Bachelor's · Health Science · Health Sciences HSC/PHL 312 ETHICS OF HEALTH CARE FALL I - 8 WEEK 2021 Section All 3.00 Credits 08/30/2021 to 10/24/2021 Modified 08/31/2021  Description

This interdisciplinary course guides students through a systematic analysis of contemporary ethical issues in health care and human services. Students will use ethical theories, principles, and codes to develop ethical decision-making processes for addressing difficult ethical dilemmas that are often encountered by professionals in human services and healthcare fields. As legal policies and historical considerations often underpin ethical issues, students will become conversant in pertinent policies to better understand the complexities of the ethical issues encountered by professionals.

COURSE OUTLINE

I. Introduction to Moral Theory and Analysis 1. Introduction to critical thinking and informed opinion 2. Foundational theories 3. Differentiating between moral, ethical and legal reasoning II. Professional Ethics, and the Tools of Ethical Decision Making 1. Principles of Bioethics 2. Ethical decision making tools 3. Moral Distress III. Ethical Codes 1. Professional Codes and Oaths: Healthcare Professional 2. Professional Codes and Oaths: Human Service Professionals 3. Human Service Professionals: An Introduction to ACA Ethical Standards IV. Provider-Patient Relationships and Patients’ Rights 1. Truth telling 2. Confidentiality and privacy 3. Patient Rights and V. Decision Making for Those Without Capacity 1. Withholding, withdrawing artificial treatments 2. Advance Directives 3. Surrogate decision making standards 4. Minors and Healthcare Decision Making Authority VI. End of Life Controversies 1. Right to Die? and assisted suicide 2. Brain death and disorders of consciousness 3. Palliative and hospice care VII. Allocation of resources 1. Drug shortages 2. Pandemic ethics 3. Being fair and equitable VIII. Beginning of Life Issues 1. Eugenics 2. Abortion 3. Forced C-Sections and home births

1 of 11  Outcomes

Upon completion of this course, students should be able to:

1. Differentiate between moral, ethical, and legal reasoning as applied to healthcare and human services professionals. 2. Discuss the process of sound moral reasoning. 3. Analyze contemporary ethical issues faced by individuals, organizations, or communities and propose reasonable solutions. 4. Formulate a decision-making process that can be defended by ethical principles for selected ethical issues in healthcare and human services. 5. Summarize historical, legal, healthcare, and human services policy considerations related to contemporary ethical issues. 6. Analyze ethical standards and social responsibilities of human services and healthcare professionals and apply appropriately to the delivery of services.  Deliverables

Click here (https://www.excelsior.edu/calendar/8-week-term-schedule/) to view the 8 week Term Schedules.

Click here (https://www.excelsior.edu/calendar/15-week-term-schedule/) to view the 15 week Term Schedules. Course Schedule Weeks start on Monday,12:01 AM ET (Eastern Time) and end on Sunday, 11:59 PM ET, US (United States).

Unless otherwise noted, all assigned items are due at the end of the module (by 11:59PM, Sunday).

Week Module & Textbook Reading Assignments Online Discussions Title and Journal Activities

2 of 11 1 Introduction Read: M (Module)1J Introduce Yourself to Moral (Journal)1 Theory and Required Reflective M (Module) Analysis Journal Activity (Discussion) Brody, H. and Clark, M. (2014). Narrative ethics: A narrative. Hastings Center Report, 44(1s), Analytical Awareness S7-S11. and Informed Opinion Denworth, L. (2014). Science gave my son the gift of sound. Time Magazine. Frank, A. (2014). Narrative ethics as dialogical story-telling. Hastings Center Report, 44(1s), S16-S20. Mascia, K. and J. Mascia. (2012). The bioethics of providing cochlear implants to children: Informed choices and autonomous decision making. Journal of the American Deafness and Rehabilitation Association JADARA, 45(2), 273-286 O'Toole, B. (2006). Four ways we approach ethics [Page contains embedded PDF file, size 82 KB]. The Journal of Dental Education. 70(11), 1152-1158. Fallacies. (2012). The Writing Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC (North Carolina) Ringo, A. (2013). Understanding deafness: Not everyone wants to be "fixed". The Atlantic magazine.

