Tag: medical education

Bioethics Blogs

Ethics Committees Should Have Standards in Preparing New Members

Guest Post: Danish Zaidi and Jennifer Kesselheim
Paper: Assessment of orientation practices for ethics consultation at Harvard Medical School-affiliated hospitals

Ethics advisory committees (EACs), or clinical ethics committees, fulfill an important role in hospitals, providing ethics consultation, contributing to hospital-wide policies, and educating staff on ethical dimensions of medical practice. Our study built upon a central question: what qualifies one to serve on these sorts of committees? It’s a question with added relevance to us as authors: Danish Zaidi was part of the inaugural class of the Harvard Medical School Master of Bioethics program and Jennifer Kesselheim is an EAC co-chair and the founding director of the Harvard Medical School Master of Medical Sciences (MMSc) in Medical Education program. We studied how EACs recruit and educate members of their committees. In particular, what orientation practices were use in educating new members of EACs and how did members perceive confidence were member in fulfilling their duties on the other end of their “orientation”?

In recent years, the American Society for Bioethics & Humanities (ASBH) has made efforts to improve and standardize practices in ethics consultation across medical institutions. The ASBH has published two foundational books regarding ethics consultation and recently their Board of Directors approved the development of a healthcare ethics consultation (HCEC) certification program. Such efforts allude to a desire for standards in ethics consultation. As such, we turned to the ASBH Core Competencies in Healthcare Ethics Consultation to identify areas that we felt committee members should have familiarity with, using these competencies as metrics to develop our survey instrument.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Hard lessons: learning from the Charlie Gard case

by Dominic Wilkinson and Julian Savulescu

 

On the 24th July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion (Box 1). Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. It is expected that life support will be withdrawn in the days ahead.

Over the course of multiple hearings at different levels of the court in both London and Strasbourg, the Charlie Gard case has raised a number of vexed ethical questions (Box 2). The important role of practical ethics in cases like this is to help clarify the key concepts, identify central ethical questions, separate them from questions of scientific fact and subject arguments to critical scrutiny. We have disagreed about the right course of action for Charlie Gard,1 2 but we agree on the key ethical principles as well as the role of ethical analysis and the importance of robust and informed debate. Ethics is not about personal opinion – but about argument, reasons, and rational reflection. While the lasting ramifications of the case for medical treatment decisions in children are yet to become apparent, we here outline some of the potential lessons.

1. Parents’ role in decision-making for children: We need to clarify harm

Much of the media attention to the Gard case has focussed on the rights of parents in decision-making for children, and whether the intervention of the courts in this case means that doctors frequently overrule parents in the UK.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – June 2017, part one by Aaron Seaman

Anthropology and Aging (open access)

The Social Context of Collective Physical Training among Chinese Elderly: An Anthropological Case Study in a Park in Beijing

Yeori Park

This study analyzes the social context in China where the elderly participate in collective physical training, a cultural activity specific to the country. For this study, senior citizens aged 60 or above who participated in collective physical training in a park in Beijing were observed for five months. Research results found that collective physical training enables formation of social networks providing mutual caring and support. On the other hand, the participants conform to the self-disciplined modern discourse to survive in the post-Mao society. They do collective physical training due to their social conditions, such as the poorly established welfare system for the aged, severance pay that is too low to cover medical expenses. Although the participants seem to autonomously choose collective physical training based on their own preferences, the context of Chinese society, including hidden government intentions, leads the elderly to participate in training activities.

