Enteral nutrition in end of life care: the Jewish Halachic ethics.

PubMed

Greenberger, Chaya

2015-06-01

Providing versus foregoing enteral nutrition is a central issue in end-of-life care, affecting patients, families, nurses, and other health professionals. The aim of this article is to examine Jewish ethical perspectives on nourishing the dying and to analyze their implications for nursing practice, education, and research. Jewish ethics is based on religious law, called Halacha. Many Halachic scholars perceive withholding nourishment in end of life, even enterally, as hastening death. This reflects the divide they perceive between allowing a fatal disease to naturally run its course until an individual's vitality (life force or viability) is lost versus withholding nourishment for the vitality that still remains. The latter they maintain introduces a new cause of death. Nevertheless, coercing an individual to accept enteral nourishment is generally considered undignified and counterproductive. A minority of Halachic scholars classify withholding enteral nutrition as refraining from prolonging life, permitted under certain circumstances, especially in situations where nutritional problems flow directly from a fatal pathology. In the very final stages of dying, moreover, there is a general consensus that enteral nourishment may be withheld, providing that this reflects the dying individuals' wishes. In the event of enteral nourishment becoming a source of overwhelming discomfort, two Halachic ethical mandates would come into conflict: sustaining life by providing nourishment and alleviating suffering. As in all moral conflicts, these would have to be resolved in practice. This article presents the issue of enteral nourishment as it unfolds in Halacha in comparison to secular and other religious perspectives. It is meant to serve as a foundation for nurses to reflect on their own practice and to explore the implications for nursing practice, education, and research. In a world that remains broadly religious, it is important to sensitize health practitioners to the

Screening Jews and genes: a consideration of the ethics of genetic screening within the Jewish community: challenges and responses.

PubMed

Levin, M

1999-01-01

Screening for genetic disorders, particularly Tay-Sachs Disease, has been traditionally welcome by the Jewish community. I review the history of genetic screening among Jews and the views from the Jewish tradition on the subject, and then discuss ethical challenges of screening and the impact of historical memories upon future acceptance of screening programs. Some rational principles to guide future design of genetic screening programs among Jews are proposed.

Jewish holidays and their associated medical risks.

PubMed

Urkin, Jacob; Naimer, Sody

2015-02-01

Religiosity is inherent in human cultures. Being different in many aspects, all have rules regarding appropriate behavior and rituals. Celebrations of social events and of holidays prevail in all major religions. These include code of dress, prayers, special food and activities which may have negative health implications. The Jewish religion is 'blessed' with an abundance of holidays each with its unique health implications. In this paper we provide an outline of the character of these festivals and possible medical repercussions on those celebrating them. Observant members of the Jewish religion and teams treating this population should be knowledgeable of potentially associated risks. Pre-holiday periods should be specifically targeted for educational and preventive activity in order diminish injury or morbidity.

Current Jewish perspectives on maternal identity.

PubMed

Wolowelsky, Joel B; Grazi, Richard V

2014-01-01

Infertility counseling is a specialized field that will continue to grow in coming years as the impact of infertility and its treatment is documented more in terms of emotional, physical, social and life consequences. We report here on more recent developments in halakha (Jewish law and ethics) that are of importance to Orthodox Jewish infertile couple considering donor gametes or surrogacy. Counselors should anticipate issues that may arise in the future and assist couples in their efforts to address them. Good medical practice values the importance of understanding the patient's individual concerns and values, including the complex psychological, sociological and cultural context in which they experience their infertility. Good counseling anticipates and addresses future problems about which patients might not currently be aware, and requires up-to-date authoritative information.

[Medical ethics as professional ethics].

PubMed

Kwon, Ivo

2012-09-25

Contemporary medical ethics is far from the traditional concept of "In-Sul (benevolent art)" or "Yul-Li (倫, ethics), which emphasizes so much the personality or the character of a doctor. Nowadays, medical ethics should be considered as "professional ethics" which regulates the acts and medical practices of ordinary doctors in their daily practice. The key concepts of the professional ethics are "autonomy", "integrity", and "professional standard" established by medical organizations such as medical societies or associations. Most of Korean doctors have not been familiar with the concept of professional ethics or professionalism, which is due to the modern history of Korea. However, the concept of professional ethics is really critical to Korean doctors from the perspective of professional dignity and social respect to this profession. The current healthcare system of Korea is suffering from many problems of both private and public sector. Nonetheless, the professional ethics is urgently demanded for that very reason.

Students' medical ethics rounds: a combinatorial program for medical ethics education.

PubMed

Beigy, Maani; Pishgahi, Ghasem; Moghaddas, Fateme; Maghbouli, Nastaran; Shirbache, Kamran; Asghari, Fariba; Abolfat-H Zadeh, Navid

2016-01-01

It has long been a common goal for both medical educators and ethicists to develop effective methods or programs for medical ethics education. The current lecture-based courses of medical ethics programs in medical schools are demonstrated as insufficient models for training "good doctors''. In this study, we introduce an innovative program for medical ethics education in an extra-curricular student-based design named Students' Medical Ethics Rounds (SMER). In SMER, a combination of educational methods, including theater-based case presentation, large group discussion, expert opinions, role playing and role modeling were employed. The pretest-posttest experimental design was used to assess the impact of interventions on the participants' knowledge and attitude regarding selected ethical topics. A total of 335 students participated in this study and 86.57% of them filled the pretest and posttest forms. We observed significant improvements in the knowledge (P < 0.0500) and attitude (P < 0.0001) of participants. Interestingly, 89.8% of participants declared that their confidence regarding how to deal with the ethical problems outlined in the sessions was increased. All of the applied educational methods were reported as helpful. We found that SMER might be an effective method of teaching medical ethics. We highly recommend the investigation of the advantages of SMER in larger studies and interdisciplinary settings.

Euthanasia: an overview and the jewish perspective.

PubMed

Gesundheit, Benjamin; Steinberg, Avraham; Glick, Shimon; Or, Reuven; Jotkovitz, Alan

2006-10-01

End-of-life care poses fundamental ethical problems to clinicians. Defining euthanasia is a difficult and complex task, which causes confusion in its practical clinical application. Over the course of history, abuse of the term has led to medical atrocities. Familiarity with the relevant bioethical issues and the development of practical guidelines might improve clinical performance. To define philosophical concepts, to present historical events, to discuss the relevant attitudes in modern bioethics and law that may be helpful in elaborating practical guidelines for clinicians regarding euthanasia and end-of-life care. Concepts found in the classic sources of Jewish tradition might shed additional light on the issue and help clinicians in their decision-making process. An historical overview defines the concepts of active versus passive euthanasia, physician-assisted suicide and related terms. Positions found in classical Jewish literature are presented and analyzed with their later interpretations. The relevance and application in modern clinical medicine of both the general and Jewish approaches are discussed. The overview of current bioethical concepts demonstrates the variety of approaches in western culture and legal systems. Philosophically and conceptually, there is a crucial distinction between active and passive euthanasia. The legitimacy of active euthanasia has been the subject of major controversy in recent times in various countries and religious traditions. The historical overview and the literature review demonstrate the need to provide clearer definitions of the concepts relating to euthanasia, for in the past the term has led to major confusion and uncontrolled abuse. Bioethical topics should, therefore, be included in medical training and continuing education. There are major debates and controversies regarding the current clinical and legal approaches. We trust that classical Jewish sources might contribute to the establishment of clinical

Teaching Ethics in Medical School.

ERIC Educational Resources Information Center

Ewan, Christine

1986-01-01

Reviews the literature regarding the teaching of ethics in medical schools. Defines medical ethics and attempts to determine the scope of medical ethics teaching. Discusses ways medical ethics could be taught and how that teaching can be assessed. Calls for increased attention into the teaching of medical ethics. (TW)

Ethics: A Theory of Medical Ethics.

PubMed

Brody, Howard

This book review characterizes Robert Veatch's A Theory of Medical Ethics as a "third-generation" treatise that looks beyond case- and issue-oriented analysis to develop the theoretical bases of a "true system of medical ethics." Veatch proposes a "draft medical ethical covenant" based on a "triple contract" model, in which the moral principles of contract keeping, autonomy, honesty, avoiding killing, and justice govern the physician's relationship to both individual patients and society.

Students’ medical ethics rounds: a combinatorial program for medical ethics education

PubMed Central

Beigy, Maani; Pishgahi, Ghasem; Moghaddas, Fateme; Maghbouli, Nastaran; Shirbache, Kamran; Asghari, Fariba; Abolfat-h Zadeh, Navid

2016-01-01

It has long been a common goal for both medical educators and ethicists to develop effective methods or programs for medical ethics education. The current lecture-based courses of medical ethics programs in medical schools are demonstrated as insufficient models for training “good doctors’’. In this study, we introduce an innovative program for medical ethics education in an extra-curricular student-based design named Students’ Medical Ethics Rounds (SMER). In SMER, a combination of educational methods, including theater-based case presentation, large group discussion, expert opinions, role playing and role modeling were employed. The pretest-posttest experimental design was used to assess the impact of interventions on the participants’ knowledge and attitude regarding selected ethical topics. A total of 335 students participated in this study and 86.57% of them filled the pretest and posttest forms. We observed significant improvements in the knowledge (P < 0.0500) and attitude (P < 0.0001) of participants. Interestingly, 89.8% of participants declared that their confidence regarding how to deal with the ethical problems outlined in the sessions was increased. All of the applied educational methods were reported as helpful. We found that SMER might be an effective method of teaching medical ethics. We highly recommend the investigation of the advantages of SMER in larger studies and interdisciplinary settings. PMID:27471586

[The importance of Jewish nursing in World War I as shown by the example of the Jewish nurses' home in Stuttgart].

PubMed

Ruess, Susanne

2010-01-01

The history of Jewish nursing in World War I has so far not been central to medical history research. Rosa Bendit's war diary is still the only source available on the voluntary service Jewish nurses provided during World War I. Their number was small compared to that of nurses in general. Jewish nursing in Germany has hardly been researched. Jewish nurses, like their Christian colleagues, took on wartime nursing tasks voluntarily. This paper will focus on the experiences of the nurses who were sent to various locations in East and West by the Stuttgart Jewish Nurses' Home. Based on quotations from the war diary their position within the medical service will be described, compared and analyzed. The paper draws attention to special characteristics in the comparison ofJewish and Christian nurses and explores issues such as religious observance, religious discrimination, patriotism and differences in the evaluation of the nurses' work. A brief outline of the history of the Stuttgart Jewish Nurses' Home illustrates their working conditions. The Jewish nurses applied themselves with as much effort and devotion as their Christian counterparts. Although there were only few of them, the Jewish nurses managed to establish a recognized position for themselves within the medical service. The history of Jewish nursing in Stuttgart ended in 1941 when the Jewish Nurses' Home was dissolved by the Nazis and four nurses were murdered in concentration camps.

Introducing the Medical Ethics Bowl.

PubMed

Merrick, Allison; Green, Rochelle; Cunningham, Thomas V; Eisenberg, Leah R; Hester, D Micah

2016-01-01

Although ethics is an essential component of undergraduate medical education, research suggests that current medical ethics curricula face considerable challenges in improving students' ethical reasoning. This article discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised: the Medical Ethics Bowl (MEB). Finally, we suggest the pedagogical advantages of the MEB when compared to other ethics curricula.

Synthetic biology: a Jewish view.

PubMed

Glick, Shimon

2012-01-01

The discipline of synthetic biology may be one of the most dramatic advances of the past few decades. It represents a radical upgrading of humankind's ability to manipulate the world in which we live. The potential for benefits to society is enormous, but the risks for deliberate abuse or dangerous miscalculations are no less great. There are serious ethical issues, legitimate concerns for biosafety, and fears of bioterrorism. The ethical dilemmas posed are new and challenging and are being addressed by various groups and commissions. The present paper presents a Jewish approach to some of the ethical issues posed by this new technology. Judaism traditionally looks favorably on man as a co-creator with God and encourages research for the benefit of humankind. Thus it would have a positive attitude towards the current goals of synthetic biology. But in the Jewish tradition man is also charged with stewardship over nature and is admonished to preserve and nurture, not just to exploit and destroy. In line with the Presidential Commission on Bioethics, it would support a carefully weighed balance between the precautionary and the "proactionary" approaches.

[Self endangerment to save life--competing Jewish legal and moral obligations].

PubMed

Gesundheit, Benjamin; Zlotnick, Eitan; Wygoda, Michael; Rosenzweig, Joshua P; Steinberg, Avraham

2014-11-01

The obligation to help others often involves personal risk. Consequently, the scope and boundaries of this obligation can present a complex dilemma, which has practical and moral implications, even in the world of medicine. In Jewish medical ethics, the dilemma stems from a confrontation between the duty to help others according to the biblical commandment: "Do not stand idly by your fellow's blood" on the one hand, and between the right and duty of man to defend himself, which is anchored in Jewish law. This article surveys the sources of this quandary in Jewish texts throughout the ages such as the Bible, Mishnah, Talmud, and responsa literature in various contexts. The discussion highlights the essential difference between the formal demands of the law, which protects human rights of self-preservation, and the moral requirement to help others even if it may include personal risk. The sources suggest distinguishing between various levels of risk ranging from high-risk to reasonable or low risk. In this way, the classic sources, provide the foundation and the tools for grappling with modern contemporary Halachic questions such as organ transplantation, and generate a Torah value-based framework to deal with new situations that may arise in the future. It is critical to assess the level of risk and the chances for success, along with other subjective considerations, in order to ensure the optimal ethical course of action.

Talking ethics with strangers: a view from Jewish tradition.

PubMed

Newman, L E

1993-12-01

The work of H. Tristram Engelhardt provides an important set of reflections for bioethics in a secular context. Taking Engelhardt's work as its point of departure this article explores the challenges that Jewish ethicists face in contributing to bioethics in a secular context. The article explores how the Jewish tradition can address issues in bioethics in ways that are true to its tradition and at the same time accessible and relevant to "moral strangers" in a secular society.

Teaching Medical Ethics to Medical Students.

ERIC Educational Resources Information Center

Loewy, Erich H.

1986-01-01

The evolution and goals of teaching medical ethics, the nature of medical ethics, and integrating such teaching into the curriculum are examined. Because moral considerations are as much a part of medical decisions as technical considerations, teaching is best done in the context of real cases. (Author/MLW)

Teaching medical ethics and law.

PubMed

Parker, Malcolm

2012-03-01

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.

Medical ethics and ethical dilemmas.

PubMed

Iyalomhe, G B S

2009-01-01

Ethical problems routinely arise in the hospital and outpatient practice settings and times of dilemma do occur such that practitioners and patients are at cross-roads where choice and decision making become difficult in terms of ethics. This paper attempts a synopsis of the basic principles of medical ethics, identifies some ethical dilemmas that doctors often encounter and discusses some strategies to address them as well as emphasizes the need for enhanced ethics education both for physicians and patients particularly in Nigeria. Literature and computer programmes (Medline and PsychoInfo databases) were searched for relevant information. The search showed that the fundamental principles suggested by ethicists to assist doctors to evaluate the ethics of a situation while making a decision include respect for autonomy, beneficence, non-maleficence and justice. Although the above principles do not give answers as to how to handle a particular situation, they serve as a guide to doctors on what principles ought to apply to actual circumstances. The principles sometimes conflict with each other leading to ethical dilemmas when applied to issues such as abortion, contraception, euthanasia, professional misconduct, confidentiality truth telling, professional relationship with relatives, religion, traditional medicine and business concerns. Resolution of dilemmas demand the best of the doctor's knowledge of relevant laws and ethics, his training and experience, his religious conviction and moral principles as well as his readiness to benefit from ethics consultation and the advice of his colleagues. Ethics education should begin from the impressionable age in homes, continued in the medical schools and after graduation to ensure that doctors develop good ethical practices and acquire the ability to effectively handle ethical dilemmas. Also, education of patients and sanction of unethical behaviour will reduce ethical dilemmas.

The Medical Ethics Curriculum in Medical Schools: Present and Future.

PubMed

Giubilini, Alberto; Milnes, Sharyn; Savulescu, Julian

2016-01-01

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Medical ethics, bioethics and research ethics education perspectives in South East Europe in graduate medical education.

PubMed

Mijaljica, Goran

2014-03-01

Ethics has an established place within the medical curriculum. However notable differences exist in the programme characteristics of different schools of medicine. This paper addresses the main differences in the curricula of medical schools in South East Europe regarding education in medical ethics and bioethics, with a special emphasis on research ethics, and proposes a model curriculum which incorporates significant topics in all three fields. Teaching curricula of Medical Schools in Bulgaria, Bosnia and Herzegovina, Croatia, Serbia, Macedonia and Montenegro were acquired and a total of 14 were analyzed. Teaching hours for medical ethics and/or bioethics and year of study in which the course is taught were also analyzed. The average number of teaching hours in medical ethics and bioethics is 27.1 h per year. The highest national average number of teaching hours was in Croatia (47.5 h per year), and the lowest was in Serbia (14.8). In the countries of the European Union the mean number of hours given to ethics teaching throughout the complete curriculum was 44. In South East Europe, the maximum number of teaching hours is 60, while the minimum number is 10 teaching hours. Research ethics topics also show a considerable variance within the regional medical schools. Approaches to teaching research ethics vary, even within the same country. The proposed model for education in this area is based on the United Nations Educational, Scientific and Cultural Organization Bioethics Core Curriculum. The model curriculum consists of topics in medical ethics, bioethics and research ethics, as a single course, over 30 teaching hours.

Evaluating ethics competence in medical education.

PubMed Central

Savulescu, J; Crisp, R; Fulford, K W; Hope, T

1999-01-01

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions. PMID:10536759

Bikkur Holim: the origins of Jewish pastoral care.

PubMed

Sheer, Charles

2008-01-01

This paper surveys classical Jewish texts--from the Hebrew Bible through Medieval codes--regarding the concept and practice of Bikkur Holim, literally, "the sick visit." How does this literature understand this ethical, religious act; who are the practitioners; what are their objectives? Although the Hebrew Bible does not contain a biblical precedent or legal mandate for Bikkur Holim, various categories of pastoral actions are traced in midrashic and talmudic texts. Their nuances are examined closely and a conceptualization of Jewish pastoral care is identified in a work by thirteenth century rabbi, jurist and physician, Nahmanides. Ezekiel 34 is proposed as the source for the rabbinic term, Bikkur Holim, as well as the conceptual understanding of Jewish pastoral care. Finally, the author posits various questions regarding the implication of his findings on the conduct of Jewish pastoral care, the value of spiritual assessment, and the nature of chaplaincy work in our various religious traditions.

Jews and mental illness: medical metaphors, anti-semitism, and the Jewish response.

PubMed

Gilman, S L

1984-04-01

The idea that Jews were prone to a specific set of illnesses is as old as the Middle Ages. In the nineteenth century the view that the Jew was especially prone to developing mental illnesses became an accepted part of medical discourse. Jewish doctors, too, believed this and had to evolve a means of dealing with their own potential madness.

Current trends in medical ethics education in Japanese medical schools.

PubMed

Kurosu, Mitsuyasu

2012-09-01

The Japanese medical education program has radically improved during the last 10 years. In 1999, the Task Force Committee on Innovation of Medical Education for the 21st Century proposed a tutorial education system, a core curriculum, and a medical student evaluation system for clinical clerkship. In 2001, the Model Core Curriculum of medical education was instituted, in which medical ethics became part of the core material. Since 2005, a nationwide medical student evaluation system has been applied for entrance to clinical clerkship. Within the Japan Society for Medical Education, the Working Group of Medical Ethics proposed a medical ethics education curriculum in 2001. In line with this, the Japanese Association for Philosophical and Ethical Research in Medicine has begun to address the standardization of the curriculum of medical ethics. A medical philosophy curriculum should also be included in considering illness, health, life, death, the body, and human welfare.

The implications of medical ethics.

PubMed Central

Thompson, I. E.

1976-01-01

In this paper, Mr Thompson, one of the research fellows appointed to the Edinburgh Medical Group research project, seeks to define medical ethics in relation to traditional ethics in the philosophical sense of enquiring into right and wrong modes of thought and conduct, and to carry that study further into the field of moral decisions made by doctors and other professional people who care for the sick. Until very recently the Victorian definition of medical ethics - medical etiquette - served the doctor well but the complexity of modern medicine and the involvement of other professional workers in medical care appears to have swept away the old framework and left a vacuum. A new medical ethic must be evolved to fill that vacuum, taking account not only of technological advances but also of relationships between doctors and other professionals associated with them and of the role in caring for the sick. PMID:781252

Dharma and medical ethics.

PubMed

Seetharam, Sridevi

2013-01-01

Despite the numerous policies, regulations and laws aimed at promoting and ensuring ethical practice in healthcare, ethical misconduct remains rampant. Perhaps something more is needed to encourage a genuine and sustained moral attitude and behaviour. To a casual reader, the regulations on ethics read merely as a list of do's and don'ts and their philosophical foundation is not clear. In actuality, morality is often grounded in philosophy. Traditionally, religious and theistic philosophies drove moral behaviour. However, this is changing due to the current trend of secularism. Hindu philosophies are among the oldest philosophies that are still thriving, and this article explores these philosophies and compares and contrasts them with some of the contemporary ethical theories to assess if they can add value to the field of medical ethics. The main theme of the article is dharma or righteous conduct, the concepts related to it and how these can have a bearing on the development of an ethical attitude and the practice of medical ethics.

Does medical education erode medical trainees' ethical attitude and behavior?

PubMed Central

Yavari, Neda

2016-01-01

In the last few years, medical education policy makers have expressed concern about changes in the ethical attitude and behavior of medical trainees during the course of their education. They claim that newly graduated physicians (MDs) are entering residency years with inappropriate habits and attitudes earned during their education. This allegation has been supported by numerous research on the changes in the attitude and morality of medical trainees. The aim of this paper was to investigate ethical erosion among medical trainees as a serious universal problem, and to urge the authorities to take urgent preventive and corrective action. A comparison with the course of moral development in ordinary people from Kohlberg’s and Gilligan's points of view reveals that the growth of ethical attitudes and behaviors in medical students is stunted or even degraded in many medical schools. In the end, the article examines the feasibility of teaching ethics in medical schools and the best approach for this purpose. It concludes that there is considerable controversy among ethicists on whether teaching ethical virtues is plausible at all. Virtue-based ethics, principle-based ethics and ethics of care are approaches that have been considered as most applicable in this regard. PMID:28050246

[Ethics, medical ethics, and occupational medicine: is their dialogue possible?].

PubMed

Buzzi, Elisa

2016-01-20

Today's medicine faces some critical moral challenges, yet the medical class suffers from an increasingly evident malaise: a growing dissatisfaction with an ethical demand often perceived as a cumbersome burden of rules and prohibitions, which risk to erode the fiduciary relations with patients. Such a negative appraisal is partly due to a narrow interpretation of the meaning of ethics, a misconception whose roots are in the positivistic stance that permeates our culture, and in its almost exclusively technological bent. This radical orientation of our culture shows itself in the vanishing of the idea of an intrinsic ethical dimension of medicine and consequent eclipse of traditional medical ethics, currently all but assimilated by bioethics. Maintaining a clear distinction between medical ethics and bioethics is a fundamental condition for guaranteeing an original ethical reflection in medicine, thereby fostering a constructive dialogue between philosophical and medical ethics. In this sense, occupational medicine holds a very propitious position, at the cross-roads to some of the most important dimensions in human life and society: health, work, environment. In a milieu which is too often inclined to efface the living human being and the deepest needs of humanity, the moral commitment of medical profession to the care of the integral reality of the embodied human person is one of the most important ethical challenges facing occupational medicine and a most valuable contribution to the current ethical debate.

The teaching of medical ethics to medical students.

PubMed Central

Glick, S M

1994-01-01

Teaching medical ethics to medical students in a pluralistic society is a challenging task. Teachers of ethics have obligations not just to teach the subject matter but to help create an academic environment in which well motivated students have reinforcement of their inherent good qualities. Emphasis should be placed on the ethical aspects of daily medical practice and not just on the dramatic dilemmas raised by modern technology. Interdisciplinary teaching should be encouraged and teaching should span the entire duration of medical studies. Attention should be paid particularly to ethical problems faced by the students themselves, preferably at the time when the problems are most on the students' minds. A high level of academic demands, including critical examination of students' progress is recommended. Finally, personal humility on the part of teachers can help set a good example for students to follow. PMID:7861430

Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism.

PubMed

Doukas, David J; McCullough, Laurence B; Wear, Stephen

2012-03-01

Medical education accreditation organizations require medical ethics and humanities education to develop professionalism in medical learners, yet there has never been a comprehensive critical appraisal of medical education in ethics and humanities. The Project to Rebalance and Integrate Medical Education (PRIME) I Workshop, convened in May 2010, undertook the first critical appraisal of the definitions, goals, and objectives of medical ethics and humanities teaching. The authors describe assembling a national expert panel of educators representing the disciplines of ethics, history, literature, and the visual arts. This panel was tasked with describing the major pedagogical goals of art, ethics, history, and literature in medical education, how these disciplines should be integrated with one another in medical education, and how they could be best integrated into undergraduate and graduate medical education. The authors present the recommendations resulting from the PRIME I discussion, centered on three main themes. The major goal of medical education in ethics and humanities is to promote humanistic skills and professional conduct in physicians. Patient-centered skills enable learners to become medical professionals, whereas critical thinking skills assist learners to critically appraise the concept and implementation of medical professionalism. Implementation of a comprehensive medical ethics and humanities curriculum in medical school and residency requires clear direction and academic support and should be based on clear goals and objectives that can be reliably assessed. The PRIME expert panel concurred that medical ethics and humanities education is essential for professional development in medicine.

A comparison of Israeli Jewish and Arab women's birth perceptions.

PubMed

Halperin, Ofra; Sarid, O; Cwikel, J

2014-07-01

birth is a normal physiological process, but can also be experienced as a traumatic event. Israeli Jewish and Arab women share Israeli residency, citizenship, and universal access to the Israeli medical system. However, language, religion, values, customs, symbols, and lifestyle differ between the groups. to examine Israeli Arab and Jewish women's perceptions of their birth experience, and to assess the extent to which childbirth details and perceptions predict satisfaction with the birth experience and the extent of assessing the childbirth as traumatic. this study was conducted in two post partum units of two major public hospitals in the northern part of Israel. The sample included 171 respondents, including 115 Jewish Israeli and 56 Arab Israeli women who gave birth to their first (33%) or second (67%) child. Respondents described their childbirth experiences using a self-report questionnaire 24-48 hours after childbirth. the Arab women were much less likely to attend childbirth preparation classes than the Jewish women (5% versus 24%). Forty-three per cent of the respondents reported feeling helpless, and 68% reported feeling lack of control during childbirth. Twenty per cent of the women rated their childbirth experience as traumatic, a rate much lower than the rate of medical indicators of traumatic birth (39%). The rate of self-reported traumatic birth was significantly higher among the Arab women than among the Jewish women (32% versus 14%). A higher percentage of the Arab women reported being afraid during labour (χ(2)=4.97, p<.05), expressed fear for their newborn's safety (χ(2)=12.44, p<.001), and reported that the level of medical intervention was excessive in their opinion, as compared to the Jewish women (χ(2)=5.09, p<.05; χ(2)=7.33, p<.01). However, both the Arab and Jewish women reported similar numbers of medical interventions and levels of satisfaction with their medical treatment. despite universal access to the Israeli health care system

MEDICAL ETHICS EDUCATION IN TURKEY; STATE OF PLAY AND CHALLENGES.

PubMed

Ekmekçi, Perihan Elif

Medical ethics can be traced back to Hippocratic Oath in antiquity. Last decade witnessed improvements in science and technology which attracted attention to the ethical impacts of the innovations in medicine. The need to combine medical innovations with a preservation of human values and to cultivate ethical competencies required by professionalism conceived medical ethics education in various levels in medical schools. Despite the diversities regarding teaching hours, methodology and content of the courses, medical ethics became a fundamental part of medical education around the world. In Turkey medical ethics education is given both in undergraduate and postgraduate levels. The high increase in the number of medical schools and shortfall of instructors who have medical ethics as their primary academic focus creates a big challenge in medical ethics education in both levels. Currently there are 89 medical schools in Turkey and only six medical schools are giving postgraduate medical ethics education. In 2010 only 33 of all medical schools could establish a separate department dedicated to medical ethics. There are no medical ethics courses embedded in residency programs. The quality and standardization of undergraduate medical ethics education has started but there are no initiatives to do so in postgraduate level.

Medical Ethics Education: Coming of Age.

ERIC Educational Resources Information Center

Miles, Steven H.; And Others

1989-01-01

A discussion of medical ethics in the medical curriculum reviews its recent history, examines areas of consensus, and describes teaching objectives and methods, course content, and program evaluation at preclinical and clinical levels. Prerequisites for successful institutionalization of medical ethics education are defined, and its future is…

Medical Students' Affirmation of Ethics Education

ERIC Educational Resources Information Center

Lehrmann, Jon A.; Hoop, Jinger; Hammond, Katherine Green; Roberts, Laura Weiss

2009-01-01

Objective: Despite the acknowledged importance of ethics education in medical school, little empirical work has been done to assess the needs and preferences of medical students regarding ethics curricula. Methods: Eighty-three medical students at the University of New Mexico participated in a self-administered written survey including 41 scaled…

What is good medical ethics? A clinician's perspective.

PubMed

Kong, Wing May

2015-01-01

Speaking from the perspective of a clinician and teacher, good medical ethics needs to make medicine better. Over the past 50 years medical ethics has helped shape the culture in medicine and medical practice for the better. However, recent healthcare scandals in the UK suggest more needs to be done to translate ethical reasoning into ethical practice. Focusing on clinical practice and individual patient care, I will argue that, to be good, medical ethics needs to become integral to the activities of health professionals and healthcare organisations. Ethics is like a language which brings a way of thinking and responding to the world. For ethics to become embedded in clinical practice, health professionals need to progress from classroom learners to fluent social speakers through ethical dialogue, ethical reflection and ethical actions. I will end by discussing three areas that need to be addressed to enable medical ethics to flourish and bring about change in everyday clinical care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Teaching, learning and assessment of medical ethics at the UK medical schools.

PubMed

Brooks, Lucy; Bell, Dominic

2017-09-01

To evaluate the UK undergraduate medical ethics curricula against the Institute of Medical Ethics (IME) recommendations; to identify barriers to teaching and assessment of medical ethics and to evaluate perceptions of ethics faculties on the preparation of tomorrow's doctors for clinical practice. Questionnaire survey of the UK medical schools enquiring about content, structure and location of ethics teaching and learning; teaching and learning processes; assessment; influences over institutional approach to ethics education; barriers to teaching and assessment; perception of student engagement and perception of student preparation for clinical practice. The lead for medical ethics at each medical school was invited to participate (n=33). Completed responses were received from 11/33 schools (33%). 73% (n=8) teach all IME recommended topics within their programme. 64% (n=7) do not include ethics in clinical placement learning objectives. The most frequently cited barrier to teaching was lack of time (64%, n=7), and to assessment was lack of time and suitability of assessments (27%, n=3). All faculty felt students were prepared for clinical practice. IME recommendations are not followed in all cases, and ethics teaching is not universally well integrated into clinical placement. Barriers to assessment lead to inadequacies in this area, and there are few consequences for failing ethics assessments. As such, tomorrow's patients will be treated by doctors who are inadequately prepared for ethical decision making in clinical practice; this needs to be addressed by ethics leads with support from medical school authorities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Against medical ethics: opening the can of worms.

PubMed Central

Cassell, J

1998-01-01

In a controversial paper, David Seedhouse argues that medical ethics is not and cannot be a distinct discipline with it own field of study. He derives this claim from a characterization of ethics, which he states but does not defend. He claims further that the project of medical ethics as it exists and of moral philosophy do not overlap. I show that Seedhouse's views on ethics have wide implications which he does not declare, and in the light of this argue that Seedhouse owes us a defence of his characterization of ethics. Further, I show that his characterization of ethics, which he uses to attack medical ethics, is a committed position within moral philosophy. As a consequence of this, it does not allow the relation between moral philosophy and medical ethics to be discussed without prejudice to its outcome. Finally, I explore the relation between Seedhouse's position and naturalism, and its implications for medical epistemology. I argue that this shows us that Seedhouse's position, if it can be defended, is likely to lead to a fruitful and important line of inquiry which reconnects philosophy and medical ethics. PMID:9549676

Ultimate justification: Wittgenstein and medical ethics.

PubMed

Hughes, J

1995-02-01

Decisions must be justified. In medical ethics various grounds are given to justify decisions, but ultimate justification seems illusory and little considered. The philosopher Wittgenstein discusses the problem of ultimate justification in the context of general philosophy. His comments, nevertheless, are pertinent to ethics. From a discussion of Wittgensteinian notions, such as 'bedrock', the idea that 'ultimate' justification is grounded in human nature as such is derived. This discussion is relevant to medical ethics in at least five ways: it shows generally what type of certainty there is in practical ethics; it seems to imply some objective foundation to our ethical judgements; it squares with our experience of making ethical decisions; it shows something of the nature of moral arguments; and, finally, it has implications for teaching medicine and ethics.

Ultimate justification: Wittgenstein and medical ethics.