Optional

Geisler, S. (2006) The value of narrative ethics to medicine.T he Journal of Physician Assistant Education.17(2), 54-57. Hooper, H. (2012, May 1). Excelsior College Library Information Literacy Tutorial: Primary, Secondary and Tertiary Sources Sanford Encyclopedia of Philosophy

View:

Required

Fleck, N.Cochlear Implant Debate

2 Bioethics and Read: M2D1: Moral Distress the Tools of Ethical Required Decision Munson, R. Intervention and reflection: Basic issues in Bioethics [PDF file, size 2.6 MB]. Making (10th ed (edition)). New York: Wadsworth Concierge Learning. Pages: 3-6; 39-44; and 932-946 Burston, A. and Tuckett, A. (2013). Moral distress in nursing: Contributing factors, outcomes and interventions. Nursing Ethics, 20(3), 312-324. Churchill, L. (2014). Narrative awareness in ethics consultations: The ethics consultant as story-maker. Hastings Center Report, 44(1), S36-S39. Epstein, E., & Delgado, S. (2010). Understanding and addressing moral distress.O nline Journal Of Issues In Nursing, 15(3), 1. Jimenez, X. F., Hernandez, J. O., & Robinson, E. M. (2015). When mediation fails: identifying and working with inappropriate surrogate decision makers. Progress In Palliative Care, 23(3), 142-147. Lachman, V. (2016). Moral resilience: Managing and preventing moral distress and moral residue. Ethics Law and Policy, 25(2), 121-124. VA (Veteran's Administration) Cases Approach –Ethics Case Consultation Summary [PDF file, size 262 KB]. Knox, J (2014). The 4C model: A reflective tool for the analysis of ethical cases at the neonatal intensive care unit. Clinical Ethics, 9(4), 120-126.

3 of 11 3 Ethical Codes Read: M (Module)3A M3D1: Ethical Codes (Assignment)1: and Required Multicultural/Diversity Case Analysis Considerations in Herlihy & Corey – Part II: ACA Code of Ethics With Illustrative Vignettes Submission Working with Patients Ethical Standards for Human Service Professionals [PDF, file size 324 KB] Due American Medical Association’s Code of Ethics [PDF file, size 12 KB] Hippocratic Oath Florence Nightingale Pledge

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Required

American Counseling Association National Association of Social Workers Principles for (AMHCA) American Mental Health Counselors Associations AMA Code of Ethics

Check your understanding

The Ethical Type Indicator

4 Provider- Read: M4A1 Ethical M4D1: Bad Ethics or Patient Issue Paper Bad Science Relationships Required Discussion and Patient AMA (American Medical Association) Opinion 10.01 - Fundamental Elements of the Patient- Rights Physician Relationship [PDF file, size 1.1 MB] Anderson, P, Petersoen, A, Graff, C. and Edberg, A. (2016) Ethical aspects of a predictive test for Huntington's Disease: along term perspective. Nursing Ethics, 23(5) 565-575. Dheensa, S., Fenick, A. and Lucassen. (2016). 'Is this knowledge mine and nobody else's? I don't feel that.' Patient views about consent, confidentiality and information sharing in genetic medicine. Journal of , 42:174-179. Spatz, E., Krumholz, H and Moulton, B. (2016). The new era of informed consent. Getting to a reasonable patient standard through shared decision making. JAMA, 315(19), 2063-2064. Patient Bill of Rights Patient's Rights in New York State

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Required

Goodman, A. (2010). The Dark History of Medical Experimentation from the Nazis to Tuskegee [Video file, 33:06 min]. Democracy Now! Provides extended insight beyond what is offered in your text regarding the and several other unethical research studies which have impacted our current regulations regarding the conduct of research and the protection of human subjects.

