General description of the course:
Health care decisions are based not only on clinical and technical grounds, but also on ethical grounds. Although we carefully weigh the clinical and technical aspects, ethical issues involved may be overlooked. A legal framework or code of conduct governing doctor’s decisions and behaviour may help overcome this problem but they often provide rigid guidelines for a limited number of situations.
General objective:
The general aim of the module is to help medical students to recognize the importance of being sensitive to ethical issues within everyday clinical practice and develop in them the ability to effectively address ethical concerns of patients as well as participants in research. Through the teaching/learning exercises in this module we aim to instil in the student, knowledge, skills and attitudes necessary to guide their conduct and decision making as a practising doctor.
Specific objectives:
Students will be able to
- critically analyse ethical issues commonly encountered in medical practice and formulate a framework within which such issues could be resolved
- demonstrate the ability to resolve ethical issues faced during common clinical scenarios
- demonstrate awareness of the main professional obligations of doctors
- Practice according to statutory requirements and codes of conduct for medical practice
- Identify the ethical aspects involved in conducting research and apply ethical principles in conducting research
- demonstrate sensitivity to ethical issues and ethical behaviour within and outside professional practice.
Implementation of the course:
The students will learn about the content of ethics during the total duration of the course, the basic principles will be learnt during the first year, topics related to different disciplines will be dealt with in respective disciplines. Learning in ethics will be reinforced during the final year of MBBS course. The research ethics will be learnt in the course on research methodology.
Medical Education Department will be responsible for organizing the orientation and reinforced course and will also coordinate with different departments for helping students to learn medical ethics.
The learning of ethics will be integrated with the rest of the curriculum and clinical practice is proposed by the use of:
- multidisciplinary academic staff representing both clinical and paraclinical fields members of relevant professionals/governing bodies (eg. Medical Council, National Medical Association)
- members from relevant disciplines (eg. law, psychology, sociology, economics, philosophy)
- country specific examples
- examples to illustrate concepts from clinical cases and routine practice
- teaching both in clinical and non clinical settings
- testing of relevant ethical issues during student assessments in other settings
- continuous reinforcement of ethical aspects across the components of the curriculum
- Handling of some topics by relevant departments in their courses
Management of the course:
It is recommended that the Medical Education Department will
- appoint a responsible core group for planning and implementation of the module
- identify resource persons at the planning stage of the module
- undertake training of trainers workshops at regular intervals to sensitise faculty to the program
- obtain feedback pertaining to each learning activity and the program as a whole from stakeholders to continuously improve the program
- provide information to both students and faculty regarding the module through handbooks
Specific objectives:
Principles of medical ethics
Students will be able to
- explain the meaning of the term ‘ethics’
- describe the development of medical ethics
- describe the core principles of medical ethics and their implications
- recognize the application of ethical codes in modern day medicine
- discuss the development of indigenous ethical codes in the South East Asian region
- describe salient features of ethical code of conduct of World Medical association and
- National medical councils
- application of ethics in relation to the cultural context
Clinical ethics: Doctor-patient relationship
Students will be able to
- discuss the ethical principles applicable within the doctor-patient relationship
- describe the patient’s expectations with regard to the above mentioned aspects and the doctor’s attitude towards those expectations
- recognize that the doctor patient-relationship is unique
Patient autonomy
Students will be able to
