From innocence to experience: Teaching medical ethics to medical students

The author describes the content and method of a course in medical ethics for second-year medical students. He discusses the clergyperson's role in teaching medical ethics in relationship to physicians and concludes with reflections upon the study of medical ethics as part of the rite of passage of medical education.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

Feminist and medical ethics: two different approaches to contextual ethics

Feminist ethics and medical ethics are critical of contemporary moral theory in several similar respects. There is a shared sense of frustration with, the level of abstraction and generality that characterizes traditional philosophic work in ethics and a common commitment to including contextual details and allowing room for the personal aspects of relationships in ethical analysis. This paper explores the ways in which context is appealed to in feminist and medical ethics, the sort of details that should be included in the recommended narrative approaches to ethical problems, and the difference it makes to our ethical deliberations if we add an explicitly feminist political analysis to our discussion of context. It is claimed that an analysis of gender is needed for feminist medical ethics and that this requires a certain degree of gener-ality, i. e. a political understanding of context.     

Evoking the moral imagination: Using stories to teach ethics and professionalism to nursing,medical, and law students

Four years ago, as colleagues in our university's law and medical schools, we designed and began offering a course for law, medical, and nursing students, studying professionalism and professional ethics by reading and discussing current and earlier images of nurses, doctors, and lawyers in literature. We wanted to make professional ethics, professional culture, and professional education the objects of study rather than simply the unreflective consequences of exposure to professional language, culture, and training. We wanted to do it in an interdisciplinary course where aspiring professionals could share their self-conceptions and their conceptions of each other, and we wanted to do it by using stories, our primary means for organizing experience and claiming meaning for it. This article tells the story of that experience: why we did it; how we did it; what we learned from doing it.     

Mental health of medical students: a cross-sectional study in Tehran

Medical students are subject to stress from sources related to medical training in addition to personal problems, resulting in significant mental distress. This study evaluates the scope of the problem in Tehran medical schools and sheds light on some of its associations. Students (604) of medicine from four medical schools in the city of Tehran responded to the Persian version of 28-item General Health Questionnaire (GHQ-28) in conjunction with a data collection sheet asking about age, sex, marital status, current training level, living place, grade point average in previous semester, and perceptions of their financial status. Of 602 students, 40.7% had mental distress (45.7% of female and 36.7% of male students). Distress was associated with being a woman (female to male odds ratio: 1.55) and very poor financial status (OR: 18.0).     

Effectiveness of a responsible conduct of research course: a preliminary study

Training in the responsible conduct of research (RCR) is required for many research trainees nationwide, but little is known about its effectiveness. For a preliminary assessment of the effectiveness of a short-term course in RCR, medical students participating in an NIH-funded summer research program at the University of California, San Diego (UCSD) were surveyed using an instrument developed through focus group discussions. In the summer of 2003, surveys were administered before and after a short-term RCR course, as well as to alumni of the courses given in the summers of 2002 and 2001. Survey responses were analyzed in the areas of knowledge, ethical decision-making skills, attitudes about responsible conduct of research, and frequency of discussions about RCR outside of class. The only statistically significant improvement associated with the course was an increase in knowledge, while there was a non-significant tendency toward improvements in ethical decision-making skills and attitudes about the importance of RCR training. The nominal impact of a short-term training course should not be surprising, but it does raise the possibility that other options for delivering information only, such as an Internet-based tutorial, might be considered as comparable alternatives when longer courses are not possible.     

The development of computer ethics: Contributions from business ethics and medical ethics

In this essay, we demonstrate that the field of computer ethics shares many core similarities with two other areas of applied ethics, Academicians writing and teaching in the area of computer ethics, along with practitioners, must address ethical issues that are qualitatively similar in nature to those raised in medicine and business. In addition, as academic disciplines, these three fields also share some similar concerns. For example, all face the difficult challenge of maintaining a credible dialogue with diverse constituents such as academicians of various disciplines, professionals, policymakers, and the general public, Given these similarities, the fields of bioethics and business ethics can serve as useful models for the development of computer ethics. A version of this paper was presented at ETHICOMP98, the Fourth International Conference on Ethical Issues of Information Technology, March 25–27, 1998, Erasmus University, the Netherlands. Kenman Wong, Ph.D., is an Associate Professor of Business Ethics; Gerhard Steinke, Ph.D., is Professor of Management and Information Systems. Both authors are at Seattle Pacific University's School of Business and Economics.     

Subjective character of experience in medical ethics: a reply to Atkins

In a recent issue of this Journal Kim Atkins argued that Thomas Nagel's argument regarding a bat's phenomenal experience is important for understanding the value placed on patient autonomy in medical ethics. In this reply to her paper, I demonstrate that Atkin's argument (a) is based on her misinterpretations of Nagel's argument, and (b) can be established without appealing to such a controversial assumption as that which she makes.     

A preliminary study of emotional intelligence, empathy and exam performance in first year medical students

A group of 156 first year medical students completed measures of emotional intelligence (EI) and physician empathy, and a scale assessing their feelings about a communications skills course component. Females scored significantly higher than males on EI. Exam performance in the autumn term on a course component (Health and Society) covering general issues in medicine was positively and significantly related to EI score but there was no association between EI and exam performance later in the year. High EI students reported more positive feelings about the communication skills exercise. Females scored higher than males on the Health and Society component in autumn, spring and summer exams. Structural equation modelling showed direct effects of gender and EI on autumn term exam performance, but no direct effects other than previous exam performance on spring and summer term performance. EI also partially mediated the effect of gender on autumn term exam performance. These findings provide limited evidence for a link between EI and academic performance for this student group. More extensive work on associations between EI, academic success and adjustment throughout medical training would clearly be of interest.