4 of 11 5 Protecting Read: M5A1: M5D1: Advanced Autonomy – Advanced Directives Decision Required Directives Making for Fins, J. (2013). Disorders of Consciousness and disordered care: families, caregivers, and Those narratives of necessity. Archives of Physical Medicine and Rehabilitation, 94, 1934-1939. Without Fins, J. (2005). Rethinking disorders of consciousness: new research and its Capacity implications. Hastings Center Report, 35(2), 22-24. Jimenez, X, Hernandez, J and Robinson, M. (2015). When mediation fails: identifying and working with inappropriate decision makers. Progress in Palliative Care, 23(3), 142-147. Shif, Y., Doshi, P., and Almoosa, K. (2015). What CPR (Cardiopulmonary resuscitation) means to surrogate decision makers of ICU (Intensive Care Unit) patients. Resuscitation, 90, 73-78. Spatz, E., Krumholz, H and Moulton, B. (2016). The new era of informed consent; Getting to a reasonable patient standard through shared decision making. JAMA, 315(19),2063-2064. Sussman, B.(2015). A narrative approach to the ethical dilemmas of surrogate decision making. Progress in Palliative Care, 23(3), 137-141.

5 of 11 6 Decisions at Read: M6D1: Choices – Life’s End Death with Dignity Required

Arras, J. (1997). Physician-assisted suicide: a tragic view. The Journal Of Contemporary Health Law And Policy, 13(2), 361-389. (28) An important article outlining the issues associated with Assisted Suicide and the arguments regarding the slippery slope down to Euthanasia. Also discusses the Supreme Court and lower court rulings with regard to the cases that led to the legalization of PAS in Oregon, Washington & by common rule, Montana. The New York State Task Force on Life and the Law. (1997).W hen death is sought assisted suicide and euthanasia in the medical context supplement to report. The NY State Task Force is an ethical legislative agency, the first of its kind, designed to address important contemporary issues on a broad base of ethical issues related to healthcare. Recommendations from the Task Force, although non-binding, are influential in many policies, cases and academic considerations both in NY and across the states. Cellarius, V. (2011). 'Early terminal sedation' is a distinct entity. Bioethics, 25(1), 46-54. Emanuel, E. et.al. (2016). Attitude and practices of euthanasia and physician assisted suicide in the United States, Canada and Europe. JAMA, 316(1): 79-90 Jansen, L. and Sulmassy, D. (2002). Sedation, alimentation, hydration and equivocation: Careful conversation about care at the end of life [PDF file, size 74 KB]. Annals of Internal Medicine, 136:845-849. Olsen, M.L. MD, et al (and others), Ethical decision making with end-of-life care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments, Mayo Clinic Proc. 2010 October (85):10 949-954. Vanier, J and Card, H (2016). In assisted dying, remember this: we are all fragile.T he Globe and Mail, March 1, 2016.

Optional

Saito, E. et al (and others) (2011) Hospice Care and Survival Among Elderly Patients With Lung Cancer. Journal of Palliative Medicine. 929-939.The Suicide Tourist This video discusses the decision of one man suffering from non-terminal ALS who chooses to travel to Switzerland to commit assisted suicide.

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Required

WGBH Educational Foundation (2012). Frontline: The Suicide Plan [Video file, 1:23:41 min]. Discusses Final Exit—Assisted Suicide ‘cult’ that is gaining interest around the country. Szabo, L. (2011). Palliative care prolongs life, reduces suffering [Article contains video file, 4:23 min]. USA TODAY. The video embedded in the article is optional for viewing. However, the article is required. Oregon Health Authority. (1997). Oregon revised statute: Death with dignity act (Chapter 127). Although you are welcome to peruse the website and read the statute in the entirety, you are only required here to focus upon rules: 127.800 s.1.01. Definitions - 127.875 s.3.13. Insurance or annuity policies. Note: Although there are a few minor distinctions, both the Oregon Statute and the Washington Death with Dignity Act are significantly the same. Oregon Public Health Division. (2015). Department of Public Health, Annual Report on Oregon's Death with Dignity Act (2015) [PDF file, size 210 KB]. Scan through the report to get an idea on how the statistics are compiled and trends recorded

6 of 11 7 Allocation of Read: M7A1: Case M7D1: A Pandemic is Resources Study – not a Game Required Student Choice

Biddson, L. et. Al (2014). Ethical Considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement [PDF file, size 607 KB]. Chest, 146(4_Suppl), e145S-e155S. A pandemic is not a game - and here's a game to prove it [PDF file, size 216 KB ]H. ealth Progress, 90(5), 53-5. Krütli, P., Rosemann, T., Törnblom, K. Y., & Smieszek, T. (2016). How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People. Plos ONE, 11(7), 1-18.