PubMed Central

Hughes, J

1995-01-01

Decisions must be justified. In medical ethics various grounds are given to justify decisions, but ultimate justification seems illusory and little considered. The philosopher Wittgenstein discusses the problem of ultimate justification in the context of general philosophy. His comments, nevertheless, are pertinent to ethics. From a discussion of Wittgensteinian notions, such as 'bedrock', the idea that 'ultimate' justification is grounded in human nature as such is derived. This discussion is relevant to medical ethics in at least five ways: it shows generally what type of certainty there is in practical ethics; it seems to imply some objective foundation to our ethical judgements; it squares with our experience of making ethical decisions; it shows something of the nature of moral arguments; and, finally, it has implications for teaching medicine and ethics. PMID:7776343

Ethics for medical educators: an overview and fallacies.

PubMed

Singh, Arjun

2010-07-01

Ethics is the rule of right conduct or practice in a profession. The basic principles of ethics are beneficence, justice and autonomy or individual freedom. There is very minor demarcation between ethics and the law. The ethics is promulgated by the professional bodies. All are expected to guide the medical professional in their practice. Medical educators have dual ethical obligations: firstly, to the society at large which expects us to produce competent health professionals, and secondly, to the students under our care. The students observe and copy what their teacher does and his/her role modelling can be a gateway to a student's character building. Due to rapid increase in the number of medical colleges, privatization, and capitalism, ethical issue has become much more relevant and needs to discuss in detail. The present paper discusses the ethics for medical educators in detail with, basic principles, common breaches of ethics and fallacies due to wrong application of ethical principles, and the approach to ethics and methods by which we can prevent and avoid breach of ethics.

Ethics for Medical Educators: An Overview and Fallacies

PubMed Central

Singh, Arjun

2010-01-01

Ethics is the rule of right conduct or practice in a profession. The basic principles of ethics are beneficence, justice and autonomy or individual freedom. There is very minor demarcation between ethics and the law. The ethics is promulgated by the professional bodies. All are expected to guide the medical professional in their practice. Medical educators have dual ethical obligations: firstly, to the society at large which expects us to produce competent health professionals, and secondly, to the students under our care. The students observe and copy what their teacher does and his/her role modelling can be a gateway to a student's character building. Due to rapid increase in the number of medical colleges, privatization, and capitalism, ethical issue has become much more relevant and needs to discuss in detail. The present paper discusses the ethics for medical educators in detail with, basic principles, common breaches of ethics and fallacies due to wrong application of ethical principles, and the approach to ethics and methods by which we can prevent and avoid breach of ethics. PMID:21716861

Medical internet ethics: a field in evolution.

PubMed

Dyer, K A; Thompson, C D

2001-01-01

As in any new field, the merger of medicine, e-commerce and the Internet raises many questions pertaining to ethical conduct. Key issues include defining the essence of the patient-provider relationship, establishing guidelines and training for practicing online medicine and therapy, setting standards for ethical online research, determining guidelines for providing quality healthcare information and requiring ethical conduct for medical and health websites. Physicians who follow their professional code of ethics are obligated not to exploit the relationship they have with patients, nor allow anyone else working with them to do so. Physicians and therapists are obligated to serve those who place trust in them for treatment, whether in face-to-face or online Internet encounters with patients or clients. This ethical responsibility to patients and clients is often in direct conflict with the business model of generating profits. Healthcare professionals involved in Medical Internet Ethics need to define the scope of competent medical and healthcare on the Internet. The emerging ethical issues facing medicine on the Internet, the current state of medical ethics on the Internet and questions for future directions of study in this evolving field are reviewed in this paper.

[Ethic review on clinical experiments of medical devices in medical institutions].

PubMed

Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

2011-07-01

Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

Medical ethics research between theory and practice.

PubMed

ten Have, H A; Lelie, A

1998-06-01

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illness of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.

A student's perspective on medical ethics education.

PubMed

Terndrup, Christopher

2013-12-01

Despite many efforts to increase ethics education in US medical schools, barriers continue to arise that impede the production of morally driven physicians who practice medicine with ideal empathy. Research has shown that, particularly during the clinical years, medical students lose the ability both to recognize ethical dilemmas and to approach such situations with compassionate reasoning. This article summarizes the current status of ethics education in US medical schools, described through the eyes of and alongside the story of a graduating medical student.

Towards a European code of medical ethics. Ethical and legal issues.

PubMed

Patuzzo, Sara; Pulice, Elisabetta

2017-01-01

The feasibility of a common European code of medical ethics is discussed, with consideration and evaluation of the difficulties such a project is going to face, from both the legal and ethical points of view. On the one hand, the analysis will underline the limits of a common European code of medical ethics as an instrument for harmonising national professional rules in the European context; on the other hand, we will highlight some of the potentials of this project, which could be increased and strengthened through a proper rulemaking process and through adequate and careful choice of content. We will also stress specific elements and devices that should be taken into consideration during the establishment of the code, from both procedural and content perspectives. Regarding methodological issues, the limits and potentialities of a common European code of medical ethics will be analysed from an ethical point of view and then from a legal perspective. The aim of this paper is to clarify the framework for the potential but controversial role of the code in the European context, showing the difficulties in enforcing and harmonising national ethical rules into a European code of medical ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[Medical ethics and patient responsibility].

PubMed

Gajda, Z

1998-01-01

When we say "medical ethics" we understand the responsibility of the physician for his medical education and his attitude to his patient. But Hippocrates is known to have said that the efficiency and good results of the treatment depends not only on the physician but on the patient and his engagement, his observance of the doctors' advice, his attitude to his own psyche and body, both in health as in illness. This is an ethical problem known to every practitioner, the problem of ethics of the patient, which ought to be more widely disseminated in society.

Jurisdiction of the Medical Ethics Committees.

PubMed

Voljč, Božidar

2017-10-01

Ethical principles of assessing medical research are to the greatest extent defined by the Nuremberg Code, the Declarations of Geneva and Helsinki, and the Oviedo Convention. Pursuant to their directives various national Medical Ethics Committees (MECs) were established which assess the ethics of research according to the risk and benefit ratio of the persons involved. Following the example of other countries, medical ethics committees eventually appeared also in hospitals and some medical and educational institutions around Slovenia. Due to an increased number of ethical challenges, it is of great importance to define the jurisdiction of the Slovenian MECs in order to ensure their coordinated operation. Exclusive jurisdiction of the national MEC includes multicentre and multi-national research, drug research (phases 1-3), high-risk research and research related to doctoral theses. The jurisdiction of the sectoral MECs includes testing the conditions for research, monitoring the execution and overviewing the final reports. A more significant jurisdiction of the sectoral MEC is preserving an ethical environment in their institutions. A network of Slovenian MECs is to be organised in the form of a jurisdiction pyramid where each member has its own obligations and responsibilities and plays an important role in relation to the entire structure.

[Medical ethics in residency training].

PubMed

Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun

2009-04-01

Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

Medical Ethics Training: A Clinical Partnership.

ERIC Educational Resources Information Center

Thomasma, David C.

1979-01-01

The ethics training program at the University of Tennessee Center for the Health Sciences involves a four-way dialogue among clinical faculty and house staff, ethics faculty and fellows, the medical students, and philosophy ethics students. The program's clinical basis allows participants to become sophisticated about ethical issues in practice.…

Veatch's new foundation for medical ethics.

PubMed

Kultgen, J

1985-11-01

Robert M. Veatch proposes a "triple contract theory" as a new foundation for medical ethics. His criticisms of unilateral "physician ethics" are sound, but uncertainty as to whether he is proposing merely imaginary or real contracts vitiates his constructive arguments. If the former, he is recommending a minor heuristic device for thinking about ethics, not a foundation. If the latter, his proposal is utterly impractical and a medical covenant will have to be developed another way.

An international survey of medical ethics curricula in Asia.

PubMed

Miyasaka, M; Akabayashi, A; Kai, I; Ohi, G

1999-12-01

Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries. To characterise the medical ethics curricula at Asian medical schools. Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand. A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country. The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties. A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics. Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse.

Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism.

PubMed

Bruns, Florian; Chelouche, Tessa

2017-04-18

Nazi medicine and its atrocities have been explored in depth over the past few decades, but scholars have started to examine medical ethics under Nazism only in recent years. Given the medical crimes and immoral conduct of physicians during the Third Reich, it is often assumed that Nazi medical authorities spurned ethics. However, in 1939, Germany introduced mandatory lectures on ethics as part of the medical curriculum. Course catalogs and archival sources show that lectures on ethics were an integral part of the medical curriculum in Germany between 1939 and 1945. Nazi officials established lecturer positions for the new subject area, named Medical Law and Professional Studies, at every medical school. The appointed lecturers were mostly early members of the Nazi Party and imparted Nazi political and moral values in their teaching. These values included the unequal worth of human beings, the moral imperative of preserving a pure Aryan people, the authoritarian role of the physician, the individual's obligation to stay healthy, and the priority of public health over individual-patient care. This article shows that there existed not only a Nazi version of medical ethics but also a systematic teaching of such ethics to students in Nazi Germany. The findings illustrate that, from a historical point of view, the notion of "eternal values" that are inherent to the medical profession is questionable. Rather, the prevailing medical ethos can be strongly determined by politics and the zeitgeist and therefore has to be repeatedly negotiated.

Prevalence of nine mutations among Jewish and non-Jewish Gaucher disease patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Horowitz, M.; Tzuri, G.; Eyal, N.

1993-10-01

The frequency of nine different mutated alleles known to occur in the glucocerebrosidase gene was determined in 247 Gaucher patients, of whom 176 were of Jewish extraction, 2 were Jewish with one converted parent, and 69 were of non-Jewish origin. DNA was prepared from peripheral blood, active glucocerebrosidase sequences were amplified by using the PCR technique, and the mutations were identified by using the allele-specific oligonucleotide hybridization method. The N37OS mutation appeared in 69.77% of the mutated alleles in Jewis patients and in 22.86% of the mutated alleles in non-Jews. The 84GG mutation, which has not been found so farmore » among non-Jewish patients, existed in 10.17% of the disease alleles among Jewish patients. The IVS2+1 mutation constituted 2.26% of the disease alleles among Jewish Patients and 1.43% among the non-Jewish patients. RecTL, a complex allele containing four single-base-pair changes, occurred in 2.26% of the alleles in Jewish patients and was found in two (1.43%) of the patients of non-Jewish extraction. Another complex allele, designated [open quotes]RecNcil[close quotes] and containing three single-point mutations, appeared in 7.8% of alleles of non-Jewish patients and in only two (0.56%) of the Jewish families. The prevalence of the L444P mutation among non-Jewish Gaucher patients was 31.43%, while its prevalence among Jewish patients was only 4.24%. The prevalence of two other point mutations-D409H and R463C- was 5.00% and 3.57%, respectively, among non-Jewish patients and was not found among the Jewish Gaucher patient population. The prevalence of the R496H mutation, found so far only among Jewish patients, is 1.13%. The results presented demonstrate that seven mutations identify 90.40% of the mutations among Jewish patients and that these seven mutations allow diagnosis of only 73.52% of the non-Jewish patients. Identification of additional mutant alleles will enhance the accuracy of carrier detection. 33 refs, 3 figs

Ethical analysis of non-medical fetal ultrasound.

PubMed

Leung, John Lai Yin; Pang, Samantha Mei Che

2009-09-01

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as 'keepsake' ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed.

An international survey of medical ethics curricula in Asia.

PubMed Central

Miyasaka, M; Akabayashi, A; Kai, I; Ohi, G

1999-01-01

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries. OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools. DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand. PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country. MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties. RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics. CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse. PMID:10635508

Rethinking medical ethics: a view from below.

PubMed

Farmer, Paul; Campos, Nicole Gastineau

2004-05-01

In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed 'resource-poor settings'- to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the 'resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning 'outcome gap' between rich and poor.

Ethics curriculum for emergency medicine graduate medical education.

PubMed

Marco, Catherine A; Lu, Dave W; Stettner, Edward; Sokolove, Peter E; Ufberg, Jacob W; Noeller, Thomas P

2011-05-01

Ethics education is an essential component of graduate medical education in emergency medicine. A sound understanding of principles of bioethics and a rational approach to ethical decision-making are imperative. This article addresses ethics curriculum content, educational approaches, educational resources, and resident feedback and evaluation. Ethics curriculum content should include elements suggested by the Liaison Committee on Medical Education, Accreditation Council for Graduate Medical Education, and the Model of the Clinical Practice of Emergency Medicine. Essential ethics content includes ethical principles, the physician-patient relationship, patient autonomy, clinical issues, end-of-life decisions, justice, education in emergency medicine, research ethics, and professionalism. The appropriate curriculum in ethics education in emergency medicine should include some of the content and educational approaches outlined in this article, although the optimal methods for meeting these educational goals may vary by institution. Copyright © 2011 Elsevier Inc. All rights reserved.

Ethical issues confronted by medical students during clinical rotations.

PubMed

Fard, Nazila Nikravan; Asghari, Fariba; Mirzazadeh, Azim

2010-07-01

This study aimed to examine the most common and important ethical issues confronting medical students during clinical rotations so that ethics-related topics can be prioritised according to students' needs and this information used to develop a curriculum for the ethics course. In a cross-sectional approach, we reviewed the medical ethics-related cases recorded in the logbooks of all medical students (n=241) at Tehran University of Medical Sciences who attended the medical ethics course during October 2006 to July 2007. As part of a graded assignment, each student was required to record three encounters with ethics-related issues in his or her logbook. A total of 713 cases were assessed. Information related to the ethical issues and the conditions in which ethical issues arose was extracted and recorded by two experts, whose analysis showed agreement of kappa 0.77. In cases of discrepancy, both experts reviewed and discussed the record until they achieved agreement. A total of 713 cases were analysed. The most common issues reported by students related to ethics in medical education (20.1%, n=143), professionalism (18.8%, n=134), confidentiality (7.6%, n=54), the doctor-patient relationship (7.3%, n=52), informed consent (7.0%, n=50) and the doctor-peer relationship (7.0%, n=50). After adjusting for length of rotation, the highest numbers of ethics-related incidents were reported from urology, general surgery, orthopaedics, internal medicine, neurology, and obstetrics and gynaecology wards. The results of this study indicate that professionalism and related elements represent one of the most important areas of concern that need to be addressed when planning courses for medical students. The other significant area of concern is that of ethics in medical education, which, although the subject is not considered essential for medical practitioners, should be taught and respected so that student sensitivity to medical ethics is maintained and even increased.

Rosenak "Teaching Jewish Values"

ERIC Educational Resources Information Center

Resnick, David

2014-01-01

Rosenak's "Teaching Jewish Values" (1986) is perhaps his most accessible book about Jewish education. After diagnosing the "diseases" of Jewish education, he endorses "teaching Jewish values" as the curricular strategy most likely to succeed given the chasm which divides traditional Jewish subject matter and the…

Chinese Confucian culture and the medical ethical tradition.

PubMed Central

Guo, Z

1995-01-01

The Confucian culture, rich in its contents and great in its significance, exerted on the thinking, culture and political life of ancient China immense influences, unparalleled by any other school of thought or culture. Confucian theories on morality and ethics, with 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics of China. The viewpoints of Confucianism on benevolence and material interests, on good and evil, on kindheartedness, and on character cultivation were all inherited by the medical workers and thus became prominent in Chinese traditional medical ethics. Hence, it is clear that the medical profession and Confucianism have long shared common goals in terms of ethics. Influenced by the excellent Confucian thinking and culture, a rather highly-developed system of Chinese traditional medical ethics emerged with a well-defined basic content, and the system has been followed and amended by medical professionals of all generations throughout Chinese history. This system, just to mention briefly, contains concepts such as the need: to attach great importance to the value of life; to do one's best to rescue the dying and to heal the wounded; to show concern to those who suffer from diseases; to practise medicine with honesty; to study medical skills painstakingly; to oppose a careless style of work; to comfort oneself in a dignified manner; to respect local customs and to be polite; to treat patients, noble or humble, equally, and to respect the academic achievements of others, etc. Of course, at the same time, Confucian culture has its own historical and class limitations, which exerted negative influences on traditional medical ethics. Now, if we are to keep up with the development of modern medicine, a serious topic must be addressed. That is how to retain the essence of our traditional medical ethics so as to maintain historic continuity and yet, at the same time, add on the new contents of medical

Chinese Confucian culture and the medical ethical tradition.

PubMed

Guo, Z

1995-08-01

The Confucian culture, rich in its contents and great in its significance, exerted on the thinking, culture and political life of ancient China immense influences, unparalleled by any other school of thought or culture. Confucian theories on morality and ethics, with 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics of China. The viewpoints of Confucianism on benevolence and material interests, on good and evil, on kindheartedness, and on character cultivation were all inherited by the medical workers and thus became prominent in Chinese traditional medical ethics. Hence, it is clear that the medical profession and Confucianism have long shared common goals in terms of ethics. Influenced by the excellent Confucian thinking and culture, a rather highly-developed system of Chinese traditional medical ethics emerged with a well-defined basic content, and the system has been followed and amended by medical professionals of all generations throughout Chinese history. This system, just to mention briefly, contains concepts such as the need: to attach great importance to the value of life; to do one's best to rescue the dying and to heal the wounded; to show concern to those who suffer from diseases; to practise medicine with honesty; to study medical skills painstakingly; to oppose a careless style of work; to comfort oneself in a dignified manner; to respect local customs and to be polite; to treat patients, noble or humble, equally, and to respect the academic achievements of others, etc. Of course, at the same time, Confucian culture has its own historical and class limitations, which exerted negative influences on traditional medical ethics. Now, if we are to keep up with the development of modern medicine, a serious topic must be addressed. That is how to retain the essence of our traditional medical ethics so as to maintain historic continuity and yet, at the same time, add on the new contents of medical

The new Italian code of medical ethics.

PubMed Central

Fineschi, V; Turillazzi, E; Cateni, C

1997-01-01

In June 1995, the Italian code of medical ethics was revised in order that its principles should reflect the ever-changing relationship between the medical profession and society and between physicians and patients. The updated code is also a response to new ethical problems created by scientific progress; the discussion of such problems often shows up a need for better understanding on the part of the medical profession itself. Medical deontology is defined as the discipline for the study of norms of conduct for the health care professions, including moral and legal norms as well as those pertaining more strictly to professional performance. The aim of deontology is therefore, the in-depth investigation and revision of the code of medical ethics. It is in the light of this conceptual definition that one should interpret a review of the different codes which have attempted, throughout the various periods of Italy's recent history, to adapt ethical norms to particular social and health care climates. PMID:9279746

Medical students' perceptions of their ethics teaching

PubMed Central

Johnston, Carolyn; Haughton, Peter

2007-01-01

The teaching of ethics in UK medical schools has recently been reviewed, from the perspective of the teachers themselves. A questionnaire survey of medical undergraduates at King's College London School of Medicine provides useful insight into the students' perception of ethics education, what they consider to be the value of learning ethics and law, and how engaged they feel with the subject. PMID:17601871

Ethics in Medical Research and Publication

PubMed Central

Masic, Izet; Hodzic, Ajla; Mulic, Smaila

2014-01-01

To present the basic principles and standards of Ethics in medical research and publishing, as well as the need for continuing education in the principles and ethics in science and publication in biomedicine. An analysis of relevant materials and documents, sources from the published literature. Investing in education of researches and potential researches, already in the level of medical schools. Educating them on research ethics, what constitutes research misconduct and the seriousness of it repercussion is essential for finding a solution to this problem and ensuring careers are constructed on honesty and integrity. PMID:25317288

Medical ethics surveillance in the Armed Forces.

PubMed

Pearn, J

2000-05-01

Modern defense services depend on a policy of the vigorous promotion of research to ensure that they retain an advantage in any future operational context. Research involving personnel within the armed forces, however, has certain constraints with respect to contemporary, best-practice medical ethics. Service members are one example of a class of "captive subjects" who require special protection in the context of medical research. (Prisoners, students, children, and the intellectually disabled are other such examples.) The majority of national defense forces now have ethical watchdog groups--institutional ethics committees--that oversee research involving service members. Such groups monitor the special considerations and constraints under which subjects in uniform can volunteer for biological research. These committees audit particularly the ethical themes of confidentiality, equality, and justice. Themes inherent in medical research in the military include the standard Beauchamp-Childress paradigm of autonomy, beneficence, nonmaleficence, and justice, to which are added the traditional military values of loyalty, respect, courtesy, and chivalry. Contemporary thinking is that the general principle of affording service members the opportunity to volunteer for research should be maintained within the constraints of compromised training time, national security, and operational necessity. Most biological research (and its outcome) does not in practice compromise confidentiality or military security. This paper presents an audit of the functioning of one national military medical ethics committee, the Australian Defence Medical Ethics Committee, and presents a discussion of its philosophies and influence within the broader military context. The Australian Defence Medical Ethics Committee believes that most research should, as an a priori condition of approval, be intended for open publication in peer-reviewed journals.

Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness.

PubMed

de la Garza, Santiago; Phuoc, Vania; Throneberry, Steven; Blumenthal-Barby, Jennifer; McCullough, Laurence; Coverdale, John

2017-08-01

One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

Teaching Medical Ethics: Some Persistent Questions and Some Responses.

ERIC Educational Resources Information Center

Pellegrino, Edmund D.

1989-01-01

Issues in the inclusion of medical ethics in the medical curriculum are discussed, including its relevance, whether or not ethics can be taught, whose ethics should be taught, the contribution of the professional ethicist, and the relevance of humanistic studies outside ethics. (MSE)

Ethics Education in New Zealand Medical Schools.

PubMed

McMillan, John; Malpas, Phillipa; Walker, Simon; Jonas, Monique

2018-07-01

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.

Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries

PubMed Central

Ypinazar, Valmae A; Margolis, Stephen A

2004-01-01

Background Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program. Methods The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed. Results All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2–9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2–7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified. Conclusions This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school

Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries.

PubMed

Ypinazar, Valmae A; Margolis, Stephen A

2004-07-30

Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program. The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed. All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2-9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2-7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified. This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction

[The Jewish Hospital in Budapest under the Nazi occupation (1944-1945)].

PubMed

Weisskopf, Varda

2008-01-01

On March 19, 1944 the German army invaded and occupied Hungary. The Waffen-SS soldiers captured the buildings of the Jewish community in Budapest, including the famous and important Jewish hospital on Szabolcs Street, founded in 1802. The Jewish hospital moved into a school belonging to the Jewish community on 44 Wesselényi Street. The hospital personnel managed to smuggle out medical equipment, and operating rooms were transferred into this central, temporary medical location. Other hospitals were founded, some inside the ghetto, others outside. The Judenrat supplied these hospitals with medical equipment obtained through contributions from Jews. The temporary hospitals admitted sick patients and a great number of those injured as a result of the war in Budapest. These hospitals operated with poor equipment. Surgeries were sometimes performed on kitchen tables, and medical equipment was sterilized by burning the synagogue's benches and library books. As of December 1944, there was no electricity in the hospitals. Thus doctors were forced to operate by the light of candles and flashlights. Nevertheless, they managed to save numerous lives. In spite of the terrible conditions under which the medical staff worked, they were committed to their mission, and their courage deserves appreciation. Ghetto Budapest was liberated by the Red army on 18th January, 1945. Thousands of Jews were released from the temporary hospitals.

Civic republican medical ethics.

PubMed

O'Shea, Tom

2017-01-01

This article develops a civic republican approach to medical ethics. It outlines civic republican concerns about the domination that arises from subjection to an arbitrary power of interference, while suggesting republican remedies to such domination in healthcare. These include proposals for greater review, challenge and pre-authorisation of medical power. It extends this analysis by providing a civic republican account of assistive arbitrary power, showing how it can create similar problems within both formal and informal relationships of care, and offering strategies for tackling it. Two important objections to civic republican medical ethics-that it overvalues independence and political participation in healthcare-are also considered and rebutted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Neuroethics: the pursuit of transforming medical ethics in scientific ethics.

PubMed

Figueroa, Gustavo

2016-02-20

Ethical problems resulting from brain research have given rise to a new discipline termed neuroethics, representing a new kind of knowledge capable of discovering the neural basis for universal ethics. The article (1) tries to evaluate the contributions of neuroethics to medical ethics and its suitability to outline the foundations of universal ethics, (2) critically analyses the process of founding this universal ethic. The potential benefits of applying neuroimaging, psychopharmacology and neurotechnology have to be carefully weighed against their potential harm. In view of these questions, an intensive dialogue between neuroscience and the humanities is more necessary than ever.

Truth-Telling in the UK Jewish Studies Classroom for Orthodox Educators

ERIC Educational Resources Information Center

Burman, Chaim

2017-01-01

UK Orthodox Jewish educators face a number of ethical dilemmas surrounding truth-telling in the classroom. While they must comply with government legislation and high standards of professional conduct, they may also wish their practice to be informed by halachic considerations. This theoretical study explores the potential tensions that may arise…

[Medical ethics and human rights training in Europe].

PubMed

Claudot, F; Van Baaren-Baudin, A J; Chastonay, P

2006-03-01

In 1999 the World Medical Association (WMA) issued a declaration recommending that there be the teaching of medical ethics and human rights included in the basic medical school curricula across Europe. The study aims to investigate the level of medical ethics and human rights training provided and to take an inventory of the existing programmes in the European Union's medical schools. The study was carried out using a self-administered questionnaire which was disseminated in the year 2002 to 219 schools of medicine in 14 of the 15 European Union member states (Luxembourg did not yet have a school of medicine). One-fourth of the medical schools solicited sent back a reply. Medical ethics are taught in 93% of medical schools; its teaching is of a multi-disciplinary and cross-cutting nature in 80% of the schools. Courses on ethics are compulsory in 75% of the cases. Human rights are taught in 63% of the European medical schools, and it is most often the case that the teaching of human rights is incorporated into the ethics courses. Even if the WMA's recommendation is not always fully implemented according to the guidelines of their declaration, this study demonstrates and reveals nonetheless the increasing of awareness and realization by European medical schools of the significance of including such a track in their programme.

Adab and its significance for an Islamic medical ethics.

PubMed

Sartell, Elizabeth; Padela, Aasim I

2015-09-01

Discussions of Islamic medical ethics tend to focus on Sharī'ah-based, or obligation-based, ethics. However, limiting Islamic medical ethics discourse to the derivation of religious duties ignores discussions about moulding an inner disposition that inclines towards adherence to the Sharī'ah. In classical Islamic intellectual thought, such writings are the concern of adab literature. In this paper, we call for a renewal of adabi discourse as part of Islamic medical ethics. We argue that adab complements Sharī'ah-based writings to generate a more holistic vision of Islamic medical ethics by supplementing an obligation-based approach with a virtue-based approach. While Sharī'ah-based medical ethics focuses primarily on the moral status of actions, adab literature adds to this genre by addressing the moral formation of the agent. By complementing Sharī'ah-based approaches with adab-focused writings, Islamic medical ethics discourse can describe the relationship between the agent and the action, within a moral universe informed by the Islamic intellectual tradition. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Patient decision-making: medical ethics and mediation.

PubMed Central

Craig, Y J

1996-01-01

A review of medical ethics literature relating to the importance of the participation of patients in decision-making introduces the role of rights-based mediation as a voluntary process now being developed innovatively in America. This is discussed in relation to the theory of communicative ethics and moral personhood. References are then made to the work of medical ethics committees and the role of mediation within these. Finally it is suggested that mediation is part of an eirenic ethic already being used informally in good patient care, and that there is a case for developing it further. PMID:8798939

Ethics in the marketing of medical services.

PubMed

Latham, Stephen R

2004-09-01

This paper deals with the ethics of marketing medical services by physicians, medical groups, hospitals and other mainstream medical caregivers in the United States. It does not deal with pharmaceutical marketing, since that raises a number of special issues, some of them legal and some having to do with the unique culture of pharmaceutical marketing, which really ought to be dealt with separately. Nor does it touch on the little-explored field of marketing alternative and complementary medicine. It begins with a general description of what is included in "the marketing process." It then briefly tours some of the difficulties faced by those who would market medical services ethically, and ends with some comments on the relevance of professionalism to ethical marketing.

Medical ethics education in China: Lessons from three schools.

PubMed

Sherer, Renslow; Dong, Hongmei; Cong, Yali; Wan, Jing; Chen, Hua; Wang, Yanxia; Ma, Zhiying; Cooper, Brian; Jiang, Ivy; Roth, Hannah; Siegler, Mark

2017-01-01

Ethics teaching is a relatively new area of medical education in China, with ethics curricula at different levels of development. This study examined ethics education at three medical schools in China to understand their curricular content, teaching and learning methods, forms of assessments, changes over time, and what changes are needed for further improvement. We used student and faculty surveys to obtain information about the ethics courses' content, teaching methods, and revisions over time. The surveys also included five realistic cases and asked participants whether each would be appropriate to use for discussion in ethics courses. Students rated the cases on a scale and gave written comments. Finally, participants were asked to indicate how much they would agree with the statement that medical professionalism is about putting the interests of patients and society above one's own. There were both similarities and differences among these schools with regard to course topics, teaching and assessment methods, and course faculty compositions, suggesting their courses are at different levels of development. Areas of improvement for the schools' courses were identified based on this study's findings and available literature. A model of the evolution of medical ethics education in China was proposed to guide reform in medical ethics instruction in China. Analysis identified characteristics of appropriate cases and participants' attitudes toward the ideal of professionalism. We conclude that the development of medical ethics education in China is promising while much improvement is needed. In addition, ethics education is not confined to the walls of medical schools; the society at large can have significant influence on the formation of students' professional values.

Can ethnography save the life of medical ethics?

PubMed

Hoffmaster, B

1992-12-01

Since its inception contemporary medical ethics has been regarded by many of its practitioners as 'applied ethics', that is, the application of philosophical theories to the moral problems that arise in health care. This 'applied ethics' model of medical ethics is, however, beset with internal and external difficulties. The internal difficulties point out that the model is intrinsically flawed. The external difficulties arise because the model does not fit work in the field. Indeed, the strengths of that work are its highly nuanced, particularized analyses of cases and issues and its appreciation of the circumstances and contexts that generate and structure these cases and issues. A shift away from a theory-driven 'applied ethics' to a more situational, contextual approach to medical ethics opens the way for ethnographic studies of moral problems in health care as well as a conception of moral theory that is more responsive to the empirical dimensions of those problems.

Cultural context in medical ethics: lessons from Japan.

PubMed

Powell, Tia

2006-04-03

This paper examines two topics in Japanese medical ethics: non-disclosure of medical information by Japanese physicians, and the history of human rights abuses by Japanese physicians during World War II. These contrasting issues show how culture shapes our view of ethically appropriate behavior in medicine. An understanding of cultural context reveals that certain practices, such as withholding diagnostic information from patients, may represent ethical behavior in that context. In contrast, nonconsensual human experimentation designed to harm the patient is inherently unethical irrespective of cultural context. Attempts to define moral consensus in bioethics, and to distinguish between acceptable and unacceptable variation across different cultural contexts, remain central challenges in articulating international, culturally sensitive norms in medical ethics.

Avoiding evasion: medical ethics education and emotion theory.

PubMed

Leget, C

2004-10-01

Beginning with an exemplary case study, this paper diagnoses and analyses some important strategies of evasion and factors of hindrance that are met in the teaching of medical ethics to undergraduate medical students. Some of these inhibitions are inherent to ethical theories; others are connected with the nature of medicine or cultural trends. It is argued that in order to avoid an attitude of evasion in medical ethics teaching, a philosophical theory of emotions is needed that is able to clarify on a conceptual level the ethical importance of emotions. An approach is proposed with the help of the emotion theory Martha Nussbaum works out in her book Upheavals of thought. The paper ends with some practical recommendations.

Cultural context in medical ethics: lessons from Japan

PubMed Central

Powell, Tia

2006-01-01

This paper examines two topics in Japanese medical ethics: non-disclosure of medical information by Japanese physicians, and the history of human rights abuses by Japanese physicians during World War II. These contrasting issues show how culture shapes our view of ethically appropriate behavior in medicine. An understanding of cultural context reveals that certain practices, such as withholding diagnostic information from patients, may represent ethical behavior in that context. In contrast, nonconsensual human experimentation designed to harm the patient is inherently unethical irrespective of cultural context. Attempts to define moral consensus in bioethics, and to distinguish between acceptable and unacceptable variation across different cultural contexts, remain central challenges in articulating international, culturally sensitive norms in medical ethics. PMID:16759415

Violence risk assessment as a medical intervention: ethical tensions

PubMed Central

Roychowdhury, Ashimesh; Adshead, Gwen

2014-01-01

Risk assessment differs from other medical interventions in that the welfare of the patient is not the immediate object of the intervention. However, improving the risk assessment process may reduce the chance of risk assessment itself being unjust. We explore the ethical arguments in relation to risk assessment as a medical intervention, drawing analogies, where applicable, with ethical arguments raised by general medical investigations. The article concludes by supporting the structured professional judgement approach as a method of risk assessment that is most consistent with the respect for principles of medical ethics. Recommendations are made for the future direction of risk assessment indicated by ethical theory. PMID:25237503

Ethics and the ethnography of medical research in Africa

PubMed Central

Molyneux, Sassy; Geissler, P. Wenzel

2008-01-01

The ethics of medical research have grown as an area of expertise and debate in recent years, with two broad approaches emerging in relation to transnational research: (1) the refinement of guidelines and strengthening of review, processes primarily to protect the right of individual research participants and strengthen interpersonal relations at the micro-level; and (2) considering more centrally, as crucial ethical concerns, the wider interests of whole populations, the functioning of research institutions, the processes of collaboration, and the ethics of inequitable international relations. We see the two areas of debate and action as complementary, and believe that social science conducted in and around transnational medical research environments can bring these two perspectives together in a more ‘situated ethics’ of research. To explore this idea for medical research in Africa, we organized a conference in December 2005 in Kilifi, Kenya. In this introduction we outline the two emerging approaches to medical ethics, summarise each of seven papers selected from the conference for inclusion in this special issue on ethics and ethnography, and finally highlight two areas of lively debate at the conference itself: the appropriateness and value of ethics guidelines and review boards for medical research; and the ethical review of social science research. Together, the papers and debates point to the importance of focusing on the ethics of relationships and on justice in both biomedicine and social science research, and on giving greater voice and visibility to the field staff who often play a crucial and under-supported role in ‘doing ethics’ in the field. They also point to the potential value of social science research on the range of relationships operating at different levels and time scales in medical research, including those surrounding community engagement activities, and the role and functioning of ethics review boards. We conclude by highlighting

Codes of medical ethics: traditional foundations and contemporary practice.

