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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. 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. 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. Before we start… Let’s Reflect…
Which one would you drink?

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. What do you think?
Courtesy of Dengue Fever Control Program, Jeddah, KSA (2006)

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. 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. Don’t judge things on what they first
appear to you!
There is always a reason why
people do things?

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. 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. 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. 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. 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?

16. 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

17. 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

18. 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

19. 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.

20. Virtue ethics
 It emphasizes the virtues, or moral
character (not duties or consequences)
 Someone in need should be helped. Agree?

21. “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.

22. 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)

23. The ‘4 principles’ model
• Autonomy: respect humans'
ability to choose,
• Beneficence: Do Good for others,
• Nonmaleficence (Do No Harm), &
• Justice
Beauchamp
Childress

24. 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

25. Scale of Permissibility of Muslim Acts

26. How do Muslims tell right from wrong?

27. 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

28. The Fiqhi Sub-Principles ‫الفقهية‬ ‫القواعد‬
‫الفرعية‬

29. Professionalism

30. 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)

31. 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…"

32. 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

33. 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

34. 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.).

35. What do you think?
Ethics… taught or inherited?

36. How does teaching of E&P works?
Knowledge Attitude Behaviour &
Practice
Transient change

37. 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

38. 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.

39. E&P… WHAT AND WHEN
TO TEACH?

40.  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…

41. How to decide what to teach?
Public
Health
Laws/
Fatwas
Policies,
guidelines
health-
allied
personnel
Admin.,
Resources
Doctor Colleagues
Patient/
family

42. 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)

43. 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

44. 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

45. 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

46. 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

47. TEACHING METHODS
How to teach what in E&P?

48. Where Learning Occurs?
Class
• Lectures
• Cases
• SPs
• Movies
• Student activities
Hospital
• Bedside teaching
• Clinical Rounds
• M &M reports
Community
• Student activities
• Research

49. 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)

50. 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

51. 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

52. 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!

53. 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 )

54. 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)

55. 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

56. 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

57. 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?

58. 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

59. 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?

60. 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

61. 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

62. Students, facilitators, methods, facilities, etc.

63. 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

64. 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 - - + + - ++ +++

65. 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

66. 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

67. 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

68. 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)

69. 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

70. 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)

71. 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.

72. 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

73. 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

74. What could be the challenges in teaching
and/or assessing E &P?
Challenges & the way ahead

75. 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

76. 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.

77. Feel Free to contact:
Ghaiath Mohamed Abas Hussein
email: ghaiathme@gmail.com
website: http://sites.google.com/site/medicalethicscourse/
Mobile: +966-566511653

78. 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