Please read this seminal/sentinel article by Kushner

Kushner, W., Pollard, J., & Ezeji-Okoye, S. (2007). Ethical triage and scarce resource allocation during public health emergencies: tenets and procedures. Hospital Topics, 85(3), 16-25. Morris, A. M., Ricci, K. A., Griffin, A. R., Heslin, K. C., & Dobalian, A. (2016). Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives. BMC Emergency Medicine, 161-7.

Please read this seminal article by Persad

Persad, G., Wertheimer, A. and Emanuel, E. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373:423-31 Quadri, F., Mazer-Amirshahi, M., Fox, E. R., Hawley, K. L., Pines, J. M., Zocchi, M. S & May, L. (2015). Antibacterial Drug Shortages From 2001 to 2013: Implications for Clinical Practice. Clinical Infectious Diseases, 60(12), 1737-1742. Rogoff, P. M. (2012). Unpredictable Drug Shortages: An Ethical Framework for Short-Term Rationing in Hospitals. American Journal Of Bioethics, 12(1), 1-9.

Case Analysis Readings for Case Study: Student Choice assignment

Choice #1: Dax Cowart Choice #2: Terri Shiavo

The articles and video listed below are provided to assist you with completing the Terri Shaivo assignment. While you are welcome to use other sources as well, it is not necessary.

Terri Schiavo Documentary: Enduring Legacy | Retro Report | The New York Times The Module Notes of Modules 1 – 5 Cyranoski, D. (2012). The mind reader. Nature, 456, 178-180. Ditto, P. (2006). What would Terri want? On the psychological challenges of surrogate decision making. Death Studies. 30(2), 135-148. Retrieved on October 13, 2010 from Academic Search Premier database Fins, J. (2009). Brain injury: the vegetative and minimally conscious states. Garrison,N Y (New York): The Hastings Center, Bioethics Briefing Book. Mathes, M. (2005). Terri Schiavo and end-of-life decisions: Can law help us out? MEDSURG Nursing. 41(3), 200-202. Perry, J., Chruchill, L. R. & Kirshner, H.S. et al (and others). (2005). The : Legal, ethical, and medical perspectives. Annals of Internal Medicine. 143(10), 744-748. Preston, T. & Kelly, M. (2006). A medical ethics assessment of the case of Terri Schiavo. Death Studies. 30(2), 121-133. Swetz, Keith M. Burkle, Christopher, & Berge , K.e t al (and others). (2014) Ten common Questions (and their answers) on Medical Futility. Mayo Clinic Proceedings. 89.7 943 – 59.

7 of 11 8 Beginning of Read: M8J1: Journal M8D1: Reformed Life Issues Reflection Eugenics? Required

ACOG (American Congress of Obstetricians and Gynecologists).(2016). Refusal of medically indicated treatment during : Committee Opinion [PDF file, size 122 KB], Obstetrics and Gynecology, 127, e-175-182. Ashe, A. and Stubblefield, A. (2010). Good intentions: bad decisions.A merican Journal of Bioethics, 10(1), 46-48. Brione, R. (2015). To what extent does or should a woman's autonomy overrule the interests of her baby? A study of autonomy related issues in the context of cesarean section. The New Bioethics, 21(1), 71-86. Cheyney, M., Burcher, P and Vedam, S. (2014). A crusade against home birthB. irth, 41(1), 1- 4. Retrieved from: https://www.researchgate.net/publication/261030340_A_Crusade_Against_Home_Birth Diekma, D and Fost, N. (2010). Ashley revisited: A response to the critics.A merican Journal of Bioethics, 10 (1), 30-44. Hutton, E. et al (and others). (2016). Outcomes associated with planned place of birth among women with low risk . Canadian Medical Association Journal (CMAJ), 188(5), E80-90. Insogna, I. and Fiester, A. (2015). Sterilization as a last resort in women with intellectual disabilities: protection or disservice. American journal of Obstetrics and Gynecology, 212(1), 34-36e1. Liao, S., Savulescu, J., & Sheehan, M. (2007). The Ashley Treatment: Best Interests, Convenience, and Parental Decision-Making. Hastings Center Report, 37(2), 16-20. Lyons, B (2010). The limits of parental authority? American Journal of Bioethics, 10(1), 16-20. McCullough, L et al (and others). (2016). Ethics and professional responsibility: Essential dimensions of planned home birth. Seminars in Perinatology, 40 (4), 222-226. Shannon, S. E., & Savage, T. A. (2007). The Ashley Treatment: Two Viewpoints. Pediatric Nursing, 33(2), 175-178.

