In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) (...) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country. (shrink)

A cross-sectional study explored the moral judgement competence and moral attitudes of 310 Czech and Slovak and 70 foreign national students at the Medical Faculty of Charles University in Hradec Králové, Czech Republic. Lind's Moral Judgement Test was used to evaluate moral judgement competence and moral attitudes depending on factors such as age, number of semesters of study, sex, nationality and religion. Moral judgement competence decreased significantly in the Czech and Slovak medical students as they grew older; in medical students (...) from other countries it did not significantly increase. The influence of other factors (sex, nationality and religion) on moral judgement competence was not proven in either the Czech and Slovak or the foreign national medical students. Moral attitudes do not change; the Czech and Slovak as well as the foreign students preferred the post-conventional levels of moral judgement (Kohlberg's 5th and 6th stages). The fact that the Czech and Slovak students' moral judgement competence decreased with age and number of semesters of study completed is not an optimistic sign: medical students who had undergone a lower number of semesters of study were morally more competent. (shrink)

Although online education is becoming increasingly commonplace in health professional education, methods to evaluate student progress and knowledge base adequately remain uncertain. This paper describes a project that attempted to assess whether or not an online course was an effective way to teach applied ethics to students preparing for the health professions by qualitatively analyzing responses to a pre-test and post-test administered to students in the course. While previous studies have reported various findings regarding the success of online ethics courses, (...) our study failed to demonstrate that students gained a greater understanding of key concepts in ethics—respect for autonomy, decisional capacity, informed consent, and role of the provider. Our findings demonstrate the need for better subjective methods of evaluation and raise questions regarding the efficacy of current models of online ethics courses for health professional students. (shrink)

Purpose: To determine motives and attitudes towards life-sustaining treatments by clinical and preclinical medical students. Methods: This was a scenario-based questionnaire that presented patients with a limited life expectancy. The survey was distributed among 455 medical students in preclinical and clinical years. Students were asked to rate their willingness to perform LSTs and rank the motives for doing so. The effect of medical education was then investigated after adjustment for age, gender, religion, religiosity, country of origin, and marital status. Results: (...) Preclinical students had a significantly higher willingness to perform LSTs in all cases. This was observed in all treatments offered in cases of a metastatic oncologic patient and an otherwise healthy man after a traumatic brain injury. In the case of an elderly woman on long-term care, preclinical students had higher willingness to supply vasopressors but not perform an intubation, feed with a nasogastric tube, or treat with a continuous positive air-pressure ventilator. Both preclinical and clinical students had high willingness to perform resuscitation on a twelve-year-old boy with a TBI. Differences in motivation factors were also seen. Discussion: Preclinical students had a greater willingness to treat compared to clinical students in all cases and with most medical treatments offered. This is attributed mainly to changes along the medical curriculum. Changes in reasons for supplying LSTs were also documented. (shrink)

Background: The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - havebeen extremely influential in the field of medical ethics, and are fundamental for understanding the currentapproach to ethical assessment in health care. This study tests whether these principles can be quantitativelymeasured on an individual level, and then subsequently if they are used in the decision making process whenindividuals are faced with ethical dilemmas. Methods: The Analytic Hierarchy Process was used as a tool for the measurement (...) of the principles. Four scenarios, whichinvolved conflicts between the medical ethical principles, were presented to participants and they madejudgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if theywere in the situation. Results: Individual preferences for these medical ethical principles can be measured using the Analytic HierarchyProcess. This technique provides a useful tool in which to highlight individual medical ethical values. Onaverage individuals have a significant preference for non-maleficence over the other principles, however, andperhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specificethical dilemmas. Conclusions: People state they value these medical ethical principles but they do not actually seem to use them directly in thedecision making process. The reasons for this are explained through the lack of a behavioural model to accountfor the relevant situational factors not captured by the principles. The limitations of the principles in predictingethical decision making are discussed. (shrink)