- explain the importance of patient autonomy
- explain current procedures adopted in the ward (clinical) setting in maintaining patient autonomy
- identify situations in which a doctor may have to go against patient autonomy
Confidentiality
Students will be able to
- recognize the importance of confidentiality in the doctor-patient relationship
- identify weaknesses in the health care system which leads to a breach of confidentiality and strategies for overcoming these shortcomings
- judge when it is justifiable to breach confidentiality
- evaluate critically the practice of the principle of confidentiality in the ward setting
Truth telling/disclosure
Students will be able to
- recognize the importance of telling the patient the truth about his/ her medical condition
- consider when it is justifiable to withhold information from a patient/relative
- make decisions regarding giving information to a patient as a medical student/doctor
- analyse the doctor’s role when there is disagreement between the doctor’s view and the views of patient, guardians or relatives
Informed consent
Students will be able to
- describe the different types of consent and the situations in which obtaining consent is required
- recognize the importance of obtaining valid consent from a patient for investigations and treatment
- explain how to proceed if a patient refuses treatment
- explain how to proceed if a patient is incompetent to give consent
- consider when it is justifiable to refrain from obtaining patient consent
End of life decisions
Students will be able to
- explain what is meant by “a good death” and the principles involved in providing
- “a good death” to a terminally ill patient
- explain the terms best interest, advance directives, withdrawal or withholding life support systems, Do Not Resuscitate (DNR) orders and euthanasia
- explain the legal situation with regards to euthanasia
- respond appropriately to a patient who requests euthanasia
- apply the ethical principles underlying management options {i.e. ventilation and other options) in the terminally ill
- apply these principles in improving the quality of life in terminally ill patients
- demonstrate how you would communicate end of life decisions to appropriate persons
Patient rights
Students will be able to
- describe the concept of rights of individuals
- identify the relationship between rights, duties and responsibilities
- outline the International Declarations of Human Rights
- describe the Declaration of Rights of the Patient developed by World Medical Association (WMA)
Social justice
Students will be able to
- explain the term social justice
- recognise the relevance of social justice to a doctor
- discuss the WHO definition of ‘Health’ and the ‘Health for all’ concept and its implications in social justice
Professional ethics: Codes of conduct
Students will be able to
- discuss the ethical importance of good communication within the medical profession and amongst other professions
- describe the international and local codes of conduct for medical practitioners
- illustrate with examples, statutory requirements for medical practitioners
Professionalism
Students will be able to
- explain the term ‘professionalism’
- describe the key attributes of a medical professional
- discuss the relationship of a professional with his colleagues and the public
- describe how professionalism benefits the medical practitioner
Medical negligence
Students will be able to
- describe the term medical negligence
- describe the criteria to be established against a doctor, when judged as negligent
- discuss the main defences available in the case of negligence
- discuss how medical practitioners can prevent being taken to courts for medical negligence
Professional misconduct
Students will be able to
- explain the term professional misconduct
- identify the occurrence of professional misconduct and the disciplinary procedures to be followed in these instances by governing bodies.
- recognize the necessity for self regulation in maintaining the standard of practice
Ethical dilemmas facing medical students
Students will be able to
- recognise medical students as part of the medical team managing patients and their responsibilities to the team and patients
- describe the ethical dilemmas that medical students face in their clinical training
- Identify methods to handle ethical concerns that involve medical trainees at individual and institutional level
- recognize that ethical issues exist in examinations such as plagiarism, cheating, etc.