PubMed

Sohl, P; Bassford, H A

1986-01-01

The Hippocratic Coprus recognized the interaction of 'business' and patient-health moral considerations, and urged that the former be subordinated to the latter. During the 1800s with the growth of complexity in both scientific knowledge and the organization of health services, the medical ethical codes addressed themselves to elaborate rules of conduct to be followed by the members of the newly emerging national medical associations. After World War II the World Medical Association was established as an international forum where national medical associations could debate the ethical problems presented by modern medicine. The International Code of Medical ethics and the Declaration of Geneva were written as 20th century restatements of the medical profession's commitment to the sovereignty of the patient-care norm. Many ethical statements have been issued by the World Medical Association in the past 35 years; they show the variety and difficulties of contemporary medical practice. The newest revisions were approved by the General Assembly of the World Medical Association in Venice, Italy October 1983. Their content is examined and concern is voiced about the danger of falling into cultural relativism when questions about the methods of financing medical services are the subject of an ethical declaration which is arrived at by consensus in the W.M.A.

Ethics of medical records and professional communications.

PubMed

Recupero, Patricia R

2008-01-01

In child and adolescent psychiatry, medical records and professional communications raise important ethical concerns for the treating or consulting clinician. Although a distinction may be drawn between internal records (eg, medical records and psychotherapy notes) and external communications (eg, consultation reports and correspondence with pediatricians), several ethical principles apply to both types of documentation; however, specific considerations may vary, depending upon the context in which the records or communications were produced. Special care is due with regard to thoroughness and honesty, collaboration and cooperation, autonomy and dignity of the patient, confidentiality of the patient and family members, maintaining objectivity and neutrality, electronic communications media, and professional activities (eg, political advocacy). This article reviews relevant ethical concerns for child and adolescent psychiatrists with respect to medical records and professional communications, drawing heavily from forensic and legal sources, and offers additional recommendations for further reading for clarification and direction on ethical dilemmas.

Teaching medical ethics in other countries.

PubMed Central

Wolstenholme, G

1985-01-01

In the past 20 years, around the world, there has been an explosion in the teaching of medical ethics. As the dust begins to settle, it would appear that such teaching is likely to have its most effective impact not during the undergraduate period but at the immediate postgraduate level and in continuing education. Whilst important contributions can be made by teachers of religion, philosophy and law, probably the essential wisdom, capable of standing a doctor in good stead throughout the developments of a lifetime's career, must largely come from those who have studied both medicine and ethics. It would be appropriate if the study of medical ethics were to lead to better international understanding among doctors. PMID:3981565

[Learning objectives achievement in ethics education for medical school students].

PubMed

Chae, Sujin; Lim, Kiyoung

2015-06-01

This study aimed to examine the necessity for research ethics and learning objectives in ethics education at the undergraduate level. A total of 393 fourth-year students, selected from nine medical schools, participated in a survey about learning achievement and the necessity for it. It was found that the students had very few chances to receive systematic education in research ethics and that they assumed that research ethics education was provided during graduate school or residency programs. Moreover, the students showed a relatively high learning performance in life ethics, while learning achievement was low in research ethics. Medical school students revealed low interest in and expectations of research ethics in general; therefore, it is necessary to develop guidelines for research ethics in the present situation, in which medical education mainly focuses on life ethics.

Metaphysics and medical ethics.

PubMed Central

Parkin, C

1995-01-01

I take issue with Frank Leavitt's sketch of a pragmatic criterion for the relevance of metaphysics to medical ethics. I argue that appeal to the potential for confusion generated by metaphysical subtlety establishes a need for better communication rather than shows philosophical insight beside the point. I demonstrate that the proposed Criterion of Relevance has absurd consequences, and I claim that the relevance of philosophical doctrines, whether ethical or metaphysical, is best accounted for in terms of improved understanding. PMID:7608933

A theoretical framework for human and veterinary medical ethics education.

PubMed

Magalhães-Sant'Ana, Manuel

2016-12-01

In their practice, physicians and veterinarians need to resort to an array of ethical competences. As a teaching topic, however, there is no accepted gold standard for human medical ethics, and veterinary medical ethics is not yet well established. This paper provides a reflection on the underlying aims of human and veterinary medical ethics education. Drawing from published literature on ethics education in the health professions a theoretical framework common to the teaching of human and veterinary medical ethics is proposed, based on three concepts: professional rules, moral virtues and ethical skills. The rules approach relies on the transmission of professional and social values by means of regulatory documents and depends intimately on the knowledge that students have of those documents. The virtues approach involves the inculcation of moral values and virtues that will stimulate students to develop desirable behaviours. The main focus of this approach to ethics is to develop students' attitudinal competences. Finally, the skills approach is focused on equipping the students with the necessary moral reasoning abilities to recognise and respect the plurality of ethical views that make part of contemporary society. This framework can inform future curriculum development in human and veterinary medical ethics as well as in other health care professions.

Transplant ethics under scrutiny - responsibilities of all medical professionals.

PubMed

Trey, Torsten; Caplan, Arthur L; Lavee, Jacob

2013-02-01

In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices.

Translational ethics? The theory-practice gap in medical ethics.

PubMed

Cribb, Alan

2010-04-01

Translational research is now a critically important current in academic medicine. Researchers in all health-related fields are being encouraged not only to demonstrate the potential benefits of their research but also to help identify the steps through which their research might be 'made practical'. This paper considers the prospects of a corresponding movement of 'translational ethics'. Some of the advantages and disadvantages of focusing upon the translation of ethical scholarship are reviewed. While emphasising the difficulties of crossing the gap between scholarship and practice, the paper concludes that a debate about the business of translation would be useful for medical ethics.

Is it possible to assess the "ethics" of medical school applicants?

PubMed Central

Lowe, M.; Kerridge, I.; Bore, M.; Munro, D.; Powis, D.

2001-01-01

Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved. Key Words: Ethics • medical school selection • personality PMID:11731605

Threats to bioethical principles in medical practice in Brazil: new medical ethics code period.

PubMed

Gracindo, G C L; da Silva Gallo, J H; Nunes, R

2018-03-15

We aimed to outline the profile of medical professionals in Brazil who have violated the deontological norms set forth in the ethics code of the profession, and whose cases were judged by the higher tribunal for medical ethics between 2010 and 2016. This survey was conducted using a database formed from professional ethics cases extracted from the plenary of the medical ethics tribunal of the Federal Council of Medicine. These were disciplinary ethics cases that were judged at appeal level between 2010 and 2016. Most of these professionals were male (88.5%) and their mean age was 59.9 years (SD=11.62) on the date of judgment of their appeals, ranging from 28 to 95 years. Most of them were based in the southeastern region of Brazil (50.89%). Articles 1 and 18 of the medical ethics code were the rules most frequently violated. The sentence given most often was the cancellation of their professional license (37.6%) and the acts most often sentenced involved malpractice, imprudence, and negligence (18.49%). It is acknowledged that concern for the principles of bioethics was present in the appeal decisions made by the plenary of the medical ethics tribunal of the Federal Council of Medicine.

Virtuous acts as practical medical ethics: an empirical study.

PubMed

Little, Miles; Gordon, Jill; Markham, Pippa; Rychetnik, Lucie; Kerridge, Ian

2011-10-01

To examine the nature, scope and significance of virtues in the biographies of medical practitioners and to determine what kind of virtues are at play in their ethical behaviour and reflection. A case study involving 19 medical practitioners associated with the Sydney Medical School, using semi-structured narrative interviews. Narrative data were analysed using dialectical empiricism, constant comparison and iterative reformulation of research questions. Participants represented virtuous acts as centrally important in their moral assessments of both themselves and others. Acts appeared to be contextually virtuous, rather than expressions of stable character traits, and virtue was linked to acts that served to protect or enhance fundamental values attached to ontological security and human flourishing. Virtue ethics, in this sense, was the single most important ethical system for each of the participants. Virtue ethics, construed as the appraisal of acts in contexts of risk, danger or threat to foundational values, emerged as the 'natural' ethical approach for medical practitioners in this case study. Teaching medical ethics to students and graduates alike needs to accommodate the priority attached to virtuous acts. © 2011 Blackwell Publishing Ltd.

[Which ethics for medical ethics? Homage to Hans Jonas, 1903-1993].

PubMed

Munzarová, Marta

2014-01-01

Hans Jonas, one of the greatest philosophers of the 20th century, devoted several studies to the ethics in context with medicine and/or to the new biomedical research. His main thoughts in this field are presented (death and dying, mortality, reflections on experimenting with human subjects - nontherapeutic research, cloning, chimaeras). He was a man of wisdom and his humanity and moral sensibility are a matter of admiration. His ethics is in full consent with ethics and the dignity of medical profession. His ideas are compared (and contrasted) with those of the new bio"ethics".

A Theoretical Framework for Human and Veterinary Medical Ethics Education

ERIC Educational Resources Information Center

Magalhães-Sant'Ana, Manuel

2016-01-01

In their practice, physicians and veterinarians need to resort to an array of ethical competences. As a teaching topic, however, there is no accepted gold standard for human medical ethics, and veterinary medical ethics is not yet well established. This paper provides a reflection on the underlying aims of human and veterinary medical ethics…

Analysis of medical confidentiality from the islamic ethics perspective.

PubMed

Tavaokkoli, Saeid Nazari; Nejadsarvari, Nasrin; Ebrahimi, Ali

2015-04-01

Confidentiality is one of the old rules of the medical profession. While emphasizing the necessity of confidentiality in religious teachings, disclosure of other's secrets to commit sin deserves punishment hereafter known. Today, progress in medical science and invention of new diagnostic and therapeutic procedures, as well as the extent of information and disclosure of the secrets of the patients, have provided more than ever. After explaining the concepts and principles of confidentiality in medical ethics, the Islamic-oriented Virtue Ethics, in a comparative review, share the differences in these two sets of ethical review and explain the issue of confidentiality. In professional medical ethics, only the behaviors of health staff are evaluated and moral evaluation of the features cannot be evaluated, but in Islamic ethics, the moral evaluation of the features that are sensual, confidentiality is more stable, without any external supervision will maintain its efficiency.

Medical ethics and education for social responsibility.

PubMed

Roemer, M I

1980-01-01

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.

The Canadian Medical Association Code of Ethics 1868 to 1996: a primer for medical educators.

PubMed

Brownell, A Keith W; Brownell, Elizabeth

2002-06-01

The Canadian Medical Association's (CMA) Code of Ethics applies to all physicians, residents, and medical students in Canada. Learning about the code must be a part of every physician's education, and keeping current with it must be a part of every physician's continuing medical education. This article, based on a review of the 19 CMA codes of ethics issued from 1868 to 1996, shows how deeply the Code of Ethics is tied to the past, highlights those topics that have been part of every version, and demonstrates how the code changed over time. This article should assist medical educators as they develop teaching material on codes of medical ethics, and would be of interest to practising physicians.

Ethical issues at the start of life.

PubMed

Sacks, J

2001-01-01

In this article the fundamentals of a Jewish ethic are set out, through which today's pressing medical ethical questions are then broached. Ethics derive from a basic view of humanity. The Bible teaches that man is created in God's image, and every life is therefore sacrosanct. Second, since life is God-given we are its guarantors, not its owners. Finally, monotheism sees God as above nature and not in it, so nature itself is not holy--man can, and indeed should, try to improve upon it. With reference to specific medical issues, the need to be wary of the erosion of the family unit and of personal identity is stressed. Concerning abortion and stem cell research, the point is made that an embryo is not a person but is a potentiality and therefore not an object to be used. Regarding genetic intervention, a line is drawn between the therapeutic and the eugenic. Every technology carries with it the possibility of diminishing or enhancing human dignity. What matters is how we use it. The way to use it is in a covenant with God, honouring his image that is mankind.

Must we remain blind to undergraduate medical ethics education in Africa? A cross-sectional study of Nigerian medical students.

PubMed

Okoye, Onochie; Nwachukwu, Daniel; Maduka-Okafor, Ferdinand C

2017-12-08

As the practice of medicine inevitably raises both ethical and legal issues, it had been recommended since 1999 that medical ethics and human rights be taught at every medical school. Most Nigerian medical schools still lack a formal undergraduate medical ethics curriculum. Medical education remains largely focused on traditional medical science components, leaving the medical students to develop medical ethical decision-making skills and moral attitudes passively within institutions noted for relatively strong paternalistic traditions. In conducting a needs assessment for developing a curriculum germane to the Nigerian society, and by extension most of Sub-Saharan Africa, this study determined the views of Nigerian medical students on medical ethics education, ethical issues related to the doctor-patient relationship and the ethical/professional dilemmas they are confronted with. Using self-administered 63-item structured questionnaires, a cross-sectional survey of the final year medical students of the University of Nigeria was conducted in July 2015.Using the Statistical Package for the Social Sciences software (SPSS Version 17), frequency counts and percentages were generated. The sample included 100 males (71.4%) and 40 females (28.6%), with the respective mean (SD) age being 24.6(5.61) and 21.8 (6.38) years. Only 35.7% were satisfied with their medical ethics knowledge, and 97.9% indicated that medical ethics should be taught formally. Only 8.6% had never witnessed a medical teacher act unethically. The dilemmas of poor communication between physicians and patients, and the provision of sub-standard care were reported highest for being encountered 'often'. A majority (60.7%) indicated that "a doctor should do his best always, irrespective of the patient's wishes". No significant difference in responses across gender was noted. There is a strong desire by the contemporary Nigerian medical student for medical ethics education. Their lack of exposure in medical

The impact of medical tourism and the code of medical ethics on advertisement in Nigeria

PubMed Central

Makinde, Olusesan Ayodeji; Brown, Brandon; Olaleye, Olalekan

2014-01-01

Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done. PMID:25722776

The impact of medical tourism and the code of medical ethics on advertisement in Nigeria.

PubMed

Makinde, Olusesan Ayodeji; Brown, Brandon; Olaleye, Olalekan

2014-01-01

Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done.

An Analysis of Student Choices in Medical Ethical Dilemmas.

ERIC Educational Resources Information Center

Woloshin, Phyllis Lerman

This report describes a study undertaken to assess student choices in medical ethical dilemmas. Medical ethical dilemmas are interpreted to include problems such as abortion, euthanasia, sterilization, experimentation on humans, allocation of scarce medical resources, and physician and health personnel training. The major purpose of the study was…

[Civil, criminal and ethical liability of medical doctors].

PubMed

Udelsmann, Artur

2002-01-01

In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors. After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions. Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians.

Using rhetorical theory in medical ethics cases.

PubMed

Heifferon, B

2000-01-01

In this paper I argue that rhetorical theory is a valuable tool in medical ethics cases. The case I use as an example is one in which traditional, philosophy-based medical ethics are applied. In this case the traditional ethical approach is not adequate to the task. Key issues and problems are not addressed, resulting in a problem that seems to be solved on the surface, but, when rhetorically analyzed, it's obvious that none of the issues have been resolved in any satisfactory way. By using rhetorical theory, such as that Michel Foucault uses in Power/Knowledge, we discover that the reason this case has not been solved is that the power issues have not been addressed. Using Foucault's concepts of "subjugated knowledge", "local knowledge", "situated knowledge", and "docile bodies", we can tease out the real issues that surface in this ethics case and solve them. Foucault also recommends we use theory as a "toolkit". I propose a model that is a further iteration of this idea. My model uses numerous rhetorical and literary theories, depending on the issues that need to be addressed in each individual medical ethics case. I briefly describe the various theories and include a handout of what the new model of using rhetorical theory in such cases would look like.

Texts in Tension: Negotiating Jewish Values in the Adult Jewish Learning Classroom

ERIC Educational Resources Information Center

Woocher, Meredith L.

2004-01-01

In this paper, the author begins with a brief classroom scene that illustrates a number of significant features of contemporary American Jewish life. The engagement of adult students with Jewish text study is an example and outgrowth of the flourishing of programs of adult Jewish learning over the past two decades. Thousands of similar Jewish…

Technology: So Pervasive in Jewish Living, so Absent from Jewish Educational Research

ERIC Educational Resources Information Center

Schein, Jeffrey

2016-01-01

The Jewish world, like the world civilization that hosts it, is awash in new technologies. Appropriately, there is a great deal of attention paid to how to improve the Jewish world and Jewish identity through technology. Paradoxically there is a paucity of literature characterizing the relationship of Jews and Judaism to technology. This article…

Moral fictions and medical ethics.

PubMed

Miller, Franklin G; Truog, Robert D; Brock, Dan W

2010-11-01

Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices is based on a series of moral fictions - motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. © 2009 Blackwell Publishing Ltd.

Medical ethics and education for social responsibility.

PubMed Central

Roemer, M. I.

1980-01-01

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization. PMID:7405276

Medication Refusal in Schizophrenia: Preventive and Reactive Ethical Considerations.

PubMed

Sabin, James

2016-06-01

Clinicians treating patients with recurrent psychosis should encourage contingency planning with patients and families for how to respond to potential recurrences. Whether or not patients create a formal psychiatric advance directive, patients, families, and clinicians will be better prepared to deal with emergencies if they include "scenario planning" as part of ongoing clinical care. In the case under discussion this was not done, resulting in an ethical conundrum as to whether it was ethically justifiable to override the proxy decision maker's refusal of medication. Law on this question is unsettled, but the author argues that from the perspective of ethics, overriding medication refusal is sometimes ethically permissible. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

Medical ethics in the primary care setting.

PubMed

Smith, H L

1987-01-01

Much popular and professional understanding of 'medical ethics' is nowadays located in quandary ethics, exotic life-and-death decision-making, and tertiary care settings. Medical ethics in the primary care setting is concerned with very different matters. Among these are issues having to do with basic self-understandings of health professionals and patients and their fiduciary relationships; with fundamental social, political and economic notions which will and do shape the allocation and distribution of health care resources; with the goals and purposes appropriate to medical interventions of various sorts; and with the care of the whole person rather than the limited attention to a particular illness or disease syndrome. The commitments of primary care medicine challenge in radical ways some cherished claims of modern liberal societies by questioning the limits of autonomous individualism and by affirming the indispensability of social justice.

The Overlapping Spheres of Medical Professionalism and Medical Ethics: A Conceptual Inquiry

ERIC Educational Resources Information Center

Ruitenberg, Claudia W.

2016-01-01

This essay examines the concepts of "professionalism" and "ethics" as they are used in health professions education and, in particular, medical education. It proposes that, in order to make sense of the construct of "professional ethics," it would be helpful to conceive of professionalism and ethics as overlapping but…

Ethical issues associated with medical tourism in Africa.

PubMed

Mogaka, John J O; Mupara, Lucia; Tsoka-Gwegweni, Joyce M

2017-01-01

Global disparities in medical technologies, laws, economic inequities, and social-cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O'Malley's (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject.

Ethical issues associated with medical tourism in Africa

PubMed Central

Mogaka, John J. O.; Mupara, Lucia; Tsoka-Gwegweni, Joyce M

2017-01-01

ABSTRACT Global disparities in medical technologies, laws, economic inequities, and social–cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O’Malley’s (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject. PMID:28740618

Transplant ethics under scrutiny – responsibilities of all medical professionals

PubMed Central

Trey, Torsten; Caplan, Arthur L.; Lavee, Jacob

2013-01-01

In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices. PMID:23444249

"Big eye" surgery: the ethics of medicalizing Asian features.

PubMed

Aquino, Yves Saint James

2017-06-01

The popularity of surgical modifications of race-typical features among Asian women has generated debates on the ethical implications of the practice. Focusing on blepharoplasty as a representative racial surgery, this article frames the ethical discussion by viewing Asian cosmetic surgery as an example of medicalization, which can be interpreted in two forms: treatment versus enhancement. In the treatment form, medicalization occurs by considering cosmetic surgery as remedy for pathologized Asian features; the pathologization usually occurs in reference to western features as the norm. In the enhancement form, medicalization occurs by using medical means to improve physical features to achieve a certain type of beauty or physical appearance. Each type of medicalization raises slightly different ethical concerns. The problem with treatment medicalization lies in the pathologization of Asian features, which is oppressive as it continues to reinforce racial norms of appearance and negative stereotypes. Enhancement medicalization is ethically problematic because cosmetic surgery tends to conflate beauty and health as medical goals of surgery, overemphasizing the value of appearance that can further displace women's control over their own bodies. I conclude that in both forms of medicalization, cosmetic surgery seems to narrowly frame a complex psychosocial issue involving physical appearance as a matter that can be simply solved through surgical means.

Internal Medicine Residents' Preferences regarding Medical Ethics Education.

ERIC Educational Resources Information Center

Jacobson, Jay A.; And Others

1989-01-01

A survey of residents (N=323) in 6 internal medicine programs investigated the topics students wanted included in the medical ethics curriculum and by which of 17 methods they would prefer to be taught. About three-fourths had previous medical ethics instruction, and most wanted more on specific topics, especially legal and end-of-life issues.…

[Truth telling to patients--A discussion of Jewish sources (corrected)].

PubMed

Gesundheit, Benjamin; Zlotnick, Eitan; Wygoda, Michael; Rosenzweig, Joshua P; Steinberg, Avraham

2014-10-01

Defining truth and truth-telling to patients are central topics in philosophy, law, and psychology, with many implications in medicine. In the last hundred years, with the transition from paternalistic medicine to a system in which the patient's autonomy is emphasized, the decision on the quantity and quality of medical information to be disclosed to the patient has become more complicated and requires careful consideration and special sensitivity on the part of the doctor. The Israeli Patients' Rights Act (1996] established guidelines for medical staff about telltting the truth to patients with occasional special authority delegated to the doctor to decide for the benefit of the patient at his discretion and with the approval of the institutional ethics committee, but in practice there are difficulties in implementing the Law. This article reviews a selection of sources from Jewish tradition throughout the ages that deal with truthtelling or concealing the truth in medical contexts and other contexts. Sources are drawn from the Bible, Mishna-Talmud, and halachic Literature, from which.conclusions can be drawn regarding this issue. In our opinion, these sources yield messages and values that are also relevant to the modern medical world. This is especially true in a multi-cultural environment such as Israel that requires the physician to consider the patient's background and to communicate information in accordance with his/her will, in an efficient and sensitive manner.

The Italian Code of Medical Deontology. Historical, ethical and legal issues.

PubMed

Patuzzo, Sara; De Stefano, Francesco; Ciliberti, Rosagemma

2018-06-15

Medical deontology is increasingly important, owing to the interests and rights which the medical profession involves. This paper focuses on the relationships of the Italian Code of Medical Deontology (CMD) with both the ethical and legal dimensions, in order to clarify the role of medical ethics within the medical profession, society and the overall system of the sources of law. The authors analyze the CMD from an ethical perspective and through the new doctrinal guidelines and current trends in the Italian law courts. From an ethical point of view,  moral philosophical analysis scarcely seems to  address professional medical ethics. Nonetheless, the CMD needs to undergo careful ethical analysis. From a legal perspective, the Italian CMD contains provisions which do not have  an official legal nature. However, they are directly binding for medical practitioners, and therefore could be understood as a supplement to the general rules of the legal system. At an ethical level, rigorous debate on the CMD is indispensable, in order to update its specific principles and to make it a real moral normative document. At a legislative level, there is a possible contradiction between a legal system that does not take into account the CMD, but which then attributes significant importance to the violation of its rules.

Ethics and animal issues in US medical education.

PubMed

Wiebers, D O; Barron, R A; Leaning, J; Ascione, F R

1994-11-01

Increasing public and regulatory agency concern about a variety of animal protection issues that affect the field of medicine have made these issues increasingly relevant to medical school curricula. The purpose of this study was to assess the availability and forms of medical school training relating to ethical, conceptual, and societal concerns in the use of animals within the field of medicine and the perceived need for such training. Questionnaire surveys were mailed to the Deans of the 125 accredited US medical schools, and completed by Deans or their designees within the same medical institution. Questionnaire recipients were informed that results would be compiled in a fashion that did not identify specific individuals or institutions. Survey responses were obtained from 84 medical institutions (67% response). Sixty respondents (71%) indicated that their medical school offered or sponsored some type of activity related to ethical and conceptual concerns in the use of animals in medical research and training. Most schools (43) offered informal discussions/seminars relating to these issues, but nine schools offered full formal courses with up to 15 lectures on these topics. Programme content and perceived need for additional instruction varied greatly amongst respondents. The results suggest a wide diversity amongst US medical schools in the availability and perceived importance of medical school training relating to ethical and conceptual concerns in the uses of animals in medicine. It is proposed that instruction in these areas be pursued with more concerted efforts to address the growing body of knowledge about non-human beings and the ethical implications of such knowledge.

New Partners in Jewish Education: Independent Afterschool Jewish Education Programs and Their Relationships with Congregational Supplementary Schools

ERIC Educational Resources Information Center

Novak Winer, Laura

2017-01-01

In recent years the Jewish community has witnessed a growth in the development of Jewish afterschool programs that provide childcare as well as Jewish educational programming to elementary age children. This possible trend may represent a diversification of options for families seeking to provide Jewish education and Jewish experiences for their…

Jewish Women's Psychological Well-Being: The Role of Attachment, Separation, and Jewish Identity

ERIC Educational Resources Information Center

Goldberg, Julie L.; O'Brien, Karen M.

2005-01-01

The purpose of this study was to examine the contributions of attachment, separation, and Jewish identity to psychological well-being in a sample of 115 late adolescent Jewish women. Results from multiple regression analyses demonstrated that attachment to parents, separation from parents, and Jewish identity collectively accounted for variance in…

Teaching and assessing medical ethics: where are we now?

PubMed Central

Mattick, K; Bligh, J

2006-01-01

Objectives To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning. Design Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives. Participants The lead for teaching and learning at each medical school was invited to complete a questionnaire. Results Completed responses were received from 22/28 schools (79%). Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development. Conclusions This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally. PMID:16507668

What is it to practise good medical ethics? A Muslim's perspective.

PubMed

Serour, G I

2015-01-01

Good medical ethics should aim at ensuring that all human beings enjoy the highest attainable standard of health. With the development of medical technology and health services, it became necessary to expand the four basic principles of medical ethics and link them to human rights. Despite the claim of the universality of those ethical principles, their perception and application in healthcare services are inevitably influenced by the religious background of the societies in which those services are provided. This paper highlights the methodology and principles employed by Muslim jurists in deriving rulings in the field of medical ethics, and it explains how ethical principles are interpreted through the lens of Islamic theory. The author explains how, as a Muslim obstetrician-gynaecologist with a special interest in medical ethics, including international consideration of reproductive ethics issues, he attempts to 'practise good medical ethics' by applying internationally accepted ethical principles in various healthcare contexts, in ways that are consistent with Islamic principles, and he identifies the evidence supporting his approach. He argues that healthcare providers have a right to respect for their conscientious convictions regarding both undertaking and not undertaking the delivery of lawful procedures. However, he also argues that withholding evidence-based medical services based on the conscientious objection of the healthcare provider is unethical as patients have the right to be referred to services providing such treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The literature of medical ethics: Bernard Häring

PubMed Central

Soane, Brendan

1977-01-01

To the general reader and watcher of television programmes medical ethics may appear to be something new. This is not so, for hundreds of articles and many books have appeared over the last 10 years or so to discuss and analyse the problems arising from the practice of medicine. In this study of two larger works - Medical Ethics and Manipulation - both by Bernard Häring, a Roman Catholic theologian - Father Brendan Soane analyses these in some detail and sets their ideas in the context of what has already been written on the major issues of medical ethics and what is likely to be foremost in discussion in the near future. Many readers of this Journal already have the particular background of knowledge to see the problems in medicine which are in fact ethical but the general reader may require help and enlightenment and this is now provided for a special field within the field. PMID:874983

The vocal load of Reform Jewish cantors in the USA.

PubMed

Hapner, Edie; Gilman, Marina

2012-03-01

Jewish cantors comprise a subset of vocal professionals that is not well understood by vocal health professionals. This study aimed to document the vocal demands, vocal training, reported incidence of voice problems, and treatment-seeking behavior of Reform Jewish cantors. The study used a prospective observational design to anonymously query Reform Jewish cantors using a 35-item multiple-choice survey distributed online. Demographic information, medical history, vocal music training, cantorial duties, history of voice problems, and treatment-seeking behavior were addressed. Results indicated that many of the commonly associated risk factors for developing voice disorders were present in this population, including high vocal demands, reduced vocal downtime, allergies, and acid reflux. Greater than 65% of the respondents reported having had a voice problem that interfered with their ability to perform their duties at some time during their careers. Reform Jewish cantors are a population of occupational voice users who may be currently unidentified and underserved by vocal health professionals. The results of the survey suggest that Reform Jewish cantors are occupational voice users and are at high risk for developing voice disorders. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

A Case Study in Jewish Moral Education: (Non-)Rape of the Beautiful Captive

ERIC Educational Resources Information Center

Resnick, David

2004-01-01

The challenge of teaching classic religious texts with flawed moral messages from a contemporary point of view is examined in the case of the Beautiful Captive of War (Deuteronomy 21:10-14). A moral dilemma is generated by contradictory ethical stands within the Jewish tradition, between which students have to choose. This dilemma is explored in…

The pre-employment medical--ethical dilemmas for GPs.

PubMed

Thuraisingham, Chandramani; Nalliah, Sivalingam

2013-04-01

In many workplaces, employment is conditional on a successful pre-employment medical examination. This examination is usually conducted by a general practitioner on the employers' panel of approved clinics or by an in-house company doctor. This article uses a case study to illustrate some of the ethical dilemmas that may be faced by GPs in the course of performing a pre-employment medical examination. Ethical issues discussed in this article include: Is it ethical for employers (based on physicians' reports) to select workers based on 'absence of illness' rather than 'fitness for work'? Should physicians divulge the illness of potential workers to third parties? What are the boundaries of a clinician's duty of care in the pre-employment medical examination setting?

Medical ethics: enhanced or undermined by modes of payment?

PubMed

Zweifel, Peter; Janus, Katharina

2017-01-01

In the medical literature [1, 2, 7], the view prevails that any change away from fee-for-service (FFS) jeopardizes medical ethics, defined as motivational preference in this article. The objective of this contribution is to test this hypothesis by first developing two theoretical models of behavior, building on the pioneering works of Ellis and McGuire [4] and Pauly and Redisch [11]. Medical ethics is reflected by a parameter α, which indicates how much importance the physician attributes to patient well-being relative to his or her own income. Accordingly, a weakening of ethical orientation amounts to a fall in the value of α. While traditional economic theory takes preferences as predetermined, more recent contributions view them as endogenous (see, e.g., Frey and Oberholzer-Gee [5]). The model variant based on Ellis and McGuire [4] depicts the behavior of a physician in private practice, while the one based on Pauly and Redisch [11] applies to providers who share resources such as in hospital or group practice. Two changes in the mode of payment are analyzed, one from FFS to prospective payment (PP), the other to pay-for-performance (P4P). One set of predictions relates physician effort to a change in the mode of payment; another, physician effort to a change in α, the parameter reflecting ethics. Using these two relationships, a change in ethics can observationally be related to a change in the mode of payment. The predictions derived from the models are pitted against several case studies from diverse countries. A shift from FFS to PP is predicted to give rise to a negative observed relationship between the medical ethics of physicians in private practice under a wide variety of circumstances, more so than a shift to P4P, which can even be seen as enhancing medical ethics, provided physician effort has a sufficiently high marginal effectiveness in terms of patient well-being. This prediction is confirmed to a considerable degree by circumstantial evidence

Imparting Medical Ethics: The Role of Mentorship in Clinical Training

ERIC Educational Resources Information Center

Rose, Gail L.; Rukstalis, Margaret R.

2008-01-01

Mentoring and ethics are integral and intersecting components of medical education. Faculty workloads and diffusion of responsibility for teaching impact both ethics and mentoring. In current academic medical center environments, the expectation that traditional one-on-one mentoring relationships will arise spontaneously between medical students…

The agency problem and medical acting: an example of applying economic theory to medical ethics.

