Medical ethics | An analysis

Medical ethics An analysisIntroductionMedical ethics became one of the most important tenet modules in most of the aesculapian schools especially in the last three decades particularly in US7 . Ethics defined as the study of morality, careful and organized reflection on and analysis of moral decision and behavior4. Hence the medical ethics is the study of ethics related to medical practice. There are tetrad primary principals for medical ethics where all basic medical didactics teaches to medical students. These are non-malfeasance, beneficence, justice and autonomy with sub sectional principals like rectitude telling and confidentiality.12 Now a days doctors are facing more ethical questions and dilemmas in day to day clinical practice, this john be part attributed to the increase in the knowledge of patients rough their health from the media and internet . Studies showed that in that respect is a strong relation between resolving ethical issues and medical errors especi ally in the area of informed consent and end of life care8. In addition, the court compensation for medico legal cases opened the door for public to determine faults for doctors or the health systems to earn some wealth from it All these make the teaching of how to handle an ethical issue and resolve it truly essential to add up in a competent skillful physician.Medical schools select disparate styles and methods for teaching medical ethics, it included didactic lecturing, small throng seminars, case based banter and simulated patient but without uniformity or consensus as to method or content7. This could be as a result of lack of agreement about what shall we teach in medical ethics7.At sultan Qaboose University, medical students have a one interdisciplinary activity (IDA) week for medical ethics during their mid(prenominal) of fifth year. During this week speakers from different medical and surgical specialties present to the students a common ethical issues encounter. T his week is also attended by Islamic bookman (Professor Albar) to comment on Islamic perspective in selective cases like abortion and end of life care . As co-organizer of the course I introduced the notification of clinical cases by the student to the entire stem. I prayed each subgroup of the students to select a case where there is an ethical issue and reflect on what was through and how can we improve it.I found the reflect practice theory is very suitable for teaching of medical ethics because it stimulates the thinking and give the students the luck to analyze the ethical dilemma and how to resolve it.The TheoryThe theory of reflective practice is attributed primarily to Donald Schn3, 5. In life and based on our knowledge and visualise we take decision easily to events that we are expecting and utilise to experience. However when surp line up or unexpected event take place, based on Schn theory, bulk develop two types of reflection to that event. The first one is Reflect ion in action and it occurs immediately.It is the ability to learn and develop continually by creatively applying flow rate and then(prenominal) experiences and reasoning to unfamiliar events while they are occurring5. The second, reflection on action, occurs later. It is a process of thinking back on what happened in a past situation, what may have contributed to the unexpected event, whether the actions taken were appropriate, and how this situation may affect future practice 5. The reflection in action can be considered as an emergency decision in which the physician should take the risk of being mistaken, however, this type of decision should be appreciated by people in license if later turned to be not the perfect way of handling it and that is because it was taken based on the inputs of that situation and surrounding circumstances unless it is clearly unrivaled approach. In contrast, the reflection on action comes later when the physician finished all duties and started re-calling cases seen and decisions taken. At this point s/he will start to bring other options and thoughts that could serve the situation better than the ones taken. This extremely important because it enables us to spend time exploring why we acted as we did, what was happening in a group and so on13. In addition if this type of reflection done in group (Peer) will lead to even more reasonable and appropriate answer to the surprise14.Since this paper discusses the teaching of medical ethics, the following example will illustrate this approach. A 32 years old pregnant lady in her third trimester involved in car accident and sustained severe head injury , brought to the casualty and treating physician confirmed her death but noticed that the infant still kicking . Limited experience and lack of awareness about the regulation of such the situation made it a surprise for the physician. He used his basic knowledge of saving life and decided to perform postmortem caesarian section (P MCS) and a second surprise came when the husband arrived to refused PMCS . Reflection on action for such case is extremely crucial to reach to an approach which is ethical, legal and satisfy the patient. It is usually reached when the case is presented to the peer and each one is discussing different perspective of the case. In the prior example the reflection on action could be asking a senior physician on duty be a good option for the case.ApplicationAt college of medicine in sultan Qaboose University, medical students are divided in group each quiet of about 10 to 15 students (Boys and Girls). Each group will be asked to prepare a clinical case seen in practice where there was an ethical issue (e.g. breaching confidentiality) and one or two of the group members will present the case to whole group during the medical ethics week forum. Students will be informed in advance about the objectives