Background: This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation. Objectives: After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated. Research design: In addition to the regular online module evaluation, specific questions (...) referring to the teaching of ethical theories were added using simple (yes/no) and Likert rating answer formats. Participants and research context: At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey. Ethical considerations: The survey was voluntary and anonymous. Students were free to write their name and additional comments. Findings: Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice. Discussion: Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem. Conclusion: The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. (shrink)

The COVID-19 pandemic crisis has had profound effects on global health, healthcare, and public health policy. It has also impacted education. Within undergraduate healthcare education of doctors, nurses, and allied professions, rapid shifts to distance learning and pedagogic content creation within new realities, demands of healthcare practice settings, shortened curricula, and/or earlier graduation have also challenged ethics teaching in terms of curriculum allotments or content specification. We propose expanding the notion of resilience to the (...) field of ethics education under the conditions of remote learning. Educational resilience starts in the virtual classroom of ethics teaching, initially constituted as an “unpurposed space” of exchange about the pandemic’s challenging impact on students and educators. This continuously transforms into “purposed space” of reflection, discovering ethics as a repertory of orientative knowledge for addressing the pandemic’s challenges on personal, professional, societal, and global levels and for discovering (and then addressing) that the health of individuals and populations also has moral determinants. As such, an educational resilience framework with inherent adaptability rises to the challenge of supporting the moral agency of students acting both as professionals and as global citizens. Educational resilience is key in supporting and sustaining professional identify formation and facilitating the development of students’ moral resilience and leadership amid moral complexity and potential moral transgression—not only but especially in times of pandemic. (shrink)

Viewing difficulty as an opportunity for learning runs counter to the common view of difficulty as a source of frustration and confusion. The aim of this article is to focus on the idea of difficulty as a stepping-off point for learning. The literature on difficulty in reading texts, and its impact on thinking and the interpretive process, serve as a foundation for the use of poetry in healthcare ethics education. Because of its complexity and strangeness compared to (...) the usual scientific and clinical texts health science students encounter, poetry is an excellent means to achieve the aim of thinking through difficulties in ethics. Specific examples of teaching and learning strategies for turning difficulty into opportunities for learning are presented, including the difficulty paper and the triple mark-up method. Both methods require students to examine their process of working through difficulties, reflect on how they make sense of difficult texts and then share their process and interpretations in a collaborative manner with peers. The importance of framing difficulties as a public, visible, collaborative process rather than a personal process is emphasized. Working together to hypothesize reasons for difficulty and map out plans to come to terms with difficulty are equally relevant for reading text as they are for reading complex ethical situations. Finally, I argue that transference of this kind of personal and collaborative learning about difficulties benefits interprofessional clinical practice, particularly when dealing with ethical issues. (shrink)

BackgroundEthical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the available literature regarding (...) ethics education that promotes ethical competence learning for healthcare professionals and students undergoing training in healthcare professions.MethodsIn this integrative systematic review, literature was searched within the PubMed, CINAHL, and PsycInfo databases using the search terms ‘health personnel’, ‘students’, ‘ethics’, ‘moral’, ‘simulation’, and ‘teaching’. In total, 40 articles were selected for review. These articles included professionals from various healthcare professions and students who trained in these professions as subjects. The articles described participation in various forms of ethics education. Data were extracted and synthesised using thematic analysis.ResultsThe review identified the need for support to make ethical competence learning possible, which in the long run was considered to promote the ability to manage ethical problems. Ethical competence learning was found to be helpful to healthcare professionals and students in drawing attention to ethical problems that they were not previously aware of. Dealing with ethical problems is primarily about reasoning about what is right and in the patient’s best interests, along with making decisions about what needs to be done in a specific situation.ConclusionsThe review identified different designs and course content for ethics education to support ethical competence learning. The findings could be used to develop healthcare professionals’ and students’ readiness and capabilities to recognise as well as to respond appropriately to ethically problematic work situations. (shrink)

Background The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues. Aim To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme ( EOLCSS) on the moral development of healthcare staff who are delivering end-of-life care. Methods The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect (...) on moral reasoning was measured pre and post education using the Defining Issues Test 2 (DIT2). Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables. Results Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning. Conclusions Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

ChatGPT has taken the academic community by storm (Cotton, Cotton, and Shipway 2023; Cox and Tzoc 2023; Sullivan, Kelly, and McLaughlan 2023). Since its release in November 2022, chatGPT has predic...