PubMed

Langer, Andreas; Schröder-Bäck, Peter; Brink, Alexander; Eurich, Johannes

2009-03-01

In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician-patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician-patient relationship in a descriptive heuristic sense. The principal-agent theory can be used to analytically grasp existing action problems in the physician-patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients' increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician's necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics.

Rethinking medical oaths using the Physician Charter and ethical virtues.

PubMed

Greiner, Alexander M; Kaldjian, Lauris C

2018-04-27

Medical oaths express ethical values that are essential to the trust within the patient-physician relationship and medicine's commitment to society. However, the contents of oaths vary between medical schools and therefore raise questions about which ethical values should be included in a medical oath. More than a decade has passed since this variability was last analysed in North America, and since that time the Physician Charter on Medical Professionalism has gained considerable attention, raising the possibility that the Charter may be influencing medical oaths and making them more consistent. The authors conducted a content analysis of 84 oaths available in 2015 from medical schools in the USA and Canada affiliated with the Association of American Medical Colleges, organising the content into three categories: (i) ethical values, (ii) principles and commitments in the Physician Charter, and (iii) ethical virtues. Only five ethical values were expressed in the majority of oaths (confidentiality, obligation to the profession, beneficence, avoiding discrimination, and honour and integrity), and respect for patient autonomy was uncommon. Only three of the Physician Charter's principles and commitments (primacy of patient welfare, social justice and confidentiality) and one virtue (honour and integrity) were reflected in the majority of oaths. Medical oaths in North America appear to be highly variable in content. Greater attention to resources like the Physician Charter can help improve the ethical content and consistency of oaths across different institutions, and throughout their education medical students should be encouraged to discuss and reflect on the principles and virtues they will profess when they graduate. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Ethics and Continuing Medical Education.

ERIC Educational Resources Information Center

Felch, William C.

1986-01-01

Aspects of ethics and continuing medical education (CME) are discussed in terms of CME consumers (physicians), providers, and others; vacation CME and "brownie points"; marketing and cosponsorship; financial support from industry; and entrepreneurialism. (CT)

[Crisis in medical ethics].

PubMed

Stellamor, K

1996-01-01

There is a disproportion between diagnostic and therapeutic medical achievements and the doctor/patient relationship. Are we allowed to do everything we are able to do in medicine? People are concerned and worried (genetic technology, invasive medicine, embryos in test tubes etc.). The crisis of ethics in medicine is evident. The analysis of the situation shows one of the causes in the shift of the paradigma-modern times to postmodern following scientific positivism-but also a loss of ethics in medicine due to an extreme secularism and to modern philosophical trends (Hans Jonas and the responsibility for the future and on the other hand modern utilitarism).

Can one do good medical ethics without principles?

PubMed

Macklin, Ruth

2015-01-01

The criteria for determining what it is to do good medical ethics are the quality of ethical analysis and ethical justifications for decisions and actions. Justifications for decisions and actions rely on ethical principles, be they the 'famous four' or subsidiary ethical principles relevant to specific contexts. Examples from clinical ethics, research ethics and public health ethics reveal that even when not stated explicitly, principles are involved in ethical justifications. Principles may come into conflict, however, and the resolution of an ethical dilemma requires providing good reasons for preferring one principle over another. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Islam and the four principles of medical ethics.

PubMed

Mustafa, Yassar

2014-07-01

The principles underpinning Islam's ethical framework applied to routine clinical scenarios remain insufficiently understood by many clinicians, thereby unfortunately permitting the delivery of culturally insensitive healthcare.This paper summarises the foundations of the Islamic ethical theory, elucidating the principles and methodology employed by the Muslim jurist in deriving rulings in the field of medical ethics. The four-principles approach, as espoused by Beauchamp and Childress, is also interpreted through the prism of Islamic ethical theory. Each of the four principles (beneficence, nonmaleficence,justice and autonomy) is investigated in turn, looking in particular at the extent to which each is rooted in the Islamic paradigm. This will provide an important insight into Islamic medical ethics, enabling the clinician to have a better informed discussion with the Muslim patient. It will also allow for a higher degree of concordance in consultations and consequently optimise culturally sensitive healthcare delivery.

Simulation-based medical education: an ethical imperative.

PubMed

Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D; Glick, Shimon

2006-01-01

Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these 2 needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.

Simulation-based medical education: an ethical imperative.

PubMed

Ziv, Amitai; Wolpe, Paul Root; Small, Stephen D; Glick, Shimon

2003-08-01

Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.

The ethics and safety of medical student global health electives

PubMed Central

Dell, Evelyn M.; Varpio, Lara; Petrosoniak, Andrew; Gajaria, Amy

2014-01-01

Objectives To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them. Methods Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas’s transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced. Results We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spend-ing a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety. Conclusions Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations. PMID:25341214

Medical ethics in pediatric critical care.

PubMed

Orioles, Alberto; Morrison, Wynne E

2013-04-01

Ethically charged situations are common in pediatric critical care. Most situations can be managed with minimal controversy within the medical team or between the team and patients/families. Familiarity with institutional resources, such as hospital ethics committees, and national guidelines, such as publications from the American Academy of Pediatrics, American Medical Association, or Society of Critical Care Medicine, are an essential part of the toolkit of any intensivist. Open discussion with colleagues and within the multidisciplinary team can also ensure that when difficult situations arise, they are addressed in a proactive, evidence-based, and collegial manner. Copyright © 2013 Elsevier Inc. All rights reserved.

[Retrospections on medical ethics and deontology in Bulgaria].

PubMed

Radanov, Stoycho

2002-01-01

The paper reviews the emergence and the development of the medical ethics and deontology from the foundations of the Bulgarian state till today. With the foundation of the Bulgarian state / 7th century / the traditions and the culture of Thracians, Slavs and Proto-Bulgarians have mixed, the ethnic rules at the beginning being traditional, closely connected with the customs and the beliefs of the ethnical groups taking part in the ethnogenesis of the Bulgarian people. After the baptizing the Christian faith is in the basis of the moral virtues of the folk healers. After the Liberation from the Turkish yoke the major legal and medical norms are being worked out, the first professional and ethical rules obligatory for all doctors and dentists have been adopted, lecturing on medical deontology and taking a Hippocratic oath have been introduced. During the totalitarian period - immediately after the Second World War the medical ethics and deontology are underestimated to a great extent. A correction is made later on after the Moral Code of the doctor in the Peoples' Republic of Bulgaria, taking of the Hippocratic oath is being renewed, and etc. In the period of democracy fundamental legal and deontological sources are established which are the key means to carry out the health reform, incl. also the deontological aspects of health care. A Code of the professional ethics of the doctors and dentists is adopted, lecturing in medical ethics is introduced, lecturing in deontology is renewed, the Hippocratic oath is being taken, various conventions are being conducted, and etc.

[Illness, culture and religion--issues of intercultural medical ethics and nursing ethics].

PubMed

Körtner, Ulrich H J

2007-01-01

Should modern medicine be allowed to do what it is capable of? And what role are religious norms and attitudes to play in both the medical course of life and the bioethical discourse of modern societies? Questions like these are subject of current intercultural medical and nursing ethics. Religious attitudes not only influence the cultural and political surroundings of medical research but also exert a practical influence on the health and illness attitudes of the individual. Coming before moral judgement should be the endeavour to understand one's counterpart, namely the patient, and his/her socio-cultural background. The question to be answered is how therapy and nursing can best be applied within the given socio-cultural framework without those responsible denying their own medical premises or their own concepts of nursing. Intercultural medical and nursing ethics provide an important contribution to the current debate on integration.

[Global aspects of medical ethics: conditions and possibilities].

PubMed

Neitzke, G

2001-01-01

A global or universal code of medical ethics seems paradoxical in the era of pluralism and postmodernism. A different conception of globalisation will be developed in terms of a "procedural universality". According to this philosophical concept, a code of medical ethics does not oblige physicians to accept certain specific, preset, universal values and rules. It rather obliges every culture and society to start a culture-sensitive, continuous, and active discourse on specific issues, mentioned in the codex. This procedure might result in regional, intra-cultural consensus, which should be presented to an inter-cultural dialogue. To exemplify this procedure, current topics of medical ethics (spiritual foundations of medicine, autonomy, definitions concerning life and death, physicians' duties, conduct within therapeutic teams) will be discussed from the point of view of western medicine.

Developing Ethical Knowledge in the Spirit of Judaism

ERIC Educational Resources Information Center

Shapira-Lishchinsky, Orly

2012-01-01

This study attempts to describe Jewish teachers' perceptions about their ethical dilemmas based on stories derived from the Bible. Sixty teachers were asked to submit descriptions of their ethical dilemmas to the study website; submissions were then discussed in focus groups. The findings were grouped by the ATLAS.ti into five categories: Telling…

Transforming educational accountability in medical ethics and humanities education toward professionalism.

PubMed

Doukas, David J; Kirch, Darrell G; Brigham, Timothy P; Barzansky, Barbara M; Wear, Stephen; Carrese, Joseph A; Fins, Joseph J; Lederer, Susan E

2015-06-01

Effectively developing professionalism requires a programmatic view on how medical ethics and humanities should be incorporated into an educational continuum that begins in premedical studies, stretches across medical school and residency, and is sustained throughout one's practice. The Project to Rebalance and Integrate Medical Education National Conference on Medical Ethics and Humanities in Medical Education (May 2012) invited representatives from the three major medical education and accreditation organizations to engage with an expert panel of nationally known medical educators in ethics, history, literature, and the visual arts. This article, based on the views of these representatives and their respondents, offers a future-tense account of how professionalism can be incorporated into medical education.The themes that are emphasized herein include the need to respond to four issues. The first theme highlights how ethics and humanities can provide a response to the dissonance that occurs in current health care delivery. The second theme focuses on how to facilitate preprofessional readiness for applicants through reform of the medical school admission process. The third theme emphasizes the importance of integrating ethics and humanities into the medical school administrative structure. The fourth theme underscores how outcomes-based assessment should reflect developmental milestones for professional attributes and conduct. The participants emphasized that ethics and humanities-based knowledge, skills, and conduct that promote professionalism should be taught with accountability, flexibility, and the premise that all these traits are essential to the formation of a modern professional physician.

[How do first codes of medical ethics inspire contemporary physicians?].

PubMed

Paprocka-Lipińska, Anna; Basińska, Krystyna

2014-02-01

First codes of medical ethics appeared between 18th and 19th century. Their formation was inspired by changes that happened in medicine, positive in general but with some negative setbacks. Those negative consequences revealed the need to codify all those ethical duties, which were formerly passed from generation to generation by the word of mouth and individual example by master physicians. 210 years has passed since the publication of "Medical Ethics" by Thomas Percival, yet essential ethical guidelines remain the same. Similarly, ethical codes published in Poland in 19 century can still be an inspiration to modem physicians.

How Christian ethics became medical ethics: the case of Paul Ramsey.

PubMed

Hauerwas, Stanley

1995-03-01

Over the last century Christian ethics has moved from an attempt to Christianize the social order to a quandary over whether being Christian unduly biases how medical ethics is done. This movement can be viewed as the internal development of protestant liberalism to its logical conclusion, and Paul Ramsey can be taken as one of the last great representatives of that tradition. By reducing the Christian message to the 'ethical upshot' of neighbour love, Ramsey did not have the resources to show how Christian practice might make a difference for understanding or forming the practice of medicine. Instead, medicine became the practice that exemplified the moral commitments of Christian civilization, and the goal of the ethicist was to identify the values that were constitutive of medicine. Ramsey thus prepared the way for the Christian ethicist to become a medical ethicist with a difference, and the difference simply involved vague theological presumptions that do no serious intellectual work other than explaining, perhaps, the motivations of the ethicist.

Perceived comfort level of medical students and residents in handling clinical ethics issues.

PubMed

Silverman, Henry J; Dagenais, Julien; Gordon-Lipkin, Eliza; Caputo, Laura; Christian, Matthew W; Maidment, Bert W; Binstock, Anna; Oyalowo, Akinbowale; Moni, Malini

2013-01-01

Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents' sense of comfort in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training.

A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children.

PubMed

Gilboa-Negari, Zehavit; Abu-Kaf, Sarah; Huss, Ephrat; Hain, Gavriel; Moser, Asher

2017-01-01

Medical clowning has proven effective for reducing pain, anxiety, and stress, however, its differential effects on children from different cultures have not yet been researched. This study evaluated the effects of medical-clowning intervention on anxiety and pain among Jewish and Bedouin children, and anxiety among their parents, in southern Israel. The study was conducted in hospital pediatric departments and employed a pre-post design involving quantitative and qualitative methods. The study included 89 children whose ages ranged from 7.5 to 12 years (39 Jewish and 50 Bedouin) and 69 parents (19 Jewish and 50 Bedouin). Questionnaires assessing pain, anxiety, and demographics were used at the pre-intervention stage and pain, anxiety, and enjoyment of different aspects of the intervention were evaluated following the intervention. The intervention stage lasted for 8-10 minutes and included the use of word play, body language, and making faces, as well as the use of props brought by the clown. Semi-structured interviews were also conducted at the post-intervention stage. The intervention reduced pain and anxiety among both groups of children and reduced anxiety among both groups of parents. However, anxiety levels were reduced more significantly among Bedouin children. The nonverbal components of the clowns' humor were most central, but it was the verbal components that mediated the reduction in anxiety among the Bedouin children. This study underscored the effectiveness and importance of medical clowning in reducing pain and anxiety among children in different cultural contexts. Moreover, the issue of culturally appropriate humor was underscored and implications for intercultural clown training are discussed.

How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

PubMed

Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans

2017-02-23

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and

Building medical ethics education to improve Japanese medical students' attitudes toward respecting patients' rights.

PubMed

Saito, Yukiko; Kudo, Yasushi; Shibuya, Akitaka; Satoh, Toshihiko; Higashihara, Masaaki; Aizawa, Yoshiharu

2011-08-01

In medical education, it is important for medical students to develop their ethics to respect patients' rights. Some physicians might make light of patients' rights, because the increased awareness of such rights might make it more difficult for them to conduct medical practice. In the present study, predictors significantly associated with "a sense of resistance to patients' rights" were examined using anonymous self-administered questionnaires. For these predictors, we produced original items with reference to the concept of ethical development and the teachings of Mencius. The subjects were medical students at the Kitasato University School of Medicine, a private university in Japan. A total of 518 students were analyzed (response rate, 78.4%). The average age of enrolled subjects was 22.5 ± 2.7 years (average age ± standard deviation). The average age of 308 male subjects was 22.7 ± 2.8 years, while that of 210 female subjects was 22.1 ± 2.5 years. The item, "Excessive measures to pass the national examination for medical practitioners," was significantly associated with "a sense of resistance to patients' rights." However, other items, including basic attributes such as age and gender, were not significant predictors. If students spent their school time only focusing on the national examination, they would lose the opportunity to receive the ethical education that would allow them to respect patients' rights. That ethical development cannot easily be evaluated with written exams. Thus, along with the acquisition of medical knowledge, educational programs to promote medical students' ethics should be developed.

Perceptions and practices of medical practitioners towards ethics in medical practice - a study from coastal South India.

PubMed

Unnikrishnan, B; Kanchan, Tanuj; Kulkarni, Vaman; Kumar, Nithin; Papanna, Mohan Kumar; Rekha, T; Mithra, Prasanna

2014-02-01

Ethics is the application of values and moral rules to human activities. Medical practitioners are expected to not only have the skills and knowledge relevant to their field but also with the ethical and legal expectations that arise out of the standard practices. The present research was conducted with an aim to study the perceptions and practices of medical practitioners towards healthcare ethics in Indian scenario and to strengthen the evidence in the field of ethics training. A cross-sectional study was carried out in three associate hospitals of a Medical College in Southern India. Medical practitioners included in the study were administered a pre-tested, semi-structured questionnaire. Data was collected based on their responses on a 5 point Likert scale and analyzed using SPSS version 11.5. The majority of the participants mentioned that their perceptions of ethics in medical practice were based on information obtained during their undergraduate training, followed by experience at work. The medical practitioners had a positive perception on issues relating to consent in medical practice. However, the same degree of perception was not observed for issues related to confidentiality and their dealing with patients during emergency conditions. The majority of the medical practitioners agreed that ethical conduct is important to avoid legal and disciplinary actions. Among the medical practitioners, the responses of specialists and non-specialists were mostly similar with major differences of opinion for a few issues. A highest level of knowledge, awareness and understanding of ethics are expected in medical practice as it is the foundation of sound healthcare delivery system. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

[The living conditions of Jewish physicians in Frankfort on Main in the late Middle Ages and Early Modern Times].

PubMed

Treue, W

1998-01-01

During almost the entire period covered in this article (ca. 1345-1745), the living conditions of Jewish physicians in the Free Imperial City of Frankfort on Main depended to a large extent on the attitudes of the Town Council. The Council, with its increasingly absolutist conception of government, supervised Jewish doctors very closely; on the other hand, it also protected them against the recurrent attacks of Christian physicians, pharmacists and clergymen. The Council understood the importance of the Jewish community to the city's economy, and the contribution of Jewish physicians to the welfare of the city and the neighboring principalities. Until the late 15th century, Jewish medical students were not admitted to European universities; the unique exception was Padua. Hence, arguments against Jewish physicians revolved around their lack of academic qualifications. Such claims were weakened at the end of the 16th century, when the first Jewish graduates from Padua University arrived in Frankfort. The opening of Western European universities in the 17th and 18th centuries enabled increasing numbers of Jews to obtain academic training. The medical profession had become a tradition in many Jewish families, beginning in the Middle Ages; and this tradition was now reinforced and complemented by academic credentials.

The Effect of Teaching Medical Ethics on Medical Students' Moral Reasoning.

ERIC Educational Resources Information Center

Self, Donnie J; And Others

1989-01-01

A study of the effect of incorporating medical ethics into the medical curriculum and comparing two teaching methods (lecture and case studies) found higher moral reasoning after instruction, but neither method was significantly more effective. (Author/MSE)

Ethics by opinion poll? The functions of attitudes research for normative deliberations in medical ethics.

PubMed

Salloch, Sabine; Vollmann, Jochen; Schildmann, Jan

2014-09-01

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we develop a sceptical position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: (a) The extent of empirical data which is needed, (b) the question of which kind of data is required and (c) the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of 'moral pragmatics'. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Medical marijuana for HIV-associated sensory neuropathy: legal and ethical issues.

PubMed

Larriviere, Daniel G

2014-10-01

The number of states legalizing medical marijuana is increasing. Medical marijuana is possibly effective therapy for HIV-associated sensory neuropathy. Despite legalization at the state level, however, the current and contradictory federal drug enforcement policy creates the risk that physicians who recommend medical marijuana to their patients will lose their ability to prescribe medications. The federal-state tension has legal and ethical implications for neurologists who receive a request for medical marijuana from their patients since neurologists must strive to both relieve suffering and obey relevant laws. Recommendation of medical marijuana by neurologists to their patients is ethically permissible but is not ethically mandatory.

Moving Beyond the Theoretical: Medical Students' Desire for Practical, Role-Specific Ethics Training.

PubMed

Stites, Shana D; Clapp, Justin; Gallagher, Stefanie; Fiester, Autumn

2018-05-04

Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.

"Low Income"--Levels in the Jewish Population; The "Jewish Poor" in Los Angeles. A Summary of Findings.

ERIC Educational Resources Information Center

Massarik, Fred

The concept "Jewish Poor" is defined simply as Jewish households (viz. households containing one or more persons defined as Jewish) whose total household cash income (1969, comparable to U.S. Census) was under 4000 dollars. The data were obtained from four sources: (1) analysis of "Jewish Poor" drawn from Los Angeles phase of…

The teaching of medical ethics.

PubMed Central

Sporken, P

1975-01-01

The following description of the situation in Maastricht in the Netherlands is unique as this is a new faculty of medicine and the opportunity has been taken to build the teaching of medical ethics into the curriculum from the start. PMID:1225974

[Reporting ethics board approval in German medical theses and journals].

PubMed

Zenz, Michael; Zenz, Julia; Grieger, Maximilian

2018-06-05

Since 1975, the Declaration of Helsinki of the World Medical Association (WMA) has clearly required ethics committee approval for research into humans. Nevertheless, this Declaration is violated quite often. As many English-language publications have addressed the theme of ethics board approval in theses and other published works, it is now to be investigated in Germany for the first time.From 2013 to 2014, a total of 1,482 medical theses at four selected universities in addition to three German-language scientific journals were reviewed. In 543 theses, reference to ethics approval would have been required according to the criteria of the Declaration of Helsinki.However, ethics approval was stated in only 58.7% of cases, and even less frequently if the prevailing doctoral regulations or instructions did not refer to the necessity of obtaining ethics approval. Theses on pediatrics mentioned ethics approval most frequently (78.6%), whereas the proportion of surgical papers was the lowest (34.9%). Among the journals, Der Nervenarzt mentioned ethics approval most frequently (59.4%) and Der Chirurg least frequently (30%).Our results point to significant deficits in mentioning ethics approval in medical theses and publications. These deficits could easily be compensated for by a thorough approach of the referees of doctoral regulations and by journal reviewers and editors.

Devotion, Diversity, and Reasoning: Religion and Medical Ethics.

PubMed

Dahnke, Michael D

2015-12-01

Most modern ethicists and ethics textbooks assert that religion holds little or no place in ethics, including fields of professional ethics like medical ethics. This assertion, of course, implicitly refers to ethical reasoning, but there is much more to the ethical life and the practice of ethics-especially professional ethics-than reasoning. It is no surprise that teachers of practical ethics, myself included, often focus on reasoning to the exclusion of other aspects of the ethical life. Especially for those with a philosophical background, reasoning is the most patent and pedagogically controllable aspect of the ethical life-and the most easily testable. And whereas there may be powerful reasons for the limitation of religion in this aspect of ethics, there are other aspects of the ethical life in which recognition of religious belief may arguably be more relevant and possibly even necessary. I divide the ethical life into three areas-personal morality, interpersonal morality, and rational morality-each of which I explore in terms of its relationship to religion, normatively characterized by the qualities of devotion, diversity, and reasoning, respectively.

In search of an ethic of medical librarianship.

PubMed Central

Crawford, H

1978-01-01

Why is the literature on the ethics of librarianship so sparse? Some of the codes of ethics proposed or officially adopted during this century are examined, with an informal commentary on the reasons why they seem to have aroused so little sustained interest and discussion. Attention is directed particularly to library--user relationships and to some of the unique ethical situations in medical libraries. PMID:678701

Suffering, compassion and 'doing good medical ethics'.

PubMed

de Zulueta, Paquita C

2015-01-01

'Doing good medical ethics' involves attending to both the biomedical and existential aspects of illness. For this, we need to bring in a phenomenological perspective to the clinical encounter, adopt a virtue-based ethic and resolve to re-evaluate the goals of medicine, in particular the alleviation of suffering and the role of compassion in everyday ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Teaching medical ethics: University of Edinburgh

PubMed Central

Boyd, Kenneth; Currie, Colin; Thompson, Ian; Tierney, Alison J.

1978-01-01

The Edinburgh Medical Group Research Project is unique in Britain. Part of its function is to experiment with teaching medical ethics both inside and outside of the Medical School. The papers which follow have been written by two full-time reseach fellows working with the Project and two of the professional advisers, one nursing and one medical. Together they give a picture of the wide scope of exerimental teaching taking place in Edinburgh and present some preliminary results from these experiments. PMID:691019

Ethical ideology and the allocation of scarce medical resources.

PubMed

Furnham, A; Ofstein, A

1997-03-01

This study was designed to determine the ethical beliefs upon which both medical and non-medical participants base their decisions when asked to construct a ranked waiting-list for treatment for patients suffering from kidney failure. Participants were given minimal demographic and medical data about hypothetical patients and were asked to rank them in order of priority for treatment. A participant's initial ethical position was determined by the Forsyth (1980) Ethical Ideology Questionnaire which provides a fourfold typology based on two factors (relativism and idealism). Each participant's personal demographic information was also obtained. The analysis yielded a main effect of the 'number of dependents' variable of the patient and its interaction with the 'religiousness' variable of the participants which reflected a utilitarian moral ideology working within an egalitarian framework. Implications of studies of this sort for sociomedical moral decision making and research on ethical and moral issues are discussed. The limitations of this sort of research are also considered.

Development of a medical humanities and ethics certificate program in Texas.

PubMed

Erwin, Cheryl J

2014-12-01

Education in the medical humanities and ethics is an integral part of the formation of future physicians. This article reports on an innovative approach to incorporating the medical humanities and ethics into the four-year curriculum in a Certificate Program spanning all four years of the medical school experience. The faculty of the McGovern Center for Humanities and Ethics at the University of Texas Medical School at Houston conceived and implemented this program to teach medical students a range of scholarly topics in the medical humanities and to engage the full human experience into the process of becoming a physician. This study follows six years of experience, and we report student experiences and learning in their own words.

How virtue ethics informs medical professionalism.

PubMed

McCammon, Susan D; Brody, Howard

2012-12-01

We argue that a turn toward virtue ethics as a way of understanding medical professionalism represents both a valuable corrective and a missed opportunity. We look at three ways in which a closer appeal to virtue ethics could help address current problems or issues in professionalism education-first, balancing professionalism training with demands for professional virtues as a prerequisite; second, preventing demands for the demonstrable achievement of competencies from working against ideal professionalism education as lifelong learning; and third, avoiding temptations to dismiss moral distress as a mere "hidden curriculum" problem. As a further demonstration of how best to approach a lifelong practice of medical virtue, we will examine altruism as a mean between the extremes of self-sacrifice and selfishness.

The teaching of medical ethics: University College, Cork, Ireland.

PubMed Central

Clarke, D D

1978-01-01

Dolores Dooley Clarke describes how the course in medical ethics at University College, Cork is structured, how it has changed and how it is likely to change as time goes on. Originally, the students seemed to view it as an intrusion 'to be tolerated' in their programme of 'strictly medical' studies. However, having moved on from that and away from the lecturer always being a Roman Catholic priest as well as a member of the Philosophy Department, the students now appear to view it as producing a stimulus for a new interest in the area of ethics for physicians. This seems to have come about through the more extensive participation of students in researching and presenting issues of medical ethics. PMID:633310

[Enhanced recovery after surgery based on medical ethics].

PubMed

Zhao, Qingchuan

2016-03-01

Enhanced recovery after surgery (ERAS), a new model of perioperative management developed in recent years, can shorten hospital stay, reduce medical cost and postoperative discomfort. However, some of these measures under the strategy are negation of the traditional recommendation and many surgeons are concerned about the medical tangle by the complications coming with the ERAS strategy. In this paper, ERAS strategy is evaluated from an ethical standpoint and the assessment factors of medical behavior are introduced based on medical virtues and medical ethnics. It is also analyzed that how to deal with the conflicts between the textbooks and the ERAS strategy, and elaborated that the medical ethics should be observed if the ERAS strategy is implemented. The scientific principles must be followed, the rights and interests of the patients need to be protected, and the informed consent should be guaranteed.

Teaching Medical Ethics in its Contexts: Penn State College of Medicine.

ERIC Educational Resources Information Center

Barnard, David; Clouser, K. Danner

1989-01-01

The medical school's ethics program evolved through cooperation with the humanities department. Key aspects of the program include the teaching of medical ethics in the context of other issues of value and meaning in medicine, and involvement of humanities faculty in the medical center. (Author/MSE)

Understanding ethical dilemmas in the emergency department: views from medical students' essays.

PubMed

House, Joseph B; Theyyunni, Nikhil; Barnosky, Andrew R; Fuhrel-Forbis, Andrea; Seeyave, Desiree M; Ambs, Dawn; Fischer, Jonathan P; Santen, Sally A

2015-04-01

For medical students, the emergency department (ED) often presents ethical problems not encountered in other settings. In many medical schools there is little ethics training during the clinical years. The benefits of reflective essay writing in ethics and professionalism education are well established. The purpose of this study was to determine and categorize the types of ethical dilemmas and scenarios encountered by medical students in the ED through reflective essays. During a 4(th)-year emergency medicine rotation, all medical students wrote brief essays on an ethical situation encountered in the ED, and participated in an hour debriefing session about these essays. Qualitative analysis was performed to determine common themes from the essays. The frequency of themes was calculated. The research team coded 173 essays. The most common ethical themes were autonomy (41%), social justice (32.4%), nonmaleficence (31.8%), beneficence (26.6%), fidelity (12%), and respect (8.7%). Many of the essays contained multiple ethical principles that were often in conflict with each other. In one essay, a student grappled with the decision to intubate a patient despite a preexisting do-not-resuscitate order. This patient encounter was coded with autonomy, beneficence, and nonmaleficence. Common scenarios included ethical concerns when caring for critical patients, treatment of pain, homeless or alcoholic patients, access to care, resource utilization, and appropriateness of care. Medical students encounter patients with numerous ethically based issues. Frequently, they note conflicts between ethical principles. Such essays constitute an important resource for faculty, resident, and student ethics training. Copyright © 2015 Elsevier Inc. All rights reserved.

Considering the Informal Jewish Educator

ERIC Educational Resources Information Center

Winer, Laura Novak

2007-01-01

Informal Jewish education can and must put greater focus on the goals of education. While socialization is a key component, it is not its sole goal. Informal Jewish education must make more central deep, serious Jewish learning in which learners can experience moments of transcendence, connection, and transformation. A key to reaching this goal…

A spoonful of care ethics: The challenges of enriching medical education.

PubMed

van Reenen, Eva; van Nistelrooij, Inge

2017-01-01

Nursing Ethics has featured several discussions on what good care comprises and how to achieve good care practices. We should "nurse" ethics by continuously reflecting on the way we "do" ethics, which is what care ethicists have been doing over the past few decades and continue to do so. Ethics is not limited to nursing but extends to all caring professions. In 2011, Elin Martinsen argued in this journal that care should be included as a core concept in medical ethical terminology because of "the harm to which patients may be exposed owing to a lack of care in the clinical encounter," specifically between doctors and patients. However, Martinsen leaves the didactical challenges arising from such a venture open for further enquiry. In this article, we explore the challenges arising from implementing care-ethical insights into medical education. Medical education in the Netherlands is investigated through a "care-ethical lens". This means exploring the possibility of enriching medical education with care-ethical insights, while at the same time discovering possible challenges emerging from such an undertaking. Participants and research context: This paper has been written from the academic context of a master in care ethics and policy. Ethical considerations: We have tried to be fair and respectful to the authors discussed and take a neutral stance towards the findings portrayed. Several challenges are identified, which we narrow down to two types: didactical and non-didactical. In order to overcome these challenges, we must not underestimate the possible resistance to a paradigm shift. Our efforts should mainly target the learning that takes place in the clinical phases of medical training and should be accompanied by the creation of awareness in healthcare practice.

Great expectations: teaching ethics to medical students in South Africa.

PubMed

Behrens, Kevin Gary; Fellingham, Robyn

2014-12-01

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves. © 2013 John Wiley & Sons Ltd.

The challenge of promoting professionalism through medical ethics and humanities education.

PubMed

Doukas, David J; McCullough, Laurence B; Wear, Stephen; Lehmann, Lisa S; Nixon, Lois LaCivita; Carrese, Joseph A; Shapiro, Johanna F; Green, Michael J; Kirch, Darrell G

2013-11-01

Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education. The authors present three overarching themes that resulted from the PRIME II discussions: transformation, question everything, and unity of vision and purpose.The first theme highlights that education toward professionalism requires transformational change, whereby medical ethics and humanities educators would make explicit the centrality of professionalism to the formation of physicians. The second theme emphasizes that the flourishing of professionalism must be based on first addressing the dysfunctional aspects of the current system of health care delivery and financing that undermine the goals of medical education. The third theme focuses on how ethics and humanities educators must have unity of vision and purpose in order to collaborate and identify how their disciplines advance professionalism. These themes should help shape discussions of the future of medical ethics and humanities teaching.The authors argue that improvement of the ethics and humanities-based knowledge, skills, and conduct that fosters professionalism should enhance patient care and be evaluated for its distinctive contributions to educational processes aimed at producing this outcome.

'Medical ethics'--an alternative approach.

PubMed Central

Haldane, J J

1986-01-01

Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium. PMID:3761336

Medical ethics and new public management in Sweden.

PubMed

Hansson, Sven Ove

2014-07-01

In order to shorten queues to healthcare, the Swedish government has introduced a yearly "queue billion" that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medical ethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medical ethics and public policy.

[Medical research-ethics applied to social sciences: relevance, limits, issues and necessary adjustments].

PubMed

Desclaux, A

2008-04-01

Social sciences are concretely concerned by the ethics of medical research when they deal with topics related to health, since they are subjected to clearance procedures specific to this field. This raises at least three questions: - Are principles and practices of medical research ethics and social science research compatible? - Are "research subjects" protected by medical research ethics when they participate in social science research projects? - What can social sciences provide to on-going debates and reflexion in this field? The analysis of the comments coming from ethics committees about social science research projects, and of the experience of implementation of these projects, shows that the application of international ethics standards by institutional review boards or ethics committees raises many problems in particular for researches in ethnology anthropology and sociology. These problems may produce an impoverishment of research, pervert its meaning, even hinder any research. They are not only related to different norms, but also to epistemological divergences. Moreover, in the case of studies in social sciences, the immediate and differed risks, the costs, as well as the benefits for subjects, are very different from those related to medical research. These considerations are presently a matter of debates in several countries such as Canada, Brasil, and USA. From another hand, ethics committees seem to have developed without resorting in any manner to the reflexion carried out within social sciences and more particularly in anthropology Still, the stakes of the ethical debates in anthropology show that many important and relevant issues have been discussed. Considering this debate would provide openings for the reflexion in ethics of health research. Ethnographic studies of medical research ethics principles and practices in various sociocultural contexts may also contribute to the advancement of medical ethics. A "mutual adjustment" between ethics of

Twenty-first Century ethics of medical research involving human subjects: achievements and challenges.