- recognize student research projects that need ethics approval and obtain approval for such projects
Relationship with the pharmaceutical industry-
Students will be able to
- recognize why doctors need to be careful when interacting with the pharmaceutical industry
- discuss the ethical and legal criteria in promotion and advertising of medicinal drugs and devices
- discuss the doctor’s role and responsibility in dealing with inappropriate promotion practices and requests by the pharmaceutical industry
Issues related to health care provision by private sector
Students will be able to
- discuss the issues of access to private health care including insurance
- discuss the ethical issues arising from doctors working in both public and private sector
OTHER TOPICS
Clinical ethics
Ethical issues related to reproductive health
Students will be able to
- describe the ethical issues of abortion — the debate about the Segal status of the embryo; the terms “pro-life” and “pro-choice” and the arguments put forward by these two camps
- discuss situations in which abortion is permitted in your country
- discuss ethical and legal issues relevant to permanent methods of contraception
- analyse the legal boundaries and ethical disputes in assisted reproductive technologies
Ethical aspects of genetics
Students will be able to
- describe how genetic information is different from other information
- discuss how genetic testing and counselling services could be provided in an ethical man
- describe how genetic information can be used to discriminate individuals by insurers, employers, and others and how discrimination based on genetic information can be prevented
- discuss ethical issues related to all forms of genetic screening (preconception, pre- implantation, prenatal, newborn, predisposition for adult onset disorders and population)
- discuss ethical issues created by sex selection, gene therapy, stem cell research/therapy, genetic enhancement including genetically modified foods, patenting genetic discoveries, therapeutic/reproductive cloning, and eugenics
Ethics of transplantation/organ donation
Students will be able to
- discuss the ethical issues of obtaining organs for transplantation in live related organ donation, live non related organ donation, cadaveric organ donation and xenotransplantation
- discuss the legal issues relating to all types of organ donation
- discuss the ethical issue of all types of organ donation in the context of a limited resource setting
Ethical aspects of treating the mentally ill
Students will be able to
- recognize mental disorder and mental incapacity
- describe ethical and legal implications of serious mental illness
- describe ethical concerns in treatment, legal detention and research on patients with severe mental disorders
- discuss the ethical and legal concerns of patients with mental illness which involve the family and community
Ethical issues in treating children
Students will be able to
- discuss the important ethical issues related to health care and research involving children such as proxy decision making and promoting the rights of the child
- formulate methods to gain cooperation of children
- assess the ability of children to give consent
- discuss ethical issues that arise in child adoption
Ethical aspects of treating patients with HIV/AIDS
Students will be able to
- Recognise that unethical practices such as refusal to treat, stigmatisation and unfair resource allocation may occur in treating patients with HIV/AIDS and how to address these issues
- Describe ethical aspects of notification and partner tracing
- Describe the correct practice of HIV/AIDS testing in patient care and in screening
Resource allocation in the health care system
Students will be able to
- discuss the principle of justice in resource allocation
- explain the term equity
- describe the theories of resource allocation
- describe the ethical issues in micro-allocation of resources
- illustrate the ethical issues in macro-allocation of resources
- describe with examples the methods utilized to allocate scarce resource in the local health care delivery system
- recognize situations in which allocation of resources is unjust and seek resolution of these situations using ethical criteria
Ethics of public health and health promotion
Students will be able to
- analyse the conflict between the issue of ‘for the good of the individual’ and for the good of the society’
- explain the ethical issues that arise in the practice of public health and health promotion
- illustrate examples of ethical issues that arise in providing public health services to groups at special risk
- discuss the relationship between public health and the law
Ethical issues of dealing with other systems of medicine
Students will be able to
- describe issues/concerns arising in situations in which there is concurrent usage of other systems of medicine by patients
- analyse the different attitudes that doctors may hold regarding other systems of medicine
- demonstrate the ability to deal effectively with conflicts arising from patient’s usage of other systems of medicine
Research ethics
Principles of research ethics
Students will be able to
- list medical research scandals/controversies that helped to shape research ethics in modern medicine
- explain what the Helsinki Declaration is and briefly describe the principles of the
- Helsinki declaration
- describe the concepts of autonomy, beneficence, non-malficence, and justice as it relates to medical research and how these principles have been incorporated in to the Declaration of Helsinki
- recognize the ethical issues involved in animal experiments
- explain the role of ethical guidelines and codes given by international organizations and professional bodies
- recognize the necessity for ethical review of research projects
- respond appropriately to questions asked in an ethics review application form
- describe how the ethical principles of collaborative partnership, social and scientific value, risk benefit assessment, fair selection of research participants,
- favourable risk benefit ratio, independent review and informed consent apply to research.
- describe the role of ethics review committees in protecting human research participants
- describe special issues relating to research on vulnerable populations, international collaborative research, clinical trials, community based research and genetic research including biobanking
- describe the responsibilities of researchers when conducting research
Publication ethics
Students will be able to
- discuss the ethical and legal issues encountered in research publications.
- recognize the role of editorial committees in reviewing scientific papers
- recognize the requirements of local/international journals in submitting research papers