This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to (...) gather feedback on the framework’s strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework. (shrink)

Healthcare ethics consultation is therefore one of the most consequential, institutionally accepted, and widespread forms of public philosophy in the United States. In this chapter, the authors begin with an overview of the development of healthcare ethics and its emergence as a concrete practice embedded in healthcare settings. They then describe the core ethical principles that inform the everyday practice of ethics consultations and the generally accepted steps involved in conducting a consultation. The authors (...) discuss the role of clinical ethicists in medical education and policy development. Finally, they conclude with some remarks on the distinctive contributions made by those with philosophical training to these endeavors and the importance of continued engagement by philosophers in this important public work. (shrink)

The past decade has witnessed a shift in the ambitions of pharmacists away from the core role of dispensing medicines towards more interesting and rewarding relationships and responsibilities with other healthcare providers and patients. The patient-centred role of pharmacists has allowed ethical issues experienced in medical practice to surface in pharmacy practice, resulting in an increase in the number and variety of ethical dilemmas that pharmacists face in their routine pharmacy practice. Pharmacy education prepares pharmacy students for practice (...) and must be in tune with the professional dynamics. Many countries that provide patient-centered pharmacy services have redesigned pharmacy ethics education while others are in various stages of revision of their curriculum in order to adequately equip future pharmacists with the rudiments required to handle ethical issues in clinical pharmacy practice. In contrast, in Nigeria, little or no pharmacy ethics is taught to pharmacy students and the challenge lies with the curriculum design and method of teaching. (shrink)

The unique context of the rural setting provides special challenges to furnishing ethical healthcare to its approximately 62 million inhabitants. Although rural communities are widely diverse, most have the following common features: limited economic resources, shared values, reduced health status, limited availability of and accessibility to healthcare services, overlapping professional–patient relationships and care giver stress. These rural features shape common healthcare ethical issues, including threats to confidentiality, boundary issues, professional–patient relationship and allocation of resources. To date, there (...) exists a limited focus on rural healthcare ethics shown by the scarcity of rural healthcare ethics literature, rural ethics committees, rural focused ethics training and research on rural ethics issues. An interdisciplinary group of rural healthcare ethicists with backgrounds in medicine, nursing and philosophy was convened to explore the need for a rural healthcare ethics agenda. At the meeting, the Coalition for Rural Health Care Ethics agreed to a definition of rural healthcare ethics and a broad-ranging rural ethics agenda with the ultimate goal of enhancing the quality of patient care in rural America. The proposed agenda calls for increasing awareness and understanding of rural healthcare ethics through the development of evidence—informed, rural-attuned research, scholarship and education in collaboration with rural healthcare professionals, healthcare institutions and the diverse rural population. (shrink)

Background Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. Research Objective The aim of this research is (...) to explore the influence of a structured self-assessment tool called the ESA “Engagement Self-Assessment” on the alignment and creation of a brave space in a nursing ethics course. Research Design This study used an exploratory, cross-sectional survey design. Participants and Study Setting Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. Ethical Considerations Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). Findings The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual “commitment to others.” Conclusion A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space. (shrink)

Background: Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center. Research objectives: The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide (...) ethics program. Research design: This study was a quasi-experimental design with seniors graduating prior to the intervention serving as the control group. Participants and research context: The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention. Ethical considerations: Study materials for each survey were submitted to the university’s IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential. Findings: Students’ perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students’ overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators. Discussion: After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric. Conclusion: Examination of the effectiveness of each part of the intervention is needed. (shrink)