PubMed

Tzamaloukas, Antonios H; Konstantinov, Konstantin N; Agaba, Emmanuel I; Raj, Dominic S C; Murata, Glen H; Glew, Robert H

2008-01-01

The field of ethics in medical research has seen important developments in the last three decades, but it also faces great challenges in the new century. The purposes of this report are to examine the current status of ethics of medical research involving human subjects and the nature of the ethical challenges facing this research, to identify the weakness of the current system of safeguards for ethical research, and to stress the importance of the ethical character of the researcher, which is the safeguard that has the greatest potential for protecting the research subjects. Researchers appreciate the risks of human medical research that create ethical dilemmas and the need for an ethical compromise in order to proceed with the research. The main elements of the compromise, formulated primarily from experiences in the Second World War, include: (1) the dominant position of the ethical principle of autonomy; (2) the demand for a signed informed consent; (3) the likelihood of improving health with the research protocol, which must be approved by a duly appointed supervising committee; and (4) an acceptable risk/benefit ratio. The main weakness of this set of safeguards is the difficulty with obtaining a truly informed consent. The new challenges to ethical medical research stem from certain types of research, such as genetic and stem cell research, and from the increasing involvement of the industry in planning and funding the research studies. Developing medical researchers with an ethical character and knowledge about ethics in medicine may be the most effective safeguard in protecting participants of medical research experiments.

The Internalization of Jewish Values by Children Attending Orthodox Jewish Schools, and Its Relationship to Autonomy-Supportive Parenting and Adjustment

ERIC Educational Resources Information Center

Cohen, Lori R.; Milyavskaya, Marina; Koestner, Richard

2009-01-01

The present study examined the way in which children attending Orthodox Jewish schools internalize the value of both their Jewish studies and secular studies, as well as the value of Jewish cultural practices. A distinction was made between identified internalization, where children perceive Jewish studies and Jewish culture to be an important…

Philip Hillkowitz The "Granddaddy of Medical Technologists" and Cofounder of the American Society for Clinical Pathologists and the Jewish Consumptives' Relief Society.

PubMed

Wright, James R; Abrams, Jeanne

2018-01-01

- In the early 20th century, the future of hospital-based clinical pathology practice was uncertain and this situation led to the formation of the American Society for Clinical Pathologists in 1922. Philip Hillkowitz, MD, and Ward Burdick, MD, were its cofounders. No biography of Hillkowitz exists. - To explore the life, beliefs, and accomplishments of Philip Hillkowitz. - Available primary and secondary historical sources were reviewed. - Hillkowitz, the son of a Russian rabbi, immigrated to America as an 11-year-old child in 1885. He later attended medical school in Cincinnati, Ohio, and then moved to Colorado, where he began his clinical practice, which transitioned into a clinical pathology practice. In Denver, he met Charles Spivak, MD, another Jewish immigrant and together they established the Jewish Consumptives' Relief Society, an ethnically sensitive tuberculosis sanatorium that flourished in the first half of the 20th century because of its national fundraising network. In 1921, Hillkowitz and Burdick, also a Denver-based pathologist, successively organized the pathologists in Denver, followed by the state of Colorado. Early the next year, they formed the American Society for Clinical Pathologists (ASCP). Working with the American College of Surgeons, the ASCP put hospital-based practice of clinical pathology on solid footing in the 1920s. Hillkowitz then established and oversaw the ASCP Board of Registry of Medical Technologists. - Philip Hillkowitz changed the directions of clinical pathology and tuberculosis treatment in 20th century America, while simultaneously serving as a successful ethnic power broker within both the American Jewish and Eastern European immigrant communities.

The essential role of medical ethics education in achieving professionalism: the Romanell Report.

PubMed

Carrese, Joseph A; Malek, Janet; Watson, Katie; Lehmann, Lisa Soleymani; Green, Michael J; McCullough, Laurence B; Geller, Gail; Braddock, Clarence H; Doukas, David J

2015-06-01

This article-the Romanell Report-offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received particular attention in recent years because of the increasing emphasis placed on professional formation by accrediting bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Yet, despite the development of standards, milestones, and competencies related to professionalism, there is no consensus about the specific goals of medical ethics education, the essential knowledge and skills expected of learners, the best pedagogical methods and processes for implementation, and optimal strategies for assessment. Moreover, the quality, extent, and focus of medical ethics instruction vary, particularly at the graduate medical education level. Although variation in methods of instruction and assessment may be appropriate, ultimately medical ethics education must address the overarching articulated expectations of the major accrediting organizations. With the aim of aiding medical ethics educators in meeting these expectations, the Romanell Report describes current practices in ethics education and offers guidance in several areas: educational goals and objectives, teaching methods, assessment strategies, and other challenges and opportunities (including course structure and faculty development). The report concludes by proposing an agenda for future research.

Ethics competences in the undergraduate medical education curriculum: the Spanish experience.

PubMed

Ferreira-Padilla, Guillermo; Ferrández-Antón, Teresa; Lolas-Stepke, Fernando; Almeida-Cabrera, Rut; Brunet, Joan; Bosch-Barrera, Joaquim

2016-10-31

Aim .To investigate if there are differences in medical ethics education between different schools of medicine in Spain, specifically between private and public schools and between recently founded schools and older ones. The curricula of medical degrees from all Spanish faculties were reviewed for the 2014/2015 academic year, identifying subjects concerning bioethics, deontology, and ethics. We identified the type of teaching, format and method of the course, the number of credits and hours, and the school year of each subject. An analysis with descriptive parameters and the Cohen's coefficient (d) was performed. All medical schools in Spain (n=44) were included. A mean of 3.64 European Credit Transfer and Accumulation System (ECTS) credits was specifically devoted to ethical values teaching in Spain. Private medical schools offered more credits than public ones (6.51 ECTS vs 2.88 ECTS, relevant difference: d=2.06>0.8), and the 10 most recently founded medical schools offered more credits than the 10 oldest (5.86 ECTS vs 2.63 ECTS, relevant difference: d=1.43>0.8). A mean of 36.75 hours was dedicated to ethics education. Although ethics education is incorporated into the training of future Spanish physicians, there is still notable heterogeneity between different medical schools in the time devoted to this topic.

Clarifying appeals to dignity in medical ethics from an historical perspective.

PubMed

Van Der Graaf, Rieke; Van Delden, Johannes Jm

2009-03-01

Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the 'special status of human beings'; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation-stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics.

Teaching medical ethics to meet the realities of a changing health care system.

PubMed

Millstone, Michael

2014-06-01

The changing context of medical practice--bureaucratic, political, or economic--demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.

The mass campaign to eradicate ringworm among the Jewish community in Eastern Europe, 1921-1938.

PubMed

Shvarts, Shifra; Romem, Pnina; Romem, Yitzhak; Shani, Mordechai

2013-04-01

Between the years 1921 and 1938, 27,600 children were irradiated during a mass campaign to eradicate ringworm among the Jewish community in East Europe. The ringworm campaign was the initiative of the American Jewish Joint Distribution Committee together with the Jewish health maintenance organization OZE (The Society for the Protection of Jewish Health). We describe this campaign that used x-rays to eradicate ringworm and its mission to enhance public health among Jewish communities in Eastern Europe during the period between the world wars. We discuss the concepts behind the campaign, the primary health agents that participated in it, and the latent medical ramifications that were found among children treated for ringworm, many years after treatment--pathologies that can be linked to the irradiation they received as children. Our research is based on historical archival materials in the United States, Europe, and Israel.

The formative years: medical ethics comes of age.

PubMed

Campbell, Alastair V

2015-01-01

When the Journal of Medical Ethics first appeared in April 1975, the prospects of success seemed uncertain. There were no scholars specialising in the field, the readership could not be guaranteed, and the medical profession itself seemed, at the very least, ambivalent about a subject thought by many to be the province of doctors alone, to be acquired through an apprenticeship model, and certainly not taught or examined in any formal sense. However, change was afoot, fresh scandals created an awareness that outside help was needed to think through the new challenges facing the profession, and the success of the medical groups revealed a clear way forward through multidisciplinary and critically reflective discussion of the host of emerging ethical and legal issues. In this article the formative years of the journal are recaptured, with a claim that the core principles on which it was founded must endure if it is to continue to 'do good medical ethics' over the next 40 years. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Interns' perceptions on medical ethics education and ethical issues at the Dokuz Eylul University School of Medicine in Turkey.

PubMed

Ozan, S; Timbil, S; Semin, S; Musal, B

2010-11-01

In Turkey and its neighboring countries, few studies have investigated medical students' reactions to ethics education and ethical issues they encounter. The aim of this study was to investigate interns' perceptions of medical ethics education and ethical issues. In students' first three years at the Dokuz Eylul University School of Medicine, various teaching methods are used in ethics education, including problem-based learning, interactive lectures and movies. During the clinical years, the curriculum helps students consider the ethical dimension of their clinical work, and during the internship period a discussion on ethical issues is held. Data were collected through a questionnaire distributed to interns in the 2005-2006 academic year. Its questions asked about interns' perceived adequacy of their ethics education, any interpersonal ethical problems they had witnessed, their approaches to ethical problems, obstacles they believe prevented them from resolving ethical problems and whether they felt themselves ready to deal with ethical problems. 67.2 % of interns were reached and all of them responded. In the assessment of the adequacy of ethics education, the most favorable score was given to educators. Students' most often mentioned ethical problems encountered were between physicians and students and between physicians and patients. Interns believed that difficult personalities on the team and team hierarchy were important obstacles to resolving ethical problems. There were significant differences between the approaches students currently used in dealing with ethical problems and how they anticipated they would approach these problems in their future professional lives. We obtained information about students' perceptions about ethics education and ethical problems which helped us to plan other educational activities. This study may assist other medical schools in preparing an ethics curriculum or help evaluate an existing curriculum.

Religion and medical ethics.

PubMed

Green, Ronald M

2013-01-01

Religious traditions of medical ethics tend to differ from more secular approaches by stressing limitations on autonomous decision-making, by more positively valuing the experience of suffering, and by drawing on beliefs and values that go beyond empiric verification. I trace the impact of these differences for some of the world's great religious traditions with respect to four issues: (1) religious conscientious objection to medical treatments; (2) end-of life decision-making, including euthanasia, physician-assisted suicide, and the withholding or withdrawing of life-sustaining treatments; (3) definitions of moral personhood (defining life's beginning and end); and (4) human sexuality. © 2013 Elsevier B.V. All rights reserved.

Excoriation (skin-picking) disorder in adults: a cross-cultural survey of Israeli Jewish and Arab samples.

PubMed

Leibovici, Vera; Koran, Lorrin M; Murad, Sari; Siam, Ihab; Odlaug, Brian L; Mandelkorn, Uri; Feldman-Weisz, Vera; Keuthen, Nancy J

2015-04-01

We sought to estimate the lifetime prevalence of Excoriation (Skin-Picking) Disorder (SPD) in the Israeli adult population as a whole and compare SPD prevalence in the Jewish and Arab communities. We also explored demographic, medical and psychological correlates of SPD diagnosis. Questionnaires and scales screening for SPD, and assessing the severity of perceived stress, depression, obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), alcohol use, illicit drug use, and medical disorders were completed in a sample of 2145 adults attending medical settings. The lifetime prevalence of SPD was 5.4% in the total sample; it did not differ between genders or within Jewish and Arab subsamples. Severity of depression (p<0.001), OCD (p<0.001) and perceived stress (p=<0.001) were greater in the SPD positive sample. Similarly, diagnoses of BDD (p=0.02) and generalized anxiety (p=0.03) were significantly more common in the SPD-positive respondents. Alcohol use and illicit substance use were significantly more common among SPD positive respondents in the total sample (both p's=0.01) and the Jewish subsample (p=0.03 and p=0.02, respectively). Hypothyroidism was more prevalent in the SPD-positive Jewish subsample (p=0.02). In the total sample, diabetes mellitus was more common in women than in men (p=0.04). Lifetime SPD appears to be relatively common in Israeli adults and associated with other mental disorders. Differences in the self-reported medical and psychiatric comorbidities between the Jewish and Arab subsamples suggest the possibility of cross-cultural variation in the correlates of this disorder. Copyright © 2014 Elsevier Inc. All rights reserved.

An ethical paradox: the effect of unethical conduct on medical students' values

PubMed Central

Satterwhite, R.; Satterwhite, W.; Enarson, C.

2000-01-01

Objective—To report the ethical development of medical students across four years of education at one medical school. Design and setting—A questionnaire was distributed to all four classes at the Wake Forest University School of Medicine during the Spring of 1996. Participants—Three hundred and three students provided demographic information as well as information concerning their ethical development both as current medical students and future interns. Main measurements—Results were analyzed using cross-tabulations, correlations, and analysis of variance. Results—Results suggested that the observation of and participation in unethical conduct1 may have disparaging effects on medical students' codes of ethics with 35% of the total sample (24% of first years rising to 55% of fourth years) stating that derogatory comments made by residents/attendings, either in the patient's presence or absence, were "sometimes" or "often" appropriate. However, approximately 70% of the sample contended that their personal code of ethics had not changed since beginning medical school and would not change as a resident. Conclusions—Results may represent an internal struggle that detracts from the medical school experience, both as a person and as a doctor. Our goal as educators is to alter the educational environment so that acceptance of such behaviour is not considered part of becoming a physician. Key Words: Ethics • ethical development • paradox • medical students • derogatory comments PMID:11270946

Medically assisted reproduction and ethical challenges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kaeaeriaeinen, Helena; Evers-Kiebooms, Gerry; Coviello, Domenico

2005-09-01

Many of the ethical challenges associated with medically assisted reproduction are societal. Should the technique be restricted to only ordinary couples or could it be used also to single females or couples of same sex? Should the future child be entitled to know the identity of the gamete donor? Should there be age limits? Can embryos or gametes be used after the death of the donor? Can surrogate mothers be part of the process? Can preimplantation diagnostics be used to select the future baby's sex? In addition, there are several clearly medical questions that lead to difficult ethical problems. Ismore » it safe to use very premature eggs or sperms? Is the risk for some rare syndromes caused by imprinting errors really increased when using these techniques? Do we transfer genetic infertility to the offspring? Is the risk for multiple pregnancies too high when several embryos are implanted? Does preimplantation diagnosis cause some extra risks for the future child? Should the counselling of these couples include information of all these potential but unlikely risks? The legislation and practices differ in different countries and ethical discussion and professional guidelines are still needed.« less

Activities of an ethics consultation service in a Tertiary Military Medical Center.

PubMed

Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J

2000-07-01

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

Black money in white coats: whither medical ethics?

PubMed

Chattopadhyay, Subrata

2008-01-01

There has been a sea change in the ethos of medicine in India in recent decades. Academic dishonesty of an alarming nature has been reported in medical colleges. Moral degeneration and corruption have engulfed the establishment at the highest level. The head of the Medical Council of India was found guilty of corruption and stripped of his position a few years ago. Many professors in private medical colleges draw a part of their salary as "black"money. There is little discussion on this growing malady within the profession. Professional medical associations have turned a blind eye towards unethical practices; sincere efforts to take a stand on ethical medicine are lacking. Marginalisation of ethics raises questions about the professional integrity, moral sensitivity and social responsibility of practitioners of modern medicine in India.

Justice and medical ethics.

PubMed

Gillon, R

1985-07-20

Justice, in the sense of fair adjudication between conflicting claims, is held to be relevant to a wide range of issues in medical ethics. Several differing concepts of justice are briefly described, including Aristotle's formal principle of justice, libertarian theories, utilitarian theories, Marxist theories, the theory of John Rawls, and the view--held, for example, by W.D. Ross--that justice is essentially a matter of reward for individual merit.

Reflections on palliative care from the jewish and islamic tradition.

PubMed

Schultz, Michael; Baddarni, Kassim; Bar-Sela, Gil

2012-01-01

Spiritual care is a vital part of holistic patient care. Awareness of common patient beliefs will facilitate discussions about spirituality. Such conversations are inherently good for the patient, deepen the caring staff-patient-family relationship, and enhance understanding of how beliefs influence care decisions. All healthcare providers are likely to encounter Muslim patients, yet many lack basic knowledge of the Muslim faith and of the applications of Islamic teachings to palliative care. Similarly, some of the concepts underlying positive Jewish approaches to palliative care are not well known. We outline Jewish and Islamic attitudes toward suffering, treatment, and the end of life. We discuss our religions' approaches to treatments deemed unnecessary by medical staff, and consider some of the cultural reasons that patients and family members might object to palliative care, concluding with specific suggestions for the medical team.

Reflections on Palliative Care from the Jewish and Islamic Tradition

PubMed Central

Schultz, Michael; Baddarni, Kassim; Bar-Sela, Gil

2012-01-01

Spiritual care is a vital part of holistic patient care. Awareness of common patient beliefs will facilitate discussions about spirituality. Such conversations are inherently good for the patient, deepen the caring staff-patient-family relationship, and enhance understanding of how beliefs influence care decisions. All healthcare providers are likely to encounter Muslim patients, yet many lack basic knowledge of the Muslim faith and of the applications of Islamic teachings to palliative care. Similarly, some of the concepts underlying positive Jewish approaches to palliative care are not well known. We outline Jewish and Islamic attitudes toward suffering, treatment, and the end of life. We discuss our religions' approaches to treatments deemed unnecessary by medical staff, and consider some of the cultural reasons that patients and family members might object to palliative care, concluding with specific suggestions for the medical team. PMID:22203878

Developing an informational tool for ethical engagement in medical tourism.

PubMed

Adams, Krystyna; Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory

2017-08-25

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists' decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service.

Teaching medical ethics to undergraduate students in post-apartheid South Africa, 2003 2006.

PubMed

Moodley, Keymanthri

2007-11-01

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa (HPCSA) subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country.

A Comparison of General Medical and Clinical Ethics Consultations: What Can We Learn From Each Other?

PubMed Central

Geppert, Cynthia M.A.; Shelton, Wayne N.

2012-01-01

Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed. PMID:22469350

Ethics competences in the undergraduate medical education curriculum: the Spanish experience

PubMed Central

Ferreira-Padilla, Guillermo; Ferrández-Antón, Teresa; Lolas-Stepke, Fernando; Almeida-Cabrera, Rut; Brunet, Joan; Bosch-Barrera, Joaquim

2016-01-01

Aim To investigate if there are differences in medical ethics education between different schools of medicine in Spain, specifically between private and public schools and between recently founded schools and older ones. Method The curricula of medical degrees from all Spanish faculties were reviewed for the 2014/2015 academic year, identifying subjects concerning bioethics, deontology, and ethics. We identified the type of teaching, format and method of the course, the number of credits and hours, and the school year of each subject. An analysis with descriptive parameters and the Cohen’s coefficient (d) was performed. Results All medical schools in Spain (n = 44) were included. A mean of 3.64 European Credit Transfer and Accumulation System (ECTS) credits was specifically devoted to ethical values teaching in Spain. Private medical schools offered more credits than public ones (6.51 ECTS vs 2.88 ECTS, relevant difference: d = 2.06>>0.8), and the 10 most recently founded medical schools offered more credits than the 10 oldest (5.86 ECTS vs 2.63 ECTS, relevant difference: d = 1.43 > 0.8). A mean of 36.75 hours was dedicated to ethics education. Conclusions Although ethics education is incorporated into the training of future Spanish physicians, there is still notable heterogeneity between different medical schools in the time devoted to this topic. PMID:27815940

Research Ethics Education in Post-Graduate Medical Curricula in I.R. Iran.

PubMed

Nikravanfard, Nazila; Khorasanizadeh, Faezeh; Zendehdel, Kazem

2017-08-01

Research ethics training during post-graduate education is necessary to improve ethical standards in the design and conduct of biomedical research. We studied quality and quantity of research ethics training in the curricula of post-graduate programs in the medical science in I.R. Iran. We evaluated curricula of 125 post-graduate programs in medical sciences in I.R. Iran. We qualitatively studied the curricula by education level, including the Master and PhD degrees and analyzed the contents and the amount of teaching allocated for ethics training in each curriculum. We found no research ethics training in 72 (58%) of the programs. Among the 53 (42%) programs that considered research ethics training, only 17 programs had specific courses for research ethics and eight of them had detailed topics on their courses. The research ethics training was optional in 25% and mandatory in 76% of the programs. Post-graduate studies that were approved in the more recent years had more attention to the research ethics training. Research ethics training was neglected in most of the medical post-graduate programs. We suggest including sufficient amount of mandatory research ethics training in Master and PhD programs in I.R. Iran. Further research about quality of research ethics training and implementation of curricula in the biomedical institutions is warranted. © 2016 John Wiley & Sons Ltd.

Are Military and Medical Ethics Necessarily Incompatible? A Canadian Case Study.

PubMed

Rochon, Christiane; Williams-Jones, Bryn

2016-12-01

Military physicians are often perceived to be in a position of 'dual loyalty' because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics (i.e., medical and military), each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different.

Medical dominance within research ethics committees.

PubMed

Humphreys, Stephen; Thomas, Hilary; Martin, Robyn

2014-01-01

Qualitative research is reported which explores the perceptions of members of the U.K.'s independent Phase I ethics committees (IECs) about key issues identified following a literature review. Audio-recorded interviews were conducted with ten expert and ten lay members from all IECs except the one to which the lead author was attached. Transcripts were thematically analyzed following a broadly hermeneutical approach. The findings-dealing with such matters as recruitment strategies and length of service; attitudes towards member categories, published ethics guidelines, and the adequacy of insurance; levels of training and views on achieving a recognised level of competence-have an intrinsic interest, but it is when the findings are considered collectively using Freidson's theory of professional dominance that they reveal the influence the medical profession can have in shaping ethics review.

Teaching and evaluation methods of medical ethics in the Saudi public medical colleges: cross-sectional questionnaire study

PubMed Central

2013-01-01

Background Saudi Arabia is considered one of the most influential Muslim countries being as the host of the two most holy places for Muslims, namely Makkah and Madina. This was reflected in the emphasis on teaching medical ethics in a lecture-based format as a part of the subject of Islamic culture taught to medical students. Over the last few years, both teaching and evaluation of medical ethics have been changing as more Saudi academics received specialized training and qualifications in bioethics from western universities. Methods This study aims at studying the current teaching methods and evaluation tools used by the Saudi public medical schools. It is done using a self-administered online questionnaire. Results Out of the 14 medical schools that responded, the majority of the responding schools (6; 42.8%), had no ethics departments; but all schools had a curriculum dedicated to medical ethics. These curricula were mostly developed by the faculty staff (12; 85.7%). The most popular teaching method was lecturing (13; 92.8%). The most popular form of student assessment was a paper-based final examination (6; 42.8%) at the end of the course that was allocated 40% or more of the total grade of the ethics course. Six schools (42.8%) allocated 15-30% of the total grade to research. Conclusion Although there is a growing interest and commitment in teaching ethics to medical students in Saudi schools; there is lack of standardization in teaching and evaluation methods. There is a need for a national body to provide guidance for the medical schools to harmonize the teaching methods, particularly introducing more interactive and students-engaging methods on the account of passive lecturing. PMID:24020917

Polish Code of Ethics of a Medical Laboratory Specialist

PubMed Central

2014-01-01

Along with the development of medicine, increasingly significant role has been played by the laboratory diagnostics. For over ten years the profession of the medical laboratory specialist has been regarded in Poland as the autonomous medical profession and has enjoyed a status of one of public trust. The process of education of medical laboratory specialists consists of a five-year degree in laboratory medicine, offered at Medical Universities, and of a five-year Vocational Specialization in one of the fields of laboratory medicine such as clinical biochemistry, medical microbiology, medical laboratory toxicology, medical laboratory cytomorphology and medical laboratory transfusiology. An important component of medical laboratory specialists’ identity is awareness of inherited ethos obtained from bygone generations of workers in this particular profession and the need to continue its further development. An expression of this awareness is among others Polish Code of Ethics of a Medical Laboratory Specialist (CEMLS) containing a set of values and a moral standpoint characteristic of this type of professional environment. Presenting the ethos of the medical laboratory specialist is a purpose of this article. Authors focus on the role CEMLS plays in areas of professional ethics and law. Next, they reconstruct the Polish model of ethos of medical diagnostic laboratory personnel. An overall picture consists of a presentation of the general moral principles concerning execution of this profession and rules of conduct in relations with the patient, own professional environment and the rest of the society. Polish model of ethical conduct, which is rooted in Hippocratic medical tradition, harmonizes with the ethos of medical laboratory specialists of other European countries and the world. PMID:27683468

Polish Code of Ethics of a Medical Laboratory Specialist.

PubMed

Elżbieta, Puacz; Waldemar, Glusiec; Barbara, Madej-Czerwonka

2014-09-01

Along with the development of medicine, increasingly significant role has been played by the laboratory diagnostics. For over ten years the profession of the medical laboratory specialist has been regarded in Poland as the autonomous medical profession and has enjoyed a status of one of public trust. The process of education of medical laboratory specialists consists of a five-year degree in laboratory medicine, offered at Medical Universities, and of a five-year Vocational Specialization in one of the fields of laboratory medicine such as clinical biochemistry, medical microbiology, medical laboratory toxicology, medical laboratory cytomorphology and medical laboratory transfusiology. An important component of medical laboratory specialists' identity is awareness of inherited ethos obtained from bygone generations of workers in this particular profession and the need to continue its further development. An expression of this awareness is among others Polish Code of Ethics of a Medical Laboratory Specialist (CEMLS) containing a set of values and a moral standpoint characteristic of this type of professional environment. Presenting the ethos of the medical laboratory specialist is a purpose of this article. Authors focus on the role CEMLS plays in areas of professional ethics and law. Next, they reconstruct the Polish model of ethos of medical diagnostic laboratory personnel. An overall picture consists of a presentation of the general moral principles concerning execution of this profession and rules of conduct in relations with the patient, own professional environment and the rest of the society. Polish model of ethical conduct, which is rooted in Hippocratic medical tradition, harmonizes with the ethos of medical laboratory specialists of other European countries and the world.

Comparison of lecture and team-based learning in medical ethics education.

PubMed

Ozgonul, Levent; Alimoglu, Mustafa Kemal

2017-01-01

Medical education literature suggests that ethics education should be learner-centered and problem-based rather than theory-based. Team-based learning is an appropriate method for this suggestion. However, its effectiveness was not investigated enough in medical ethics education. Is team-based learning effective in medical ethics education in terms of knowledge retention, in-class learner engagement, and learner reactions? This was a prospective controlled follow-up study. We changed lecture with team-based learning method to teach four topics in a 2-week medical ethics clerkship, while the remaining topics were taught by lectures. For comparison, we formed team-based learning and lecture groups, in which the students and instructor are the same, but the topics and teaching methodologies are different. We determined in-class learner engagement by direct observation and student satisfaction by feedback forms. Student success for team-based learning and lecture topics in the end-of-clerkship exam and two retention tests performed 1 year and 2 years later were compared. Ethical considerations: Ethical approval for the study was granted by Akdeniz University Board of Ethics on Noninvasive Clinical Human Studies Ethics committee. Short-term knowledge retention did not differ; however, team-based learning was found superior to lecture at long-term retention tests. Student satisfaction was high with team-based learning and in-class engagement was better in team-based learning sessions. Our results on learner engagement and satisfaction with team-based learning were similar to those of previous reports. However, knowledge retention results in our study were contrary to literature. The reason might be the fact that students prepared for the end-of-clerkship pass/fail exam (short term) regardless of the teaching method. But, at long-term retention tests, they did not prepare for the exam and answered the questions just using the knowledge retained in their memories. Our

Ethics and professionalism in medical physics: a survey of AAPM members.

PubMed

Ozturk, Naim; Armato, Samuel G; Giger, Maryellen L; Serago, Christopher F; Ross, Lainie F

2013-04-01

To assess current education, practices, attitudes, and perceptions pertaining to ethics and professionalism in medical physics. A link to a web-based survey was distributed to the American Association of Physicists in Medicine (AAPM) e-mail membership list, with a follow-up e-mail sent two weeks later. The survey included questions about ethics/professionalism education, direct personal knowledge of ethically questionable practices in clinical care, research, education (teaching and mentoring), and professionalism, respondents' assessment of their ability to address ethical/professional dilemmas, and demographics. For analysis, reports of unethical or ethically questionable practices or behaviors by approximately 40% or more of respondents were classified as "frequent." Partial or complete responses were received from 18% (1394/7708) of AAPM members. Overall, 60% (827/1377) of the respondents stated that they had not received ethics/professionalism education during their medical physics training. Respondents currently in training were more likely to state that they received instruction in ethics/professionalism (80%, 127/159) versus respondents who were post-training (35%, 401/1159). Respondents' preferred method of instruction in ethics/professionalism was structured periodic discussions involving both faculty and students/trainees. More than 90% (1271/1384) supported continuing education in ethics/professionalism and 75% (1043/1386) stated they would attend ethics/professionalism sessions at professional/scientific meetings. In the research setting, reports about ethically questionable authorship assignment were frequent (approximately 40%) whereas incidents of ethically questionable practices about human subjects protections were quite infrequent (5%). In the clinical setting, there was frequent recollection of incidents regarding lack of training, resources and skills, and error/incident reporting. In the educational setting, incidents of unethical or ethically

Jewish Learning in American Universities: The First Century. The Modern Jewish Experience.

ERIC Educational Resources Information Center

Ritterband, Paul; Wechsler, Harold S.

This book examines the evolution of Jewish studies as an academic discipline within the history and sociology of higher education in the United States from the late 19th century to the present. Chapter 1 discusses the effects of European and American academic history on the late 19th-century appearance of Jewish learning in American universities.…

Modeling Medical Ethics through Intelligent Agents

NASA Astrophysics Data System (ADS)

Machado, José; Miranda, Miguel; Abelha, António; Neves, José; Neves, João

The amount of research using health information has increased dramatically over the last past years. Indeed, a significative number of healthcare institutions have extensive Electronic Health Records (EHR), collected over several years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to use them to improve the delivery of care to the ones in need. Research Ethics Boards in Portugal and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to EHRs. However, we feel we have an effective way to handle Medical Ethics if we look to the problem under a structured and more rational way. Indeed, we felt that physicians were not aware of the relevance of the subject in their pre-clinical years, but their interest increase when they were exposed to patients. On the other hand, once EHRs are stored in machines, we also felt that we had to find a way to ensure that the behavior of machines toward human users, and perhaps other machines as well, is ethically acceptable. Therefore, in this article we discuss the importance of machine ethics and the need for machines that represent ethical principles explicitly. It is also shown how a machine may abstract an ethical principle from a logical representation of ethical judgments and use that principle to guide its own behavior.

The Mass Campaign to Eradicate Ringworm Among the Jewish Community in Eastern Europe, 1921–1938

PubMed Central

Romem, Pnina; Romem, Yitzhak; Shani, Mordechai

2013-01-01

Between the years 1921 and 1938, 27 600 children were irradiated during a mass campaign to eradicate ringworm among the Jewish community in East Europe. The ringworm campaign was the initiative of the American Jewish Joint Distribution Committee together with the Jewish health maintenance organization OZE (The Society for the Protection of Jewish Health). We describe this campaign that used x-rays to eradicate ringworm and its mission to enhance public health among Jewish communities in Eastern Europe during the period between the world wars. We discuss the concepts behind the campaign, the primary health agents that participated in it, and the latent medical ramifications that were found among children treated for ringworm, many years after treatment—pathologies that can be linked to the irradiation they received as children. Our research is based on historical archival materials in the United States, Europe, and Israel. PMID:23409897

Medical Ethics

MedlinePlus

... have an ethical aspect. For example, there are ethical issues relating to End of life care: Should a patient receive nutrition? What about advance directives and resuscitation orders? Abortion: When does life begin? Is it ethical to terminate a pregnancy with a birth defect? ...

[Medical ethical aspects of culture in social interactions with Muslim patients].

PubMed

Ilkilic, I

2007-07-30

In today's world, the plurality of values is considered to be a constitutive feature of modern societies. In these societies, transcultural patient-physician relationships are a part of daily medical practice. Culturally determined value systems can be crucial for understanding the perception of notions such as "health" and "illness", leading to fundamental differences in assessing medical interventions and therapeutic objectives. Therefore, transcultural conflicts of interest are presenting medical ethical decision-making with new challenges. Time and again, medical practice demonstrates that cultural differences between physician and patient are correlated with the complexity of medical ethical conflicts, as can be seen in the relationship between Muslim patients and non-Muslim physicians in the German health care system. This paper discusses some of the central issues in these relationships like communication, sense of shame, religious duties, and medical end-of-life decisions, analyzing some concrete cases. Subsequently, a number of medical ethical theses relevant for multicultural societies will be discussed.

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice.

