and cases, as well as ethicalissues that have been raised in response to the Covid-19 pandemic.Week 1 (August 26): Introduction(Phyllis Migdal MD, MA)In this week we will discuss the historical development of clinical ethics committees, theircomposition, and their primary roles (policy, advisory case review, education). We will alsointroduce the function of providing clinical ethics consultation in small teams. How does thispractice work? What are its strengths? How often is this service requested and by whom? Whatis the relationship of the ethics committee to offices of (a) Legal Risk Management and (b)Patient Advocacy?1

Readings:Hoffmann D.E., & Tarzian A.J. (2008). The Role and Legal Status of Health Care EthicsCommittees in the United States. In A.Iltis, S. Johnson & B Hinze, Legal perspectives inbioethics (1st ed.). Rutledge.Ranieri, D. (2015). Training in Ethics Consultation: A Model for Physician Assistant Programs,”J of Physician Assistant Education, 26(4), 212-214.Stony Brook Med “Ethics Consultation”Who’s Who in the Hospital SettingEthics Consultations. (2016). AMA Code of Medical Ethics Opinion 10.7.1. Retrieved cs/ethics-consultationsEthics Committees in Health Care Institutions. (2016). AMA Code of Medical Ethics Opinion10.7. Retrieved from: hics-committees-healthcare-institutionsBegin reading:Jonsen, Siegler & Winslade, Clinical Ethics 8th Edition: A Practical Approach to EthicalDecisions in Clinical Medicine, Introduction and Topic OneWeek 2 (September 2): Introduction to the Healthcare Setting, the Law of HealthcareDecisions, Informed Consent, Healthcare Agents, and Surrogacy – Zoom Session(Robyn McKeefrey RN, MA)We will discuss various procedures and forms developed within the healthcare setting thatattempt to address common ethical issues in healthcare with an emphasis on consent forms,surrogacy, and agents designated by proxy. Various pitfalls will be addressed.Readings:Stony Brook Medicine Consent to Operation or Procedure and Anesthesia 2017 (McKeefrey)Informed Consent FormsCh. 16 Ethics and the LawRobert N. Swindler, “New York’s Family Health Care Decisions Act,” NYSBA Journal, June2010, pp. 18-27.Stony Brook Med - The Patient’s Bill of RightsThe MOLST Form (Medical Orders for Life-Sustaining Treatment” (McKeefrey)2

The MOLST Form - Frequently Asked Questions (McKeefrey)What is a MOLST Form?New York State Health Care ProxyJonsen, Siegler & Winslade, Clinical Ethics 8th Edition: A Practical Approach to EthicalDecisions in Clinical Medicine, Topic Two.Week 3 (September 9): Introduction to Case Analysis and Some Approaches to EthicalReasoning(Phyllis Migdal MD, MA)We will introduce students to the basics of clinical case write-ups and clinical case analysis.The ethics chart note is intended to serve multiple purposes, and understanding how to properlystructure one is essential to both this course and to the usefulness of any future writing in thisarea you might do. You will also be provided with a template to model your assignments on. Wewill discuss approaches to ethics case analysis (inductive details, ethical principles involved,casuistical dimensions, the Jonsen rubric, who decides, framing goals, shared decision makingand its basis/limits, etc.).Readings:Anonymous. (1998). It’s over, Debbie. JAMA, 259(2), 272.Courtenay R. Bruce, et al., (2014). Practical Guidance for Charting Ethics Consultation. HECForum, 26, 79-93.Ethics Case Consultation Toolkit Summary TemplateExemplary Clinical Ethics Chart NoteKillbride, M.K., & Joffe, S. (2018). The new age of patient autonomy: Implications for thepatient-physician relationship. Journal of the American Medical Association 320(19), 19731974.Kopar, P.K., Kramer, J.B., Brown, D.E., Bochicchio, G.V. (2021). Critical Ethics: How toBalance Patient Autonomy with Fairness When Patients Refuse Coronavirus Disease 2019Testing. Critical Care Explorations, 3(1), e0326.Schumann, J.H., & Alfandre, D. (2008). Clinical Ethical Decision Making: The Four TopicsApproach. Seminars in Medical Practice, 11, 36-42.Stony Brook Med - Steps in Practical Judgement3