Teaching ethics is crucial to health sciences education. Doing it well requires a willingness to engage contentious social issues. Those issues introduce conflict and risk, but avoiding them ignores moral diversity and renders the work of ethics education irrelevant. Therefore, when (not if) contentious issues and moral differences arise, they must be acknowledged and can be addressed with humility, collegiality, and openness to support learning. Faculty must risk moments when not everyone will “feel safe,” so the (...) candor implied in psychological safety can emerge. The deliberative and social work of ethics education involves generous listening, wading into difference, and wondering together if our beliefs and arguments are as sound as we once thought. By forecasting the need for candid engagement with contentious issues and moral difference, establishing ground rules, and bolstering due process structures for faculty and students, a riskier and more relevant ethics pedagogy can emerge. Doing so will prepare everyone for the moral diversity they can expect in our common life and in practice. (shrink)

:This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand’s medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the “professionalism” and “professional development” in medical curricula.

A common financial model used in business decisions is the cost/benefit comparison. The costs of a proposed project are compared with the benefits, and if the benefits outweigh the costs, the project is accepted; if the costs exceed the benefits, the project is rejected. This model is applicable when tangible costs and benefits can be reasonably measured in monetary units. However, it is difficult to consider intangible factors in this model because intangible factors cannot be readily quantified in money.While some (...) might argue that the financial model should not apply to healthcare decisions, the fact is that costs do enter into the picture. People may decide to forego needed healthcare because they cannot afford it. Healthcare providers may make choices based in part on the costs of diagnosis and treatment, rather than solely on medical information and what is best for the patient. Should financial issues enter into healthcare decisions – decisions about human health and well being? If so, how should the costs and benefits be measured and evaluated? What are some ethical issues and dilemmas involved in such decisions? (shrink)

While 4E approaches to cognition are increasingly introduced in educational contexts, little has been said about how 4E commitments can inform pedagogy aimed at fostering ethical competencies. Here, we evaluate a 4E-inspired ethics exercise that we developed at a technical university to enliven the moral imagination of engineering students. Our students participated in an interactive tinkering workshop, during which they materially redesigned a healthcare artifact. The aim of the workshop was twofold. Firstly, we wanted students to experience how (...) material choices at the levels of design and functionality can enable morally significant reimaginings of the affordances commonly associated with existing artifacts. We term this type of reimagining world-directed moral imagination. Secondly, through the design process, we wanted students to robustly place themselves in the lived embodied perspectives of (potential) users of their selected artifacts. We term this person-directed moral imagination. While student testimonies about the exercise indicate that both their world-directed and person-directed moral imagination were enlivened, we note that the fostering of robust person-directed moral imagination proved challenging. Using 4E insights, we diagnose this challenge and ask how it might be overcome. To this end, we engage extensively with a recent 4E-informed critique of person-directed moral imagination, raised by Clavel Vázquez and Clavel-Vázquez (2023). They argue that person-directed moral imagination is profoundly limited, if not fundamentally misguided, particularly when exercised in contexts marked by emphatic embodied situated difference between the imaginer and the imagined. Building upon insights from both the 4E field and testimonies from critical disability studies, we argue that, while their critique is valuable, it ultimately goes too far. We conclude that a 4E approach can take on board recent 4E warnings regarding the limits of person-directed moral imagination while contributing positively to the development of moral imagination in engineering ethics education. (shrink)

Healthcare ethics has become part of the standard curriculum of students in the health professions. The goals of healthcare ethics education are to give students the skills they need to identify, assess, and address ethical issues in clinical practice and to develop virtuous practitioners. Incorporating the medical humanities into medical school, for example, is intended to foster empathy and professionalism among students and to provide mechanisms for enhanced physician well-being. Yet, despite the long-standing inclusion of (...) the humanities in nursing curricula, increases in the amount and kinds of scientific knowledge essential for clinical practice has resulted in the erosion of the “humanistic arts” from nursing education. One potential solution to this challenge comes with the increase in interprofessional education, where students in a variety of healthcare professions programs come together to learn about issues common to all healthcare fields. (shrink)

