Teaching medical ethics for undergraduate medical students

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  • - principles meant to guide action for all in similar circumstances—e.g., principle of respect for autonomy directs us to act in ways that honour the free and informed decisions and actions of others
  • على عكس ما يتوقعه الكثيرون من أن الدنيا شرق وغرب فإن لكل مجتمع في الدنيا منظومته القيمية التي يضبط عليها سلوك المنتكين إليه سواء على مستوى القبيلة أو الإقليم أو القطر أو الدين أو غير ذلك مما قد يجمع مجموعة من البشر في منظومة قِيمية مشتركة.
  • Column 2 (Deeds are by intentions) – Box 1: please insert a comma after “intentions.”
    Column 3 (Difficulty calls forth ease) – Box 4: please change other’s to others’.
    Column 4 (Injury should be relieved) – Box 3: If possible, this box should be made a little bigger so that its text can be read more easily. Box 5: Please omit the semicolon after “evils.”
    Column 5 (Customs are recognized) – Box 1: Please insert a comma after “ones.”
  • Teaching medical ethics for undergraduate medical students

    1. 1. TEACHING MEDICAL ETHICS FOR UNDERGRADUATE MEDICAL STUDENTS (BY NON-SPECIALIZED STAFF) AHFAD UNIVERSITY FOR WOMEN (14 FEBRUARY 2015) Ghaiath M. A. Hussein Doctoral Researcher, university of Birmingham, Former Assistant Professor, Faculty of Medicine King Fahad Medical City, King Saud Bin Abdulaziz University for Health Sciences Email: ghaiathme@gmail.com
    2. 2. Outline of the Workshop • Morality, Ethics, bioethics & Professionalism • Teaching Bioethics & Professionalism (Why? What? When?) Part 1: Concepts & Misconcepts • How to teach E&P? • How to evaluate? • Challenges in teaching & evaluation • Summary and conclusion Part2: Teaching & Evaluation
    3. 3. This workshop is… is NOT…  Is aiming to:  Introduce the main concepts related to terminology and taxonomy of ethics;  Discuss the need to teach ethics, what to teach; and  Provide practical hints on how to deliver ethics topics  Is NOT a workshop on:  Medical ethics  Professionalism  Medical education  Islamic jurisprudence (Fiqh) ethics  Is NOT a ‘ready-to-use’ prescription
    4. 4. Before we start… Let’s Reflect… Which one would you drink?
    5. 5. Less Embarrassing Choices  I have to meet the deadline of this important assignment… how about some ‘copy & paste’ from Google?  I need to pass the exam.. Shall I ‘collaborate’ with the colleague next to me?  I need the organs of this dying patient... Pull the plug?  I need the money of this Pharmaceutical company. Shall I ‘tweak’ the results of my research on their drug?  I need to be trained ...tell the patient you’re a ‘doctor’?
    6. 6. What do you think? Courtesy of Dengue Fever Control Program, Jeddah, KSA (2006)
    7. 7. Levels of moral response The expressive level • unanalyzed expressions or feelings that, • by themselves, don’t provide reasons or justification) The pre- reflective level • justification via law, religious tenets, social values, codes of ethics, etc.; • accepted uncritically The reflective level • reasoned ethical argument • defense based on ethical principles, rules, virtues, values to which we consciously subscribe; • justification provided Thomas J and Waluchow W, 1998
    8. 8. Ethical/Moral reasoning  It is the process we need to go through to reach a decision about an ethical issue.  It helps us to differentiate: description of the way the world is; an actual state of affairs (“is”) judgment about the way things should be (“ought”). they are meant to guide actions. Key values in bioethics have corresponding (e.g., principle of respect for autonomy)
    9. 9. Don’t judge things on what they first appear to you! There is always a reason why people do things?
    10. 10. What is ethics? What are the branches of ethics? What is bioethics? What is medical/clinical ethics? What is an ethical issue? How do people resolve ethical issues? What is professionalism? What are the professional commitments of the medical doctor/student? Key definitions and concepts
    11. 11. What is ethics?  A system of moral principles or standards governing conduct.  a system of principles by which human actions and proposals may be judged good or bad, right or wrong;  A set of rules or a standard governing the conduct of a particular class of human action or profession;  Any set of moral principles or values recognized by a particular religion, belief or philosophy;  The principles of right conduct of an individual. (UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4)
    12. 12. Ethics Bioethics Clinical ethics Research ethics Resource allocation ethics Public health ethics Nursing ethics Other Business ethics Environmental ethics Social ethics Organizational ethics IT ethics Other
    13. 13. What is bioethics?  It is derived from Greek bio- life and ethics moral.  The science/art that aims at identification, analysis, and resolution of the ethical issues in almost any field that is related to human life and health. What is clinical/medical ethics?  It is that branch of bioethics that is related to the identification, analysis, and resolution of moral problems that arise in the healthcare of individual patients.
