See www.publichealthreviews.eu issue on PH Ethics

T Tulchinsky Hebrew University Hadassah, Jerusalem, Isreal

Thank you for the very useful link to Issue 5 of the PH Review. It dsicussed the ethics of a few aspects of public health at the policy level. One paper mentioned that, despite the high regard for teaching ethics, little is know on this topic and there was no specific discussion on what is or should be taught.

I think little is known about teaching ethics in clinical practice and direct patient care. Does anyone put any comment on this?

As an educator who is involved in teaching, in addition to nursing students, students of rehabilitation sciences as well as medical students, I find it very important for all health care professionals to know about ethics. In my opinion it would be much better to offer the same course to all types of professionals. In this way they will develop a unified understanding of the ethical concepts and the role of each discipline in applying these concepts when facing ethical dilimmas. The students should know what types of ethical relations they need to develop with each other, with patients as well as the community at large. The students of each discipline should also be acquainted with the code of conduct for their profession and the codes of conduct of the other professions. Since we need health care services to be coprehensive and holistic, then, collaboration and coordination and the use of team approch to care become a basic issue. This type of approach has much to do with understanding ethics.

The issue of teaching ethics becomes even much more essential when we deal with patients in critical care units where the types of patients' problems, the technology, and the stressors add to the complixity of decisions to be made. Therefore, for students at the postgraduate level, or senior years of undergraduate study need to go more in depth studying ethical dilimmas and ways to overcome ethical distress in order to be able to help patients, colleagues and oneself.

I think ethics is a key part of the preparation for students to become doctors. One of the wyas that ethics can be introduced is as reflections on ethical dilemmas in medical practice, especially if these reflections are reviewed with the students by a senio medical practitionr / ethicist. We did some reseach which did show that students valued these reflections as part of ther education.

Article Do medical students value clinical reflection? A mixed metho...

Very nice query and I hope its a sincere one. Nice not to ask or answer but to follow and know. World's first universities, teaching Institutions have been in India and so were the earliest medical education centers and lot much has been said long time back. But the morals, conducts and ethics should be or change with time, place and region in some form or other. Its not a matter of few lines and I'd be coming with whole of it some of my paper may be. But still we could say on some to start with. there are different codes for doctors\medical students, paramed staff and people in other educational streams.

We call the very educated, learned and intellectual as "Brahman" in ancient Indian sciences who is the at the top of social ladder. The doctor today also the scientists are the Brahmans of today.

Firstmost of codes would be, to attain knowledge first attain humility.

When learning don't have the thought of money.

have a very disciplined life that means-- eat less, sleep less, live a celibate life and try to make a balanced life with physical activity and social interaction.

The incarnation as a learned is called as the second life so one has new parents and new brothers. Teachers and your batchmates. They should be treated like as such.

Basically there could be codes during studentship, during profesional duty and the life outside one's duty.

In the highly competitive and intellectual field, the professional rivalry is high. So a formed grade of hierarchy is maintained specially senior and junior.

And there is lengthy accord of the attire, demeanor, speech, behaviour, personal life and its ideals,

A doctor is one who is a researcher, a teacher and a healer all at the same time, ideally one of it. But when we lay ethics and codes for professionals the society also should comply in because the health worker is devoting and sacrificing his-er life by strict personal rules.

Similarly, there are rules for other workers.

@ Fathieh, personally I do feel that different healthcare professionals should have the same course in ethics. It makes sense as the relevant ethical pricniples are the same. It may also help with inter-disciplinary understanding and teamwork. However, a joint education may be difficult to implement. How to structure the teaching of ethics within different curriculums in itself is an issue.

@ Mathew. Clinical reflection is certainly one way to do it, though in practice it will be mixed with the discussion of many non-ethical issues. The topics covered would also vary from one case to another. Having small group discussions would also require many teaching professionals who themsleves have sufficient ethical training. How do you propose to address these issues?

@ Shailesh. Ethics do change with time and vary with culture. Thank you for your input and your local perspective. Can you elaborate on the difference in healthcare ethics between India and othe countries? And how is ethics taught in India?