Keep working your way through topic two: Jonsen, Siegler & Winslade, Clinical Ethics 8thEdition: A Practical Approach to Ethical Decisions in Clinical Medicine, Topic Two.Week 4 (September 16): Ethical Case Resolution and Mediation(Clare Whitney PhD, MBE, RN)In this week, we will discuss an approach to clinical ethics consultation through mediation.Clinical ethics mediation involves core pillars of neutrality, conflict resolution, and enhancingcommunication between conflicting parties. Professional mediators seek to manage and findmutually acceptable resolutions to clinical conflicts stemming from conflicting values,perceptions of disrespect, and miscommunications, misunderstandings, or other breakdowns incommunication. We will discuss the framework of identifying Positions and Interests, thelimitations of Principlism in the context of ethics consultation, and common communicationtechniques used by ethics mediators.Readings:Fiester, A. M. (2015). Weaponizing principles: Clinical ethics consultations & the plight of the morallyvulnerable. Bioethics, 29(5), 309-315.Bergman, E. J. (2015). Identifying Sources of Clinical Conflict: A Tool for Practice and Training inBioethics Mediation. The Journal of Clinical Ethics, 26(4), 315-323.Fiester, A. (2012). The “difficult” patient reconceived: an expanded moral mandate for clinical ethics. TheAmerican Journal of Bioethics, 12(5), 2-7.Fiester, A. (2007). The failure of the consult model: why “mediation” should replace “consultation”. TheAmerican Journal of Bioethics, 7(2), 31-32.Week 5 (September 23): Reproduction - Zoom Session(Robyn McKeefrey RN, MA)Reproductive ethics assures that the basic rights of all people to decide freely concerningwhether or not to reproduce is independent of discrimination, coercion or violence. In makingthose choices, the framework of human rights and basic medical ethics principles of autonomy,self-determination, justice, liberty, individual freedom and equitable access to services all apply.In this section we will explore within the field of reproductive ethics the topics ofpreimplantation genetic diagnosis (PGD), the deaf culture, and assisted reproductive technologywith applicable case studies sure to result in an interesting paradigm of discussion.Readings:American Society for Reproductive Medicine. (2013). Criteria for number of embryos totransfer: A committee opinion. Fertility and Sterility, 99(1), 44-46.Bronson R. (1997). In memoriam. Human Reproduction, 12(2), 208.4

Edwards R. G., & Beard H.K. (1997). Destruction of cryopreserved embryos. HumanReproduction, 12(1), 3-5.Fahmy, M. S. (2011). On the supposed moral harm of selecting for deafness. Bioethics, 8/dd5de7274edcb2cc74e92a407a17d4dad626.pdfGroce, N. E. (2016). Deafness on Martha’s Vineyard. Encyclopaedia ness-on-Marthas-VineyardHladek, G. (2009). Cochlear implants, the deaf culture, and ethics. The Institute for Applied andProfessional Ethics, Ohio University. Levy, N. (2002). Deafness, culture, and choice. Journal of Medical Ethics, 28(5), 284-285.https://jme.bmj.com/content/28/5/284Mand, C., Duncan, R. E., Gillam, L. Collins, V., & Delatycki, M. B. (2009). Genetic selectionfor deafness: The views of hearing children of deaf adults. Journal of Medical Ethics, 35(12),722-728.Shaw, G. (2012). Breaking News: The Ethics of Designing a Deaf Baby. The Hearing Journal,65(5), text/2012/05000/Breaking News The Ethicsof Designing a Deaf.2.aspxWeek 6 (September 30): Pain(Kevin Zacharoff, MD)Pain is one of the most common reasons that people seek medical attention in the UnitedStates today, with an estimated 60 million people suffering from a pain-related condition at anygiven time. In the year 2000, pain was designated as the “fifth vital sign” giving people the rightto have their pain assessed and treated by their healthcare providers. A number of ethicaldilemmas have surfaced since; including the increased/over-prescribing of opioid medicationsfor patients with chronic pain, lack of oversight of suspicious dispensing of opioid analgesics bypharmaceutical companies and drug distributors, along with abuse, misuse, and addiction relatedto these medications. The “opioid overdose epidemic” has led to the dilemma of balancing thesafe, compassionate and effective treatment of chronic pain and negative outcomes (includingoverdose deaths) associated with the increased use of medications used to achieve these goals.Additionally, deadly illicit opioids such as fentanyl mixed with heroin and other illicit substanceshave further blurred the lines between responsible parties for this increasing epidemic. Theemergence of the Coronavirus pandemic in some ways has magnified the societal impact of thesephenomena with more people dying of opioid-related overdoses than ever before. This sessionalong with reading materials will provide a forum for discussion and analysis of this importantsituation facing healthcare and society today.5