    14. 14. Questions answered by Bioethics deciding what we should do (what decisions are morally right or acceptable);  Example: Should patient A or B have the ICU bed? explaining why we should do it (how do we justify our decision in moral terms); and  Why did we decide to admit A & not B? describing how we should do it (the method or manner of our response when we act on our decision).  What are we going to do for patient B?
    15. 15. Main Western Philosophies Abrahamic religions Oriental philosophies Utilitarianism (act & rule) Islamic Buddhist Deontology Jewish Confucius Feminist ethics Catholic Indian Casuistry Virtue ethics Protestant Persian Principlism Jehovah Witnesses Social-contract Christian Ethics
    16. 16. Deontology & Rights-based ethics  Deontology :  It is duty-based; people should act so as to fulfill their duties to others; acts should always follow a set of maxims (e.g. do not lie); and less concerned with the act’s consequences.  Rights-based ethics:  involves a larger number of principles and is addressed more to the actions of institutions and governments, e.g. Universal Declaration on Bioethics and Human Rights, (UNESCO) in October 2005. It provides more binding legal rights Immanuel Kant
    17. 17. Consequentialism (utilitarianism)  Consequentialism (utilitarianism) the right action is that which produces the greatest sum of pleasure to the greater number, • Act utilitarianism: a person should act in the way that produces the best outcome; • Rule utilitarianism: looks at the consequences of general rules instead of the consequences of individual acts
    18. 18. Feminist ethics and Casuistry  Feminist ethics: (Ethics of Care) commitment to correcting male biases (e.g. women’s subordination is morally wrong) and that the moral experience of women is as worthy of respect as that of men.  Casuistry: The greatest confidence in our moral judgments resides not at the level of theory, where we endlessly disagree, but rather at the level of the case, where our intuitions often converge without the benefit of theory.
    19. 19. Virtue ethics  It emphasizes the virtues, or moral character (not duties or consequences)  Someone in need should be helped. Agree?
    20. 20. “Contractarianism”: Social Contract Theory Agreement (or consent) of all individuals subject to collectively enforced social arrangements shows that those arrangements have some normative property (e.g. legitimate, just, obligating, etc.). (http://plato.stanford.edu/entries/contractarianism-contemporary/) 1. Political theory: claims that legitimate authority of government must derive from the consent of the governed, where the form and content of this consent derives from the idea of contract or mutual agreement. 2. The moral theory: claims that moral norms derive their normative force from the idea of contract or mutual agreement.
    21. 21. Principlism  Principle-Based Theories Principlism is one way of approaching professional deontology  Examples:  Hippocrates’ oath (“First, do no harm” or “Primum non nocere”)  Belmont Report, produced in 1978 (three principles)  Beauchamp and Childress in 2001 (four principles— beneficence, non-maleficence, respect for persons, and justice)
    22. 22. The ‘4 principles’ model • Autonomy: respect humans' ability to choose, • Beneficence: Do Good for others, • Nonmaleficence (Do No Harm), & • Justice Beauchamp Childress
    23. 23. An Islamic approach to ethics  The Model of Goals of Islamic Laws (‫الشريعة‬ ‫:)مقاصد‬ All Islamic legislations came to achieve these main purposes/goals of preserving the person’s:  Soul/Self/Life (Hifz An-Nafs): Prohibited abortion  Religion/Faith (Hifz Ad-deen): regular worship  Mind/Intellect (Hifz Al-Aql): prohibited alcohol  Wealth (Hifz Al-Mal):prohibited gambling &  Progeny/Lineage (Hifz Al-Nasl/Nasab): prohibited prostitution and adultery
    24. 24. Scale of Permissibility of Muslim Acts
    25. 25. How do Muslims tell right from wrong?