I agree with these previous answers, really this is very important query,I think that many researchers or educators don't confront themselves with this query. personally, I suggested that all of us need to measure /evaluate her/himself on the scale of ethics however in clinical areas with patients, in study room with students. In my opinion, ethics is not a sort of course I have to study rather than a case we have to encourage ourselves and all surroundings to live it.

Thank you for your further comments. Certainly, staffing with the right amount of people with the right qualifications can be difficult. Ethical practice is not solely based on a qualification, but also peer acceptability ("Are this person's ethical standards high enough to pass on thier kowledge?") although there are qualifications which also validate a person's academic grounding in ethics. In terms of simple person hours, an alternative can be online moderation of reflections, allowing the students to share with peers but reducing the contact time required from lecturers.

It is interesting that you should say that ethical reflections might have 'non-ethical issues'- In fact, there are very few clinical scenarios which do not have ethical facets to them. Students are redirected to the appropriate source if they want to discuss a purely clinical question, for example a pharmacology question.

I have enjoyed reading this discussion on teaching ethics. I teach in an undergraduate physiotherapy program and agree with comments that teaching ethics should be common across all health disciplines. A scaffolded approach to teaching ethics is implemented at my institution where ethics subjects are not taught as discrete subjects but rather ethics is taught across the year levels through a range of problem based learning subjects thereby allowing scaffolding of teaching according to student year level and clinical experience. In this way, reflection as suggested above is definitely used as a vehicle to teach ethics.

However, I would like to make an important distinction between teaching ethics and nurturing the development of ethical professional behaviour in our healthcare professional students. In my experience, teaching physiotherapy students ethics through exploration of professional codes of conduct and discussing ethical dilemmas does not always translate into ethical clinical practice. This is often due to a sense of powerless students perceive when undertaking clinical placements. I am then left to consider the likelihood of this behaviour changing when students graduate. Students often identify unethical or unprofessional behaviour and comment that they would never do that particular action but feel powerless to change particular circumstances. Perhaps the answer lays in empowering students with confidence and courage to not only understand ethical practice but to practise ethically.

I teach a single class on ethics and a single class on rationing to both MBA students and MHA students in the context of a survey course of 10-16 classes.

My focus in both classes is on hospital or healthcare system non-clinician managers.

In the ethics class I use the Duke case called "HCA" which illustrates some of the ethical issues at the provider/payor interface and provider/patient interface. In the rationing class I use a case written by Witswaterrand University about the Jo'burg hospital, which illustrates very tough choices on prioritization.

I've taught both cases for years and recommend them for use in a Socratic-style approach to mature students. Trust this helps.

Best

Marco

I think we need to teach ethic as a separate subject. Also we need to discuse about ethical case of patients of clinics.

I am a coordinator and educator in the bioethics module in the 2nd largest and oldest medical college in Saudi Arabia over the last 10 years. I think it should be an essential component of all health professional curriculae. However, I beleive in tailoring it to the needs of each profession i.e. the basic principles and overview can be given to everybody but the advanced part should be customised.

Ethics is included as one of the units of nursing subject taught in Indian nursing curriculum.Rapidly upcoming international heath care environments are far more demanding and making fresh grads.vulnerable for errors. I believe the essence of patient safety and altruism in professional practice lies in Ethics and Quality. Therefore I agree with Saghar and Hassan for it's inclusion as subjects in every health care curriculum. Further cusomization could be done assessing potential ethical conflicts and legal accountability specific to each profession.

We can not merely focus on student preparation but also must focus on the organizational culture to be conducive for ethical practice and quality to match with what is being preached.

As health care advances, nurses and other health professionals will find themselves in ethical dilemnas. It is imperative to posess self awareness which requires honesty with oneself regarding learned beliefs and values. Therefore, an ethics course should be mandatory in all health care professional curriculum

It seems that education in ethics is highly desirable. There is still some doubt in my mind as to how this is best organized. Should it be highly structured so that key concepts could be delivered, or should it be merged with the technical or clinical training?