Social Contract on Elderly Caregiving in Contemporary Chile

Carola Salazar

This paper explores the definitions of social contract on elderly caregiving among a group of seven Chilean aging experts. The data show that for Chileans, family remains a strong institution that should provide care of its members, with daughters or daughters-in-law being the preferred person to provide care. Also, age segregation, along with the gradual privatization of services such as health care and the pension system, promotes individuality: this can become a problem for future generations because they are no longer concerned with helping others.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Confronting Medicine in the Holocaust & Beyond

By Hedy S. Wald

Galilee, Israel, May 7-11, 2017. I was privileged to be at the Second International Scholars Workshop on “Medicine in the Holocaust and Beyond.” Why so meaningful?  Why so needed? 140 purposeful, passionate scholars from 17 countries delved into the past history of medicine at its worst in order to inform the future.  From 1933-1945, presumed healers within mainstream medicine (sworn to uphold the Hippocratic Oath) turned into killers (1).  Yes, medical ethics in Nazi-era medical school curricula existed, yet included “unequal worth of human beings, authoritative role of the physician, and priority of public health over individual-patient care”(2).  In Western Galilee College, (Akko), Bar-Ilan University Faculty of Health Sciences (Safed), and Galilee Medical Center and Ghetto Fighters’ Museum, (both in Nahariya), historians, physicians, nurses, medical and university educators, medical students, ethicists and more gathered to grapple with this history and consider how learning about medicine in the Holocaust can support healthy professional identity formation with a moral compass for navigating the future of medical practice with issues such as prejudice, assisted reproduction and suicide, resource allocation, obtaining valid informed consent, and challenges of genomics and technology expansion (3)…

The conference, in essence, served as a lens for the here and now, reinforcing my contention (and others’) that history of medicine in the Holocaust curricula including confronting the Nazi physicians’ and scientific establishment’s euthanasia of “lives unworthy of life,” forced sterilizations, horrific experimentation on their victims, and medicalized genocide (leading to the destruction of a third of the European Jewish population and many others) is a “moral imperative” in healthcare professions education (1,4).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Caregiving: Can It Be An Attribute of Our Healthcare System?

By David C. Leach

An old joke begins by asking that you imagine a man drowning 100 feet offshore while a conservative and a liberal are observing.  The conservative throws him a 50 foot rope and says: “swim the extra distance, it’s good for you.”  The liberal, on the other hand, throws him a 100 foot line and then promptly drops his end of the line in order to go and do another good deed.

While offering insight into our politics the story also illuminates some of our habits around caregiving in our current healthcare system and the policies supporting that system.  Certainly individual stories of near heroic caring can be found, but the system itself is designed around processes and structures that seem to diminish the importance of the caring relationships at the heart of our work.  Caregivers frequently depend on work arounds.  What would it take to develop a system that respects, rewards, or at least enables genuine caregiving?

Caregiving, of course, is an attribute of humans, not systems.  To care for another requires a voluntary opening of the heart to compassion; it requires noticing and acknowledging the uniqueness of the other and a willingness to enter into their context.  Keenan defines mercy as the willingness to enter into the chaos of the other.  (1) The biblical story of the Good Samaritan (Luke, 10:33) illuminates an interesting attribute of caregiving that may indicate why humans can care and systems cannot; the clue is in the voice of the verbs used.  The story is well known: a traveler has been assaulted and robbed.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Euthanasia in Canada: Early Returns

Last week’s New England Journal of Medicine carried a report from physicians in Toronto about early results implementing “Medical Assistance in Dying,” or “MAiD,” the preferred euphemism for doctor-assisted suicide or euthanasia, in Canada.

“MAiD” became legally sanctioned throughout Canada in 2016.  It includes not only assisted suicide—where a doctor provides a patient with a drug prescription intended to be lethal if taken as directed—but also euthanasia, in which a doctor actively kills a patient, at the latter’s request (at least for now).  The recounts provisions in Canadian law intended to limit “MAiD” to people whose medical condition is deteriorating from a serious, incurable disorder, and to ensure that people who receive “MAiD” do so after freely requesting it, and affirming that request after 10 days to think it over.

To keep things “controlled,” the Toronto program is entirely hospital based, limited to lethal IV injection for which recipients are evaluated and ultimately killed by dedicated physicians who have freely agreed to participate.  The specific hospital ward where a patient is euthanized is rotated, so that no ward gets the title of the “MAiD ward,” but the medical team is set.