    26. 26. The Major Islamic Ruling Principles • Each action is judged by the intention behind it The principle of Intention (Qasd): • Certainty can not be removed by doubt The principle of Certainty (Yaqeen): • Injury should be relieved The principle of Injury/Harm (Dharar): • Difficulty calls forth ease The principle of Hardship (Mashaqqat): • Custom is recognized as a source of law The principle of Custom (Urf): Each of the main principles has a set of sub-principles
    27. 27. The Fiqhi Sub-Principles ‫الفقهية‬ ‫القواعد‬ ‫الفرعية‬
    28. 28. Professionalism
    29. 29. Professionalism  It encompasses the personal, organizational & corporate standards of behavior expected of the members of a same profession. (Wikipedia, 2012)  Professionalism in medicine requires the physician to serve the interests of the patient (and community) above his or her self-interest.  Professionalism aspires to altruism, accountability, excellence, duty, honour, integrity, and respect for other. (ABIM, 2000)
    30. 30. Elements of Professionalism  Altruism is the essence of professionalism. The best interest of the patients, not self-interest, is the rule.  Accountability is required at many levels - to individual patients, society and the profession…  Excellence entails a conscientious effort to exceed normal expectations and make a commitment to life-long learning…  Duty is the free acceptance of a commitment to service.  Honour and integrity are the consistent regard for the highest standards of behaviour and refusal to violate ones personal and professional codes.  Respect for others (patients and their families, other physicians and professional colleagues such as nurses, medical students, residents, subspecialty fellows, and self) is the essence of humanism…"
    31. 31. 10 commitments of professional doctor The Doctor is committed to:  Professional competence  Honesty with patients  Patients’ confidentiality  Maintaining appropriate relationships  Improving quality of care  Improving access to care  Just distribution of finite resources  Scientific knowledge  Maintaining trust by managing COI’s  Professional responsibilities
    32. 32. Commitments as a Professional Medical Student The Medical Student is committed to respect for:  professors, preceptors, and peers  guest speakers and visiting patients  cadavers and anatomical specimens in the anatomy lab  the institution of which s/he is a part  patients and their families at clinical encounters  patient confidentiality  all members of the health care team  administrative and support staff  the core values of professionalism
    33. 33. Lack of Professionalism Signs and Symptoms (ABIM, 2001) 1- Abuse of power 2- Arrogance (offensive display of superiority and self- importance); 3- Greed (when money becomes the driving force); 4- Misrepresentation (lying, and fraud); 5- Impairment (any disability that may prevent the physician from discharging his/her duties); 6- Lack of conscientiousness (failure to fulfill responsibilities); 7- Conflicts in interests (self-promotion/ advertising or unethical collaboration with industry; acceptance of gifts; and misuse of services, etc.).
    34. 34. What do you think? Ethics… taught or inherited?
    35. 35. How does teaching of E&P works? Knowledge Attitude Behaviour & Practice Transient change
    36. 36. What happens without E&P teaching? “Sub-ethical doctor”? Vulnerable patient ‘Dictator’ professor Strict hierarchy Sub-ethical researcher Sub-ethical clinician Sub-ethical teacher Sub-ethical…etc. Poor/No accountability Poor/No ethics curriculum Poor role models
    37. 37. Importance of teaching E&P  Moral reasoning (and not only the medical facts) makes the physician more competent to deal with his patients as a whole (body and soul), and not merely dealing with their sick bodies.  It improves the analytical thinking abilities,  Engage and empower the understanding of the Islamic moral framework, which helps doctors to provide better care & consultation, when needed;  Teaching E&P helps in improving the clinical outcome of the healthcare they provide.
    38. 38. E&P… WHAT AND WHEN TO TEACH?
    39. 39.  We teach E&P to make our graduates able to:  Constitute, express and sustain professional and efficient relationships with their patients, colleagues, and the resources to the best of the patients and the profession  We do NOT teach them E&P to be:  Virtuous persons  Religious scholars  Our clones…
    40. 40. How to decide what to teach? Public Health Laws/ Fatwas Policies, guidelines health- allied personnel Admin., Resources Doctor Colleagues Patient/ family
    41. 41. Know when… know what… know how Phase Students’ characteristics Pre- clinical  Fresh from high school  No previous personal exposure to patients  ‘Ideal’ figure of the doctor as ‘angel of mercy’  Effect of the personal (good or bad) experiences with the health system  Ethics is inherited from their communities and family (the way they were raised up)
    42. 42. Know when… know what… know how Phase Students’ characteristics Clinical  Students are exposed to and start communicating with patients  Students begin to ‘feel (and maybe act) like doctors’  Students’ imagination becomes more realistic by exposure to the system (how the system really works?)  Feelings of frustration, shock, confusion, coping, surrender… when what they think right/ethical doesn’t match what their seniors do
    43. 43. Know when… know what… know how Phase Students’ characteristics Near- graduation (specialized)  Students are technically almost doctors  They feel the direct responsibility towards the patients, colleagues and the system  Main focus and concern on ‘whatever it takes to get graduated’  Personal clinical specialty preferences start to get established  Near-mature clinical style of practice  Students’ mindsets are more towards ‘clinical analysis’ kind of thinking and doing things
    44. 44. Topics usually given in E&P curriculum I: Introduction and Basics of Islamic Medical Ethics  Introduction to the concepts of ethics, bioethics, and medical ethics  Comparison between the western and Islamic medical ethics  Professional duties of the doctor towards self, colleagues, patients, and community.  Basic ethical principles and guidelines (national and international)  Overview on patients' rights II: Practical Aspects of Medical Ethics  Informed consent to treatment  Privacy and confidentiality  Medical Malpractice, Misconduct & Medical Errors  Terminally Incurable Diseases and the End of Life (EOL) Decisions  Financial Aspects in Practice and Conflict of Interests (COI)  How to manage ethical issues in clinical practice?  Resource allocation  Ethics of public health  Islamic Fiqhi Rulings in Major Medical Specialties
    45. 45. Topics usually given in E&P curriculum(2) III. Professionalism  Concepts of professionalism  Professional duties on the medical student  Professional duties on the doctor (towards self, pt., colleagues, community, and the profession)  Non-professional attitudes and practices IV: Research Ethics  This section includes the ethical issues that are encountered before, during and after the conduct of research.  Basic concepts in research ethics  The ethical standards of research  The concepts of benefit and harm in research  Informed consent in research  Research on vulnerable groups  Privacy and confidentiality in research  Conflict of interests in research  Ethical review of research
    46. 46. TEACHING METHODS How to teach what in E&P?