Ideally we should do both, but this would be unlikely in most curriculum. Does anyone have any further thoughts on this?

I think if you merge ethics in clinical training you could have a problem of standardization of material taught to all students and at the same time not all clinicians may devote sufficient proportion of their clinical sessions to teaching of ethics. I think ethics should be taught as a separate subject. It could be made more appealing to students if it is delivered mainly in a participatory fashion and in the form of case studies. In my experience this is more effective and much more highly appreciated by the students than presentation of concepts in the abstract.

I teach medical ethics for undergraduate students: medical doctors, nurses and also ethics in medical research for post-graduate students. In my opinion and my experiences, its similar in curriculum when we teach on principle, but in practices we can use diffirent cases to teach for medical doctors or nurses because of the diffrent tasks of professional. Its important to teach ethics in the context of law and standard of professional value.

It is a hard taks, because residents just wants to do "hands". Its mean exploring patients, making surgery, do anything. The best way is teaching with example. Those medical seniors has to do everything between ethical. I share a paper wrote by my group: Promoting networks between evidence-based medicine and values-based medicine in continuing medical education.

Altamirano-Bustamante MM, Altamirano-Bustamante NF, Lifshitz A, Mora-Magaña I, de Hoyos A, Avila-Osorio MT, Quintana-Vargas S, Aguirre JA, Méndez J, Murata C, Nava-Diosdado R, Martínez-González O, Calleja E, Vargas R, Mejía-Arangure JM, Cortez-Domínguez A, Vedrenne-Gutiérrez F, Sueiras P, Garduño J, Islas-Andrade S, Salamanca F, Kumate-Rodríguez J, Reyes-Fuentes A.

BMC Med. 2013 Feb 15;11:39. doi: 10.1186/1741-7015-11-39.

Enjoy it !

I

I am teaching in local nursing school for training of pre and post registered nurses. We have ethics component for both courses because we believe that ethics is an important component. In the diploma course for the pre-registered nurses, the ethics is only one part in a particular module, but it is also being emphasized when the students are trained in other clinical modules.

For advanced diploma course for post-registered nurses, the students are coming back to school for their specialist training. The area of specialization includes critical care, emergency nursing, midwifery, pediatrics, oncology, neuroscience, gerontology and many more. The students will need to attend a compulsory module on legal and ethical perspectives in healthcare, where they will get better understanding about legal and ethics in healthcare. The legal and ethics component is incorporated and further emphasized in the specialist modules.

Hope this sharing may help in some way.

There is an undoubted need for a separate subject on Ethics in a nursing or other health care profession curriculum, of a pre or post-registration course as well as a need for teaching ethical care and ethical decision making during all clinical or theoretical courses. The module of ethics should be specially designed for each healthcare profession as ethical issues and dilemas between different professions, may vary a lot. However, I think that because of the demands of our highly competitive society and the stress put on nurses, doctors and other healthcare professionals for acquiring academic qualifications, we should specifically focus on teaching future health professionals how to deal with ethical dilemmas in research. Professional codes, laws, regulations, and ethics committees can provide some guidance but the final determinant of how research is performed, rests with the researcher's value system and moral code. To prepare future nurses or doctors, ethics in research, must receive special attention in the curricula. The criticism and uncertainties that arise, should be rather encouraged than suppressed in healthcare education. Case studies and scenarios in class, as well as dealing with real ethical dilemas in research projects of students, can be useful tools towards that direction. I attach an article about conflicts betwen research ethics and the caring nature of Nursing that may be useful.

Article What are the Major Ethical Issues in Conducting Research? Is...

Ethical education is imperative in both undergraduate and postgraduate education, as have already been commented on. However ethics is not something which lends itself well to didactic teaching. I think it is much more effective for students to be presented with ethical dilemmas and allow them to develop their reasoning and arguments. This is then supplemented by tutor guidance.