Optional

Procon.org. (n.d.), Pro & Con Arguments: should abortion be legal. Kerruish, N. and McMillan, J. (2015). Parental reasoning about growth attenuation therapy: report of a single case study. Journal of Medical Ethics, 41:745-749.

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Required

CBS (2012).New Prenatal Test creates ethical and political fallout [Video file, 7:09 min]. Transcript [DOCX file, size 18 KB]. Brief interview with Paul Root Wolpe about ethical implications of prenatal testing Johar, Majid. (March 23, 2015).Incredible Real Photography of the journey from a sperm to human baby- Developing in the womb[Video file, 3:16 min]. This short clip is neither pro-choice nor pro-life, but merely a fascinating fact-based video of human development from conception to birth.

The course schedule

 Evaluation

Grade Ranges

A = 90-100%

B = 80-89%

C = 70-79%

D = 60-69% 8 of 11 F = below 60% Breakdown

Activity/Assessment % of final grade

Participation in Course 35% Discussion

Journal entry 5%

Ethical Issues Paper 30%

Case Analysis: Student choice 30%

Total 100%

The grade breakdown

Criteria COURSE REQUIREMENTS

Course Activities:

Before beginning your course work, be sure to review the Excelsior College Guidelines for Online Interaction (http://www.excelsior.edu/netiquette) (a.k.a. Online Etiquette or “Netiquette”). If you have any questions regarding these guidelines, please feel free to direct them to your instructor.

Discussions – 35% Discourse and articulation of ideas are critical components of ethical care for all. As such, this course is heavily focused on discussion. The course discussions serve as a way to gauge your understanding of the module topic as well as to facilitate an open discussion with fellow students and your instructor. You are responsible for participating in each discussion, which will be graded on discussion content, quality, and frequency of discussion posts. Once the discussion board is closed, you will not be able to post for grade credit. Any missed discussions will be taken into consideration when calculating grades. Please see your discussion rubric to understand what is expected of you.

Reflective Journal – 5%

There is ONE required journal due in Module 1. The journal is a private communication submitted to your instructor.

Ethical Issues Paper – 30%

For this paper you will develop a response to a hypothetical ethical dilemma and demonstrate an appropriate ethical decision- making process. The case scenario includes various social problems which you will identify as well as ethical dilemmas to which you will apply ethical principles, theories, and decision-making processes.

Case Study: Student Choice – 30%

There are two case studies you will choose between for this assignment. These are comprehensive cases and allow you to analyze the landmark case of your choosing. The first choice is the case of Dax Cowart. The second choice is the case of Terri Schiavo.

FORMATTING AND STYLE FOR WRITTEN ASSIGNMENTS:

9 of 11 All assignments (the Case Studies and the Op-Ed essay) should include a title page (assignment title, your name, class, date and instructor’s name), APA (American Psychological Association) formatted inline citations as appropriate and a bibliography for any references used. You may list your references for each question at the end of the individual response, or as one compiled bibliography.  Institutional Policies

STUDENT PARTICIPATION

Weekly course participation is required. Please see the Student Participation Policy (https://info.excelsior.edu/student- policies/student-participation-policy-for-online-courses/) for more details.

INSTRUCTOR PARTICIPATION

Your instructor will:

Post a welcome message during the first 24 hours of the course. Schedule real time office hours through Canvas tools and/or by individual appointment. Communicate with you through the Canvas communication tools, including internal course messaging. Respond to student communications within two business days. Log into the course to review and participate at least three different days a week in 15-week courses, or four different days a week in 8-week courses. Provide you with formative feedback midway through the course based on work submitted to that point. Grade all formative assignments within 7 business days in 15-week courses and 4 business days in 8-week courses, and will grade final summative work within 5 business days after the end of the term.