Clinical ethics training programs are responsible for preparing their trainees to be competent ethics consultants worthy of the trust of patients, families, surrogates, and healthcare professionals. While the American Society for Bioethics and Humanities (ASBH) offers a certification examination for healthcare ethics consultants, no tools exist for the formal evaluation of ethics trainees to assess their progress toward competency. Medical specialties accredited by the Accreditation Council for Graduate Medical Education (ACGME) use milestones to (...) report trainees’ progress along a continuum of professional development as a means of “operationalizing and implementing” medical competencies. Utilizing the Core Competencies for Healthcare Ethics Consultation and the ACGME and American Board of Pediatrics’ (ABP) Pediatric Milestones Project, we developed milestones for 17 subcompetencies in clinical ethics consultation and academic bioethics. As the field of clinical ethics becomes more standardized, such tools will be needed to promote the development of robust training programs and to certify that their graduates are competent practitioners. (shrink)

While the use of archives is common as a research methodology in the history and philosophy of science, training in archival methods is more often encountered as part of graduate-level training than in the undergraduate curriculum. Because many HPS instructors are likely to have encountered archival methods during their own research training, they are uniquely positioned to make effective pedagogical use of archives in classes comprised of undergraduate science students. Further, because doing this may require changing the way HPS instructors (...) think about the aims and varieties of archival research, archivists themselves can be valuable resources in developing archives-based learning activities for science students in HPS classrooms. In this article, we describe an archives-based learning activity developed for a population of primarily pre-medical students in a healthcare ethics class and discuss the pedagogical benefits of this activity. This activity was developed via a collaboration between an HPS instructor and an education archivist. Our hope is that this discussion may serve both as a proof of concept for the use of archives-based learning activities as tools for teaching HPS to science students, and as an argument for the unique benefits that archival engagement can impart to science students. (shrink)

As part of a project to examine health care ethics consultation in Canada, we surveyed individuals who were considered by themselves or others to play a significant role in health care ethics consultation. Since one goal of the project was to examine the education and abilities necessary for consultants, we sought to determine the qualifications and skills currently possessed by persons considered to be ethics consultants. For the purposes of the questionnaire, health care ethics consultation (...) was defined broadly to include consultation on ethical issues in clinical care or in clinical research, ethics consultation to Clinical Ethics Committees, Research Ethics Committees, and policy formulation committees in health care institutions; clinical ethics work was defined more broadly still to include, in addition to the above, ethics education, administration, research and writing on bioethics other than the above, and public speaking.Three hundred and fifty questionnaires were sent to individuals and institutions across Canada that were thought to have some involvement in health care ethics consultation. Two hundred and fifty-three questionnaires were returned for a response rate of 72%. This report presents initial findings of the study and attempts to provide a comprehensive overview of the current state of ethics consultation within Canada. The survey examines demographics, educational background, time spent on ethics, institutional affiliations, approaches to the role of consultation, research related issues, and attitudes toward certification. (shrink)

Holocaust education is important for learning how healthcare has been leveraged to influence social change in the past and how it can be used to advocate for ethical social change in the future. By understanding how medical professionals became the social and political leaders of Nazi Germany, today’s health professionals can learn how to avoid unethical politicization. By understanding how early twentieth century discourse on medico-social issues used terms and language that are similar, if not the same, as (...) today’s debates, proponents of different sides of these debates can understand the troubling subtexts and potential consequences of their – and the opposing side’s – positions. (shrink)

Background: Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress. Objectives: The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs’ experiences of (...) ethical issues. Methods: Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home. Findings: The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work. Conclusions: The review highlighted a need for improved ethics education for care-providers. (shrink)