Ethics has been practised ever since medicine has been practised albeit implicitly. Medicine comes with its own morality and values. However, since the scandals (past and present) a resurgence of values in medicine has occurred. There is growing recognition that medical practise needs to be guided and hence medical practitioners (and all related to the health-care sector) need to be 'made' aware of ethical practices. This is not to say that all practitioners of medicine are unaware of or in violation of ethical practices, because they are not; it is only a minority who act unethically, though even those is enough to merit consideration of the fact that ethics teaching to medical professional is important.

How to do it is an important question. The idea of teaching values in medicine through case based studies (as stated by Ahmed Adeel and Etienne Ciantar) is very useful - practitioners engage more with everyday situations which will provide them with answers or ways to reach an ethical answer. These case based studies would be specific to the context they are being discussed in. This is important (as Hasan Alzahrani writes) contextualized approaches to ethics is essential, otherwise transposing a value system that is alien to the local context in a 'beam me up Scottie' fashion may not work.

Some may argue that what 'is' is not what 'ought' to be but what 'is' can inform how to apply what 'ought ' to be in a sensitive and sensible manner. Though values in medicine ought to be universal they are affected by the local context, as medicine is not practised in vacuum. Hence the charter for health values website (as Elizabeth Rider ) writes should not be a useful resource but also a forum to discuss and collaborate to incorporate perspectives of health -care professionals from varied cultures (and you will be surprised by the congruence of values between health -care professionals ).

Thankfully, we have no "ethics" training in our current curriculum for medical students....so the discussion offers a panoramic view of thoughts. The presumption that v r ethically sufficient is pervasive in the minds of policy makers....now there are attempts to introduce it at least for medical students!

We have so much to learn, is it ethical to introduce more, even if its about ethics? Y not make it optional

I believe there should be one ethics course in medical training. I had to take an ethics course. It is required training in Clinical Psychology. Medical students need to know that morals, ethics, and laws do not have the same definition in ethics training. There are ethical models that help professionals make decisions, like the Jone's Four Step Model. Ethics is more than 'do no harm'. We are given video scenarios that teach us how to deal with ethical issues in research. It is an interactive video experience. We can choose different paths.

Having the desire to learn about ethics is good. But in fast pace and complex environment in healthcare, making decisions/judgements that affect patient's treatment or relationships in hospitals employees is tough. Knowing the subject matter, and making the decisions in non-ideal conditions, are different and challenging. How could future nurses or doctors develop this capacity to made the right ethical decision?

You could do an online program at your own pace. I know that you are extremely busy as medical students, but this would be an alternative to classroom time. I'm an online student, so I may be biased. Just a thought.

Dear Anthony, I hope you are right. Maybe, we could see a drop in the number of malpratice suits against doctors and nursing

NEJM article by Jena AB, Seabury S, Lakdawalla D, Chandra, A Malpractice Risk According to Physician Specialty NEJM 2011 365 629-36

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

The Accreditation Council for Pharmacy Education in the United States stipulates that Ethics be taught in all 129 Schools and Colleges of Pharmacy in the U.S. At the University of Minnesota, the Academic Health Center approaches the teaching Ethics from an interprofessional perspective. Students from Dentistry, Medicine, Nursing, Pharmacy, Public Health and Veterinary Medicine team up to discuss case scenarios illustrating ethical dilemmas. This leads to very interesting discussions looking at the same problem from different professions' perspectives!

I have been teaching professional practice ethics to Pharmacy students since 1993. Possibly of interest to the international audience participating in this particular discussion thread, in 2005 I introduced a module in my course addressing multicultural ethics. The module has been very well received by the students.

I have attached the Learning Objectives from my course, and would be happy to share specific materials from my course for those who might be interested.

Learning Objectives attached as promised.

Hi, Timothy. Thanks for your sharing. Would it be possible to send me your course outline and any other material, particularly on multicultural ethics. Most grateful.

[email protected]

Every person comes to the study of a health related discipline with many aspects of moral character internalized. An important element in ethics education is to help students to assess their current level of moral development and to examine how it corresponds to generally accepted ethical norms. Values clarification and some study of theories of moral development can be helpful here. Ethical traditions of the past and present should be explored and used to expand the student's moral point of view and the justification he/she can provide for it. While it is important that students be "given" the philosophical arguments for ethical reasoning, the practice of reflection and critique of these arguments can be made on the basis of, for example, feminist theory that points to the gender differences in the evolution of a moral point of view based on social and political experiences that form the context for it. Equally important, are consideration of how race and class, as well as gender, influence in how moral theory is understood. These are just a few ideas that might expand the discourse among students, and promote the reflectiveness required for ethical practice.