Some noteworthy points:

  • MAiD was assigned to the Department of Supportive Care. Other clinical departments demurred out of concerns like “conscientious objections of staff” and “obscuring their specialty’s role in protecting life.”
  • As reported elsewhere, patients receiving MAiD sought it because of loss of autonomy, as well as inability to enjoy life, not because of uncontrolled physical symptoms. These people “tended to be white and relatively affluent.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

“I Never Considered That.” Medical Student Professionalism Peer- Evaluations and the Self-Identity of a Future Physician.

By Anna Lama

I recently presented a workshop on the assessment of professionalism at the Southern Group on Educational Affairs (SGEA) conference.  I planned to discuss the elements of assessment: developing a framework to define professionalism, discussing successful assessment practices and reviewing the various tools available to assess professionalism.1  Much to my surprise, the discussion quickly moved into deeper inquiry on student participation, perceptions, and self-identity through the use of peer evaluations on professionalism…

What do your students say about their feedback when they receive it?
Do you talk to students about overtly critical reviews?  Overtly glowing reviews?
How do you deal with initial reactions to those comments?
Are they anonymous?
How do you know they are reflecting and “getting real” with themselves?

Inquiring minds wanted to know! Thankfully, two of my medical students happened to be in the room with me.  “I really value the content of the peer evals, and the scale was not difficult to use.  This evaluation tool can help students with their teamwork skills which translate really well to working with patients.”  Gasp! My heart stopped beating for a moment as my student offered his unscripted reflection.  He was able to share a perspective in the most honest and intimate way.

As the assessment director for the West Virginia University School of Medicine, I read hundreds, if not thousands, of evaluation data pieces per year.  While all are important pieces, the most interesting is our student peer-to-peer evaluation and self-evaluation, which specifically addresses professionalism.  Both evaluations are similar in structure where the students are to identify strengths and weaknesses, through specific questions, within nine domains such as honesty and integrity, accountability, responsibility, etc.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Medical Students Can Handle the Truth; Their Mentors Should be More Open About It

By Shannon Tapia

Medical School is rough.  Fortunately there is a recent movement to make medical education more humane.  The movement to bring humanity, ethics, and love back into the molding of our future physicians is crucial. Personally, I felt my medical school was on the forefront of this push.  Perhaps it was because we had Jesuit priests for attendings and the hospital’s motto of “We also treat the human spirit” filtered into the treatment of students.  Whether it was something about myself or my medical school, I was fortunate to never experience the depression, competitive urges, burnout and isolation that is so prevalent during American medical school years…

But there is an underlying and hidden truth that is never spoken about, or at least wasn’t to me, in medical school.  As students we are warned how tough medical school is and furthermore how absolutely draining residency is.  When we’re in the thick of either in even the most uplifting programs and schools, we are monitored for burnout, offered services to prevent it, and given support in ways students and residents of the 20th century never were. More frequently now, we are prepared for these harsh realities.  But what we’re not told, ever, is that even if and when we make it through medical school and residency/fellowship to attending physicians we may well find it’s not greener on the other side.  We may still first experience burnout when we’re supposed to be summiting our Everest Mountain of medical training. As many mountain climbers will tell you, often the way down from the peak is just as hard if not harder than the climb up.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

TOMORROW (4/5)! Crowdfunding Medical Care: Identifying Ethical Implications

Crowdfunding Medical Care: Identifying Ethical Implications April 5, 2017 12:30 PM  Tosteson Medical Education Center, Room 227 Harvard Medical School, 260 Longwood Ave., Boston, MA Register for this event This event is free and open to the public, but seating … Continue reading

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

REGISTER NOW (4/5)! Crowdfunding Medical Care: Identifying Ethical Implications

Crowdfunding Medical Care: Identifying Ethical Implications April 5, 2017 12:30 PM  Tosteson Medical Education Center, Room 227 Harvard Medical School, 260 Longwood Ave., Boston, MA Register for this event This event is free and open to the public, but seating … Continue reading

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.