:A common goal of ethics education is to equip students who later become health practitioners to not only know about the ethical principles guiding their practice, but to also autonomously recognize when and how these principles might apply and assist these future practitioners in providing care for patients and families. This article aims to contribute to discussions about ethics education pedagogy and teaching, by presenting and evaluating the use of the visual arts as an educational approach (...) designed to facilitate students’ moral imagination and independent critical thinking about ethics in clinical practice. We describe a sequence of ethics education strategies over a 3 year Doctor of Physiotherapy program, focusing on the final year professional ethics assessment task, which involved the use of visual arts to stimulate the exploration of ethics in healthcare. The data were analyzed using both thematic and content analysis. Two key themes centered on emotional responses and lateral thinking. The use of artwork appeared to facilitate imaginative, emotional, and conceptual thinking about ethics and clinical experience. This study provides some evidence to support the effectiveness of the use of the visual arts in promoting students’ recognition of ethical dimensions within their clinical experience and reflection on their emerging professional identity. As one student noted, she left the museum “somewhat changed.”. (shrink)

What is health policy for? In Health and the Good Society, Alan Cribb addresses this question in a way that cuts across disciplinary boundaries. His core argument is that biomedical ethics should draw upon public health values and ethics; specifically, he argues that everybody has some share of responsibility for health, including a responsibility for promoting greater health equality. In the process, Cribb argues for a major rethink of the whole project of health education.

Research question and aim Clinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020, a CEC was established in an Oncology Research Hospital in the North of Italy. This paper describes the development process and the activities performed 20 months from the CEC’s implementation, to increase knowledge about CEC’s implementation strategy. Research design We collected quantitative data related to number and characteristics of CEC (...) activities carried out from October 2020 to June 2022 using the CEC internal database. Data were reported descriptively and compared with data from the literature to provide a complete overview of the CEC’s development and implementation process. Participants and research context The study has been conducted at the local health authority (LHA) of Reggio Emilia. It is a report of the activities provided by the CEC, where no HPs or patients were involved. Ethical Considerations The report is part of a larger study named EVAluating a Clinical Ethics Committee implementation process (EvaCEC), which has been approved by the Local Ethics Committee (AUSLRE Protocollo n° 2022/0026554 of 24/02/2022). EvaCEC is also the first author's PhD project. Findings In total, the CEC performed 7 ethics consultations (EC), published three policies related to particular ethical questions of clinical and organizational practice, provided one educational online course on ethics consultation targeting employed HPs, and promoted a specific dissemination process among the different departments of the LHA. According to our results, the CEC widely fulfilled the standard threefold set of clinical ethics support services tasks (namely, ethics consultation, ethics education, and policy development), but further investigations are needed to evaluate the CEC’s impact on clinical practice. Conclusion Our findings may increase knowledge regarding the composition, role, and tasks of a CEC in an Italian setting, informing future strategies and efforts to regulate these institutions officially. (shrink)

In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students’ experiences and their stories.

It is time for the noon conference. Your job is to impart a career-changing experience in ethics to a group of students and interns gathered from four different schools with varying curriculums in ethics. They have just finished 1½ h of didactic sessions and lunch. One third of them were on call last night. Your first job is to keep them awake. The authors argue that this “tragic case” approach to ethics education is of limited value (...) because it limits understanding of moral problems to dilemmas; negates the moral agency of the student; encourages solutions that are merely intellectual; and suggests that ethical encounters are a matter for experts. The authors propose an alternative that focuses on three issues: the provider-patient relationship, the relationships between providers in the everyday world of health work and, the social position of healthcare providers in society. In this approach, teachers are not experts but more like guides on a journey who help students to learn that much of ethical practice comprises living through difficult situations of caring for vulnerable others and who help students to navigate some of these difficulties. (shrink)

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees, almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

Background: The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions. Objectives: To examine ethics interventions (...) conducted on healthcare professionals and healthcare students to achieve ethics-related outcomes. Research design: A systematic review. Methods: Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis. Ethical consideration: This systematic review was conducted following good scientific practice in every phase. Findings: It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics. Conclusion: Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals. (shrink)