Health ethics as well as jurisprudence will help

Professions have codes of ethics, standards of practice, and defined roles in ethical conduct and ethical decision-making. These should be addressed early in the education of health-related disciplines because they provide important context for addressing ethical concerns in practice. Students should be aware that decisions by solo practitioners has become the exception rather than the rule in current practice. Students should be afforded experiences with ethics committees in clinical settings and oriented to ethics consultation and resources within practice settings. Experiencing the application of codes of ethics, standards of practice, and application of ethical reasoning to real clinical situations would prove valuable. This would bring theory from "the book to the bedside". Interdisciplinary education in ethics helps the various disciplines to appreciate the perspectives of others' professional roles.

Jurisprudence is broad, but that shouldn't be a reason for a nurse to know nothing about it.

I think some topics are commum for all health professionals.But also each discipline will face differents challenges in their practices. There is an article that discusses about the limitation of an ethical code for everybody in health care. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113129/

I believe that ethics are an important aspect to clinical research and health care in general. There are plenty of discussions in the literature and books devoted to this subject. I strongly believe that there are disparities in the treatment of patients in lower socioeconomic classes as compared to the well insured in the US. To me, this is an ethical issue that needs to be addressed and emphasized on a regular basis. Another issue related to the first is judging patients based on their standing in the community. My wife is also in the health care field and witnesses these ethical disparities on a daily basis. One of the tenents of a practice known as "mindfulness" , which my wife will be researching as an advanced degree student, is to not judge others. She will be instructing her co-workers to do the same in the interest of not only reducing stress in health care workers, but allowing them to provide better health care to their patients by reducing the effects of stress on the quality of the care they provide to ALL patients.

You make some salient and disturbing claims. I suspect these are issues for healthcare providers in other countries as well and there are factors that impact on these behaviours beyond the ethical.

I am a Senior Clinic Coordinator for a baccalaureate dental hygiene program. HIPAA, electronic personal health information (ePHI), encrypted networking, digital transmission of information, etc. are all very complex and highly sensitive issues that require individuals to understand and value the laws and regulations. It is too easy for health care providers to not abide by the law for the sake of convenience.

I think an entire course on HIPAA and ethics related to patient privacy laws is needed. Thanks.

In response to Ms. Agado's comment (from an 1980 ISU grad): As a condition for accreditation, every U.S. School or College of Pharmacy must address both the ethical and legal considerations regarding the protection and sharing of protected (i.e. private) patient information. Usually this occurs in the Pharmacy Law course. For the international participants in this forum who may not be familiar with HIPAA, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law enacted in the U.S. in 1996. HIPAA arose out of concerns about inappropriate use of private patient health information. These concerns were well-founded, based on some egregious incidents of misuse of individual patient health information that patients thought to be private. Some of this information was being sold to companies interested in marketing specific health-related products and services to patients suffering from specific health conditions. Interested forum participants can learn much more about HIPAA than they probably want to know by searching HIPAA on the Internet. Really is a rather interesting history leading up to passage of this legislation.

Bioethics is a must in medical education regardless the students are future doctors, nurses, or other health related professionals. The problem is there will be no way to assess how successful the course will be to the students. Worst of all, most of the students were absent from the class. HIPPA rule is applied to USA for a reason. If there is not legal responsibility then some of us will forget to abide by the bioethics. However, HIPPA does noty apply to all the medical related issues. Use you wisdom to arrange the course according to your cultural background will be vital.