PubMed

Madani, Mansoureh; Larijani, Bagher; Madani, Ensieh; Ghasemzadeh, Nazafarin

2017-01-01

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians' practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine.

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice

PubMed Central

Madani, Mansoureh; Larijani, Bagher; Madani, Ensieh; Ghasemzadeh, Nazafarin

2017-01-01

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians’ practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine. PMID:29282423

Gender Role Socialization in Jewish Men.

ERIC Educational Resources Information Center

Lasser, Jon; Gottlieb, Michael C.

There has been little empirical research on the gender role socialization of Jewish men. This paper explores Jewish male gender role socialization and provides a model by which gender and ethnicity may be studied. A description of the gender role socialization of Jewish men, with an emphasis on advantages and disadvantages of such socialization…

Illegal Drug Use in Orthodox Jewish Adolescents.

PubMed

Fogel, Joshua

2004-01-01

Orthodox Jewish adolescents are increasingly seeking stimulation with illegal drugs. Eleven Orthodox Jewish adolescents were surveyed with semi-structured interviews on the Orthodox Jewish cultural aspects of their illegal drug use. Adolescents had mixed beliefs about religious teachings affecting their illegal drug use. No consistent pattern existed for particular ethnic aspects of Orthodox Jewish religious practice as a risk factor for illegal drug use. Language used to describe illegal drug use in this population is described. Unlike illegal drug use in secular and non-Jewish adolescents, these adolescents reported very little family discord or poor relationships with their parents.

Evaluating the effects of an integrated medical ethics curriculum on first-year students.

PubMed

Chin, Jacqueline J L; Voo, Teck Chuan; Karim, Syahirah Abdul; Chan, Yiong Huak; Campbell, Alastair V

2011-01-01

An integrated biomedical ethics track was implemented as part of the new medical undergraduate curriculum at the National University of Singapore Yong Loo Lin School of Medicine in academic year (AY) 2008/2009. This study analyses the effects of the new curriculum on fi rst-year students' knowledge, confidence and opinions in relation to the subject. In a cohort-based quasi-experimental study, we administered a pre-course and post-course questionnaire to a group of fi rst-year students in AY2008/2009 who underwent the new biomedical ethics curriculum. The same questionnaire was carried out with the fi rst-year cohort of AY2007/2008, who had received only ad hoc teaching in biomedical ethics. The questionnaire focused on the students' opinions on selected taught topics in biomedical ethics and law, and formal ethics education; their confidence in relation to specific clinical ethical competencies; and their knowledge of selected taught topics in the fi rst-year syllabus. The experimental cohort acquired more knowledge and confidence. They rated more positively formal ethics teaching and assessment as a requirement of medical education. Attitudes were found to have been 'professionalised' within the experimental group, with significantly greater receptiveness towards ethical codes of the profession and the regulatory role of the Singapore Medical Council. They were found to be more conservative with respect to legislative changes in healthcare. The pioneer biomedical ethics curriculum had significant effects on the ethical development of fi rst-year medical students. Longitudinal research through further phases of the integrated curriculum is needed to identify learning issues that affect the consolidation of knowledge, confidence and attitudes in medical ethics, law and professionalism.

Creation of a National, At-home Model for Ashkenazi Jewish Carrier Screening.

PubMed

Grinzaid, Karen Arnovitz; Page, Patricia Zartman; Denton, Jessica Johnson; Ginsberg, Jessica

2015-06-01

Ethnicity-based carrier screening for the Ashkenazi Jewish population has been available and encouraged by advocacy and community groups since the early 1970's. Both the American College of Medical Genetics and the American Congress of Obstetricians and Gynecologists recommend carrier screening for this population (Obstetrics and Gynecology, 114(4), 950-953, 2009; Genetics in Medicine, 10(1), 55-56, 2008). While many physicians inquire about ethnic background and offer appropriate carrier screening, studies show that a gap remains in implementing recommendations (Genetic testing and molecular biomarkers, 2011). In addition, education and outreach efforts targeting Jewish communities have had limited success in reaching this at-risk population. Despite efforts by the medical and Jewish communities, many Jews of reproductive age are not aware of screening, and remain at risk for having children with preventable diseases. Reaching this population, preferably pre-conception, and facilitating access to screening is critically important. To address this need, genetic counselors at Emory University developed JScreen, a national Jewish genetic disease screening program. The program includes a national marketing and PR campaign, online education, at-home saliva-based screening, post-test genetic counseling via telephone or secure video conferencing, and referrals for face-to-face genetic counseling as needed. Our goals are to create a successful education and screening program for this population and to develop a model that could potentially be used for other at-risk populations.

[Ethical behavioral standards of medical students on examinations and studies].

PubMed

Tolkin, Lior; Glick, Shimon

2007-06-01

In recent years the medical literature has reflected an increasing interest in the medical ethics of physicians and medical students. Studies have shown that cheating in medical school is frequent enough to cause concern, that there is a positive correlation between students' ethical attitude and their ethical behavior and between cheating in school and cheating in patient care. This study aims to examine student attitudes towards cheating, their self-reported behavior, analyze cultural and sub-cultural differences, and to reach practical conclusions that might be incorporated into the teaching of ethics in medical schools. Anonymous questionnaires were distributed to 193 first and second year students of the Israeli and American programs at Ben-Gurion University. The questionnaire consisted of fifty three multiple choice questions. The students were asked to state their opinion on various cheating practices at medical school and dishonesty in patient care, to estimate how they would resolve various ethical dilemmas and to provide some demographic information. The results were analyzed using SPSS. T-tests, Chi-Square tests, one-way analysis of variance, and Pearson and Spearman's coefficients, all used as appropriate. Completed questionnaires were returned by 141 students (73%). The majority of the students regard cheating in an exam (93%) or on a final paper (85%) to be morally unacceptable behavior. Copying during an exam is regarded as more morally unacceptable than copying a homework exercise. The majority of the students consider faking a patient's laboratory results to be morally unacceptable behavior (98%). American students regard copying a homework exercise, reconstructing exam questions for the benefit of next year students and giving answers to a fellow student during an exam to be more morally unacceptable in comparison to the Israeli students. Married students consider cheating to be more morally unacceptable than unmarried students. A positive

[Medical ethics under the bioethics' point of view: the moral surgical practice].

PubMed

Antonio, Eliana Maria Restum; Fontes, Tereza Maria Pereira

2011-01-01

The professional practice of medicine today has a strong biological approach due to the increasing specialization of medical science. Often, science itself does not help to address and resolve a particular situation of a medical professional, and this is where human and social sciences, and especially other disciplines such as bioethics, can give a more humane and socialist approach, by systematically studying human behavior in the field of life and health sciences, considering moral values and principles. As part of this study, the segment that is limited to the analysis of ethical conflicts arising from the practice of medicine and patient care is known as medical ethics. Medical ethics, in the context of surgery, involves the integration of the surgical patient with the nature of the surgeon, influenced by his training and experience, his sensitivity to identify what is right. Ethics should not only be in the procedure, the surgery itself or in what happens in an operating room or even in the exercise of surgery as a specialty. Ethics must be in the life and conduct of the surgeon, so that all life and professional acts should be ethically valid.

Against the magnanimous in medical ethics.

PubMed Central

Kottow, M H

1990-01-01

Supererogatory acts are considered by some to be part of medicine, whereas others accept supererogation to be a gratuitous virtue, to be extolled when present, but not to be demanded. The present paper sides with those contending that medicine is duty-bound to benefit patients and that supererogation/altruism must per definition remain outside and beyond any role-description of the profession. Medical ethics should be bound by rational ethics and steer away from separatist views which grant exclusive privileges but also create excessive demands, way beyond what physicians perform or are willing and able to offer. PMID:2231634

Against the magnanimous in medical ethics.

PubMed

Kottow, M H

1990-09-01

Supererogatory acts are considered by some to be part of medicine, whereas others accept supererogation to be a gratuitous virtue, to be extolled when present, but not to be demanded. The present paper sides with those contending that medicine is duty-bound to benefit patients and that supererogation/altruism must per definition remain outside and beyond any role-description of the profession. Medical ethics should be bound by rational ethics and steer away from separatist views which grant exclusive privileges but also create excessive demands, way beyond what physicians perform or are willing and able to offer.

Teaching medical ethics to undergraduate students in post‐apartheid South Africa, 2003–2006

PubMed Central

Moodley, Keymanthri

2007-01-01

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa (HPCSA) subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country. PMID:17971474

Deontological foundations for medical ethics?

PubMed

Gillon, R

1985-05-04

Gillon outlines the principles of the deontological, or duty-based, group of moral theories in one of a series of British Medical Journal articles on the philosophical foundations of medical ethics. He differentiates between monistic theories, such as Immanuel Kant's, which rely on a single moral principle, and pluralistic theories, such as that of W.D. Ross, which rely on several principles that potentially could conflict. He summarizes the contributions of Kant and Ross to the development of deontological thought, then concludes his essay with brief paragraphs on other deontological approaches to the resolution of conflicting moral principles.

Annual report of Council, 1985-1986: medical ethics.

PubMed

1986-03-29

Recent activities of the Council of the British Medical Association related to ethical and public policy issues are described. The Council has been working to improve the network of local research ethics committees and favors the establishment of a national committee to review research proposals. It has been engaged in efforts to shape the Data Protection Act to safeguard the confidentiality of personal health records and to protect the confidentiality of minors who seek contraceptive advice without their parents' knowledge. Other Council concerns include advertising by the medical profession and the physician's role in law enforcement in Great Britain and in investigations of torture on the international scene.

Medical ethics on film: towards a reconstruction of the teaching of healthcare professionals

PubMed Central

Volandes, Angelo

2007-01-01

The clinical vignette remains the standard means by which medical ethics are taught to students in the healthcare professions. Although written or verbal vignettes are useful as a pedagogic tool for teaching ethics and introducing students to real cases, they are limited, since students must imagine the clinical scenario. Medical ethics are almost universally taught during the early years of training, when students are unfamiliar with the clinical reality in which ethics issues arise. Film vignettes fill in that imaginative leap. By providing vivid details with images, film vignettes offer rich and textured details of cases, including the patient's perspective and the clinical reality. Film vignettes provide a detailed ethnography that allows for a more complete discussion of the ethical issues. Film can serve as an additional tool for teaching medical ethics to members of the healthcare professions. PMID:17971475

Medical ethics on film: towards a reconstruction of the teaching of healthcare professionals.

PubMed

Volandes, Angelo

2007-11-01

The clinical vignette remains the standard means by which medical ethics are taught to students in the healthcare professions. Although written or verbal vignettes are useful as a pedagogic tool for teaching ethics and introducing students to real cases, they are limited, since students must imagine the clinical scenario. Medical ethics are almost universally taught during the early years of training, when students are unfamiliar with the clinical reality in which ethics issues arise. Film vignettes fill in that imaginative leap. By providing vivid details with images, film vignettes offer rich and textured details of cases, including the patient's perspective and the clinical reality. Film vignettes provide a detailed ethnography that allows for a more complete discussion of the ethical issues. Film can serve as an additional tool for teaching medical ethics to members of the healthcare professions.

Ethics and professionalism in medical physics: A survey of AAPM members

PubMed Central

Ozturk, Naim; Armato, Samuel G.; Giger, Maryellen L.; Serago, Christopher F.; Ross, Lainie F.

2013-01-01

Purpose: To assess current education, practices, attitudes, and perceptions pertaining to ethics and professionalism in medical physics. Methods: A link to a web-based survey was distributed to the American Association of Physicists in Medicine (AAPM) e-mail membership list, with a follow-up e-mail sent two weeks later. The survey included questions about ethics/professionalism education, direct personal knowledge of ethically questionable practices in clinical care, research, education (teaching and mentoring), and professionalism, respondents’ assessment of their ability to address ethical/professional dilemmas, and demographics. For analysis, reports of unethical or ethically questionable practices or behaviors by approximately 40% or more of respondents were classified as “frequent.” Results: Partial or complete responses were received from 18% (1394/7708) of AAPM members. Overall, 60% (827/1377) of the respondents stated that they had not received ethics/professionalism education during their medical physics training. Respondents currently in training were more likely to state that they received instruction in ethics/professionalism (80%, 127/159) versus respondents who were post-training (35%, 401/1159). Respondents’ preferred method of instruction in ethics/professionalism was structured periodic discussions involving both faculty and students/trainees. More than 90% (1271/1384) supported continuing education in ethics/professionalism and 75% (1043/1386) stated they would attend ethics/professionalism sessions at professional/scientific meetings. In the research setting, reports about ethically questionable authorship assignment were frequent (approximately 40%) whereas incidents of ethically questionable practices about human subjects protections were quite infrequent (5%). In the clinical setting, there was frequent recollection of incidents regarding lack of training, resources and skills, and error/incident reporting. In the educational setting

Good medical ethics, from the inside out--and back again.

PubMed

Oakley, Justin

2015-01-01

I argue here that good medical ethics requires an empirically-informed moral psychology of medical virtue along with sound action-guiding prescriptions for virtuous medical practice. After distinguishing between three levels of justification, I indicate how medical virtue ethics can draw constructively on relevant empirical research in developing feasible and realistic aspirational standards for doctors, and in evaluating how policymakers can support doctors in acting on the virtues that doctors agreed to be guided by when they joined the profession. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

What Does the Patient Say? Levinas and Medical Ethics.

PubMed

Burns, Lawrence

2017-04-01

The patient-physician relationship is of primary importance for medical ethics, but it also teaches broader lessons about ethics generally. This is particularly true for the philosopher Emmanuel Levinas whose ethics is grounded in the other who "faces" the subject and whose suffering provokes responsibility. Given the pragmatic, situational character of Levinasian ethics, the "face of the other" may be elucidated by an analogy with the "face of the patient." To do so, I draw on examples from Martin Winckler's fictional physician narratives. In addition, I explore how the standpoint of the physician conceals a related but often unacknowledged dimension of care: the obligation to nurse. For both nurse and physician, one question encapsulates Levinas' medical ethics: "What does the patient say?" Using this as my guiding question, I examine the context within which physician, nurse, and patient meet in order to highlight their shared vulnerability and the care relationship that binds them together. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Teaching Jewish-Christian Relations in the University Classroom.

ERIC Educational Resources Information Center

Shermis, Michael, Ed.

1988-01-01

This special issue on "Teaching Jewish-Christian Relations in the University Classroom" is meant to be a resource for those involved in Jewish studies and who teach about Jewish-Christian relations. It offers an introduction to the topics of the Jewish-Christian encounter, Israel, anti-Semitism, Christian Scriptures, the works of Elie…

Pediatric obstetrical ethics: Medical decision-making by, with, and for pregnant early adolescents.

PubMed

Mercurio, Mark R

2016-06-01

Pregnancy in an early adolescent carries with it specific ethical considerations, in some ways different from pregnancy in an adult and from medical care of a non-pregnant adolescent. Obstetrical ethics emphasizes the right of the patient to autonomy and bodily integrity, including the right to refuse medical intervention. Pediatric ethics recognizes the right of parents, within limits, to make medical decisions for their children, and the right of a child to receive medical or surgical interventions likely to be of benefit to her, sometimes over her own objections. As the child gets older, and particularly during the years of adolescence, there is also a recognition of the right to an increasingly prominent role in decisions about her own healthcare. Pediatric obstetrical ethics, referring to ethical decisions made by, with, and for pregnant early adolescents, represents the intersection of these different cultures. Principles and approaches from both obstetrical and pediatric ethics, as well as a unified understanding of rights, obligations, and practical considerations, will be needed. Copyright © 2016. Published by Elsevier Inc.

The patient-centered medical home: an ethical analysis of principles and practice.

PubMed

Braddock, Clarence H; Snyder, Lois; Neubauer, Richard L; Fischer, Gary S

2013-01-01

The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

[Indication: scientific and ethical basis of medical practice].

PubMed

Neitzke, G

2014-02-01

The medical indication provides a rational foundation for treatment decisions. An indication can be defined as the reasonable professional judgement that a medical procedure is suitable and useful to reach a specific therapeutic goal with a certain probability. An indication includes empirical, causal and purposive considerations and justifications, and a scrutiny of the individual case. This ensures that medical aspects of the patient, therapeutic goals and evidence-based knowledge are integrated and represented in the indication. An indication justifies a treatment proposal to the patient, which may only be carried out after a procedure of informed consent. Indications can be considered as the ethical basis of treatment decisions and as the heart of professionalism: indications should be used as a professional tool to protect against irrational therapeutic expectations, while ensuring the patient's right for reasonable treatment. In health care that is increasingly shaped by economic constraints, conscientious indications ensure the professional and ethical basis of medical treatment decisions.

[Bioethics is dead. Long live medical ethics!].

PubMed

Barrio Maestre, José María

2015-01-01

The purpose of this paper is to show a paradigmatic crisis in academic bioethics. Since an important part of bioethicists began to relativize the ethical prohibition of killing an innocent human being, one way or another they began to ally with the death industry: the business of abortion, and then that of euthanasia. The thesis of this paper is that by crossing that Rubicon bioethics has been corrupted and has lost its connection to the ethical, political and legal discourse. One can only hope that it will revive from its ashes if it retakes the ″taboo″ of the sacredness of human life, something for which medical ethics could provide invaluable help, because it still keeps the notion that ″a doctor should not kill″, although in an excessively ″discreet″ and somehow ″ashamed″ way. However, conscientious doctors know more about ethics than most bioethicists.

Giving voice to African thought in medical research ethics.

PubMed

Tangwa, Godfrey B

2017-04-01

In this article, I consider the virtual absence of an African voice and perspective in global discourses of medical research ethics against the backdrop of the high burden of diseases and epidemics on the continent and the fact that the continent is actually the scene of numerous and sundry medical research studies. I consider some reasons for this state of affairs as well as how the situation might be redressed. Using examples from the HIV/AIDS and Ebola epidemics, I attempt to show that the marginalization of Africa in medical research and medical research ethics is deliberate rather than accidental. It is causally related, in general terms, to a Eurocentric hegemony derived from colonialism and colonial indoctrination cum proselytization. I end by proposing seven theses for the critical reflection and appraisal of the reader.

Ethics, jurisprudence, and economics in the medical school curriculum.

PubMed Central

O'Neill, L. C.; Davidson, R. C.; Tupper, C. J.; Scherger, J. E.; Walsh, D. A.

1990-01-01

Medical ethics, medical jurisprudence, and medical economics are recognized as important components of a medical school curriculum. These subjects were introduced through a course given at the University of California, Davis, School of Medicine. Four aspects of the format and content of the course were instrumental to its success. Teaching principles of medical ethics within the context of jurisprudence and economics permitted the students to gain an understanding of the institutions and processes that act as positive and negative constraints on physicians' clinical and professional behavior. The course was offered during the fourth year following required clinical rotations so that all aspects of the course could be based on the clinical experiences of the students. It was presented in a continuing medical education format away from the normal teaching environment of first- and second-year classrooms and third-year clerkships. Finally, the course was designed by a multidisciplinary, multidepartmental planning group that included students. PMID:2260303

[Medical ethics in prison medicine].

PubMed

Bernheim, J

1980-11-01

A series of situations and decisions involving medical ethics in a prison medical service are discussed. The doctor's independence is considered in relation to his contract with administrative authorities. In contrast with most private doctor-patient relationships, there is usually no possibility for prisoners to choose their doctor and vice-versa. Freedom of consent on the part of the patient may also imply a right to no-treatment. Medical care in prison is not easy to delineate, also because patients often try to involve the doctor in non-medical demands. A prison doctor should avoid taking part in decisions which ought to be made by the judiciary or by administrative authorities. Programmes involving preventive medicine and sociotherapy imply collaboration between therapeutic and security staff. The continuous interplay and readjustment between powers based on public authority, on the rights of each individual prisoner and on the medical programmes makes it possible for some sort of therapeutic freedom to exist in the prison.

Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods.

PubMed

AlMahmoud, Tahra; Hashim, M Jawad; Elzubeir, Margaret Ann; Branicki, Frank

2017-01-01

Ethics and professionalism are an integral part of medical school curricula; however, medical students' views on these topics have not been assessed in many countries.  The study aimed to examine medical students' perceptions toward ethics and professionalism teaching, and its learning and assessment methods. A self-administered questionnaire eliciting views on professionalism and ethics education was distributed to a total of 128 final-year medical students. A total of 108 students completed the survey, with an 84% response rate. Medical students reported frequently encountering ethical conflicts during training but stated only a moderate level of ethics training at medical school (mean = 5.14 ± 1.8). They noted that their education had helped somewhat to deal with ethical conflicts (mean = 5.39 ± 2.0). Students strongly affirmed the importance of ethics education (mean = 7.63 ± 1.03) and endorsed the value of positive role models (mean = 7.45 ± 1.5) as the preferred learning method. The cohort voiced interest in direct faculty supervision as an approach to assessment of knowledge and skills (mean = 7.62 ± 1.26). Female students perceived greater need for more ethics education compared to males (p = < 0.05). Students who claimed that they had experienced some unprofessional treatment had a more limited view of the importance of ethics as a subject (P = 0.001). Medical students viewed ethics education positively and preferred clinically attuned methods for learning.

A Data Base for Curriculum Design in Medical Ethics.

ERIC Educational Resources Information Center

Tiberius, Richard G.; Cleave-Hogg, Doreen

1984-01-01

A study to provide information about medical students' prior knowledge of and attitudes toward medical ethics is reported. A questionnaire was administered to 845 entering medical students at the University of Toronto. The results support the need for a course that requires thinking rather than rote memory. (Author/MLW)

[Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center].

PubMed

Richter, G

2014-08-01

Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service

The Hidden Curriculum, Ethics Teaching, and the Structure of Medical Education.

ERIC Educational Resources Information Center

Hafferty, Frederic W.; Franks, Ronald

1994-01-01

Issues concerning inclusion of ethics instruction in the medical school curriculum are discussed, including whether ethics should be presented as a body of knowledge or matter of professional identity and the "hidden curriculum" of medicine as a form of socialization. Recommendations for the structuring of an ethics curriculum are…

Medical decision and patient's preference: 'much ethics' and more trust always needed.

PubMed

Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K

2011-01-01

There is much discussion on medical ethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice.

Medical ethics in an era of bioethics: resetting the medical profession's compass.

PubMed

Pellegrino, Edmund D

2012-02-01

What it means to be a medical professional has been defined by medical ethicists throughout history and remains a contemporary concern addressed by this paper. A medical professional is generally considered to be one who makes a public promise to fulfill the ethical obligations expressed in the Hippocratic Code. This presentation summarizes the history of medical professionalism and refocuses attention on the interpersonal relationship of doctor and patient. This keynote address was delivered at the Founders of Bioethics International Congress (June, 2010).

Subject, function, and trend in medical ethics research: a comparative study of Chinese and non-Chinese literature using bibliometrics.

PubMed

Jiang, Lanhui; Shen, Jiantong; Li, Youping; Deng, Shaolin; Wu, Taixiang; Chen, Baoqing; Xie, Zhiyi; Qin, Chaoyi; Yu, Zhiyuan; Qin, Chuan; Huang, Jin; Liu, Xuemei; Li, Yan; Jiang, Jie

2012-05-01

To perform a comparative quantitative and qualitative analysis of Chinese and non-Chinese medical ethics literature using systematic research and literature analysis in order to discern research trends in the area and provide baseline data as a reference for relevant decision making and further study. We retrieved articles using MeSH terms and keywords related to medical ethics in PubMed and CNKI, and then constructed a set of charts by applying word co-occurrence, The Pathfinder Networks algorithms, an included subject chart, a research field relationship chart, and strategy coordination charts. The total of number of papers retrieved from PubMed was six times that retrieved from CNKI. Outside China, medical ethics has been studied in eight fully shaped subject fields, including morals, ethical review, physician-patient relationships, clinical trials, euthanasia, ethics education, clinical ethics, and health policy. In contrast, medical ethics research in China is still confined to five subject fields: morals, physician-patient relations, medical ethics education, ethical review, and medical research. Medical ethics research outside China emphasizes the application of medical ethics to solve emerging problems in clinical and medical research. It is mainly centered on morals, ethical review, and physician-patient relations. By comparison, medical ethics research in China places greater emphasis on morals and medical education. In order to narrow this gap between China and other countries, we should broaden the research scope of medical ethics and add more applied research, such as ethical review and medical education. © 2012 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Medical Decision and Patient's Preference: 'Much Ethics' and More Trust Always Needed

PubMed Central

Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K

2011-01-01

There is much discussion on medical ethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice. PMID:21647328

What is good medical ethics? A very personal response to a difficult question.

PubMed

Farsides, Bobbie

2015-01-01

A personal reflection upon a career in medical ethics leads to four conclusions on what makes for 'good medical ethics'. Good medical ethics is practical in approach, philosophically well grounded, cross disciplinary, and while it might not be a necessary feature, the experience of the author suggests that it is the work of 'good people'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.

PubMed

Heubel, Friedrich; Biller-Andorno, Nikola

2005-01-01

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

Ethics teaching in a medical education environment: preferences for diversity of learning and assessment methods

PubMed Central

AlMahmoud, Tahra; Hashim, M. Jawad; Elzubeir, Margaret Ann; Branicki, Frank

2017-01-01

ABSTRACT Background: Ethics and professionalism are an integral part of medical school curricula; however, medical students’ views on these topics have not been assessed in many countries. Objective: The study aimed to examine medical students’ perceptions toward ethics and professionalism teaching, and its learning and assessment methods. Design: A self-administered questionnaire eliciting views on professionalism and ethics education was distributed to a total of 128 final-year medical students. Results: A total of 108 students completed the survey, with an 84% response rate. Medical students reported frequently encountering ethical conflicts during training but stated only a moderate level of ethics training at medical school (mean = 5.14 ± 1.8). They noted that their education had helped somewhat to deal with ethical conflicts (mean = 5.39 ± 2.0). Students strongly affirmed the importance of ethics education (mean = 7.63 ± 1.03) and endorsed the value of positive role models (mean = 7.45 ± 1.5) as the preferred learning method. The cohort voiced interest in direct faculty supervision as an approach to assessment of knowledge and skills (mean = 7.62 ± 1.26). Female students perceived greater need for more ethics education compared to males (p = < 0.05). Students who claimed that they had experienced some unprofessional treatment had a more limited view of the importance of ethics as a subject (P = 0.001). Conclusion: Medical students viewed ethics education positively and preferred clinically attuned methods for learning. PMID:28562234

Teaching ethics in religious or cultural conflict situations: a personal perspective.

PubMed

Benari, Gili

2009-07-01

This article portrays the unique aspects of ethics education in a multicultural, multireligious and conflict-based atmosphere among Jewish and Arab nursing students in Jerusalem, Israel. It discusses the principles and the methods used for rising above this tension and dealing with this complicated situation, based on Yoder's ;bridging' method. An example is used of Jewish and Arab students together implementing two projects in 2008, when the faculty decided to co-operate with communities in East Jerusalem, the Arab side of the city. The students took it upon themselves to chaperon the teachers who came to watch them at work, translate, and facilitate interaction with a guarded and suspicious community. This approach could also be relevant to less extreme conditions in any inter-religious environment when trying to produce graduates with a strong ethical awareness.

Medical ethics--a Christian view.

PubMed Central

Habgood, J S

1985-01-01

All ethics has a religious dimension. This paper considers how specific Christian insights concerning death, suffering, human nature and human creatureliness can help to expose more fully the moral issues at stake in some of the dilemmas faced by doctors. It ends by acknowledging the crushing burden of decision-making which rests on many in the medical profession, and indicates the importance of religious resources in dealing with this. PMID:3981562

Ethical learning on international medical electives: a case-based analysis of medical student learning experiences.

PubMed

Bowsher, Gemma; Parry-Billings, Laura; Georgeson, Anna; Baraitser, Paula

2018-04-11

Students on international medical electives face complex ethical issues when undertaking clinical work. The variety of elective destinations and the culturally specific nature of clinical ethical issues suggest that pre-elective preparation could be supplemented by in-elective support. An online, asynchronous, case-based discussion was piloted to support ethical learning on medical student electives. We developed six scenarios from elective diaries to stimulate peer-facilitated discussions during electives. We evaluated the transcripts to assess whether transformative, experiential learning took place, assessing specifically for indications that 1) critical reflection, 2) reflective action and 3) reflective learning were taking place. We also completed a qualitative thematic content analysis of the discussions. Of forty-one extended comments, nine responses showed evidence of transformative learning (Mezirow stage three). The thematic analysis identified five themes: adopting a position on ethical issues without overt analysis; presenting issues in terms of their effects on students' ability to complete tasks; describing local contexts and colleagues as "other"; difficulty navigating between individual and structural issues, and overestimation of the impact of individual action on structures and processes. Results suggest a need to: frame ethical learning on elective so that it builds on earlier ethical programmes in the curriculum, and encourages students to adopt structured approaches to complex ethical issues including cross-cultural negotiation and to enhance global health training within the curriculum.

77 FR 38631 - Request for Comments on Ethical Issues Associated with the Development of Medical Countermeasures...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Request for Comments on Ethical Issues Associated with the... ethical issues associated with the development of medical countermeasures for children, including ethical considerations surrounding clinical research with children, ethical considerations surrounding pediatric medical...

Lifelong Learning in Ethical Practice: A Challenge for Continuing Medical Education.

ERIC Educational Resources Information Center

Kenny, Nuala; Sargeant, Joan; Allen, Michael

2001-01-01

Questionnaires and small-group discussions with a physician-ethicist revealed that physicians had very little formal ethics training in medical school. They did not feel they needed a very high level of confidence regarding ethical issues in practice, but lacked a systematic approach to identification and analysis of ethical issues. (Contains 24…

Empirical research in medical ethics: how conceptual accounts on normative-empirical collaboration may improve research practice.

PubMed

Salloch, Sabine; Schildmann, Jan; Vollmann, Jochen

2012-04-13

The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis.

Medical ethics contributes to clinical management: teaching medical students to engage patients as moral agents

PubMed Central

Caldicott, Catherine V; Danis, Marion

2013-01-01

OBJECTIVES In order to teach medical students to engage more fully with patients, we offer ethics education as a tool to assist in the management of patient health issues. METHODS We propose that many dilemmas in clinical medicine would benefit by having the doctor embark on an iterative reasoning process with the patient. Such a process acknowledges and engages the patient as a moral agent. We recommend employing Kant’s ethic of respect and a more inclusive definition of patient autonomy drawn from philosophy and clinical medicine, rather than simply presenting dichotomous choices to patients, which represents a common, but often suboptimal, means of approaching both medical and moral concerns. DISCUSSION We describe how more nuanced teaching about the ethics of the doctor–patient relationship might fit into the medical curriculum and offer practical suggestions for implementing a more respectful, morally engaged relationship with patients that should assist them to achieve meaningful health goals. PMID:19250356

Medical students and controversial ethical issues: results from the multicenter study SBRAME.

PubMed

Lucchetti, Giancarlo; de Oliveira, Leandro Romani; Leite, José Roberto; Lucchetti, Alessandra Lamas Granero

2014-12-15

Medical students(MS) will face ethical issues throughout their lives as doctors. The present study aims to investigate medical students' opinions on controversial ethical issues and factors associated with these opinions. SBRAME (Spirituality and Brazilian Medical Education) is a multicenter study involving 12 Brazilian medical schools with 5950 MS. Participants completed a questionnaire that collected information on socio-demographic data, medical schools characteristics, religious beliefs and opinions on controversial ethical issues. Of all MS, 3630 participated in the survey (61.0%). The sample was 53.8% women and the mean age was 22.5 years. In general, most MS have no objections to prescription of birth control (90.8%), adult stem cell use (87.5%), embryonic stem cell use (82.0%) and abortion for genetic reasons (51.2%). Approximately half of students have no objections to human cloning (47.3%), 45.7% to withdrawal of artificial life support, 41.4% to euthanasia and 23.3% to abortion for failed contraception. Socio-demographic data such as age, gender and income had little influence on MS opinions. On the other hand, medical schools characteristics (number of medical students in the university, year of medical school foundation, location of the university and type of university) and religious aspects (religious affiliation, religious attendance, non-organizational religiousness and intrinsic religiousness) were highly correlated with their opinions. In general, MS with more supportive opinions on controversial ethical issues were less religious and from non-traditional (newer), urban, public and bigger universities. The current study reveals MS have different opinions regarding controversial ethical issues. Noteworthy, these opinions seem to be shaped more by university characteristics and religious beliefs than socio-demographic data.

[Debates on the "Jewish nurse" within the Jewish communities in Austro-Hungary around 1900].

PubMed

Malleier, Elisabeth

2008-01-01

The debate about the organisation of nursing became acute during the last decades of the 19th century when big modern Jewish hospitals were built in several cities of the Habsburg Monarchy. This led to an increase in the demand for nurses and to the initiation of a discussion about the professionalisation of Jewish nursing. In these debates different actors with different intentions were involved. While hospitals were looking mainly for inexpensive and unlimited working nurses, middle-class organisations such as B'nai B'rith emphasised the necessity for women to learn a useful profession to be able to support their husbands economically. Furthermore, feminists and women's associations tried to set new standards for female education, emphasising economic independence and improving the working conditions for women. Jewish feminists such as Henriette Weiss in Vienna, Ida Fuerst in Budapest, and Julie Leipen in Prague tried to build up Jewish nursing schools. The different strategies of implementations and the result of their efforts will be the main focus of this paper.

