This is a comprehensive, 100-hour continuing education program designed to strengthen physician associates'/assistants' knowledge and clinical decision-making across a broad range of common and complex conditions affecting adult health. The curriculum integrates evidence-based approaches to cardiovascular and metabolic disease, musculoskeletal and neurologic disorders, behavioral health, pain and substance-related concerns, and ethical and end-of-life care. Topics include heart failure, hypertension, diabetes, overweight and obesity, osteoporosis, back pain, Parkinson disease, behavioral addictions, opioid safety, anabolic steroid use, medical ethics, and counseling patients and families at the end of life. The program also addresses the evidence, safety considerations, and potential drug interactions associated with natural medicines and dietary supplements used for depression, anxiety, and weight loss. Emphasizing whole-person care, this program equips physician assistants to apply current evidence and clinical principles to the assessment, management, counseling, and ongoing care of diverse adult patients.
- 1. Part I— Treatment of Heart Failure: An Update — 10 CREDITS
- 2. Part II — Hypertension: Strategies to Improve Outcomes — 5 CREDITS
- 3. Part III — Low Back Pain — 15 CREDITS
- 4. Part IV — Alternative Therapies for Depression and Anxiety — 5 CREDITS
- 5. Part V — Medical and Illicit Use of Anabolic Steroids — 5 CREDITS
- 6. Part VI — Supplements for Weight Loss — 5 CREDITS
- 7. Part VII — Type 2 Diabetes: Treatment Strategies for Optimal Care — 5 CREDITS
- 8. Part VIII — Diagnosing and Treating Overweight and Obese Patients — 5 CREDITS
- 9. Part IX — Osteoporosis: Diagnosis and Management — 5 CREDITS
- 10. Part X — Behavioral Addictions — 15 CREDITS
- 11. Part XI — Parkinson Disease — 10 CREDITS
- 12. Part XII — Counseling Patients at the End of Life — 5 CREDITS
- 13. Part XIII — Medical Ethics for Physicians — 5 CREDITS
- 14. Part XIV — Opioid Safety: Balancing Benefits and Risks — 5 CREDITS
This course is designed for physician assistants and interested healthcare professionals.
Patricia Lea, RN, DNP, MSEd, CCRN, received a Bachelor of Science degree in Nursing in 1973 from Houston Baptist University in Houston, Texas. She returned to graduate school to complete a Master’s degree in Education, specifically Health Education, in 1996 from Baylor University in Waco, Texas, and a Doctorate in Nursing Practice in Executive Leadership in 2014 from American Sentinel University in Aurora, Colorado. Dr. Lea specializes in critical care nursing, with an emphasis on heart failure and sepsis. She started her career at the Houston Methodist Hospital in the cardiovascular ICU and opened an acute dialysis unit at what is now Baylor St. Luke’s Medical Center in the Houston Medical Center. Dr. Lea was a Cardiovascular Clinical Coordinator and Director of the Heart Failure Clinic at Hillcrest Baptist Medical Center in Waco, Texas. In 2004, Dr. Lea returned to Houston and was employed as a Senior Research Clinical Nurse Specialist at the Texas Heart Institute coordinating stem cell and cardiac stent trials. She is currently Associate Professor and Baccalaureate Program Director at the University of Texas Medical Branch School of Nursing in Galveston, Texas.
John J. Whyte, MD, MPH, is currently the Chief Medical Officer at WebMD. In this role, he leads efforts to develop and expand strategic partnerships that create meaningful change around important and timely public health issues. Previously, Dr. Whyte was the Director of Professional Affairs and Stakeholder Engagement at the FDA’s Center for Drug Evaluation and Research and the Chief Medical Expert and Vice President, Health and Medical Education at Discovery Channel, part of the media conglomerate Discovery Communications.