LATE ASSIGNMENT POLICY

All assignments (e.g. papers, projects, etc.) are expected to be submitted on time. If unplanned or extenuating* circumstances prevent on time submission, then students should follow these guidelines:

Contact your instructor with details about the extenuating circumstances if you are requesting permission to submit late. If a student submits an assignment late without permission, it will not be graded until the student communicates with the instructor. If there is no communication with the instructor before the assignment grade is due, a grade of zero will be assigned. The first late submission in the course will be accepted and graded without penalty up to 5 days after the due date. After 5 days of no submission, the instructor may assess a late penalty of 5 percent per day. All subsequent late assignments may be assessed a late penalty of 5 percent per day, starting on day one. There will be no 5-day grace period. This policy does not pertain to discussion posts. Please review the course specific discussion rubric for further guidance. Please note that course structure may result in exceptions to the late policy. In this case, the instructor will either clarify or arrange guidelines for submission of assignments with the student(s). No work will be accepted after the final day of the term unless an official course extension has been granted. Excelsior College Extension Policy (https://www.excelsior.edu/policy/course-extensions/)

LATE QUIZ/EXAM POLICY

It is recommended students begin quizzes and exams prior to 9:00 PM Eastern Time. All quizzes and exams must be completed by 11:59 PM Eastern Time. Most quizzes and exams are automatically submitted at 11:59 Eastern Time. If you have unplanned circumstances that prevent you from completing, please contact your instructor. Please note that some course differences and certain circumstances may result in exceptions to the quiz/exam policy. Your grade will be based on completed work. Students with prior approval for accommodations must plan their start time accordingly. If you have questions, please contact your instructor. Extenuating circumstances* are considered without penalty.

* Some types of extenuating circumstances that will be considered, if they prevent the student from completing the assignment or assessment on time, are the following:

an illness or injury a death of a family member or significant other

10 of 11 a significant change in employment or military status a trauma in the student’s life technical issues a natural disaster Assistance to Students in Disaster and Emergency Areas (https://www.excelsior.edu/policy/assistance-to- students-in-disaster-and-emergency-areas/) unplanned events Please note: What will not be considered are some planned events such as weddings, vacations, etc.

Documentation for extenuating circumstances may be required.

ACADEMIC INTEGRITY

Cheating and Plagiarism

Academic Integrity is a valued part of your education, and the college expects you to submit work that is your own. Intentional plagiarism, and online cheating, including the purchasing of papers or sharing course materials, examinations or quizzes with outside vendors/websites in an unauthorized manner is a serious offense. To ensure the high standards of the college are upheld, all work will be processed through anti-plagiarism software available in the course. Please see the policy on Academic Integrity (https://www.excelsior.edu/policy/academic-integrity/) for more details. We want you to be successful! If you need assistance in writing a paper or studying, please contact your course instructor or advisor.

Copyright Protections

In addition, you should be aware that content in Excelsior College courses is owned by the College or third parties and is typically subject to some form of copyright protection. Therefore, these materials may only be used by you for educational purposes as part of your participation in Excelsior College courses. It is your responsibility to properly use the information and materials in each course.

GENERAL POLICIES

You are responsible for being familiar with all the policies that are related to your activity in this course. Complete information on Excelsior College policies can be found in your course or by visiting Excelsior College Policies (https://www.excelsior.edu/policies/).

Technology Requirements

Please be sure to review System Requirements and Required Software (http://help.excelsior.edu/system-requirements-and-required- software/). This is especially important if you are taking a course that contains any interactive components, such as games and simulations.

Accessibility

Accessibility statements for each technology utilized within a course can be found on this Technology Accessibility (https://www.excelsior.edu/page/accessibility/) page. If you have questions on the accessibility of technologies, contact Accessibility Services (https://www.excelsior.edu/support-resources/accessibility-services/).

Privacy on External Websites

In some courses, the use of applications or certain websites may require providing personal information. Click each link to view the application’s privacy statement.  Additional Items

This course contains the technologies listed below. Click each link to view each technology’s accessibility statement.

Canvas Learning Management System (http://info.excelsior.edu/accessibility/canvas) Microsoft Word (http://info.excelsior.edu/accessibility/word-2013) YouTube (http://info.excelsior.edu/accessibility/youtube) Vimeo (http://info.excelsior.edu/accessibility/vimeoplayer)

View more information about Disability Services (http://www.excelsior.edu/disability-services).

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