Relevance of the rationalist-intuitionist debate for ethics and professionalism in medical education.

PubMed

Leffel, G Michael; Oakes Mueller, Ross A; Curlin, Farr A; Yoon, John D

2015-12-01

Despite widespread pedagogical efforts to modify discrete behaviors in developing physicians, the professionalism movement has generally shied away from essential questions such as what virtues characterize the good physician, and how are those virtues formed? Although there is widespread adoption of medical ethics curricula, there is still no consensus about the primary goals of ethics education. Two prevailing perspectives dominate the literature, constituting what is sometimes referred to as the "virtue/skill dichotomy". The first perspective argues that teaching ethics is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. The second perspective suggests that teaching ethics is a means of creating virtuous physicians. The authors argue that this debate about medical ethics education mirrors the Rationalist-Intuitionist debate in contemporary moral psychology. In the following essay, the authors sketch the relevance of the Rationalist-Intuitionist debate to medical ethics and professionalism. They then outline a moral intuitionist model of virtuous caring that derives from but also extends the "social intuitionist model" of moral action and virtue. This moral intuitionist model suggests several practical implications specifically for medical character education but also for health science education in general. This approach proposes that character development is best accomplished by tuning-up (activating) moral intuitions, amplifying (intensifying) moral emotions related to intuitions, and strengthening (expanding) intuition-expressive, emotion-related moral virtues, more than by "learning" explicit ethical rules or principles.

The effect of teaching medical ethics on medical students' moral reasoning.

PubMed

Self, D J; Wolinsky, F D; Baldwin, D C

1989-12-01

A study assessed the effect of incorporating medical ethics into the medical curriculum and the relative effects of two methods of implementing that curriculum, namely, lecture and case-study discussions. Results indicate a statistically significant increase (p less than or equal to .0001) in the level of moral reasoning of students exposed to the medical ethics course, regardless of format. Moreover, the unadjusted posttest scores indicated that the case-study method was significantly (p less than or equal to .03) more effective than the lecture method in increasing students' level of moral reasoning. When adjustment were made for the pretest scores, however, this difference was not statistically significant (p less than or equal to .18). Regression analysis by linear panel techniques revealed that age, gender, undergraduate grade-point average, and scores on the Medical College Admission Test were not related to the changes in moral-reasoning scores. All of the variance that could be explained was due to the students' being in one of the two experimental groups. In comparison with the control group, the change associated with each experimental format was statistically significant (lecture, p less than or equal to .004; case study, p less than or equal to .0001). Various explanations for these findings and their implications are given.

Phronesis as an ideal in professional medical ethics: some preliminary positionings and problematics.

PubMed

Kristjánsson, Kristján

2015-10-01

Phronesis has become a buzzword in contemporary medical ethics. Yet, the use of this single term conceals a number of significant conceptual controversies based on divergent philosophical assumptions. This paper explores three of them: on phronesis as universalist or relativist, generalist or particularist, and natural/painless or painful/ambivalent. It also reveals tensions between Alasdair MacIntyre's take on phronesis, typically drawn upon in professional ethics discourses, and Aristotle's original concept. The paper offers these four binaries as a possible analytical framework for classifying and evaluating accounts of phronesis in the medical ethics literature. It argues that to make sense of phronesis as a putative ideal in professional medical ethics--for example, with the further aim of crafting interventions to cultivate phronesis in medical ethics education--the preliminary question of which conception of phronesis is most serviceable for the aim in question needs to be answered. The paper identifies considerable lack of clarity in the current discursive field on phronesis and suggests how that shortcoming can be ameliorated.

An ethical paradox: the effect of unethical conduct on medical students' values.

PubMed

Satterwhite, R C; Satterwhite, W M; Enarson, C

2000-12-01

To report the ethical development of medical students across four years of education at one medical school. A questionnaire was distributed to all four classes at the Wake Forest University School of Medicine during the Spring of 1996. Three hundred and three students provided demographic information as well as information concerning their ethical development both as current medical students and future interns. Results were analyzed using cross-tabulations, correlations, and analysis of variance. Results suggested that the observation of and participation in unethical conduct may have disparaging effects on medical students' codes of ethics with 35% of the total sample (24% of first years rising to 55% of fourth years) stating that derogatory comments made by residents/attendings, either in the patient's presence or absence, were "sometimes" or "often" appropriate. However, approximately 70% of the sample contended that their personal code of ethics had not changed since beginning medical school and would not change as a resident. Results may represent an internal struggle that detracts from the medical school experience, both as a person and as a doctor. Our goal as educators is to alter the educational environment so that acceptance of such behaviour is not considered part of becoming a physician.

Challenges of Pre- and Post-Test Counseling for Orthodox Jewish Individuals in the Premarital Phase.

PubMed

Rose, E; Schreiber-Agus, N; Bajaj, K; Klugman, S; Goldwaser, T

2016-02-01

The Jewish community has traditionally taken ownership of its health, and has taken great strides to raise awareness about genetic issues that affect the community, such as Tay-Sachs disease and Hereditary Breast and Ovarian Cancer syndrome. Thanks in part to these heightened awareness efforts, many Orthodox Jewish individuals are now using genetics services as they begin to plan their families. Due to unique cultural and religious beliefs and perceptions, the Orthodox Jewish patients who seek genetic counseling face many barriers to a successful counseling session, and often seek the guidance of programs such as the Program for Jewish Genetic Health (PJGH). In this article, we present clinical vignettes from the PJGH's clinical affiliate, the Reproductive Genetics practice at the Montefiore Medical Center. These cases highlight unique features of contemporary premarital counseling and screening within the Orthodox Jewish Community, including concerns surrounding stigma, disclosure, "marriageability," the use of reproductive technologies, and the desire to include a third party in decision making. Our vignettes demonstrate the importance of culturally-sensitive counseling. We provide strategies and points to consider when addressing the challenges of pre- and post-test counseling as it relates to genetic testing in this population.

Module for Interns in Medical Ethics: A Developmental Diegesis.

PubMed

Mahajan, Rajiv; Goyal, Parmod Kumar; Sidhu, Tanvir Kaur; Kaur, Upinder; Kaur, Sandeep; Gupta, Vitull

2017-12-01

Media report is rife with incidences of doctor-patients' conflict, and this partly is due to communication gap and unethical practices being adopted by the doctors. Our regular curriculum fails to impart any training in ethical issues in patient care. Imparting training to students in these soft-skills is the need of the hour. To develop a module for interns in medical ethics (MIME) in patient care, validate it and pilot run the module for standardization. After conducting faculty development workshop in curriculum designing and three rounds of Delphi with alumni, a module in medical ethics was developed and peer validated. The questionnaire for pilot run, questionnaire for future use of module delivery and pre- and post-test were also peer validated. The module was delivered to 17 interns as pilot run in the form of 4 days' workshop. After pilot run, the module was standardized to 10 broad topics and 3 days' workshop. The questionnaire for future delivery of module in regular routine was also validated during pilot run. Twenty-five faculty members participated in 1 day faculty development workshop and 59 alumni completed three rounds of Delphi. After peer review by five experts, a module of 11 broad areas was developed and was pilot run on 17 interns. Based on the feedback from pilot run, a standardized, validated 18 h teaching MIME in patient care was developed. Pilot study proves that curriculum innovation in the form of medical ethics training to interns; when as undergraduate students, they actively participate in patient care under supervision will go a long way in inculcating soft skills like ethics, compassion and communication in them.

Jewish views on abortion.

PubMed

Jakobovits, I

1968-01-01

In Jewish law right and wrong, good and evil, are absolute values which transcend time, place, and environment. They defy definition by human intuition or expediency. Jewish law derives from the Divine revelation at Mount Sinai as expounded by sages faithful to, and authorized by, its writ. The Talmud rules that if a woman is in hard travail, and her life must be saved, the child must be aborted and extracted. The mother's life comes first. The fetus is not a human life until it is born. But 19th century Rabbinical works state that it is immoral to destroy a monster child. Modern rabbis are unanimous in condemning abortion, feticide, or infanticide as an unconscionable attack on human life. However, Jewish law allows abortion if the pregnancy will cause severe psychological damage to the mother. No civilized society could survive without laws which occasionally cause some suffering or personal anguish. One human life is worth a million lives, because each life is infinite in value. In cases of rape or incest Jewish law still does not sanction abortion. Man's procreative responsibilities are serious and carry rights and obligations which would be upset by liberalized abortion laws. If a person kills a person who is mortally wounded, the killer is guilty of a moral offense.

Antiprogestin drugs: ethical, legal and medical issues.

PubMed

Cook, R J; Grimes, D A

1992-01-01

RU 486 allows women the choice of a medical rather than a surgical abortion, and, for most women, the choice is one of procedure, not of whether to have an abortion. Issues surrounding RU 486 were explored in an American Society of Law and Medicine conference in December 1991 entitled "Antiprogestin Drugs: Ethical, Legal and Medical Issues." An introduction to 14 conference papers provides an overview of the proceedings. Baulieu, the father of RU 486, described updated developments in its use and the medically supervised method of abortion. Bygdeman and Swahn presented their work in Sweden on combining RU 486 with a prostaglandin to make abortion more effective. They suggested that the drug may be an attractive postovulation contraceptive. Greenslad et al. discussed service delivery aspects of the use of RU 486. Holt considered the implications of use of the drug in low-resource settings. A survey of obstetricians and gynecologists, presented by Heilig, indicates that 22% more physicians would perform a medical abortion. Patient perspectives were addressed by David, who stated that measuring acceptability of an abortion technique is difficult; women have historically used whatever method is available. A collaborative research project in India and Cuba on why women chose certain methods was reported by Winikoff et al. (90% of women would choose medical abortion if faced with the choice again). Berer analyzed French data on women's perspectives on medical vs. surgical abortion. The question of adolescent use of the drug was considered by Senderowitz, who lamented the lack of data on the subject and described what is known about adolescent pregnancy. Macklin proposed a framework for ethical analysis and used facts to address ethical questions. Weinstein provided another ethical framework, to analyze whether pharmacists have a right to refuse to provide abortifacient drugs. Buc approached the subject from a legal point of view and concluded that, whereas legal problems

Empirical research in medical ethics: How conceptual accounts on normative-empirical collaboration may improve research practice

PubMed Central

2012-01-01

Background The methodology of medical ethics during the last few decades has shifted from a predominant use of normative-philosophical analyses to an increasing involvement of empirical methods. The articles which have been published in the course of this so-called 'empirical turn' can be divided into conceptual accounts of empirical-normative collaboration and studies which use socio-empirical methods to investigate ethically relevant issues in concrete social contexts. Discussion A considered reference to normative research questions can be expected from good quality empirical research in medical ethics. However, a significant proportion of empirical studies currently published in medical ethics lacks such linkage between the empirical research and the normative analysis. In the first part of this paper, we will outline two typical shortcomings of empirical studies in medical ethics with regard to a link between normative questions and empirical data: (1) The complete lack of normative analysis, and (2) cryptonormativity and a missing account with regard to the relationship between 'is' and 'ought' statements. Subsequently, two selected concepts of empirical-normative collaboration will be presented and how these concepts may contribute to improve the linkage between normative and empirical aspects of empirical research in medical ethics will be demonstrated. Based on our analysis, as well as our own practical experience with empirical research in medical ethics, we conclude with a sketch of concrete suggestions for the conduct of empirical research in medical ethics. Summary High quality empirical research in medical ethics is in need of a considered reference to normative analysis. In this paper, we demonstrate how conceptual approaches of empirical-normative collaboration can enhance empirical research in medical ethics with regard to the link between empirical research and normative analysis. PMID:22500496

The place of the ideal observer in medical ethics.

PubMed

Churchill, L R

1983-01-01

The idea of an ideal observer is frequently employed in ethical reasoning and has recently been introduced into medical ethics. The contemporary use of this idea, however, is deeply flawed. It ignores important social and personal dimensions of ethics. By espousing a perspective of observation removed from history and community, the ideal observer notion encourages a pretense of objectivity and overlooks the distortions of distance. If taken seriously as a model for choice, the ideal observer is incoherent, as it dispenses with the concrete moral agent and the locus of choice. Adam Smith's 'impartial spectator' is examined as a more adequate statement of the need for appreciating diverse perspectives in ethical choices.

Fluoridation: a violation of medical ethics and human rights.

PubMed

Cross, Douglas W; Carton, Robert J

2003-01-01

Silicofluorides, widely used in water fluoridation, are unlicensed medicinal substances, administered to large populations without informed consent or supervision by a qualified medical practitioner. Fluoridation fails the test of reliability and specificity, and, lacking toxicity testing of silicofluorides, constitutes unlawful medical research. It is banned in most of Europe; European Union human rights legislation makes it illegal. Silicofluorides have never been submitted to the U.S. FDA for approval as medicines. The ethical validity of fluoridation policy does not stand up to scrutiny relative to the Nuremberg Code and other codes of medical ethics, including the Council of Europe's Biomedical Convention of 1999. The police power of the State has been used in the United States to override health concerns, with the support of the courts, which have given deference to health authorities.

A Required and Elective Curriculum in Ethics for Medical Students.

ERIC Educational Resources Information Center

Frank, Hugh A.

1988-01-01

An introduction to medical ethics has been incorporated into the core curriculum by the inclusion of four courses in social and behavioral sciences at the University of California, San Diego, School of Medicine. The ethical dimensions of the subjects being considered are thoroughly explored in the group discussions. (MLW)

A workshop on medical ethics at the College of Medicine, Lagos University.

PubMed

Olukoya, A A

1984-12-01

As part of an effort to improve the teaching of medical ethics in the College of Medicine, Lagos University two-day workshops were organised. Participants included people from various walks of life, for example politicians, lawyers, doctors, and patients. The workshops were quite successful, and have led to more extensive teaching of medical ethics in the college.

[Maimonides, a physician in the 12 century. Contribution to the history of medical ethics and deontology].

PubMed

Pavlović, B

2000-01-01

Maimonides, Moses ben Maimon (1135-1204), Jewish physician, philosopher and scholar was the first after Hippocrates to write a text of a "prayer" he spoke out at the beginning of his medical profession, e. i. when he took oath. The text of "Maimonides's prayer" is today obligatory in some schools of medicine in the United States of America.

The new military medical ethics: legacies of the Gulf Wars and the War on Terror.

PubMed

Miles, Steven H

2013-03-01

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990-1991) and the War on Terror (2001-). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non-therapeutic bioactive agents to soldiers were set aside because of the sense of being in a 'new kind of war'. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military-civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency. © 2011 Blackwell Publishing Ltd.

Developing a Questionnaire for Iranian Women's Attitude on Medical Ethics in Vaginal Childbirth.

PubMed

Mirzaee Rabor, Firoozeh; Taghipour, Ali; Mirzaee, Moghaddameh; Mirzaii Najmabadi, Khadigeh; Fazilat Pour, Masoud; Fattahi Masoum, Seyed Hosein

2015-12-01

Vaginal delivery is one of the challenging issues in medical ethics. It is important to use an appropriate instrument to assess medical ethics attitudes in normal delivery, but the lack of tool for this purpose is clear. The aim of this study was to develop and validate a questionnaire for the assessment of women's attitude on medical ethics application in normal vaginal delivery. This methodological study was carried out in Iran in 2013 - 2014. Medical ethics attitude in vaginal delivery questionnaire (MEAVDQ) was developed using the findings of a qualitative data obtained from a grounded theory research conducted on 20 women who had vaginal childbirth, in the first phase. Then, the validation criteria of this tool were tested by content and face validity in the second phase. Exploratory factor analysis was used for construct validity and reliability was also tested by Cronbach's alpha coefficient in the third phase of this study. SPSS version 13 was used in this study. The sample size for construct validity was 250 females who had normal vaginal childbirth. In the first phase of this study (tool development), by the use of four obtained categories and nine subcategories from grounded theory and literature review, three parts (98-items) of this tool were obtained (A, B and J). Part A explained the first principle of medical ethics, part B pointed to the second and third principles of medical ethics, and part J explained the fourth principle of medical ethics. After evaluating and confirming its face and content validity, 75 items remained in the questionnaire. In construct validity, by the employment of exploratory factor analysis, in parts A, B and J, 3, 7 and 3 factors were formed, respectively; and 62.8%, 64% and 51% of the total variances were explained by the obtained factors in parts A, B and J, respectively. The names of these factors in the three parts were achieved by consideration of the loading factor and medical ethics principles. The subscales of

Clinical and Phenotypic Differences in Inflammatory Bowel Disease Among Arab and Jewish Children in Israel.

PubMed

Rinawi, Firas; Assa, Amit; Bashir, Husam; Peleg, Sarit; Shamir, Raanan

2017-08-01

Data on inflammatory bowel disease (IBD) phenotypes among the Arab population in Israel or in the neighboring Arab countries is scarce. We aimed to assess differences in disease phenotype among Arab and Jewish children living in Israel. We performed a retrospective chart review of pediatric IBD cases, which were diagnosed at the Schneider Children's Medical Center and Ha'Emek Medical Center in Israel between 2000 and 2014. Demographic, clinical, and phenotypic variables were compared between Arabs and Jews from Eastern (Sephardic) and Western (Ashkenazi) origin. Seventy-one Arab children with IBD were compared with 165 Ashkenazi and 158 Sephardic Jewish children. Age and gender did not differ between groups. Sephardic and Ashkenazi Jewish Crohn's disease (CD) patients had significantly more stenotic behavior (24 and 26 vs. 5%, p = 0.03) and less fistulzing perianal disease (15 and 11 vs. 31%, p = 0.014) compared with Arab patients. Arab children with ulcerative colitis (UC) had more severe disease at diagnosis compared to Sephardic and Ashkenazi Jews reflected by higher Pediatric UC Activity Index (45 vs. 35 and 35, respectively, p = 0.03). Arab patients had significantly lower proportion of anti-Saccharomyces cerevisiae antibodies positivity (in CD) and perinuclear anti-neutrophil cytoplasmic antibodies positivity (in UC) than both Sephardic and Ashkenazi Jewish children (23 vs. 53 and 65%, p = 0.002 and 35 vs. 60 and 75%, respectively, p = 0.002). Arab and Jewish children with IBD differ in disease characteristics and severity. Whether genetic or environmental factors are the cause for these differences is yet to be determined.

Curricular priorities for business ethics in medical practice and research: recommendations from Delphi consensus panels.

PubMed

DuBois, James M; Kraus, Elena M; Gursahani, Kamal; Mikulec, Anthony; Bakanas, Erin

2014-11-15

No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics.

Awareness of ethical issues in medical education: an interactive teach-the-teacher course.

PubMed

Chiapponi, Costanza; Dimitriadis, Konstantinos; Özgül, Gülümser; Siebeck, Robert G; Siebeck, Matthias

2016-01-01

We conducted an international, interdisciplinary teach-the-teacher course to sensitize physicians from different countries to ethical issues in medical education. The purpose of this study was to assess the effects of this course. Before and after participating in a short session on ethical issues in medical education, 97 physicians from different countries in Africa, Asia, and Europe completed a self-assessment questionnaire on their competence and interest in this field. The short session consisted of working in small groups to identify, analyze and discuss ethical dilemmas described in case vignettes adapted from published examples or written by medical students. In addition to the questionnaire, we conducted a large-group experience to explore four basic orientations of participants in ethical thinking: relativism, intentionalism, consequentialism, and absolutism. We found a significant self-perceived increase in the participants' ability to identify and describe ethical issues and students' dilemmas, in their knowledge about these issues and teaching professionalism, and in their ability to describe both students' perspectives and teachers' and students' behaviors. In addition, participants' feeling of understanding their own culturally learned patterns of determining what is right and wrong increased after taking part in the course. The four contrasting basic ethical orientations showed no significant differences between participants regarding nationality, age, or gender. Ethics of education is an important issue for medical teachers. Teachers' self-perceived competence can be increased by working on case vignettes in small groups.

Awareness of ethical issues in medical education: an interactive teach-the-teacher course

PubMed Central

Chiapponi, Costanza; Dimitriadis, Konstantinos; Özgül, Gülümser; Siebeck, Robert G.; Siebeck, Matthias

2016-01-01

Purpose: We conducted an international, interdisciplinary teach-the-teacher course to sensitize physicians from different countries to ethical issues in medical education. The purpose of this study was to assess the effects of this course. Method: Before and after participating in a short session on ethical issues in medical education, 97 physicians from different countries in Africa, Asia, and Europe completed a self-assessment questionnaire on their competence and interest in this field. The short session consisted of working in small groups to identify, analyze and discuss ethical dilemmas described in case vignettes adapted from published examples or written by medical students. In addition to the questionnaire, we conducted a large-group experience to explore four basic orientations of participants in ethical thinking: relativism, intentionalism, consequentialism, and absolutism. Results: We found a significant self-perceived increase in the participants’ ability to identify and describe ethical issues and students’ dilemmas, in their knowledge about these issues and teaching professionalism, and in their ability to describe both students’ perspectives and teachers’ and students’ behaviors. In addition, participants’ feeling of understanding their own culturally learned patterns of determining what is right and wrong increased after taking part in the course. The four contrasting basic ethical orientations showed no significant differences between participants regarding nationality, age, or gender. Conclusion: Ethics of education is an important issue for medical teachers. Teachers’ self-perceived competence can be increased by working on case vignettes in small groups. PMID:27275510

Ethical challenges in Emergency Medical Services: controversies and recommendations.

PubMed

Becker, Torben K; Gausche-Hill, Marianne; Aswegan, Andrew L; Baker, Eileen F; Bookman, Kelly J; Bradley, Richard N; De Lorenzo, Robert A; Schoenwetter, David J

2013-10-01

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

Private-sector research ethics: marketing or good conflicts management? The 2005 John J. Conley Lecture on Medical Ethics.

PubMed

Dresser, Rebecca

2006-01-01

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies' internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical companies' ethics materials and describe shortcomings in the companies' existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs.

75 FR 25099 - Jewish American Heritage Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-07

... 8513 of April 30, 2010 Jewish American Heritage Month, 2010 By the President of the United States of... also maintained their own unique identity. During Jewish American Heritage Month we celebrate this... Jewish American Heritage Month. I call upon all Americans to observe this month with appropriate programs...

Ethical dilemmas in medical humanitarian practice: cases for reflection from Médecins Sans Frontières.

PubMed

Sheather, Julian; Shah, Tejshri

2011-03-01

Médecins Sans Frontières (MSF) is an independent medical humanitarian organisation working in over 70 countries. It has provided medical assistance for over 35 years to populations vulnerable through conflict, disease and inadequate health systems. Medical ethics define the starting point of the relationship between medical staff and patients. The ethics of humanitarian interventions and of research in conflict settings are much debated. However, less is known about the ethical dilemmas faced by medical humanitarian staff in their daily work. Ethical dilemmas can be intensified in humanitarian contexts by insecure environments, lack of optimum care, language barriers, potentially heightened power discrepancies between care providers and patients, differing cultural values and perceptions of patients, communities and medical staff. Time constraints, stressful conditions and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas, as can frustration that such reflection does not necessarily provide instant solutions. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care. Ethical reflection has a central role in MSF, and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research. We illustrate and discuss some real ethical dilemmas facing MSF teams. Only by sharing and seeking guidance can MSF and similar actors make more thoughtful and appropriate decisions. Our aim in sharing these cases is to invite discussion and dialogue in the wider medical community working in crisis, conflict or with severe resource limitations.

[The perception of ethics from the point of view of medical students].

PubMed

García-Mangas, José Alberto; García-Vigil, José Luis; Lifshitz, Alberto

2016-01-01

The present study was conducted to characterize the ethical environment in which medical students and internal are trained. The aim of this article is to identify the perception of ethics in medical students. The instrument was constructed by pairs: the socially desirable and socially undesirable exploring 10 principles and 24 ethical values. Through rounds of experts the instrument was validated with 35 pairs with 70 statements. The internal consistency of the instrument with the coefficient of determination "r2" reached a "p" value of < 0.025. In the overall analysis to compare means, students gave higher scores than interns with "p" value of < 0.002. A comparison of the principal differences was found in seven of the ten principles explored and in three (freedom, honesty and solidarity) no differences were noted in the rate of perception of the ethics (RPE). The were statistically significant differences between groups with a "p" value of < 0.04 in which students perceive higher scores with interns. We conclude that learning environments are not prone to ethical reflection and changes depending on the degree in training in medical school, with a worse perception in greater degrees.

[Is personalism or utilitarianism an adequate foundation of medical ethics?].

PubMed

Biesaga, T

1998-01-01

The article rejects utilitarianism as a proper theory for medical ethics. Utilitarians lavishly use various slogans of effective action, development and better civilization. However, the principle of prosperity of humanity in the utilitarian interpretation makes the value of the human person subject to society. Social interest threatens the individual here because it defines his/her value of life. The drift towards maximalization of benefits and prosperity of humanity strikes the seriously ill, e.g. babies with brain damages, Down's syndrome, etc., people after accidents and with serious brain defects, the terminally ill. The principle of quality of life (lebensunwertes Leben) used by utylitarians allows them to argue, that euthanasia, abortion is in the interest of the patient. Some utilitarians openly admit that such ideas as "universal happiness", "prosperity", "benefit" are empty ideas, fictions to which one cannot attribute any contents. So utilitarianism, not defining its fundamental ideas, can easily change medical ethics in a theory of elimination of the uncomfortable people. Therefore, as a theory utilitarianism cannot serve as the basis for medical ethics.

Medical humanities: an aid to ethical discussions.

PubMed Central

Moore, A R

1977-01-01

'The ethical landscape', the title given to part of a course devised by Mr. Moore, is described in full in this paper. The whole course is a new adventure in medical education designed to help students to explore the ethical problems in the practice of medicine. The 'ethical landscape' is seen through discussion based on passages from literature depicting doctors' and patients' dilemmas. As the results summarized in the tables show, the students found the course well worth while, and thought that they had gained a new insight into the problems with which they would be confronted and also into their own personalities and those of their fellow students whom previously they had only known superficially. The Chairman of the course, Mr. Moore, was also subjected to assessment from his students, because on the skill of the Chairman such a course would fail or succeed. PMID:870691

The Jewish contribution to medicine. Part III. The 19th and 20th centuries in the USA.

PubMed

Dubovsky, H

1989-08-05

The Jewish hospital movement in the USA, which started in the last century for Jews as foreign immigrants and was extended to the general population this century, is an extensive organisation. Refugee physicians from Europe laid the foundations of Jewish medical involvement in medicine in the USA with Abraham Jacobi, the founder of paediatrics, Landsteiner, who discovered blood grouping, and Waksman, who evolved streptomycin. Other eminent workers, such as the Flexner brothers in medical education and research, Libman, who pioneered blood culture in the USA, and Salk and Sabin with the poliomyelitis vaccine were prominent in the major contribution of Jews to medicine in the USA.

Ethical Considerations on Disclosure When Medical Error Is Discovered During Medicolegal Death Investigation.

PubMed

Wolf, Dwayne A; Drake, Stacy A; Snow, Francine K

2017-12-01

In the course of fulfilling their statutory role, physicians performing medicolegal investigations may recognize clinical colleagues' medical errors. If the error is found to have led directly to the patient's death (missed diagnosis or incorrect diagnosis, for example), then the forensic pathologist has a professional responsibility to include the information in the autopsy report and make sure that the family is appropriately informed. When the error is significant but did not lead directly to the patient's demise, ethical questions may arise regarding the obligations of the medical examiner to disclose the error to the clinicians or to the family. This case depicts the discovery of medical error likely unrelated to the cause of death and describes one possible ethical approach to disclosure derived from an ethical reasoning model addressing ethical principles of respect for persons/autonomy, beneficence, nonmaleficence, and justice.

Teaching Jewish History to the "Other."

ERIC Educational Resources Information Center

Goffman, Daniel

1991-01-01

Presents a course in Jewish history and culture for non-Jewish students. Stresses the importance of understanding and respecting all cultures, eliminating cultural stereotypes, and preventing polarization and xenophobia. Includes a weekly course syllabus and bibliography. Discusses the importance of countering stereotypes before presenting some…

Nurses' perception of ethical climate at a large academic medical center.

PubMed

Lemmenes, Donna; Valentine, Pamela; Gwizdalski, Patricia; Vincent, Catherine; Liao, Chuanhong

2016-09-07

Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses' job satisfaction, organizational commitment, retention, and physician collaboration. At a metropolitan academic medical center, we examined nurses' perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics. We used a descriptive correlational design and nurses (N = 475) completed Olson's Hospital Ethical Climate Survey. Data were analyzed using STATA. Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants' rights were protected. Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses' age, race, and specialty area. These findings contribute to what is known about ethical climate and nurses' characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings. © The Author(s) 2016.

Influence of Course in Medical Ethics and Law on Career Plans of Medical Students

ERIC Educational Resources Information Center

Cheng, Shi-Yann; Lin, Lih-Hwa; Kao, Chung-Han; Chan, Tzu-Min

2015-01-01

Background: The significant increase in medical disputes and lawsuits in recent years in Taiwan has severely affected behavior and ecology in medical practice. For this reason, we designed integrated courses on ethics and law and conducted a questionnaire-based career plan study to understand whether these issues influence their specialty…

A Medical Ethics Assessment of the Case of Terri Schiavo

ERIC Educational Resources Information Center

Preston, Tom; Kelly, Michael

2006-01-01

The social, legal, and political discussion about the decision to stop feeding and hydration for Terri Schiavo lacked a medical ethics assessment. The authors used the principles of medical indications, quality of life, patient preference, and contextual features as a guide to medical decision-making in this case. Their conclusions include the…

Obstructive Sleep Apnea: Comparison of Syndrome Severity and Risk Factors for Adult Jewish and Arab Males in Northern Israel.

PubMed

Carel, Rafael S; Brodsky, Inna; Pillar, Giora

2015-08-01

Background: Obstructive sleep apnea (OSA) is a common health problem with an estimated prevalence of 4% among men, many of whom are undiagnosed and untreated. To compare demographic characteristics, health profiles, risk factors, and disease severity in Arab and Jewish men with OSA syndrome. In this cross-sectional study we retrospectively analyzed clinical data from the medical files of men ≥ 22 years old who were referred to the Rambam Medical Center sleep clinic during the period 2001-2009 with a suspected diagnosis of OSA. OSA severity was measured using the apnea-hypopnea index (AHI). Categorical variables were compared using the chi-square test. Relations between OSA severity and a set of independent risk factors were assessed by linear regression analysis. A total of 207 men were included (39 Arabs, 19%; 168 Jews, 81%). Arab participants were younger than their Jewish counterparts (45.5 ± 8.9 years vs. 49.8 ± 11.8, P = 0.04) and their body mass index (BMI) was higher (3.1 ± 5.1 vs. 30.0 ± 4.4, P = 0.001). OSA severity (AHI score) was higher among Arab men, with low, medium and high severity scores seen in 10%, 33% and 56% of Arab men vs. 35%, 29% and 37% of Jewish men, respectively [T(198) = 2.39, P = 0.02]. Mean blood oxygen saturation was comparable. Arab men presenting for evaluation of sleep apnea harbored more severe OSA symptoms, were younger, and had higher BMI compared to Jewish men. Since OSA syndrome evolves for several years until it becomes severe, these findings suggest that Arab men seek medical assistance later than Jewish men with OSA.

How philosophy of medicine has changed medical ethics.

PubMed

Veatch, Robert M

2006-12-01

The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, epistemology, and political philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring--stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy.

Flexner's ethical oversight reprised? Contemporary medical education and the health impacts of corporate globalisation.

PubMed

Faunce, Thomas A; Gatenby, Paul

2005-10-01

Abraham Flexner's famous reports of 1910 and 1912, Medical Education in the United States and Canada and Medical Education in Europe, were written to assist the development of a positive response in university curricula to a revolution in understanding about the scientific foundations of clinical medicine. Flexner pointed out many deficiencies in medical education that retain contemporary resonance. Generally underemphasised in Flexner's reports, however, were recommendations promoting a firm understanding of and commitment to medical ethics as a basis of medical professionalism. Indeed, Flexner's praise for the scholastic basic of German medical education appeared somewhat ironic when the ethical inadequacies of prominent Nazi doctors were revealed at the Nuremberg Trials. This article suggests that contemporary medical educators, like Flexner, may be at risk of inadequately addressing a major challenge to evolving medical professionalism. Medical ethics, health law and even the international right to health are now increasingly emphasised in medical curricula. The same cannot be said, however, of lobbying principles arising from the structures of corporate globalisation, although these are rapidly becoming an even more dominant force in shaping medical practice around the globe. Conclusion Today it is the normative tension between medical ethics, health law and international human rights on the one hand and the lobbying principles and strategies of corporate globalisation that must urgently become the focus of major recommendations for reshaping the teaching of medical professionalism. Suggestions are made as to how this might practically be achieved.

Jewish College Women: Future Leaders of the Jewish Community?

ERIC Educational Resources Information Center

Lavender, Abraham D.

1977-01-01

It is concluded from this data that the American Jewish community deprives itself of many needed talents to the extent that it does not encourage participation in its leadership positions of all individuals, regardless of sex. (Author/AM)

A New Approach to Jewish Divorce.