Readings:Achenbach, J., Bernstein, L., Harrow J, R., & Boburg, S. An Onslaught of Pills, Hundreds ofThousands of Deaths: Who is Accountable? The Washington Post. July 20, 2019.Aviv, R. “Prescription for Disaster: The Heartland’s Pain-pill Problem,” The New Yorker, May 5,2014.Cheatle, M. D., Gallagher, R. M., & O’Brien, C. P. (2018). Low risk of producing opioid usedisorder in primary care by prescribing opioids to prescreened patients with chronic noncancerpain. Pain Medicine, 19(4), 764-773.Chen, J. H. (2016). The Patient You Least Want To See. JAMA, 315(16), 1701-1702.Feke, T. I Am a Doctor, But I Didn’t Cause the Opioid Epidemic. KevinMD.com. May 26, 2016.Retrieved from: cause-opioidepidemic.htmlInstitute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention,Care, Education, and Research. Retrieved f.pdfKroenke, K. (2017). Management of chronic pain in the aftermath of the opioid backlash,”JAMA, 317(23), 2365-2366.Ludwig, M. June 2021. The War on Drugs Comes to the Doctor’s Office. www.truthout.org .Volkow, N. Collision of the COVID-19 and Addiction Epidemics. Annals of Internal Medicine.www.annals.org. April 2, 2020.Volkow, N. Stigma and the Toll of Addiction. The New England Journal of Medicine. April 2,2020.Wamsley, L. Fentanyl Surpasses Heroin as Drug Most Often Involved In Deadly Overdoses.NPR. December 12, 2018.Yong, RJ, Mullins, PM, Bhattacharyya, N. Prevalence of chronic pain among adults in theUnited States, PAIN: April 02, 2021.Week 7 (October 7): Palliative Care(Laureen Diot ANP-C, WCC, ACHPN)6

Palliative care medicine encompasses the care of patients and families during serious,possibly life-threatening illnesses. The goals of ensuring that patient preferences are met alongwith providing the relief of pain and suffering are important aspects of palliative care. Thedifferences with hospice care will be discussed and how ethical guidelines can be used to helpthe patient and family make decisions about their care.Readings:Colby, WH. (2019). Nancy Cruzan and the withhold versus withdraw dilemma. AmericanJournal of Bioethics, 19(3), -and-the-withhold-versus-withdrawdilemma/Fine, RL. (2005). From Quinlan to Schiavo: Medical, ethical, and legal issues in severe braininjury. Baylor University Medical Center Proceedings, BUMC 18, PMC1255938/Lutz, R. (2020). Adjusting palliative care practices for a pandemic. Contagion Live o, GA. (2005). A matter of life and death. Genome Biology 6, les/PMC1175946/Week 8 (October 14): Ethical Issues in Clinical Trial Research in Oncology(Jules Cohen, MD)The practice of oncology requires a deep understanding of clinical trial research, both toapply the results of completed trials to ongoing patient management decisions and to improvefuture patient care by enrolling new participants in ongoing clinical trials. The ethics of clinicaltrial research starts with the infamous Tuskegee experiment and evolves through thearticulation of the Nuremberg Code, the Belmont Report and the Declaration of Helsinki. In thissession, we will discuss the 7 main principles of human subject research (social and clinicalvalue, scientific validity, subject selection, risk/benefit ratio, independent review, informedconsent and respect for participants) and consider related issues such as the use of placebos,randomization, and blinding. We will review the high risk/benefit ratio of phase I clinical trials,bias in the reporting of phase III clinical trial results, and the Food and Drug Administration’suse of accelerated approval to bring drugs to market despite limited evidence ofefficacy. Finally, we will consider the cost of developing an FDA-approved drug (including thenumber of clinical trial participants required) and the soaring cost of novel targeted agents andimmunotherapies and whether this alarming trend is sustainable in the long run.Readings: TBDDUE: In class Case Presentations (4-box approach)7