    47. 47. Where Learning Occurs? Class • Lectures • Cases • SPs • Movies • Student activities Hospital • Bedside teaching • Clinical Rounds • M &M reports Community • Student activities • Research
    48. 48. Visual • Retrieve images • Prefer ‘seeing’ graphs, images, etc. •«‫شايف‬..‫شكله‬ ‫الموضوع‬.. ‫نظري‬ ‫وجهة‬..‫كده‬ ‫شكله‬.. ‫تخيل؟‬..!‫ر؟‬َّ‫تصو‬» Audio • Retrieve sounds • Prefer ‘stories’ • Details-oriented •«‫اسمع‬..‫لك‬ ‫بقول‬..‫قلت‬ ‫لنفسي‬..‫جواي‬ ‫صوت‬..‫نشاز‬» Sensual • Retrieves sensations (touch, smell, etc.) • Prefer ‘emotions’ • ‘touching’ person •«‫أن‬ ‫حاسس‬..‫بارد‬..‫الموضوع‬ ‫فاحت‬ ‫ريحته‬..‫للزول‬ ‫مرتاح‬ ‫ما‬ ‫ده‬..‫الخيط‬ ‫طرف‬ ‫مسكت‬..‫زول‬ ‫لذيذ‬..‫تقيل‬»‫كتاب‬ ‫من‬ ‫مقتبسة‬ ‫األمثلة‬(‫ع‬ ‫شريف‬ ‫للدكتور‬ ‫أغبياء؟‬ ‫حولك‬ ‫من‬ ‫لماذا‬‫رفة‬)
    49. 49. Class-Based methods Interactive sessions (lectures)  Suitable Topics:  Foundation and principles  Theoretical (parts of) topics: e.g. Fiqhi & Philosophical issues  Advantages:  Safe learning environment  Better control  Disadvantages:  Needs interaction to keep students alert  Monotonicity and teacher dominance
    50. 50. Class-Based methods (2) Problem solving and case discussion  Suitable Topics:  Practical aspects (consent, privacy, confidentiality)  Research ethics  Advantages:  Engaging to students  Closer to reality  Disadvantages:  Development and suitability of cases  Logistic needs
    51. 51. Class-Based methods (3) Glossary and debates: Glossary: Students are asked to define an ethics-related terminology. Defined terms are gathered in a glossary by the end of the course Debate: Two groups of students are asked to make an argument, and defend it, while the other group tries to provide a counter-argument  Suitable Topics:  New terminology and Provocative topics  E.g. (SOPA), Teaching ethics is needed for medical students? For vs. Against  Advantages:  Engaging  Make students search and reason  Disadvantages:  Good argument for a bad cause!