ERIC Educational Resources Information Center

Eisenstein, Ira

1983-01-01

Describes recent changes in the traditional Jewish law of divorce, which permits a husband to divorce his wife but does not sanction the wife's divorcing him. The rabbis of the Reconstructionist Movement in Judaism have innovated an egalitarian divorce to prevent Jewish women from becoming abandoned wives. (JAC)

[Limitation of medical treatment and ethics in chronic recurrent Clivus chordoma].

PubMed

Egger, Alexandra; Müller-Busch, H Christof

2008-01-01

In this paper ethical questions concerning the limitation and termination of medical treatment of comatose patients will be discussed on the basis of a case study. The team is confronted with extremely high communicative and ethical demands, since every person engaged in the treatment and care of the patient should take part in this decision making process. The final responsibility regarding the medical decisions, however, lies with the doctor in charge. In such cases advance directives or living wills are important and should be taken into consideration.

Remembering More Jewish Physicians

PubMed Central

Weisz, George M.; Grzybowski, Andrzej

2016-01-01

The history of medicine has been an intriguing topic for both authors. The modern relevance of past discoveries led both authors to take a closer look at the lives and contributions of persecuted physicians. The Jewish physicians who died in the Holocaust stand out as a stark example of those who merit being remembered. Many made important contributions to medicine which remain relevant to this day. Hence, this paper reviews the lives and important contributions of two persecuted Jewish physicians: Arthur Kessler (1903–2000) and Bronislawa Fejgin (1883–1943). PMID:27487308

Appealing to the crowd: ethical justifications in Canadian medical crowdfunding campaigns

PubMed Central

Snyder, Jeremy; Crooks, Valorie A; Mathers, Annalise; Chow-White, Peter

2017-01-01

Medical crowdfunding is growing in terms of the number of active campaigns, amount of funding raised and public visibility. Little is known about how campaigners appeal to potential donors outside of anecdotal evidence collected in news reports on specific medical crowdfunding campaigns. This paper offers a first step towards addressing this knowledge gap by examining medical crowdfunding campaigns for Canadian recipients. Using 80 medical crowdfunding campaigns for Canadian recipients, we analyse how Canadians justify to others that they ought to contribute to funding their health needs. We find the justifications campaigners tend to fall into three themes: personal connections, depth of need and giving back. We further discuss how these appeals can understood in terms of ethical justifications for giving and how these justifications should be assessed in light of the academic literature on ethical concerns raised by medical crowdfunding. PMID:28137998

Bagels, Schnitzel and McDonald's--"Fuzzy Frontiers" of Jewish Identity in an English Jewish Secondary School

ERIC Educational Resources Information Center

Scholefield, Lynne

2004-01-01

Using data gathered during a case study of the "culture" of a Jewish secondary school, this article explores the indeterminate boundaries of Jewish identity. By examining the mechanisms that control what and who comes into the school, and what is approved and disapproved of in the school, a picture emerges of what and who is counted as…

Medical Students' Development of Ethical Judgment - Exploring the Learners' Perspectives using a mixed methods approach.

PubMed

Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W

2016-01-01

Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students' perspectives on their development in ethical judgment has received less attention. Better insights in the learners' experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient's parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant's preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants' responses changed overtime. Accepting parents' autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents' decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical training, the

Constructivism and Jewish Early Childhood Education

ERIC Educational Resources Information Center

Muller, Meir

2013-01-01

Having an educational theory as a school's foundation is a key component in successful educational endeavors. However, many Jewish early childhood programs do not commonly use educational theory to support methods of instruction. In this study 14 children from a constructivist-based Jewish kindergarten class are interviewed to determine how they…

Childbirth customs in Orthodox Jewish traditions.

PubMed Central

Bodo, K.; Gibson, N.

1999-01-01

OBJECTIVE: To describe cultural beliefs of Orthodox Jewish families regarding childbirth in order to help family physicians enhance the quality and sensitivity of their care. QUALITY OF EVIDENCE: These findings were based on a review of the literature searched in MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Science Abstracts (1984 to present). Interviews with several members of the Orthodox Jewish community in Edmonton, Alta, and Vancouver, BC, were conducted to determine the accuracy of the information presented and the relevance of the paper to the current state of health care delivery from the recipients' point of view. MAIN MESSAGE: Customs and practices surrounding childbirth in the Orthodox Jewish tradition differ in several practical respects from expectations and practices within the Canadian health care system. The information presented was deemed relevant and accurate by those interviewed, and the subject matter was considered to be important for improving communication between patients and physicians. Improved communication and recognition of these differences can improve the quality of health care provided to these patients. CONCLUSIONS: Misunderstandings rooted in different cultural views of childbirth and the events surrounding it can adversely affect health care provided to women in the Orthodox Jewish community in Canada. A basic understanding of the cultural foundations of potential misunderstandings will help Canadian physicians provide effective health care to Orthodox Jewish women. PMID:10099807

[Non-medical applications for brain MRI: Ethical considerations].

PubMed

Sarrazin, S; Fagot-Largeault, A; Leboyer, M; Houenou, J

2015-04-01

The recent neuroimaging techniques offer the possibility to better understand complex cognitive processes that are involved in mental disorders and thus have become cornerstone tools for research in psychiatry. The performances of functional magnetic resonance imaging are not limited to medical research and are used in non-medical fields. These recent applications represent new challenges for bioethics. In this article we aim at discussing the new ethical issues raised by the applications of the latest neuroimaging technologies to non-medical fields. We included a selection of peer-reviewed English medical articles after a search on NCBI Pubmed database and Google scholar from 2000 to 2013. We screened bibliographical tables for supplementary references. Websites of governmental French institutions implicated in ethical questions were also screened for governmental reports. Findings of brain areas supporting emotional responses and regulation have been used for marketing research, also called neuromarketing. The discovery of different brain activation patterns in antisocial disorder has led to changes in forensic psychiatry with the use of imaging techniques with unproven validity. Automated classification algorithms and multivariate statistical analyses of brain images have been applied to brain-reading techniques, aiming at predicting unconscious neural processes in humans. We finally report the current position of the French legislation recently revised and discuss the technical limits of such techniques. In the near future, brain imaging could find clinical applications in psychiatry as diagnostic or predictive tools. However, the latest advances in brain imaging are also used in non-scientific fields raising key ethical questions. Involvement of neuroscientists, psychiatrists, physicians but also of citizens in neuroethics discussions is crucial to challenge the risk of unregulated uses of brain imaging. Copyright © 2014 L’Encéphale, Paris. Published by

The Terri Schiavo case: legal, ethical, and medical perspectives.

PubMed

Perry, Joshua E; Churchill, Larry R; Kirshner, Howard S

2005-11-15

Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care. First, the authors review the current medical understanding of persistent vegetative state, including the requirements for patient examination, the differential diagnosis, and the practice guidelines of the American Academy of Neurology regarding artificial nutrition and hydration for patients with this diagnosis. Second, they examine the legal history, including the 2000 trial, the 2002 evidentiary hearing, and the subsequent appeals. The authors argue that the law did not fail Terri Schiavo, but produced the highest-quality evidence and provided the most judicial review of any end-of-life guardianship case in U.S. history. Third, they review alternative ethical frameworks for understanding the Terri Schiavo case and contend that the principle of respect for autonomy is paramount in this case and in similar cases. Far from being unusual, the manner in which Terri Schiavo's case was reviewed and the basis for the decision reflect a broad medical, legal, and ethical consensus. Greater clarity regarding the persistent vegetative state, less apprehension of the presumed mysteries of legal proceedings, and greater appreciation of the ethical principles at work are the chief benefits obtained from studying this provocative case.

Methodological and Ethical Issues in Pediatric Medication Safety Research.

PubMed

Carpenter, Delesha; Gonzalez, Daniel; Retsch-Bogart, George; Sleath, Betsy; Wilfond, Benjamin

2017-09-01

In May 2016, the Eshelman School of Pharmacy at The University of North Carolina at Chapel Hill convened the PharmSci conference to address the topic of "methodological and ethical issues in pediatric medication safety research." A multidisciplinary group of experts representing a diverse array of perspectives, including those of the US Food and Drug Administration, children's hospitals, and academia, identified important considerations for pediatric medication safety research and opportunities to advance the field. This executive summary describes current challenges that clinicians and researchers encounter related to pediatric medication safety research and identifies innovative and ethically sound methodologies to address these challenges to improve children's health. This article addresses 5 areas: (1) pediatric drug development and drug trials; (2) conducting comparative effectiveness research in pediatric populations; (3) child and parent engagement on study teams; (4) improving communication with children and parents; and (5) assessing child-reported outcomes and adverse drug events. Copyright © 2017 by the American Academy of Pediatrics.

'We are (not) the master of our body': elderly Jewish women's attitudes towards euthanasia and assisted suicide.

PubMed

Baeke, Goedele; Wils, Jean-Pierre; Broeckaert, Bert

2011-06-01

In Belgium, dominant ideological traditions--Christianity and non-religious humanism--have the floor in debates on euthanasia and hardly any attention is paid to the practices and attitudes of ethnic and religious minorities, for instance, Jews. This article aims to meet this lacuna. Qualitative empirical research was performed in the Orthodox Jewish community of Antwerp (Belgium) with a purposive sample of elderly Jewish (non-)Hasidic and secularised Orthodox women. In-depth interviews were conducted to elicit their attitudes towards (non-)voluntary euthanasia and assisted suicide. The research reveals diverse views among women in the community on intentionally terminating a patient's life. Absolute rejection of every act which deliberately terminates life is found among the overwhelming majority of (religiously observant) Orthodox (Hasidic and non-Hasidic) women, as they have an unconditional faith and trust in God's sovereign power over the domain of life and death. On the other hand, the views of secularised Orthodox women--mostly irreligious women, who do not consider themselves Orthodox, thus not following Jewish law, yet say they belong to the Orthodox Jewish community--show an acceptance of voluntary euthanasia and assisted suicide but non-voluntary euthanasia is approached more negatively. As they perceive illness and death as merely profane facts, they stress a patient's absolute right towards self-determination, in particular with regard to one's end of life. Among non-Hasidic Orthodox respondents, more openness is found for cultivating a personal opinion which deviates from Jewish law and for the right of self-determination with regard to questions concerning life and death. In this study, these participants occupy an intermediate position. Our study reveals an interplay between ethical attitudes on euthanasia and religious convictions. The image one has of a transcendental reality, or of God, has a stronger effect on one's (dis)approval of euthanasia

Ethics in medical information and advertising.

PubMed

Serour, G I; Dickens, B M

2004-05-01

This article presents findings and recommendations of an international conference held in Cairo, Egypt in 2003 concerning issues of ethical practice in how information is provided to and by medical practitioners. Professional advertising to practitioners and the public is necessary, but should exclude misrepresentation of qualifications, resources, and authorship of research papers. Medical institutions are responsible for how staff members present themselves, and their institutions. Medical associations, both governmental licensing authorities and voluntary societies, have powers and responsibilities to monitor professional advertisement to defend the public interest against deception. Medical journals bear duties to ensure authenticity of authorship and integrity in published papers, and the scientific basis of commercial advertisers' claims. A mounting concern is authors' conflict of interest. Mass newsmedia must ensure accuracy and proportionality in reporting scientific developments, and product manufacturers must observe truth in advertising, particularly in Direct-to-Consumer advertising. Consumer protection by government agencies is a continuing responsibility.

Jewishly-Informed Mature Adult Service-Learning

ERIC Educational Resources Information Center

Bretan, Gail Helene

2013-01-01

The purpose of this study is to describe, implement, and interpret the intersection of service-learning, Jewish values and ways of knowing, adult education, and lifelong learning for people over the age of 50. By expanding service-learning to include both older adults and Jewish ways of knowing, there is potential for transforming these frameworks…

An eight-year follow-up national study of medical school and general hospital ethics committees in Japan

PubMed Central

Akabayashi, Akira; Slingsby, Brian T; Nagao, Noriko; Kai, Ichiro; Sato, Hajime

2007-01-01

Background Ethics committees and their system of research protocol peer-review are currently used worldwide. To ensure an international standard for research ethics and safety, however, data is needed on the quality and function of each nation's ethics committees. The purpose of this study was to describe the characteristics and developments of ethics committees established at medical schools and general hospitals in Japan. Methods This study consisted of four national surveys sent twice over a period of eight years to two separate samples. The first target was the ethics committees of all 80 medical schools and the second target was all general hospitals with over 300 beds in Japan (n = 1457 in 1996 and n = 1491 in 2002). Instruments contained four sections: (1) committee structure, (2) frequency of annual meetings, (3) committee function, and (4) existence of a set of guidelines for the refusal of blood transfusion by Jehovah's Witnesses. Results Committee structure was overall interdisciplinary. Frequency of annual meetings increased significantly for both medical school and hospital ethics committees over the eight years. The primary activities for medical school and hospital ethics committees were research protocol reviews and policy making. Results also showed a significant increase in the use of ethical guidelines, particularly those related to the refusal of blood transfusion by Jehovah's Witnesses, among both medical school and hospital ethics committees. Conclusion Overall findings indicated a greater recognized degree of responsibilities and an increase in workload for Japanese ethics committees. PMID:17598923

What future for ethical medical practice in the new National Health Service?

PubMed Central

Persaud, R D

1991-01-01

The British Government is implementing some major alterations to the way health services in Great Britain are organised. As well as the introduction of competition between health care providers, their financial interests are to be linked to their output, in efforts to use market forces to increase efficiency and cut costs. This paper looks at the possible impact of these changes of health care organisation on ethical medical practice. This is investigated with particular reference to the country whose health service has embraced most closely these elements of the market--the United States of America. The question to be answered is whether high standards of ethical care are ensured by factors somehow intrinsic to the medical profession, and are therefore immune to changes in the economics of health care. This assumption is shown to be questionable in light of what is known about the determinants of ethical medical practice. PMID:2033624

Traditional Jewish Learning: Philosophy and Practice.

ERIC Educational Resources Information Center

Pollak, Susan

Education was so much a part of Jewish thought and way of life that it was often taken for granted, e.g., the early sages never wrote an articulated plan for education principles and practices. The introduction to this overview of traditional Jewish education discusses the basic concepts of belief in the efficacy of education, the integration of…

To clone or not to clone--a Jewish perspective.

PubMed Central

Lipschutz, J H

1999-01-01

Many new reproductive methods such as artificial insemination, in vitro fertilisation, freezing of human embryos, and surrogate motherhood were at first widely condemned but are now seen in Western society as not just ethically and morally acceptable, but beneficial in that they allow otherwise infertile couples to have children. The idea of human cloning was also quickly condemned but debate is now emerging. This article examines cloning from a Jewish perspective and finds evidence to support the view that there is nothing inherently wrong with the idea of human cloning. A hypothesis is also advanced suggesting that even if a body was cloned, the brain, which is the essence of humanity, would remain unique. This author suggests that the debate should be changed from "Is cloning wrong?" to "When is cloning wrong?". PMID:10226913

(ETHNO-)MEDICAL ETHICS IN GLOBALIZING CHINA: TRACING LOCAL KNOWLEDGE AND ADAPTATION OF BIOMEDICINE.

PubMed

Micollier, Evelyne

2015-12-01

Encounters between several bodies of therapeutic knowledge have led to a restructuring of the entire health system, including a transformation in medical ethics. Defining "new ethics" with both Chinese and international characteristics, is part of the ongoing knowledge production process: plural health ideas, practices and medical sciences develop within the broader framework of social and economic transition. Such transition simultaneously reveals and encourages China's influence and position in an era of globalization including in the technical and knowledge production domains. Re-alignments in medical ethics in Reform China (post-1979) highlight a rather under-explored aspect of medical plurality enabling these ethics to be used as an analytical lens to provide information about social and political issues. In this article, two sets of ethical principles, one from Late Imperial China (Late Ming Era), the other from post-Mao China (1980s), are detailed and analysed. They were selected as case-studies mainly because they reflected at the time of their emergence an on-going radical change in society in the realm of health and medicine. Therefore both sets unveil the process of legitimizing a "Chinese medicine" in a context of epistemological shift: such a process takes various conceptual and practicalforms framed along the lines of the current dominant ideological system and constrained by socio-economic and political factors. Finally, issues relative to research ethics, bioethics and the New Health Reform guidelines raised in the 2000s, which represents also a significant historical turn for China, are discussed. Drawn from the overall discussion throughout the text, several concluding remarks contribute to advocate for "win-win" encounters--from the East to the West and from the South to the South, and for more implementable transnational/global ethics designing.

[The organization of Jewish dentists in pre-Israel Palestine].

PubMed

Keren-Kratz, M

2016-04-01

The first modern dental institutes were established in Europe and in the USA during the 1840s. At that period there wasn't a single qualified doctor in Palestine, not to mention a professional dentist. A couple of decades later, as the number of Christian pilgrims grew, some modern hospitals were established and a few non-Jewish dentists opened their clinics in Jerusalem, which was then and in the following decades, the region's largest city. In Europe, dentistry became a popular profession among Jews in general and among Jewish women in particular. The first Jewish dentist settled in Jerusalem in the mid-1880s. Other dentists were slow to arrive and their number began to grow only after the turn of the 20th century. Their professional education varied from those who were trained as apprentices by other dentists to those which studied a couple of years in an academic dental school. The devastation caused by WWI prompted American-Zionist organizations to send a special medical unit to Palestine in 1918. Along medical supplies it also brought a small group of doctors and dentists. The two American dentists that decided to remain in Palestine took upon themselves to spread their medical and scientific knowledge. They also organized the dentists, whose number grew considerably during the 1920s, and called the authorities to regulate the dental profession. In 1926 the British authorities issued a decree regulating all medical professions. It demanded that dental practitioners will be licensed after proving their previous studies and professional knowledge. In 1931, local dentists' organizations decided to establish the Palestine Dental Association. Five years later it was accepted as a member by the International Dental Federation (FDI) and was recognized by the local authorities. Since the 1930s, prominent Jewish dentists from abroad were invited to come to Palestine to lecture, and local dentists participated in international conferences. This prompted the first

The globalization of education in medical ethics and humanities: evolving pedagogy at Weill Cornell Medical College in Qatar.

PubMed

del Pozo, Pablo Rodríguez; Fins, Joseph J

2005-02-01

The authors discuss their experience in implementing a Medical Ethics and Humanities course for premedical students at Weill Cornell Medical College in the Arabian Gulf emirate of Qatar. The course, first offered in 2003, is designed to prepare these students for the medical school curriculum to follow and to make global medical knowledge meaningful for their local context. Pedagogical challenges included the cross-cultural tensions that could emerge when introducing themes from Western medical ethics and humanities into this overwhelmingly Islamic context. The authors outline the response to this challenge and strategies to broaden student inquiry without engaging in indoctrination. This seminar-based course was designed around seven thematic areas of increasing biopsychosocial complexity, from nature and biology, to the patient, the physician, and the family, to broader questions of hospital care, the health care system, and the place of law in modern medicine. Readings from the literature of the Western and Arabic traditions were used, including selections by Hippocrates, Thomas, Kafka, Mahfouz, and Pellegrino. It is too early to know the ultimate impact of the course, but students demonstrated enthusiasm for ethics and the medical humanities and a willingness to consider new and novel ways of knowing. The authors anticipate that this grounding in the humanities will complement the students' work in the sciences and help further develop their nascent professional identities in an increasingly global medical community.

Feminist ethics and menopause: autonomy and decision-making in primary medical care.

PubMed

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Life and Medical Ethics in Pediatric Neurosurgery.

PubMed

Yamasaki, Mami

2017-02-15

Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child's condition accurately and evaluate the outcome. However, to treat or not to treat also depends on the medical resources and social-economic status of the community, the parents' religion and philosophy, the policies of the institutions involved, and the limits of medical science. Moral dilemmas will continue to be addressed as medical progress yields treatments for untreatable diseases in the future.

Teaching medical students to discern ethical problems in human clinical research studies.

PubMed

Roberts, Laura Weiss; Warner, Teddy D; Green Hammond, Katherine A; Brody, Janet L; Kaminsky, Alexis; Roberts, Brian B

2005-10-01

Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p < .02). Students in the criteria-focused group were better able than students in the control group (p < .03) to discern specific ethical problems, more closely resembling expert assessments. Unexpectedly, the group focused on clinical research participants identified fewer problems than did the control group (p < .05). The criteria-focused intervention produced enhanced ethical evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

The robustness of medical professional ethics when times are changing: a comparative study of general practitioner ethics and surgery ethics in The Netherlands.

PubMed

Dwarswaard, J; Hilhorst, M; Trappenburg, M

2009-10-01

Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance.

Knowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria Hospitals, Egypt.

PubMed

Mohamed, A M; Ghanem, M A; Kassem, A

2012-09-01

This cross-sectional study was conducted to assess the knowledge, perceptions and practices towards medical ethics of physician residents at university hospitals in Alexandria, Egypt. A self-administered structured questionnaire was used for knowledge and perceptions and a checklist for observations of doctor-patient interactions in the outpatient setting. Only 18.0% ofthe 128 participating residents had obtained their knowledge from their medical education and 29.9% were dissatisfied with the roles played by the ethics committee. Most of the residents had satisfactory knowledge and 60.2% had satisfactory perceptions regarding ethical issues. The lowest perception score was in the domain of disclosing medical errors. Only 48.0% of the residents were compliant with the principles of medical ethics in practice and 52.0% of patients were dissatisfied with their treating physicians. The study identified areas of unsatisfactory knowledge and practices towards ethical issues so as to devise means to sensitize residents to these issues and train them appropriately.

Teachers' Study Guide: Jewish Legends. The Image of the Jew in Literature.

ERIC Educational Resources Information Center

Mersand, Joseph; Wiesel, Elie

The Jewish legends which are a major part of Jewish life and literature are the focus of this study guide for teachers. Excerpts from a lecture on Jewish legends are followed by suggestions for classroom activities, discussion topics related to the study of Jewish legends, and a bibliography for both teachers and students on Jewish legend and…

Attitudes of rehabilitation medicine doctors toward medical ethics in Malaysia.

PubMed

Mazlina, M; Julia, P E

2011-06-01

Medical ethics issues encountered in rehabilitation medicine differ from those in an acute care setting due to the complex relationships among the parties involved in rehabilitative care. The study examined the attitudes of Malaysian rehabilitation doctors toward medical ethics issues commonly encountered during patient care. We surveyed 74 rehabilitation physicians and residents in Malaysia using a self-administered descriptive questionnaire. The questions covered medical ethics issues on allocation of resources, patient confidentiality, discharge planning, goal-setting, reimbursement documentation, decision-making capacity and withdrawal of life support. The overall response rate was 69 percent. More than 80 percent of respondents would disclose confidential information to their team members if it would affect the rehabilitation process. More than two-thirds of respondents would not allocate scarce rehabilitation resources if the functional outcome is marginally positive. Issues involving patients' autonomy in decision-making, both in life-threatening and non-life-threatening situations, showed mix responses. The least common response was on the issue of discharge planning, where 51 percent of respondents would send a patient back to a nursing home with suboptimal care if there were no other alternatives. The attitude of Malaysian rehabilitation doctors toward ethical issues is reflective of the level of maturity of rehabilitation medicine in Malaysia. Issues on allocation of resources, discharge planning and decision-making capacity are significantly influenced by limited rehabilitation facilities in parts of the country. The lack of influence from external factors, such as a developed health insurance system, contributes to the difference in attitude between rehabilitation doctors in Malaysia and those in developed countries.

The professional medical ethics model of decision making under conditions of clinical uncertainty.

PubMed

McCullough, Laurence B

2013-02-01

The professional medical ethics model of decision making may be applied to decisions clinicians and patients make under the conditions of clinical uncertainty that exist when evidence is low or very low. This model uses the ethical concepts of medicine as a profession, the professional virtues of integrity and candor and the patient's virtue of prudence, the moral management of medical uncertainty, and trial of intervention. These features combine to justifiably constrain clinicians' and patients' autonomy with the goal of preventing nondeliberative decisions of patients and clinicians. To prevent biased recommendations by the clinician that promote such nondeliberative decisions, medically reasonable alternatives supported by low or very low evidence should be offered but not recommended. The professional medical ethics model of decision making aims to improve the quality of decisions by reducing the unacceptable variation that can result from nondeliberative decision making by patients and clinicians when evidence is low or very low.

Reform in medical ethics curriculum: a step by step approach based on available resources

PubMed Central

Asghari, Fariba; Mirzazadeh, Azim; Samadi, Aniseh; Safa, Aliakbar Nejati; Jafarian, Ali; Farahani, Ali Vasheghani; Razavi, Seyed Hasan Emami

2011-01-01

In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students’ ethical awareness and enable them to make ethical decisions. Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden’s ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006–2007 academic year for the first time. The student feedback indicated that the new curriculum was successful in increasing the students’ awareness of ethical issues and enabled them to understand and accept their professional obligations. Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it. PMID:23908750

Ethics of emergent information and communication technology applications in humanitarian medical assistance.

PubMed

Hunt, Matthew; Pringle, John; Christen, Markus; Eckenwiler, Lisa; Schwartz, Lisa; Davé, Anushree

2016-07-01

New applications of information and communication technology (ICT) are shaping the way we understand and provide humanitarian medical assistance in situations of disaster, disease outbreak or conflict. Each new crisis appears to be accompanied by advancements in humanitarian technology, leading to significant improvements in the humanitarian aid sector. However, ICTs raise ethical questions that warrant attention. Focusing on the context of humanitarian medical assistance, we review key domains of ICT innovation. We then discuss ethical challenges and uncertainties associated with the development and application of new ICTs in humanitarian medical assistance, including avoiding harm, ensuring privacy and security, responding to inequalities, demonstrating respect, protecting relationships, and addressing expectations. In doing so, we emphasize the centrality of ethics in humanitarian ICT design, application and evaluation. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Medical Students’ Development of Ethical Judgment – Exploring the Learners’ Perspectives using a mixed methods approach

PubMed Central

Langer, Thorsten; Jazmati, Danny; Jung, Ole; Schulz, Christian; Schnell, Martin W.

2016-01-01

Objective: Contemporary healthcare requires physicians to have well developed ethical judgment skills in addition to excellent clinical skills. However, no consensus has been reached on how to best teach ethical judgment skills during medical training. Previous studies revealed inconclusive results and applied varying theoretical frameworks. To date, the students’ perspectives on their development in ethical judgment has received less attention. Better insights in the learners’ experiences can help to improve educational interventions in medical ethics. Methods: A vignette featuring a challenging case with opposing views between a patient’s parents and a physician followed by a questionnaire was presented to a cohort of medical students at a German medical school at three points in time during their medical training (Year 1, 2 and 5). The questionnaire included closed and open-ended questions addressing the participant’s preferred, hypothetical actions, their reasoning as well as the resources informing their reasoning. Content analysis was used for qualitative data; frequencies and percentages were used to describe quantitative findings. Results: The response rate remained stable (28%) over the study period. Participants’ responses changed overtime. Accepting parents’ autonomy in the decision-making process was the majority standpoint of students in year 1 and 2 and became less often cited in year 5 (Year 1/2/5: 68/67/48%). On the contrary, not readily following the parents’ decision for medical reasons was a minority standpoint in year 1 and became more prevalent over time (year 1/2/5: 12/17/42%). Judgments were only partly based on ethics training. Instead, participants drew on experiences from their clinical clerkships and their personal lives. Throughout the study, participants did not feel well-prepared to make a judgment in the case (Average 2.7 on a Likert-Scale; 1=very well prepared, 4=very poor). Conclusions: Over the course of their medical

Professional Decisions and Ethical Values in Medical and Law Students.

ERIC Educational Resources Information Center

Rezler, Agnes G.; And Others

1990-01-01

This project evaluated and compared the values used by medical and law students when dealing with ethical dilemmas in the practice of law and medicine. The Professional Decisions and Values Test was given to 77 medical students and 92 law students. Differences were noted on beneficence, professional responsibility, and harm avoidance. (MLW)

The ethical physician encounters international medical travel.

PubMed

Crozier, G K D; Baylis, Françoise

2010-05-01

International medical travel occurs when patients cross national borders to purchase medical goods and services. On occasion, physicians in home countries will be the last point of domestic contact for patients seeking healthcare information before they travel abroad for care. When this is the case, physicians have a unique opportunity to inform patients about their options and help guide them towards ethical practices. This opportunity brings to the fore an important question: What role should physicians in more-developed home countries play in promoting or constraining international medical travel towards less-developed destination countries? In our view, critical attention to the decision spaces of patients-defined by the personal circumstances, socio-cultural cues, and legal constraints that inform decision-making-is a useful starting point for evaluating the proper response of physicians to various forms of international medical travel.

Ethical issues in advertising and promotion of medical units.

PubMed

Solomon, Maria; Radu, Gabriel; Hostiuc, Marinela; Margan, M Madalin; Bulescu, I Alexandru; Purcarea, Victor Lorin

2016-01-01

Bioethics tries to define the medical activity and any other related activity needed to maintain the function of a health institution, through the development of principles and moral values. Bioethics is quite broad and has a background that combines various disciplines such as medicine, philosophy, law, sociology, and theology. Advertising and promotion are part of the strategy aimed at developing and maintaining relationships with the targeted audience (patients). To regulate this activity, it was necessary to develop ethical rules of healthcare marketing. The content of promotional messages must be truthful and should not create unjustified expectations. The doctor or the healthcare unit must be able to provide the services claimed in the advertisement. From an ethical point of view, marketing communication should be more consistent with reality, even if its purpose is to shed light on more attractive issues. In this context, the categories and groups vulnerable to certain content of the advertising message should be mentioned. A patient with a serious suffering will be easily influenced and will tend to trust any promise easily, with the desire to heal. Ethically, the information presented must not alter the reality and should not give false hopes to patients. Those responsible for marketing in the healthcare field must keep in mind the ethics code of the medical profession, must maintain an honest marketing communication, which does not create inaccurate expectations, must not denigrate other colleagues, and must use a message whose content should respect the dignity of the profession.

Medical and professional ethics in sixteenth-century Istanbul: towards an understanding of the relationships between the Ottoman State and the medical guilds.

PubMed

Shefer, Miri

2002-01-01

This paper contributes to the understanding of Ottoman medical guilds, their relationship with the government, and the role played by medical ethics in this framework. Decrees by the sultans (sing. fermăn), issued in the Ottoman Imperial Council (Divăn) in Istanbul during the sixteenth century, concern themselves also with medical and ethical issues. The sheer number of these decrees may give the erroneous impression that the quality of medicine in the Ottoman Empire was low. This paper argues, however, that many of the complaints brought before the Ottoman authorities were instigated by medical guilds' members against their colleagues and competitors, not by aggravated patients demanding compensation from negligent healers. The discourse of medical ethics was raised in these cases not for its own sake, rather it embodied efforts by medical guild members to defend their economic interests and their intellectual and social status in the brutal competition in the medical realm.

Experiential Jewish Education Has Arrived! Now What?

ERIC Educational Resources Information Center

Kress, Jeffrey S.

2014-01-01

Experiential Jewish education has been experiencing a time of growth, during which theory development, research, and practice have established a strong voice for the construct. Much of the focus to this point has been on definitions (particularly the distinction between "experiential" and "informal" Jewish education) and on…

Quality of publication ethics in the instructions to the authors of Iranian journals of medical sciences.

PubMed

Salamat, Fatemeh; Sobhani, Abdol-Rasoul; Mallaei, Mahin

2013-03-01

Providing a perfect instruction to authors can prevent most potential publication ethics errors. This study was conducted to determine the quality of ethical considerations in the instructions to the authors of Iranian research scientific journals of medical sciences (accredited by the Commission for Accreditation and Improvement of Iranian Medical Journals) in October 2011. Checklist items (n=15) were extracted from the national manual of ethics in medical research publications, and the validity of the manual of ethics was assessed. All the accredited Iranian journals of medical sciences (n=198) were entered into the study. The instructions to the authors of 160 accredited Iranian journals were available online and were reviewed. The ANOVA and Kendall Correlation coefficient were performed to analyze the results. A total of 76 (47.5%) of the 160 journals were in English and 84 (52.5%) were in Farsi. The most frequently mentioned items related to publication ethics comprised "commitment not to send manuscripts to other journals and re-publish manuscripts" (85%, 83.8%), "aim and scope" of the journal (81.9%), "principles of medical ethics in the use of human samples" (74.4%), and "review process" (74.4%). On the other hand, the items of "principles of advertising" (1.2%), "authorship criteria" (15%), and "integrity in publication of clinical trial results" (30.6%) were the least frequently mentioned ones. Based on the study findings, the quality of publication ethics, as instructed to the authors, can improve the quality of the journals.

Ethical aspects of medical age assessment in the asylum process: a Swedish perspective.

PubMed

Malmqvist, Erik; Furberg, Elisabeth; Sandman, Lars

2018-05-01

According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analysed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.

Medical ethics and Islam: principles and practice

PubMed Central

Gatrad, A; Sheikh, A

2001-01-01

A minimum level of cultural awareness is a necessary prerequisite for the delivery of care that is culturally sensitive. In this paper we simplify and highlight certain key teachings in Islamic medical ethics and explore their applications. We hope that the insights gained will aid clinicians to better understand their Muslim patients and deliver care that pays due respect to their beliefs.

 PMID:11124793

Informing the patient about a fatal disease: from paternalism to autonomy--the Jewish view.