This book is open access under a CC BY 4.0 license. This book examines the current state of elective placements of medical undergraduate students in developing countries and their impact on health care education at home. Drawing from a recent case study of volunteer deployment in Uganda, the authors provide an in-depth evaluation of the impacts on the students themselves and the learning outcomes associated with placements in low resource settings, as well as the impacts that these forms of (...) student mobility have on the host settings. In addition to reviewing the existing literature on elective placements, the authors outline a potential model for the future development of ethical elective placements. As the book concurs with an increasing international demand for elective placements, it will be of immediate interest to universities, intermediary organizations, students as consumers, and hosting organisations in low-resource settings. (shrink)

Conventional medical training offers little help to students to resolve the ethical dilemmas they face as healthcare professionals. Public awareness of the ethical behavior of medical practitioners has been growing. Aim of this study was to assess knowledge of, practice in and attitudes of healthcare ethics among medical, dental and physiotherapy postgraduate students. A cross-sectional analysis based on a questionnaire was performed at a hospital and dental institution of the medical college. The present study included 60 postgraduate (...) students. The questionnaire on health care ethics is a 44-point self-administered standardized questionnaire that poses ethical dilemmas in 5 vignettes with closed-ended questions to test awareness, attitude and experience in the area of healthcare ethics. In the first half of the questionnaire, knowledge and attitude were assessed using 5 case scenarios representing ethical dilemmas and the participants answered the questions using the 5 point likert scale. The second half assessed the practice of Ethics in research and clinical practice. The expected time to fill each questionnaire was about 10–15 min. 62 questionnaires were distributed. 60 completed questionnaires were returned. The response rate was 96%. The mean age of the postgraduates was 26.23 ± 2.33. Among the participants 28 were male and 32 female. 20 completed questionnaires from each, medical, dental and physiotherapy postgraduate students were collected. The multiple group comparison showed that the difference in the knowledge scores were statistically significant between dental and physiotherapy and between medical and physiotherapy but no significant difference between medical and dental. Study suggests that abstract knowledge cannot be converted into practical knowledge automatically. There is a major lack of knowledge of the ethics of health care among graduate students. The postgraduate curriculum must include a good mix of both theoretical concepts and practical application of multidisciplinary healthcare ethics ethical principles and guidelines. (shrink)

Medical ethics education is crucial for medical students and trainees, helping to shape attitudes, beliefs, values, and professional identities. Exploration of ethical dilemmas and approaches to resolving them provides a broader understanding of the social and cultural contexts in which medicine is practiced, as well as the ethical implications of medical decisions, fostering critical thinking and self-reflection skills imperative to providing patient-centered care. However, exposure to medical ethics topics and their clinical applications can be limited by curricular (...) constraints and the availability of institutional resources and expertise. Podcasts, among other Free Open Access Medical Education (FOAMed) resources, are a novel educational tool that offers particular advantages for self-directed learning, a process by which learners engage in asynchronous educational opportunities outside of traditional academic or clinical settings. Podcasts can be readily distributed to wide audiences and played at any time, reducing barriers to access and offering a level of flexibility that is not possible with traditional forms of education and is well-suited to busy schedules. Podcasts can also use real voices and storytelling to make the content memorable and eminently human. This paper describes the development, production process, and impact of Core IM’s “At the Bedside,” a podcast focusing on issues in medical ethics and the medical humanities, intending to supplement standard bioethics curricula in an accessible, relevant, and engaging way. The authors advocate for broad incorporation of podcasts into medical ethics education. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics (...) class='Hi'>education might be causing them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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Background There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods In January 2018, following the successful implementation of (...) a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/ MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results The majority of respondents were female, white and mid-20s in age. Almost half of respondents reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos. (shrink)

Ethics education is recognized as an integral component of health professionals’ education and has been occurring in various guises in the curricula of health professional training in many countries since at least the 1970s. However, there are a number of different aims and approaches adopted by individual educators, programs, and, importantly, different health professions that may be characterized according to strands or trends in ethics education.