    52. 52. Class-Based methods (4) Student seminars  How to do it?  Students groups are given topics to summarize & present to their colleagues  Suitable Topics:  Topics that are not covered in the curriculum, e.g. many of the Islamic rulings (Fatwas) and Fiqhi issues  Advantages:  Students remember best what they search and present by themselves  Disadvantages:  Uncontrolled Group dynamics  Inefficient groups (group members)  Credibility and integrity of what the students present (Whatever Google brings can do the job fine )
    53. 53. Class-Based methods (5) Case studies and case presentation  How to do it?  Students groups are given ethical scenarios (dilemmas), preferably modified from true cases to summarize, analyze & present to their colleagues  Suitable Topics:  Clinical ethics (e.g. consent, confidentiality, EOL, etc.) and research ethics  Advantages:  Students utilize the ethics analysis tools and start ‘resolving’ ethical issues by themselves  Self-confidence  Disadvantages:  Unresolved issues and disagreements may lead to frustration  Inefficient groups (group members)  Heavy reliance on a specific reference (especially religious)
    54. 54. Class-Based methods (6) True story telling (by patient, patient relative, or a doctor)  How to do it?  A patient, a patient’s relative, or a clinician who has been exposed to a situation with ethical dilemma is invited to give a short talk about his/her experience with receiving or giving medical care  Suitable Topics:  Clinical ethics (e.g. consent, confidentiality, EOL, etc.) and research ethics  Advantages:  Human engagement and reflection  Links theory to practice  Disadvantages:  Hesitance by patients to come and contribute their experiences  Sharing sad stories can be distressing/depressing for the narrator  Confidentiality issues
    55. 55. Class-Based methods (7) Watching movies or documentaries that discuss ethical issues.  How to do it?  Selected drama movies or documentaries are presented to the students  Suitable Topics:  Clinical ethics (e.g. consent, confidentiality, EOL, etc.) and research ethics  Advantages:  Human engagement and reflection  Many topics are covered in short time  Disadvantages:  Distraction by unrelated events in the film  Approaches to ethical issues in the movies may not match the ILOs  Refusal to watch movies for religious reasons
    56. 56. WIT movie… as an example  This is bit more than watching a drama movie and cry!  After watching the first 5-10 minutes, students are asked to answer few questions. For example: 1. How did you feel? (sad, happy, satisfied, etc.) 2. What are the ethical issues discussed/presented in this part of the movie? 3. How did the doctor communicate with his patient? 4. Who did what wrong, ethically speaking? Explain why you think it is ethically wrong. 5. How would have you done, if you were in his/her position? 6. Could he have done it better? How? 7. If you were the patient, what would you have liked to know? To have?
    57. 57. Hospital-Based methods (1) Clinical (or Research) Ethics Consultations  How to do it?  Students groups are invited to attend a true (or mock) ethics consultation meeting  Suitable Topics:  Clinical ethics (e.g. consent, confidentiality, EOL, etc.) and research ethics  Advantages:  Students are exposed to true experience on ‘how things work in real life?’  Matching theory to practice  Disadvantages:  Confidentiality issues (hospital policy)  Hard to endorse large number of students  Disagreements among committee members are not educationally structured
    58. 58. Hospital-Based methods (2) Narrative Ethics (listen to the patients)  How to do it?  True (or SPs) patients are invited to share their admission experiences with emphasis on what they (dis)liked about their clinical team  Suitable Topics:  Professionalism, consent, privacy  Advantages:  Students start communicating humanly (not mechanically) with patients  Matching theory to practice  Disadvantages:  Patients’ hesitance to share their stories (SPs as alternative)  Confidentiality and COI issues  Consent from patients?
    59. 59. Standardized patients (SPs)  This is a more advanced method that is based on making professional actors work on simulating a patient with a given condition.  This SP is then interviewed by the student in front of the other students, and supposed to behave like a real patient.  This could be used in many topics, but it is more efficient in topics that needs direct doctor-patient communications like breaking bad news, or taking consent
    60. 60. Some tips that worked  Clear instructions and students’ guide  Dedicated website (https://sites.google.com/site/medicalethicscourse)  Lectures  Presentations  Case of the week  Assignments  Students’ forums  Group emails  Delegate students’ leaders
    61. 61. Students, facilitators, methods, facilities, etc.