Week 9 (October 21): Ethical Issues in Cardiology(Gregg Cantor MD)In this session we will discuss ethical issues in cardiology. We will mainly focus onpacemakers/defibrillators and their potential withdrawal in end-of-life situations. These devicescan bring much benefit to a patient’s life, however, can also function against a patient’s wishesduring end-of-life situations. Students will learn about these benefits and dilemmas and discussthe differences between the discontinuance these devices provide versus other medical therapies.Next, we will discuss impacts the Covid-19 pandemic brought upon cardiac patients andcardiologists regarding patient care and clinical decision making.Readings:Pacemakers and Defibrillators. Columbia University Department of Surgery. (A brief overviewof pacemakers and defibrillators to be reviewed in reatments/pacemakers-and-defibrillatorsBenjamin, MM & Sorkness, CA. (2017). Practical and ethical considerations in the managementof pacemaker and implantable cardiac defibrillator devices in terminally ill patients. Proc (BaylUniv Med Cent), 30(2), PMC5349811/Bevins, MB. (2011). The ethics of pacemaker deactivation in terminally ill patients. Journal ofPain and Symptom Management, 41(6), df?pii S0885-3924%2811%2900202-8Bharadwaj, P & Ward, KT. (2008). Ethical considerations of patients with pacemakers.American Family Physician, 78(3), mlKramer, DB, Kesselheim, AS, Brock, DW, & Maisel, WH. (2010). Ethical and legal views ofphysicians regarding deactivation of cardiac implantable electrical devises: A quantitativeassessment. Heart Rhythm, 7(11), s/PMC3001282/pdf/nihms-243099.pdfMitchell, J. (2020). How coronavirus changed the way patients responded to a heart attack.Reported in the British Heart ttackCOVID caused major decline in heart attack patients seeking care. (2021). Diagnostic andInterventional ing-care8

Fersia, O, Bryant, S, Nicholson, R, McMeeken, K, Brown, C, Donaldson, B, Mackay, A.(2020). The impact of the COVID-19 pandemic on cardiology services. BMJ, 7(e001359).doi: com/content/7/2/e001359DUE: Chart NoteWeek 10 (October 28): Nutrition/Feeding/PEGS(Maria Basile MD)One of the complications of later-stage Alzheimer's Disease (AD) and other advanceddementias is the difficulty associated with adequate feeding and nutrition. Early in the course ofthe disease, this may manifest simply as irregular feeding patterns. As neurologic functionbecomes increasingly compromised, patients eventually suffer a lack of control over swallowingboth solids and liquids. Family and friends are often faced with the unfortunate reality ofwatching a loved one suffer not only the drawn-out cognitive decline associated with thesediseases, but also a terminal stage whereby achieving basic nutrition and hydration becomes aneveryday challenge. Through the 1980's and mid-1990's, application of the PEG (percutaneousendoscopic gastronomy) tube (invented in 1979) procedure toward patients with advanceddementia became commonplace, and replaced the older practice of assisted oral feeding. Therelatively simple procedure, which passes a feeding tube directly through the nearby skin andthen directly into the stomach itself, was thought to present a humane method for keeping thesepatients adequately fed and hydrated by bypassing the compromised swallowing mechanism. Itwas also hoped that PEG tube placement would reduce associated complications such as bedsores from malnutrition and aspiration pneumonia from poor swallowing. However, by 2000 anumber of key articles were published seriously questioning the value and the ethics of PEG usein individuals with end-stage AD. Since then debate has raged over the PEG and its uses amongdeeply forgetful people.Our session will focus on the clinical ethical literature around this topic, which we willdiscuss in detail. We will also examine a number of clinical cases where PEG use is considered.Readings:Ba, Y, Castillo, BS, Tchakarov, A, Escobar, MA, Cotton, BA, Holcomb, JB, Brown, RE. (2016).Providing hemostatic and blood conservation options for Jehovah’s Witness patients in a largemedical center. Annals of Clinical and Laboratory Science 46(6), 654-661.Casarett D, Kapo, J, & Caplan, A. (2005). Appropriate use of artificial nutrition and Hydration –Fundamental principles and recommendations. NEJM 353(24), 2005, 2607-2612.Hoffman, M. R. (2019). Tracheostomies and PEGS: When are they really indicated? Surg ClinNorth Am 99(5), 955-965.Kato, T. (2020). A transplant surgeon’s story of surviving COVID-19. American Society ofTransplant Surgeons: Chimera. Retrieved from: vid-199

