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Medical ethics teaching programs at the University of California, San Francisco, and the University of Washington.

The author describes the comparative dearth of scholarship and literature on medical ethics in 1972 when he began designing an elective lecture-discussion course at the School of Medicine, University of California, San Francisco (UCSF). He traces the development of ethics teaching at that school and of his conviction that medical cases must be the focus of ethics education, not merely as illustrations but as the matrix of the ethical problems encountered and their resolution. Eventually, a required fourth-year course was developed that focused upon four essential aspects of medical cases: medical indications, patient preferences, quality of life, and external socioeconomic factors. This course and its evaluation--including inherent quandaries of evaluating ethics teaching--are described; he attributes the success of the course to the appropriateness of the four-part format for analysis and the support and participation of leading members of the medical faculty. Throughout this description of the UCSF program are short descriptions of the additions to the bioethics literature that were made during the mid- and late 1970s. The author then describes the present ethics teaching program at the University of Washington School of Medicine, where he has taught since 1987, and the intriguing and perhaps innovative possibilities for expanding and redefining that program.

Bioethical Issues↗

Development of the medical humanities program at East Carolina University.

The medical humanities program at East Carolina University School of Medicine has 50 contact hours with medical students in the required curriculum, fourth-year electives that are well-subscribed (47% of the members of the class of 1989 took one or more), and programs for residents, fellows, and faculty. The author discusses several crucial decisions made in the first year of the program (1978-79) that affected the nature and development of the program: first, to begin the medical humanities courses in the preclinical required curriculum and use these courses as a base to build on in the clinical years; second, to develop a program through all years of training while preserving time for faculty research; third, to arrange for program faculty to team-teach with clinical faculty; fourth, to show the importance of the humanities programs and courses by the way in which they were constructed and situated in the curriculum; and fifth, to seek primarily to teach a method of inquiry.

Bioethical Issues↗

The Nordic concept of 'faellesskab'.

The complex of cultural, political and societal affiliations, both in a historic and a contemporary perspective, is expressed by a special term in the Nordic languages, 'faellesskab', often with the addition of 'folkelig', as 'folkeligt faellesskab', where 'folkelig' means of the people. No corresponding term exists in English. For medical ethics the concept 'faellesskab', or whatever wording is chosen to serve the semantics of this term, is vital. In research ethics and clinical decision-making complex ethical analyses and normative evaluations are necessary. They cannot be based solely on moral relativism, whether being based on results of opinion polls or on a widespread 'every man minds his own business' concept. 'Faellesskab' possesses the necessary base of common values.

Bioethical Issues↗

Assessing the clinical ethical competence of undergraduate medical students.

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context.

Australia↗

The current state of clinical ethics and healthcare ethics committees in Belgium.

Ethics committees are the most important practical instrument of clinical ethics in Belgium and fulfil three tasks: the ethical review of experimental protocols, advising on the ethical aspects of healthcare practice, and ethics consultation. In this article the authors examine the current situation of ethics committees in Belgium from the perspective of clinical ethics. Firstly, the most important steps which thus far have been taken in Belgium are examined. Secondly, recent opinion by the Belgian Advisory Committee on Bioethics with regard to ethics committees is presented and the activities of Belgian ethics committees are discussed. Finally, the option to bring research ethics and clinical ethics under the roof of just one committee is criticised using a pragmatic and a methodological argument. Concomitantly, the authors build an argument in favour of the further development of ethics consultation.

Belgium↗

Making sense of dignity.

In this review of Leon Kass's Life, liberty and the defense of dignity and Deryck Beyleveld and Roger Brownsword's Human dignity in bioethics and biolaw. I consider the prospects for a theory of dignity as a basis for bioethics research. I argue that dignity theories are worth exploring in more detail, but that research needs to consider both "antitheory" accounts of the language of bioethics, and to give more weight to accounts of dignity as an outcome of holding positive liberties and as something that has a psychological dimension.

Bioethical Issues↗

Can arguments address concerns?

People have concerns, and ethicists often respond to them with philosophical arguments. But can conceptual constructions properly address fears and anxieties? It is argued in this paper that while it is possible to voice, clarify, create and-to a certain extent-tackle concerns by arguments, more concrete practices, choices, and actions are normally needed to produce proper responses to people's worries. While logical inconsistencies and empirical errors can legitimately be exposed by arguments, the situation is considerably less clear when it comes to moral, cultural, and emotional norms, values, and expectations.

Attitude to Health↗

Ethics and dentistry: 2. Ethics and risk management.

The previous paper explored the meaning of ethics, especially its relationship to dentistry. Here, we examine a practical application for solving ethical problems. Together, the two articles should provide dentists with a core of relevant knowledge about ethics and a ready guide to the daily relevance of ethics.

Bioethical Issues↗