Dr. Schapera brings up a couple of interesting points. First, I would argue that Ethics is indeed system of behaviors and speech, but behaviors and speech BASED on "knowledge" of what is right or wrong. This knowledge may also be referred to as "values." As Dr. Teng suggests above, the cultural in which a person is raised and lives influences the definition of "right and wrong." Regardless of culture, however, I would offer that all health professionals develop their sense of ethically acceptable behavior following a similar path: As wee tots, health professionals begin to obtain their knowledge of right and wrong from the adults in their lives, primarily family members. Then as schoolchildren, future health professionals obtain additional knowledge about right and wrong from their school teachers (and for better or worse, from their peers). Later still, health professionals add to, and hone their knowledge regarding "ethical professional behavior" from their professional school professors and clinical preceptors.

That the U.S. Congress felt it necessary to pass a law such as HIPAA to govern ethical behavior among health professionals in this country is a sad commentary on how (a small number of) health professionals betrayed the public trust related to protecting the privacy of patient information. HIPAA carries substantial financial penalties of up to $US 1.5 million for each violation. It is indeed unfortunate that Congress feels that this level of potential punishment is needed to encourage professionals to "do the right thing."

Have you ever heard of the study that was going on at Harvard on Ethics? It is called The Good Works Project. I am sure you can google it. We did a small study here with students answering questions in focus groups. I will attach a little snippet of the results for you to see. Susan

AHRQ Disparities Report Shows Healthcare Gaps in Quality and ...

https://www.aamc.org/.../052413ahrqreportshowshealthcaregapsinquality...‎

May 24, 2013 - These disparities are even more pronounced for measures of healthcare access: poor, low-income, and middle-income people had wors

I have just been studying this topic in an ethics class I am taking. I find the disparity between what physicians are being taught and what nurses are being taught is amazing. For instance the issue of verity or truthfulness is taught differently, with doctors being taught that they should not necessarily tell the truth if they feel it will take away hope. As a nurse I think that being truthful is imperative. If a prognosis is poor, the person should be told because they need to be able to make decisions based on accurate information. A few more months or days of hope may take away the ability to take final steps to end a life with dignity and respect. I believe that ethics education is crucial. We have so many more ways that medicine can impact a life today, but just because they are available does not always mean we should use them. We need to be able to defend our decisions based on sound teaching and sound principles and reasoning.

My biggest problem with not being truthful is that people don't always have the opportunity to make final decisions when they are not given truthful answers. For instance, I have worked with cancer patients who are given the really rosy outcome from doctors that they "could live another 20 years", when if fact, their diagnosis and prognosis really don't support that rosy projection. So, would the patient choose the aggressive therapy if they knew that they more than likely would only live another year or two? Would they instead make the choice to spend their remaining days with family and be as comfortable as possible? Would they necessarily want to spend their assets on medical care, or on providing for their family to the best of their ability? I do not say that people should not have hope, or that they should always be given the most dire information alone, but I for one would want to make decisions based on reality rather than on pie in the sky projections.

We hear sometimes: "everybody has reason and nobody has reason". I think this should be aapplied in situation. Here I think there isn´t the right or the wrong. There is the more adequate in response to patient´expecttions. I have learned about humanity in caring (after a long way of learning).The respect and the justice to patient begin with the attitude of listenning to him/her.And we do this day by day. In approximating and understanding what he/she says and feels. In exerciizing the empathy. a cleef instrument in caring, physician or nurse; and other health professionals. Then we should understand what he/she wants and needs.I think this is ethical posture in caring for. It will guide us to know what is necessary to attend him/her in that moment. And if he/her wants to really know about the truth. If he/she are prepared to hear it. or no. Then we shoud wait for his/her future indications if he/her changes the perception relation to his/her reality.

Adding Professionalism can answer the question , it definitely ensures bringing up the professionals to the height of fulfillment in the context of societal needs.

Professionalism as a continuous taught /assessed course for the medical students , nurses or even for any other profession may approximate the needs of various professionals .

particularly for medical students this course should have started at an early stage of curriculum ladder and then should be continued to the clinical years as that would be the hands on time / real life dr-patient encounters etc.

starting this course in early years will let students have metacognition and later on in the clinical years their attitudinal skills would better be practiced as well as measured.

theoretically the fundamentals / Professionalism attributes/basic and essential elements remain same with little variation in the practical part , in other words there is little difference among different cultures and societies so it would require in the curriculum to make some topics e.g. PROFESSIONALISM IN DIFFERENT CULTURAL CONTEXT , WHERE taught content will target a more realistic viewpoint in consistence with that particular societal needs where the content is taught moreover there should not be major difference among various professions when it comes to teach them professionalism yet the assessment varies.