Prior to this, Dr. Whyte was in the Immediate Office of the Director at the Agency for Healthcare Research Quality. He served as Medical Advisor/Director of the Council on Private Sector Initiatives to Improve the Safety, Security, and Quality of Healthcare. Prior to this assignment, Dr. Whyte was the Acting Director, Division of Medical Items and Devices in the Coverage and Analysis Group in the Centers for Medicare & Medicaid Services (CMS). CMS is the federal agency responsible for administering the Medicare and Medicaid programs. In his role at CMS, Dr.Whyte made recommendations as to whether or not the Medicare program should pay for certain procedures, equipment, or services. His division was responsible for durable medical equipment, orthotics/prosthetics, drugs/biologics/therapeutics, medical items, laboratory tests, and non-implantable devices. As Division Director as well as Medical Officer/Senior Advisor, Dr. Whyte was responsible for more national coverage decisions than any other CMS staff.
Dr. Whyte is a board-certified internist. He completed an internal medicine residency at Duke University Medical Center as well as earned a Master’s of Public Health (MPH) in Health Policy and Management at Harvard University School of Public Health. Prior to arriving in Washington, Dr. Whyte was a health services research fellow at Stanford and attending physician in the Department of Medicine. He has written extensively in the medical and lay press on health policy issues.
Mark Rose, BS, MA, LP, is a licensed psychologist in the State of Minnesota with a private consulting practice and a medical research analyst with a biomedical communications firm. Earlier healthcare technology assessment work led to medical device and pharmaceutical sector experience in new product development involving cancer ablative devices and pain therapeutics. Along with substantial experience in addiction research, Mr. Rose has contributed to the authorship of numerous papers on CNS, oncology, and other medical disorders. He is the lead author of papers published in peer-reviewed addiction, psychiatry, and pain medicine journals and has written books on prescription opioids and alcoholism published by the Hazelden Foundation. He also serves as an Expert Advisor and Expert Witness to law firms that represent disability claimants or criminal defendants on cases related to chronic pain, psychiatric/substance use disorders, and acute pharmacologic/toxicologic effects. Mr. Rose is on the Board of Directors of the Minneapolis-based International Institute of Anti-Aging Medicine and is a member of several professional organizations.
Chelsey McIntyre, PharmD, is a clinical pharmacist who specializes in drug information, literature analysis, and medical writing. She earned her Bachelor of Science degree in Genetics from the University of California, Davis. She then went on to complete her PharmD at Creighton University, followed by a clinical residency at the Children’s Hospital of Philadelphia (CHOP). Dr. McIntyre held the position of Drug Information and Policy Development Pharmacist at CHOP until her move to Washington state in 2017, after which she spent the next six years as a clinical editor for Natural Medicines, a clinical reference database focused on natural products and alternative therapies. She continues to create rigorous professional analysis and patient education materials for various publications while also practicing as a hospital pharmacist. Her professional interests include provider and patient education, as well as the application of evidence-based research to patient care.
Lisa Hutchison, LMHC, has more than 20 years of experience providing individual and group counseling with adults. She specifically focuses on teaching assertiveness, stress management, and boundary setting for empathic helpers. Ms. Hutchison graduated from the University of Massachusetts, Boston, with a Master’s degree in education for mental health counseling.
John M. Leonard, MD, Professor of Medicine Emeritus, Vanderbilt University School of Medicine, completed his post-graduate clinical training at the Yale and Vanderbilt University Medical Centers before joining the Vanderbilt faculty in 1974. He is a clinician-educator and for many years served as director of residency training and student educational programs for the Vanderbilt University Department of Medicine. Over a career span of 40 years, Dr. Leonard conducted an active practice of general internal medicine and an inpatient consulting practice of infectious diseases.