Post, SG. (2001). Tube feeding and advanced progressive dementia. Hastings Center Report31(1), 36-42.Schultze, J, Mazzola, R, Hoffmann, F. (2016), Incidence of tube feeding in 7174 newly admittednursing home residents with and without dementia. American Journal of Alzheimer's Disease &Other Dementias 31(3), 27-33.Singer, AJ, Morley, EJ, Henry, MC. (2020). Staying ahead of the wave. NEJM 382(18), e44-e45Week 11 (November 4): Ethical Issues in Clinical Pediatrics(Kathleen Culver, DNP, RN, CPNP, MA, Rina Meyer, MD)In this week’s class, we will explore the unique ethical challenges facing pediatric patientsand their health care providers. In pediatrics, most decisions are made by surrogate decisionmakers, calling into question the concept of “best interest of the child” and requiring us toidentify the appropriate decision-makers. We will look at a case that highlights theseissues. Additionally, adolescent patients are at the cusp of their ability to make autonomousdecisions. We will explore what happens when these decisions differ from the decisions ofeither their parents or the medical team. Finally, we will look at one of the most vulnerablepediatric populations – developmentally disabled children – and explore the challenges inherentin their care, and the multiple players involved.Readings:Baines, P. (2008). Medical Ethics for Children: Applying the Four Principles to Paediatrics.Journal of Medical Ethics, 34, 141-145.Cunnings, C.L. & Mecurio, M.R. (2010). Autonomy, Beneficence, and Rights. Pediatrics inReview, 31(6), 252-255.Fost, NC. (1985). Ethical Issues in the Care of Handicapped, Chronically Inn, and DyingChildren. Pediatrics in Review, 6(10), 291-296.Jonsen, Siegler & Winslade, Clinical Ethics 8th Edition: A Practical Approach to EthicalDecisions in Clinical Medicine, Topic Three.DUE: Position PaperWeek 12 (November 11): Discussion of topics of interest from Jonsen, Siegler, Winslade(Migdal)In class presentation of a topic of interest ( 10-15 minutes) from your readings in the text.Explore the clinical ethical issue in depth and the key take-aways or learning points as the topicrelates to ethical decision making. You can work in groups of 2-3 students if areas of interest aresimilar. Please inform me of the topic and members of the group the week prior to this session.10

Jonsen, Siegler & Winslade, Clinical Ethics 8th Edition: A Practical Approach to EthicalDecisions in Clinical Medicine, Topic Four.Week 13 (November 18) Student Presentations on Position Papers(Migdal)In class presentation of position paper drawing on any of the topics discussed in the coursethat interested you. Please discuss your position on the ethical issue and the arguments for andagainst your position. You should be able to lead 15-20 minute discussion about this topic thatexplores your topic in-depth. Consider if you would like to prepare a PPT, show a video or otherinformation to add to the discussion.Week 14 (December 2) Student Presentations on Position PapersGRADINGOn all papers include: Name on title page Page number APA or MLA in-text and reference list citationsAbsences: Must be excused prior to class If you miss more than one class or if absence was not excused a 3-5 page write-up isrequired about the topic of the week you missed.1. Students will be asked to turn in an ethics chart note following a specific template that wewill discuss early in the course. Chart note will be worth 30 points (20%).2. Students will lead an in-class 10-minute discussion of a topic of interest from theClinical Ethics text. (10%)3. Students will turn in a 7-page position paper on any topic covered in the course, drawingfrom the assigned readings and further research. You may use the topic as a spring boardfor your thoughts and positions that go beyond the discussion in class. Outside resourcesmay be used to contribute to the strength of your position and should be cited in APA orMLA format. Students should select a topic from the week that engages them. (20%)Writing a Position Paper: (adapted from Xavier University guide, 2014)a.) The purpose of a position paper is to generate support on an issue. It describes aposition on an issue and the rational for that position.11