Hays, Richard, Gary Hamlin, and Roger Worthington. "Developing professionalism in health professional learners." The clinical teacher 10.1 (2013): 64-66.

1. It is necessary to re-introduce the Hippocratic oath obliging to it as necessary condition for a degree. Bio-Technologies are not the meaning of health professions, true missions for taking care of suffering persons.

2. It is necessary to Introduce a curriculum in “Medical ethics”, where possibilities and objective limits to health professionals are considered ( eg killing a child in the uterus (induced abortion) or kill a patient in a terminal state) re-introducing the concept of a spiritual objective meaning in health professions which only can give a meaning to the right to be cared and to health. In medicine the irreducible and mysterious dignity of an human being, a person, determines objective limitations to other persons with bio-technological powers. Who can decide about life or death of an other human being ? Only an omnipotent person !

3. Teaching Person Centered Medicine and Person centered clinical method which are coherent with the epistemological revolution of medical science, to date not known by the majority of health professionals. (see http://www.unambro.it/html/smistamentoISPCM.html)

http://www.unambro.it/html/pdf/milano2013.pdf

and http://www.unambro.it/html/pdf/PCM_History.pdf.

Theoretical and Clinical techers must update their teaching skills and research method in medical education. To date traditional education is not sufficient.

Health professionals must be necessarily able to work with subjective resources and problems of persons which are related to biological variables and pathogenesis or unhealthy behaviors, implementing resources of persons also for resolving existential problems posing ethical problems., not resolving it with technical acts in substitution of moral and behavioral responsibility of persons/patients., spread behavior of many superficial and not prepared health professionals ignorant about iatrogenic effects of their acts, able also to speculate on human misery and suffering.

Medicine is an "ethical science".

Giuseppe R.Brera

Dean of the Milan School of Medicine

Director of the International School in Person Centered Medicine

Letter for Research Gate 18.11.2013

Need for knowledge and awareness concerning ethics in medical sciences and clinical practice depends on post, tasks, and area of responsibility of the particular health care worker. There is of course need for description of the minimal necessary knowledge and experience on each post. From my point of view (senior assistant, neurorehabilitation) neuroethics is key issue, affecting both work of interdisciplinary therapeutic team and co-operation with patients, his/her family/caregivers. Significance of neuroethics will increase in the future, concerning e.g. new drugs, brain-computer interfaces, neuroprostheses, deep brain stimulation, etc.

I feel medical curriculum should include module on bioethics and principles on which it is based but at the same time, ethical aspects should run longitudinal across all undergraduate years and be component of all teaching modules. It should be re-enforced by practical demonstration by teaching faculty. Such a holistic approach will help

It must be a patient centered medical education, research and practice, than money related

Ethics is universally defined as the principle of what is right and what is wrong? Major ethical principles include autonomy, beneficence, nonmalfeasance, justice, veracity, confidentiality, and fidelity. However, what is right and what is wrong is contextual. Personally there is no specific measure or parameters of what is right and what is wrong because it is contextual.

Should we have the same ethics course for nurses and doctors and other professionals?

Ethics is required in all courses or professions but applied variably depending on how they do things in their profession and how they are expected to behave in their profession. Thus, we have what we call codes of practice and codes of conduct as a nurse, doctor, teacher, engineer, lawyer, businessman, and others.