Contributing faculty, Patricia Lea, RN, DNP, MSEd, CCRN, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John J. Whyte, MD, MPH, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Mark Rose, BS, MA, LP, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Chelsey McIntyre, PharmD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, Lisa Hutchison, LMHC, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
Contributing faculty, John M. Leonard, MD, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
John V. Jurica, MD, MPH
John M. Leonard, MD
The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
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#41970: The Adult Patient: Evidence-Based Care for Mind and Body
Part 13 of 14 · Chapter 1 of 13
Table of Contents
- INTRODUCTION
- BRIEF HISTORY OF BIOETHICS
- LANDMARK COURT CASES
- PATIENT SELF-DETERMINATION ACT (PSDA) OF 1990
- DEFINITIONS OF ETHICAL PRINCIPLES
- ETHICS AND THE DECISION-MAKING PROCESS
- ETHICAL THEORETICAL SYSTEMS
- PRACTICAL APPLICATION OF ETHICAL THEORIES
- SETTING UP A WORKABLE ETHICAL DECISION-MAKING FRAMEWORK
- PHYSICIAN-ASSISTED SUICIDE
- AMA CODE OF ETHICS
- CONCLUSION
- RESOURCES
- Works Cited
The purpose of this course is to briefly review the history, theory, and practical application of ethical principles to issues that arise in clinical practice. The goals of the course are to heighten awareness and promote self-reflection, address knowledge gaps, improve communication and decision-making skills, and promote reasonable, humane care for patients and families.
Upon completion of this course, you should be able to:
- Outline the history of bioethics, including the evolution of the physician-patient relationship.
- Discuss the Karen Ann Quinlan and Nancy Cruzan cases as they influenced national and state healthcare policies.
- State the purpose of the Patient Self-Determination Act (PSDA) of 1990 and the role of healthcare professionals.
- Differentiate between the types of advance directives.
- Discuss the national ethical standards frameworks and their relationship to ethical decision making for patients.
- Define terminology regarding bioethics, including the principles guiding medical ethical decision making.
- Compare and contrast various ethical theories as they relate to health care.
- Describe elements of setting up a workable ethical decision-making framework.
In today's ever-changing societal and healthcare environments, physicians are confronted with choices concerning what is best for their patients, their practice, their institution, or themselves; such choices often impose ethical considerations that challenge the physician to render a decision in accordance with the principles and values of the profession. These choices can become enmeshed in ethical dilemmas that emerge from conflicting values or administrative rules and legalities. Ethics issues range from the extraordinary, such as end-of-life decisions, to the mundane, such as whether to accept certain gifts from a pharmaceutical company, but all require some understanding of the ethical principles that govern best professional practice and test one's resolve to act in accordance with these values. When ethical dilemmas or conflicts of interest do arise, it is useful to be well informed as to how similar issues have been adjudicated in the past and what tools are at hand to assist in the decision-making process.
The precepts and principles contained within various ethical systems can assist in conceptualizing a problem-solving approach allied in resolving an ethical dilemma. Whether decision-making involves an individual facing end-of-life choices or an institution setting administrative policies, these systems and principles can help the healthcare professional clear the blurred lines that may develop in difficult ethical situations. For example, if a known user of illicit drugs demands opioid pain management, how then should appropriate treatment choices be made by those responsible for care? Other examples of potential management dilemmas might be an individual with alcohol use disorder needing a liver transplant, a patient with diabetes who seemingly refuses to adhere to a diet protocol, a sedentary businessman who resists lifestyle changes necessary for cardiovascular risk reduction, or a physician whose stress level is beyond the coping stage.
Oftentimes, the patient's aspirations or goals may not correspond with what the family or physician believes would be best. Even between seemingly alike individuals, with similar education and background, value systems may prove to be radically different. Consider the patient who refuses life support while the family insists they want every lifesaving measure taken, or conversely, the comatose patient whose family members want life support and other interventions stopped, even as the physician refuses to discontinue therapy.
Until fairly recently, the majority of clinical and ethical decisions in medicine were made by physicians acting in a paternalistic manner toward their patients. Questions regarding many issues, such as organ transplantation, assisted life support, patient self-determination, appropriation of dialysis, in-vitro fertilization, cloning, and even the use of generic drugs, did not arise. The reason is simple: these techniques and procedures were not available.
In order to better understand contemporary medical ethics, it is helpful to look back at how ethical principles, frameworks, and/or codes have evolved over centuries. More specifically, it is important to recall several 20th century events in research and medicine that solidified the need for the study and application of ethics and led to the emergence of the field of bioethics. The following pages present a brief discussion of some of the information regarding ethical issues in medicine as it pertains to the role of physicians in the 21st century.