b.) Choose an issue where there are clearly varying opinions that can be argued andsubstantiated.c.) Narrow your topic, define and limit your issue.d.) Format:i. Introduction: (Identifies the issue and states your position)The first section begins with the selection of a topic that has multipleviewpoints and written to capture the reader’s attention. The introductoryparagraph includes a statement of your position (thesis), and how thepaper will proceed in terms of arguments in favor of your position and thecounterarguments that you will elaborate on in the body of your paper.ii. The main body: (Provides background info, supporting evidence,discussion of both sides of the issue)Develops the thesis discussed in the introduction. The body of your paperincludes supporting information for your position from the class readingsor other sources. Further, this section includes why alternative positionsare incorrect or not as strong as the position you support.iii. Conclusion:Summarizes the main strengths of your position and points toward afurther question that you will not address at this time.Re-cap: Writing a position Paper:-Re-read the readings for the week you have chosen to write about, think about somequestion that are of interest to, and try to respond to it in depth.Introductory paragraph(s) that include a thesis, a clearly stated position and how you willproceedMain body includes support for your position and addresses counter-positions and theirrebuttalEnd with a strong conclusionBibliography (APA or MLA)4. In class presentation your position based on your position paper. (10%)5. Classic case-presentation – 4-box approach, PowerPoint Presentation and ReflectionPaper (25%)a. Case analysis using a systematic process to identify and defend an ethicaldilemma using ethical principles.i. Cases to be distributed in classb. Presentation using the Four Topics Chart by Jonsen, et al.i. Identify the Issue1. Provide an overview of the case2. Outline the options3. Construct ethical arguments4. Evaluate the arguments provided in the classical caseii. Make a decision/recommendation12

1. Since cases are historical, can provide support for or against thedecision2. Provide recommendations to support your decisioniii. Form 2 reflective questions about the case1. To stimulate further discussion about the ethical dilemma2. This will be the basis of your 2-page written reflection6. The remaining 15% will be class attendance, assigned readings and participation. It isimportant to be an active and vocal contributor to discussion.a. Please note attendance requirements FromOfficial Stony Brook University Policy: Statements required to appear in all syllabi on theStony Brook campus: Americans with Disabilities Act: If you have a physical, psychological,medical or learning disability that may impact your course work, please contact DisabilitySupport Services, ECC (Educational Communications Center) Building, room128, (631) 6326748. They will determine with you what accommodations, if any, are necessary andappropriate. All information and documentation is confidential. Academic Integrity: Eachstudent must pursue his or her academic goals honestly and be personally accountable for allsubmitted work. Representing another person's work as your own is always wrong. Faculty arerequired to report and suspected instances of academic dishonesty to the Academic Judiciary.Faculty in the Health Sciences Center (Schools of Health Technology & Management, Nursing,Social Welfare, Dental Medicine) and School of Medicine are required to follow their schoolspecific procedures. For more comprehensive information on academic integrity, includingcategories of academic dishonesty, please refer to the academic judiciary website athttp://www.stonybrook.edu/uaa/academicjudiciary/ Critical Incident Management: Stony BrookUniversity expects students to respect the rights, privileges, and property of other people. Facultyare required to report to the Office of Judicial Affairs any disruptive behavior that interrupts theirability to teach, compromises the safety of the learning environment, or inhibits students' abilityto learn. Faculty in the HSC Schools and School of Medicine are required to follow their schoolspecific procedures.13

1 (updated 8/5/2021) HCB 521 Clinical Ethics Practicum Course Director Phyllis Migdal MD, MA will attend sessions throughout Core Supplemental Faculty: Robyn McKeefrey RN, MA Session Faculty: Maria Basile MD, Jules Cohen MD, Kathleen Culver DNP, RN, CPNP, MA, Laureen Diot ANP-C, WCC, ACHPN, Rina Meyer MD, Clare Whitney PhD, MBE,