Surgery Clerkship students participate in ethics discussions built around cases that they and their peers encounter during their clerkships.

Directions

  • From your first day as a clerk, keep this project in mind and look for a clinical situation that raises an ethical issue.
  • Formulate a brief but clear description of the situation. Conclude the description with a question that focuses on the central ethical issue(s). This description will be presented, in oral or written form, to your classmates in a small group discussion.
  • Identify the ethical principles/concepts that are relevant to deciding how you should respond to the question.
  • Identify the conflict. Your question is likely to involve at least two important principles/concepts that happen to conflict in this particular situation.
  • Consider what more you would need to learn about your case in order to reach a decision about your professional responsibility in the face of the conflict(s). How would you acquire the information (e.g., what questions should you ask, what materials should you consult)?
  • Consult the bioethics literature to find an article or chapter that enriches your understanding of the subject you have chosen.
  • Prepare a 10 minute presentation on the subject – In your small group ethics session on the last Wednesday of the clerkship, you will present your case and lead a discussion of the ethical issue(s) it raises. In each discussion the group will try to reach a consensus about what should be done. Please provide a brief ½ page write-up.


Goals

This project is designed to help students develop skills in recognizing and addressing the ethical issues that arise in clinical practice. It also provides students with a model for clinical reasoning about ethical questions.

Specifically, this project helps students to:

  • Recognize and identify ethical problems that arise in clinical practice.
  • Develop a model for addressing these problems.
  • Learn to consult the literature of bioethics.
  • Engage in a critical analysis of the issue(s) and reach a conclusion about what should be done.
  • Develop the habit of justifying ethical positions by providing reasons.
  • Develop skill in leading an ethics discussion.
  • Tolerate a reasonable range of different positions on an ethical issue.
  • Strive to reach a consensus with their peers.


Suggested Resources

There is a vast literature in bioethics. The quality is highly variable. Avoiding materials of dubious value is the most important consideration in locating useful resources. In general, students should avoid personal web sites: attention should be focused on reputable sources. Books by reputable publishers are often worthwhile. The Bibliography of Bioethics (available in the reference section of Levy Library) is a good place to start searching for articles on specific topics. Students may also want to do a MEDLINE search.

Below is a list of some recommended sources to help guide students to materials that are likely to have value. Those marked [*] are most likely to be clinically relevant. This is not a comprehensive list, but a guide. Students should use it to locate material on basic concepts, and to select articles from current literature. Students should also feel free to consult the Medical Ethics reading packets that are normally distributed in 1st- and 2nd-year mini-courses.


Anthologies & Reference Books

J Arras & B Steinbock, Ethical Issues in Modern Medicine, 1998.

TL Beauchamp & L Walters, Contemporary Issues in Bioethics, 5th Edition, Wadsworth, 1999.

H Kuhse & P Singer,  A Companion to Bioethics, Blackwell, 1998.

* TK Kushner & DC Thomasma, Ward Ethics: Dilemmas for medical students and doctors in training, Cambridge, 2001.

TA Mappes & D DeGrazia, Biomedical Ethics 6th Edition, McGraw Hill, 1996.

R Munson, Intervention and Reflection, 6th Edition, Wadsworth, 1999.

* M. Parker & Donna Dickenson, The Cambridge Medical Ethics Workbook, Cambridge, 2001.

* G.E. Pence, Classic Cases in Medical Ethics: Accounts of Cases That Have Shaped Medical Ethics, third edition, McGraw-Hill, 1999.

W Reich, Encyclopedia of Bioethics, Macmillan Reference, 2000.

DC Thomasma & T Kushner, Birth to Death: Science and Bioethics, Cambridge, 1996.

DC Thomasma & PA Marshall, Clinical Medical Ethics Cases and Readings, University Press of America, 1995.


Web Resources

Journals

  • American Journal of Bioethics (AJOB)
  • Bioethics
  • British Medical Journal
  • Cambridge Quarterly of Healthcare Ethics
  • Hastings Center Report
  • JAMA
  • Journal of Clinical Ethics
  • Journal of Law, Medicine & Ethics
  • Journal of Medicine and Philosophy
  • Kennedy Institute of Ethics Journal
  • NEJM
  • Science
  • Theoretical Medicine and Bioethics

Foundations of Bioethics

TL Beauchamp & JF Childress, Principles of Biomedical Ethics, 5th Edition, Oxford, 2001.

B Gert, CM Culver, KD Clouser, Bioethics: A Return to Fundamentals, Oxford, 1997.