1. Rothman DJ. Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. New York, NY: Basic Books; 1991.
2. Monette DR, Sullivan TJ, DeJong CR, Hilton TP. Applied Social Research: A Tool for Human Services. 9th ed. Belmont, CA: Brooks/Cole; 2014.
3. U.S. Department of Health and Human Services. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Available at https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html. Last accessed December 9, 2025.
4. The Hastings Center for Bioethics. Available at https://www.thehastingscenter.org. Last accessed December 9, 2025.
5. Presidential Commission for the Study of Bioethical Issues. History of Bioethics Commissions. Available at https://bioethicsarchive.georgetown.edu/pcsbi/history.html. Last accessed December 9, 2025.
7. Malcolm AH. Judge Allows Feeding-Tube Removal. Available at https://www.nytimes.com/1990/12/15/us/judge-allows-feeding-tube-removal.html. Last accessed December 9, 2025.
8. Authority: Secs. 1102,1861. 1864. 1866. 1867, and 1871 of the Social Security Act (42 U.S.C. 1302.1395x. 1395aa. 1395cc. 1395dd. and 1395hh) and sec. 602 (k) of Pub. L. 9621 (42 U.S.C 1395ww note).
9. The Joint Commission. 2025 Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission Resources; 2024.
10. Kenyon P. What Would You Do? An Ethical Case Workbook for Human Service Professionals. Pacific Grove, CA: Brooks/Cole Publishing Company; 1999.
12. Rushton CH, Hogue EE. Balancing personal risk with professional responsibility: the case of AIDS. Pediatr Nurs. 1993;196(4):415, 418-420.
14. Harper MG. Ethical multiculturalism: an evolutionary concept analysis. ANS Adv Nurs Sci. 2006;29(2):110-124.
15. Congress EP. Social Work Values and Ethics: Identifying and Resolving Professional Dilemmas. Chicago, IL: Nelson-Hall; 1999: 31-33.
16. Pence T, Cantrall J (eds). Ethics in Nursing: An Anthology. New York, NY: National League for Nursing; 1990.
17. Macklin R. Ethical relativism in a multicultural society. Kennedy Inst Ethics J. 1998;8(1):1-22.
18. Ross JW, Bayley C, Michel V, Pugh D. Handbook for Hospital Ethics Committees. Chicago, IL: American Hospital Association; 1986.
19. Sevilla Mátir JF, Willis DR. Using bilingual staff members as interpreters. Fam Pract Manag. 2004;11(7):34-36.
20. Ngo-Metzger Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18(1):44-52.
21. Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355(3):229-231.
22. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255-299.
23. Basu G, Costa VP, Jain P. Clinicians' obligations to use qualified medical interpreters when caring for patients with limited English proficiency. AMA J Ethics. 2017;19(3):245-252.
25. Grinfeld MJ. Assisted suicide: just how far did the Supreme Court go. Psychiatric Times. 1997;14(8).
26. Oregon Health Authority. Oregon's Death with Dignity Act. Available at https://www.oregon.gov/oha/ph/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx. Last accessed December 9, 2025.
27. Oregon Health Authority. 2024 Oregon Death with Dignity Act: Data Summary. Available at https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year27.pdf. Last accessed December 9, 2025.
28. American Medical Association. AMA History. Available at https://www.ama-assn.org/about/ama-history/ama-history. Last accessed December 9, 2025.
29. American Medical Association. Council on Ethical and Judicial Affairs. Available at https://www.ama-assn.org/about/council-ethical-judicial-affairs. Last accessed December 9, 2025.
30. American Medical Association. Code of Medical Ethics. AMA Principles of Medical Ethics. Available at https://code-medical-ethics.ama-assn.org/principles. Last accessed December 9, 2025.
31. American Medical Association. Code of Medical Ethics. Chapters. Available at https://code-medical-ethics.ama-assn.org/chapters. Last accessed December 11, 2025.
Part 13 of 14 · Chapter 1 of 13
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