    62. 62. Who do we evaluate in E&P course for what? Students • Knowledge • Understanding • Reasoning • Practice Educators • Knowledge • Interaction • Teaching methods • Answering questions Course • Content • Objectives • Coordination • Accessibility to material • Meet ILOs & expectations
    63. 63. Tools commonly used to assess students What does it assess? MCQs Short essays Cases/ problems OSCE Assignments Research Practical Knowledge + ++ ++ + +++ +++ ++ Understanding + +++ +++ + +++ ++ ++ Reasoning + +++ +++ ++ +++ +++ + Ethical Analysis - ++ +++ ++ +++ +++ ++ Competencies - - + + - ++ +++
    64. 64. MCQs  How to do it?  Either Best Answer or T/F  A stem presents a case scenario followed by choices; one of which only is (most) correct  Suitable Topics:  MCQs are suitable for almost all topics  Advantages:  easy to mark  Covers many topics  Disadvantages:  Abstract (does not reflect the student’s reasoning)  Some choices may be debatable
    65. 65. Example of MCQs ‫م‬ ‫فأي‬ ،‫متيقن‬ ‫غير‬ ‫انك‬ ‫غير‬ ‫احتضار‬ ‫حالة‬ ‫في‬ ‫انه‬ ‫لك‬ ‫وبدا‬ ‫برءه‬ ‫يرجى‬ ‫ال‬ ‫مريض‬ ‫لديك‬ ‫كان‬ ‫إذا‬‫ن‬ ‫األمثل؟‬ ‫تصرفك‬ ‫هو‬ ‫الفقهية‬ ‫والقواعد‬ ‫المواقف‬ ‫من‬ ‫اآلتي‬ .A‫محكمة‬ ‫العادة‬ ‫بقاعدة‬ ‫عمال‬ ‫أعضاءه‬ ‫من‬ ‫لالستفادة‬ ‫وفاته‬ ‫إعالن‬ .B‫الضررين‬ ‫اخف‬ ‫بقاعدة‬ ‫عمال‬ ‫لغيره‬ ‫سريره‬ ‫إلخالء‬ ‫وفاته‬ ‫إعالن‬ .C‫بالشك‬ ‫يزول‬ ‫ال‬ ‫اليقين‬ ‫بقاعدة‬ ‫عمال‬ ‫وفاته‬ ‫من‬ ‫تتيقن‬ ‫حتى‬ ‫االنتظار‬ .D‫المال‬ ‫على‬ ‫بالحفاظ‬ ‫الشريعة‬ ‫لمقصد‬ ‫تحقيقا‬ ‫عنه‬ ‫األجهزة‬ ‫فصل‬ .E‫بمقاصدها‬ ‫األمور‬ ‫لقاعدة‬ ‫تحقيقا‬ ‫آخر‬ ‫تخصصي‬ ‫لمستشفى‬ ‫نقله‬  A psychiatrist is conducting a trial on a drug that would (if the trial succeeds) reduce the suicidal tendency in severely depressed patients. They will only use the trial’s medication for 3 months. He took their consent. What is the ethical stand from this trial? A. Ethically acceptable because it reduces the patients' suffer B. Ethically acceptable because the consent was taken C. Ethically unacceptable because of doubtful drug efficiency D. Ethically unacceptable because of lack of patients' competence E. Becomes ethical if nobody gets harmed after the trial
    66. 66. Short essays  How to do it?  The students are asked to mention/discuss a certain topic  Suitable Topics:  Topics that has more knowledge than analysis (e.g. Fiqhi Issues)  Advantages:  easy to put, assesses topics not covered by MCQs  Disadvantages:  Hard to answer (students are not used to write)  Hard to mark, especially in large numbers of students
    67. 67. Example of Short Essay  What are the measures that should be taken by doctors and hospitals to ensure their patients' privacy and the confidentiality of their medical information? (5 Marks) ‫الطب‬ ‫وبعمل‬ ‫بالصحة‬ ‫عالقتها‬ ‫خالل‬ ‫من‬ ‫الشريعة‬ ‫مقاصد‬ ‫ناقش‬‫يب‬ (5‫درجات‬)
    68. 68. Cases/Problems  How to do it?  Select a true case that has ethical aspects to it, modify it then add some questions to it to be answered  Suitable Topics:  Clinical ethics and ethical analysis topics  Advantages:  reflects students ability to analyze ethical issues  Disadvantages:  Not easy to formulate and may be hard to mark
    69. 69. Example of Case Scenario  Parkinson patient case Dr. Nerve, the famous neurologist used to tell some of the interesting things happened to him along the day while having dinner with his wife, a School Principal. He told her about one of his patients. He told his wife about a poor elderly bus driver who had Parkinson disease and had to take an unusually high dose of medication to suppress the tremors. When she enquired if this affects the patient's ability to drive, he told her that the medication made the patient sleepy all day. The wife told him that she suspects that she might know this patient; as there is a bus driver at her school who used to come late for the last few weeks. She asked for the name of the patient and realized that the patient was a driver for her school transport company. She dismissed him the next morning.  Mention at least 5 patient rights and discuss whether Dr. Nerve breached any of them. (2 marks)  Was his action of telling his wife ethically justifiable? Why? (1 mark)  Discuss the conditions in which disclosing patient's information is justifiable, and whether this case fulfills these conditions. (2 marks)
    70. 70. Assignments  These assignments are usually about cases with ethical problems guided in each assignment by a set of questions.  They are intended to be a self-reflection on what the student has learnt so far along the course to express his/her understanding, than to focus on reaching a correct answer.  Assessment of assignments: 1. Originality of content. 2. Novelty of content. 3. Strength of arguments. 4. Uniform editing. 5. Proper citation  Students should abide to the professional academic conduct, without the abuse of internet. Use software to detect plagiarism. Plagiarism similarity score of 20% or more means that the student’s work will be rejected and will have to resubmit it.