and strategies of this approach and each group will linked to a facilitator who is usua lly senior medical/paramedical ability with experience of making difficult medical decisions6. The group will keep in touch with facilitator either in person or online (e.g. email) to show the contents, organise and suitability of the case for presentation and discussion. The facilitator will guide the students in selecting the case and how to formulate the ethical issue and its resolution and use steps in table-1 adopted from Catherine Myser.9, 11S/he will also teach them some basic ethical principal like doctors should refrain from being judgmental, patronizing or minipulative2. S/he will direct them to the appropriate resources and personals whenever required. In Oman, many decisions of ethical dilemma are driven by Islamic teaching and this is very prevalent in medical field, hence students will be directed to Islamic scholars who have some medical background in order to champion them understanding Islamic teaching in medical field. During the medical ethics IDA week forum, e ach group will present their case to the entire group in the presence of the facilitators. The presentation will be briefing about the case, the ethical issue, what was done, and how can we do better? More time will be given for discussion and comments by other students who are not member of the presenting group. The discussion will be regulated and guided by the facilitator supervising the presenting group. At the end of discussion the facilitator will resolve any argument and give the final comment summarizing the ethical issue and the best way to deal with it. give-and-take Medical schools around the world used different models in teaching medical ethics the variation in selection of teaching model could rise from the availability of resources, number of students and curriculum design. For example, both university of Pennsylvania and university of Washington used small group facilitation and peer interaction while uniformed services university introduced a novel model called SCO OP which stand for Students Clinical Observation Of Preceptors11 . A SCOOP reverses the process of evaluation by giving the students evaluation form and ask them to evaluate the teachers. This gives them the opportunity to identify the teaching skills and methods reflect on them and hence acquire the appropriate one and avoid the other one. Shaheen and his group wrote in gossip about time to unified approach to medical ethics where he advocated for unified framework of ethics education justifying that it will ensures measurable and accountable prat for the complex of far-reaching ethical issues present in the medical field7 . However, it is difficult and impractical to unify the contents and materials of medical ethics for different parts of the world where there is a diversity of culture, believe and traditional values. That is because most of the ethical decisions are driven by these factors. For example, In Oman (and other Muslims countries) it is forbidden to drink any sum total of alcohol as per the Islamic teaching, hence it is unethical to advice patient to drink alcohol as part of heart protection advice while the same advice can be carried out normally in non-Muslim country. However, I support the statement of Rameshkumar in his paper Ethics in medical curriculum when he verbalize The structure of ethics education has to be closely monitored and the curriculum goals have to be well defined.10 The strength of this proposal is that there is national and international bowel movement toward teaching of medical ethics to both pre and post graduates students. Most of the senior physicians who did not have cookery in medical ethics realized that it made a gap in their qualification and they urge the new generation in order not to miss the chance. In Oman the support of the current and previous deans of college of medicine at sultan Qaboose University along with other many medical faculties will make this proposal overcome any obstacles. In addition, there absorb of health care providers from different medical disciplines in any activities in medical ethics (workshop, seminars and lectures) will prepare the ground and the environment for the proposal to kick upstairs up at the university. This interest always clears during our annual medical ethics week where we get several requests from different institutes and departments asking for registration to the event although the week primarily designed for medical students.The challenges that this proposal might face is the limited resources that include trained personals and teaching material. The later is easier to overcome since it merely financial and the college is secure to provide any recommended teaching material as long as there is a clear vision and mission of its utilization. In term of training personals, there are already two faculties sent abroad for master in bioethics. In addition, there are several faculties who has special interest in teaching of ethics, all thes e will make the overcome of human resources obstacles more feasible. RecommendationIn order to implement this theory in teaching medical ethics to medical students I recommend the college to consider the following pointsIdentify and train people interested in teaching of medical ethics. The training should be for high degree ( Master , PhD ) and it is preferred to be in a center where culture and value of people are close to Oman.Provide teaching resources and materials to students. It should include textbooks, journals, video etc.Instruct the clinicians to integrate teaching of issues related to medical ethics in their daily patient care.Include assessment of medical ethics in the standard summative and formative methods of assessment in the college.Regular evaluation and audit of the program in order be veritable farther .