As the largest sector of the health professions in the United States with more than three million registered nurses, the world needs to hear our voices in forging a new vision of Ethical Legal and Sociocultural Issues (ELSI) in nursing education, research and practice (NERP). NERP is constantly evolving and is at the cutting edge of nursing. integrating ELSI in NERP is our obligation to the global society. The ethical issues we need to integrate in NERP are autonomy, justice, veracity, fidelity, nonmalfeasance and beneficence. The legal issues are: public law, criminal law, and tort law. The sociocultural issues in ELSI are accommodation, building bridges, collaboration, and diversity (A-B-C-D). Further, envisioning ELSI through the Complexity, Synergy, and Systems (CSS) lenses/theories engages nurses all over the world in the multifaceted nature of nursing (complexity theory), its collaborative relationship with various disciplines (synergy theory), and the permeability of nursing's boundaries (systems theory). Teaching ELSI through CSS as a theoretical framework and lens grounds NERP to withstand and transform challenges into opportunities for growth and positive outcomes. Evidence-based literature in all NERP curriculum needs examined through ELSI.

hi. I am master of medical education. I think that some principles of ethics for nurses and other healthcare team are the same. but because of differences in work position, you have to use your creation to educate them different topics or subjects or courses.

I belive that all the medical disciplines should have a strong teaching of ethics. I've heard and I've seen an incredible amount of doctors and nurses that don't do the right thing (don't respect the principles of bioethics) because they don't know what is the right thing. I think that one of the biggest reasons of today's amount of medical-related legal issues is the fact that medical professional don't know anything about ethics.

Of course.  

The tough questions are who is capable of teaching it?  Not just any physician who thinks he is ethical!  And how should it be taught...there are many examples of how not to teach it.  Don't make the same mistake!

@ Jeffrey

Indeed it's tough, yet there's a need. Can you elaborate on how not to do it?

Ethical problems in Medicine are a component of its epistemology, that is the Meaning, Methods, and Knowledge objects of Medical Science.

Ethical problems are comprehended in the philosophical concept of Meaning and in its objectivity.

Medical Science and the health concepts are changed and Medical ethics must start by this change.

The paradigm change will be formalized in the Conference:

"Medical Science and Health Paradigm Change"

Milan. 13-14-15 October 2017

If you agree sign "La Charte Mondiale de la Santé-The World Health Charter"

(Text and info on the Conference web site"

https://www.healthparadigmchange.it

The online site of my book on medical ethics in Islam is :

 The book of ISLAMIC APPROACH TO MEDICINE IS FOUND IN

THIS SITE

http://www.islamicmedicine. org/SayadBook2.htm

This book was written by the request of the medical faculty of King AbdulAziz University in Jeddah KSA in 1985 and forwarded by the Grand Imam of Al-Azhar  and published twice by Al-Azhar supreme Council of research  and translated to Engish by Professor Tawfeek Al-Tamimi Dean of the Medical faculty of Dammam KSA. It was translated also to Persian language. The Kuwait medical association published it and distributed 4000 copies free to the medical staff in Kuwait.

All referees agreed about the main ethical issues, but there are few points that differed by the difference between societies. it should be taken in consideration.

All referees agreed about the main ethical issues, but there are few points that differed by the difference between societies. it should be taken in consideration.

I agree that ELSI (Ethical, Legal and Sociocultural Issues) differ among societies. In this article, general principles are discussed which could be useful in responding to ELSI globally.

Kasia Kozlowska (a psychiatrist at the University of Sydney) and I (a lawyer/philosopher/bioethicist and Senior Editor of the Harvard Review of Psychiatry) just published (with Palgrave Macmillan) an open access (free download) book, "Rethinking Health Care Ethics," in which a central issue is how ethics should be taught in the health professions. I hope you will take a look. Here's the download link: https://www.palgrave.com/us/book/9789811308291

I believe that the best way to teach ethics is through problem based learning , where you can teach ethics and professionalism within a clinical context .

Please read my attached book about ethics for health professionals.The book was forwarded by the Grand Imam Sheikh Al-Azhar( who is equivalent to the Pope of Rome in Christianity) when I was a professor at Al-Azhar University, and published in 1978 and translated to English at the faculty of Medicine Dammam university KSA. The basic principle is that the health professional is doing his job not for salary or reputation or self esteem but he tries to do the best in his job in response to the message of God to be rewarded for his effort not by humans in our life but from God in the day-after.