    71. 71. Case Studies  The case study  To assess the student’s ability to define, analyze and be able to use the relevant tools to resolve ethical issues. In a case study the student is asked to find a case with one or more ethical issues around it.  A case study will be typically composed of these sections: 1. The presentation of the case 2. What are the ethical issues in the case? 3. What are the ethical and Fiqhi principles at stake? 4. Ethical case analysis 5. Fiqhi Case analysis 6. Case resolution
    72. 72. Practical Activities  Ethics book review  Public awareness campaign  Producing short film (documentary) on an ethical issue  Ethics education material  Short Play or scene  Movie review  Ethics consultation meeting  Research ethics review meeting  Other activities that the student thinks relevant
    73. 73. What could be the challenges in teaching and/or assessing E &P? Challenges & the way ahead
    74. 74. What could be challenging to you? Example of challenge Possible solutions Not content experts The ‘Community of Support’ Under-estimated by deans, clinicians, or students Involve them early. Integrate your efforts. Bargain for more credit hours Students’ frustration (not used to use their minds!) - Do it gradually - Analogy to clinical analysis Not used to ‘innovative’ methods - You can still use the ‘old ways’ efficiently - Let others (students) do them! Subjective assessments (e.g. no model answer) - MCQs may help (not a big fan!) - Clear instructions & keywords for assessment
    75. 75. Take Home Messages  Teaching of E&P is about the principles and tools that the future doctor can use to manage the ethical issues they will face in healthcare practice  There are many factors that need to be included in curriculum development  Make sure you use the suitable teaching and assessment format.
    76. 76. Feel Free to contact: Ghaiath Mohamed Abas Hussein email: ghaiathme@gmail.com website: http://sites.google.com/site/medicalethicscourse/ Mobile: +966-566511653
    77. 77. Movie (year) Topics covered in the movie A Beautiful Mind (2001): Schizophrenia A Clockwork Orange (1971): Behavior Control A Place for Annie (1994): Pediatric Ethics, Nursing Ethics, AIDS A Private Matter (1992): IVF, Thalidomide, researchers, doctors, parents An Enemy of the People (1978): Public Health An Inconvenient Truth (2006): Global warming, environment And the Band Played On (1993): HIV, research ethics, healthcare Antwone Fisher (2002): Psychiatry Artificial Intelligence (2001): Artificial kid with real feelings competing with a real child for the love of his mother Assisted Living (2003): Alzeheimer's, nursing home At First Sight (1999): Blindness, operation restoring sight Awakening (1990): Clinical research, experimental use of drugs Barbarian Invasions (2002): Personal Values, end of life Bicentennial Man (1999): Futuristic Robot pleading for full human status Blade Runner (1982): Cloning, what does it mean to be human Breathing Lessons: The Life and Work of Mark O'Brien (1996): Life with severe disability Cardiac Arrest (1994): Transplantation Charly (1968): Living with Disability, research on humans Children of a Lesser God (1986): Autonomy and deafness Children of a Lesser God (1986): Deafness Choices of the Heart: The Margaret Sanger Story (1995): Struggle for birth control rights City of Joy (2002): Compassionate care, justice Code 46 (2003): Personal relationship affected by genetic incompatibility Coma (1978): Organ trade and theft Coming Home (1978): Coping with PTSD and paraplegia Coming Home (1978): Dealing with paralysis Creator (1985): Life extension, cryogenics Erin Brokovitch (2000): Public health, justice Extreme Measures (1996): Medical Research, using patients as means, informed consent First do no Harm (1997): Epilepsy, fight against medical establishment Flatliners (1990): Medical students experimenting on each other Forever Young (1992): Cryonics, research ethics, humans as guinea pigs GATTACCA (1997): Genetic Determinism, genetic engineering Girl Interrupted (1999): Child psychiatry, mental hospital Godsend (2004): Human Cloning Good Will Hunting (1997): Therapist-physician relationship, surviving child abuse Heartsound (1984): Organizational Ethics, doctor falling ill, code mismanagement, on call incompetence I am Sam (2001): Down Syndrome If These Walls Could Talk (1996): Abortion If These Walls Could Talk, part 2 (2000): Gender Identity/Homosexuality Iris (2001): Coping with Alzheimer's It's my Party (1996): End of life, family, autonomy Jonh Q (2002): Allocation or organs, justice, health care, organizational ethics, personal ethics, duty to treat Jurrasic Park (1993): Research Ethics, DNA Kids Like These (1987): Coping with a child with Down Syndrome Genetic counseling K-Pax (2001): Delusional disorders, therapist-patient relationship Lorenzo’s Oil (1992): old patient and end of life Losing Isaiah (1999): Pediatric Ethics, best interest Malice (1993): All knowing doctor, physician-patient relationhip Marvin's Room (1996): Family coping with advanced cancer and bone marrow donation Marvin's Room (1996): End of life Mask (1985): Teen with facial and skull deformity, parental concern Million Dollar Baby (2004): Euthanasia and assisted suicide Minority Report (2002): Scientific Research, protection of humans subjects Miss Evers Boys (1997): Scientific Research, Tuskegee Syphilis Study, Informed Consent, Right to treatment Molly (1999): Autism My Flesh and Blood (2003): Children with special needs My Left Foot (1989): Cerebral Palsy, disability rights, autonomy My Life (1993): Terminal illness, end of life, autonomy, decisions, quality of life My Life Without Me (2003): End of life Near Death (1989): ICU, end of life, relationships between members of the healthcare team, religious figures and family Personal, religious, ethical, medical, psychological issues Nell (1994): Language and development Night, Mother (1986): Geriatrics, choice of ending one's life Normal (2002): Gender change, autonomy, personhood, cultural stigma On Our Own Terms: End of life, palliative care, therapy and support One Flew Over the Cuckoo's Nest (1975): Mental health institution Ordinary People (1980): Child psychiatry, family relations Outbreak (1995): Public Health Ethics Paralyzing Fear: The Story of Polio (1998): Polio, vaccination, scientists Passion Fish (1992): Spinal cord injury, nursing ethics Patch Adams (1998): Character of physicians, humour in medicine Philadelphia (1993): AIDS patients and their rights Radio Flyer (1992): Child psychiatry Rain Man (1988): Autism, autonomy, competence Ray (2004): Blindness, Ray Charles Regarding Henry (1991): Memory loss, physician-patient relationship Roe v Wade (1989): Abortion See What I Say (1981): Hearing impaired Shameless: The ARTof Disability (2006): Disability, euthanasia, psychology, art, special education Sicko (2007): Health Care Systems, HMOs stories Silver Spring Monkeys: Experimentation on Animals (PETA documentary) Snow Cake (2006): Autism Something the Lord Made (2004): Clinical Ethics, racial segregation, Sound of Fury (2000): Deafness Steel Magnolias (1989): Organ donation, diabetes Sunset Story (2003): Geriatrics, assisted living Talk to Her (2002): PICU, doctor-patient relationship, coma, nursing ethics The Band Played On (1993): AIDS The Boys from Brazil (1978): Cloning, nature vs nurture The Constant Gardener (2005): Pharmaceutical companies and the testing of new drugs The Diving Bell and the Butterfly (2008): Transformation of a patient in locked-in syndrome The Doctor (1991): Character of a physician, health care organization ethics The eight day (1996): Down Syndrome The Final Cut (2004): Neuroethics, cutting up memory slices of a person's life The Great Santini (1979): Child psychiatry, parents The Handmaid's Tale (1990): Abortion The Handmaid's Tale (1990): Female fertility and reproduction The Hospital (1971): Organizational ethics The Insider (1999): Public health, corporate greed, reporting ethical misconduct The Island (2005): Cloning humans The Island of Dr: Moreau (1996): DNA experimentation The Lynchberg Story (1993): Eugenics The Miracle Worker (1962): Deafness, blindness, Hellen Keller The Other Sister (1999): Coping with mental challenge The Ryan White Story (1998): Pediatric hemophilia, AIDS, public health, pediatric ethics The Sea Inside (2005): Assisted suicide, Competence The Self Made Man (2005): Choosing death, autonomy, end of life choices Makropulos Case Life extension, desire for immortality The Twilight of the Golds (1997): Possible role of genetics in determining sexual orientation The Verdict (1982): Medical error, cover-up, nursing ethics This Boy's Life (1993): Teen psychiatry, abusive father Tuesday's with Morrie (1999): ALS, end of life, closure Unessary Fuss: Experimentation on Animals (PETA documentary) Waterdance (1992): Dealing with paralysis What’s Eating Gilbert Grape (1993): Autism When a Man Loves a Woman (1994): Alcoholism, rehabilitation When did you Last See Your Father? (2007): Parent-child relationship, terminal illness Whose Life is it Anyway (1981): Euthanasia, competence, conflict between physicians when it comes to decision making Who decides? Wit (2002): End of life, physician-patient relationship, research ethics

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