Healthcare institutions have been making increasing efforts to standardize consultation methodology and to accredit both bioethics training programs and the consultants accordingly. The focus has traditionally been on the ethics consultation as the relevant unit of ethics intervention. Outcome measures are studied in relation to consultations, and the hidden assumption is that consultations are the preferred or best way to address day-to-day ethical dilemmas. Reflecting on the data from an internal quality improvement survey and the literature, we (...) argue that having general ethics education as a key function of ethics services may be more important in meeting the contemporaneous needs of acute care settings. An expanded and varied ethics education, with attention to the time constraints of healthcare workers’ schedules, was a key recommendation brought forward by survey respondents. Promoting ethical reflection and creating a culture of ethics may serve to prevent ethical dilemmas or mitigate their effects. (shrink)

Currently, there is no authoritative credentialing process for individuals engaged in ethics practice, no accreditation system that sets minimum education standards for programs aiming to prepare these individuals for their work, and little evidence available that any particular training model is actually achieving its pedagogical goals. At the same time, a number of healthcare organizations and universities now routinely offer post-graduate programs, clinical fellowships and in-house training specifically devised to prepare graduates for ethics practice. However, while (...) their numbers appear to be growing, information about these programs is limited. In this paper, we describe the goals, content and strategies of three educational programs offered in Ontario, Canada. These case studies highlight the diversity of ethics education available to those who engage in ethics practice and underscore the need to take this variety into account in the development of future education standards that would specify minimally acceptable educational requirements. (shrink)

Ethics of Inclusion captures fairness and social justice for all from an ethical perspective in our post-pandemic world. The book discusses inequality in Healthcare, Economics & Finance, Education, Digitalization, and the Environment, in order to envision economics of diversity and a transition to a more inclusive society. A wide-ranging approach addresses issues of inequality in access to innovations such as telemedicine and artificial intelligence, economic gains of robotics, and big data insights. A rising performance gap between the (...) finance sector and the real economy opens in the post-COVID-19 era, with system-inherent inequality, given elevated inflation levels and disparate impacts of low interest rate regimes around the globe. Education offers social transfer hubs and inclusion potential for societal advancement and international development. The transition to a greener economy is addressed in an analysis of the Green New Deal and European Green Deal including the Sustainable Finance Taxonomy. The book sets out a hopeful agenda for equality and social justice to deliver a post-pandemic Renaissance. (shrink)

The European Biomedical Ethics Practitioner Education Project (EBEPE), funded by the BIOMED programme of the European Commission, is a five-nation partnership to produce open learning materials for healthcare ethics education. Papers and case studies from a series of twelve conferences throughout the European Union, reflecting the ‘burning issues’ in the participants' healthcare systems, have been collected by a team based at Imperial College, London, where they are now being edited into a series of seven (...) activity-based workbooks for individual or group study. These draft workbooks are now being read by a network of critical readers across Europe, whose comments will be incorporated into the final versions of the workbooks. The result will be the first European-wide and Europe-centred resource for teaching students, practitioners, and members of ethics committees. Topics covered include: • Resource allocation and rationing • The rights of children and young people • Long-term care of the elderly • Mental health and mental illness • Autonomy and patient choice • Decisions at the end of life • A study guide to using the workbooks The collaborative nature of the project has highlighted differentiated national approaches in medical ethics. Against the British and Dutch rights-orientated approach have emerged two other alternative models: the Nordic preference for administrative resolution of entitlement disputes, and the southern European emphasis on deontological codes. A genuinely European reconstruction of autonomy and rights, using hermeneutic, feminist and narrative approaches to counterbalance individualistic models, is emerging across the workbooks. The programme has also uncovered national differences in how ethics should be taught, with the workbooks' style being an experiential approach. Thus the EBEPE project is developing new models in both substantive and pedagogic senses, about both what should be taught and how it should be presented. (shrink)