The goal of the present study was to elucidate what influences medical students’ attitudes and interests in medical ethics. At the end of their first, fifth and last terms, 409 medical students from all six medical schools in Sweden participated in an attitude survey. The questions focused on the students’ experience of good and poor role models, attitudes towards medical ethics in general and perceived effects of the teaching of medical ethics. Despite a low response rate at some schools, this (...) study indicates that increased interest in medical ethics was related to encountering good physician role models, and decreased interest, to encountering poor role models. Physicians involved in the education of medical students seem to teach medical ethics as role models even when ethics is not on the schedule. The low response rate prevents us from drawing definite conclusions, but the results could be used as hypotheses to be further scrutinised. (shrink)

The application of artificial intelligence (AI) in hospitals yields many advantages but also confronts healthcare with ethical questions and challenges. While various disciplines have conducted specific research on the ethical considerations of AI in hospitals, the literature still requires a holistic overview. By conducting a systematic discourse approach highlighted by expert interviews with healthcare specialists, we identified the status quo of interdisciplinary research in academia on ethical considerations and dimensions of AI in hospitals. We found 15 fundamental manuscripts by constructing (...) a citation network for the ethical discourse, and we extracted actionable principles and their relationships. We provide an agenda to guide academia, framed under the principles of biomedical ethics. We provide an understanding of the current ethical discourse of AI in clinical environments, identify where further research is pressingly needed, and discuss additional research questions that should be addressed. We also guide practitioners to acknowledge AI-related benefits in hospitals and to understand the related ethical concerns. (shrink)

In a Swedish setting physicians are unlikely to give explicitly paternalistic reasons when asked about their attitudes towards patients’ involvement in decision-making. There is considerable risk that they will disguise their paternalism by giving ‘socially correct answers’. We suggest that disguised paternalism can be revealed with the help of indexes based on certain responses in postal questionnaires. The indexes were developed using material from a study examining attitudes of Swedish physicians to physician-assisted suicide (PAS). Apart from being asked about their (...) attitudes, they were asked to prioritise between different arguments for and against PAS. One argument for PAS was: “PAS should be permitted out of respect for patients’ autonomy”. One argument against PAS was: “PAS should not be permitted since the non-maleficence principle in this case takes precedence over respecting patients’ autonomy”. Responses to the latter argument formed the cornerstone of a disguised-paternalism index, while an autonomy index was based on answers to the former argument. Applying our indexes to data from the PAS survey, we found that female GPs, surgeons, and older male physicians were least paternalistic. Among female physicians one finds both the most autonomy-respecting groups (female surgeons and GPs) and the least autonomy-respecting groups (female oncologists and psychiatrists); together with older male physicians in general, female GPs are the group displaying least disguised paternalism. We suggest that questionnaires exploring paternalism might be improved by including case-specific questions or statements by which to explore disguised paternalism. Here our indexes might be useful tools. (shrink)

Through the exponential growth in digital devices and computational capabilities, big data technologies are putting pressure upon the boundaries of what can or cannot be considered acceptable from an ethical perspective. Much of the literature on ethical issues related to big data and big data technologies focuses on separate values such as privacy, human dignity, justice or autonomy. More holistic approaches, allowing a more comprehensive view and better balancing of values, usually focus on either a design-based approach, in which it (...) is tried to implement values into the design of new technologies, or an application-based approach, in which it is tried to address the ways in which new technologies are used. Some integrated approaches do exist, but typically are more general in nature. This offers a broad scope of application, but may not always be tailored to the specific nature of big data related ethical issues. In this paper we distil a comprehensive set of ethical values from existing design-based and application-based ethical approaches for new technologies and further focus these values to the context of emerging big data technologies. A total of four value lists were selected for this. The integrated list consists of a total of ten values: human welfare, autonomy, non-maleficence, justice, accountability, trustworthiness, privacy, dignity, solidarity and environmental welfare. Together, this set of values provides a comprehensive and in-depth overview of the values that are to be taken into account for emerging big data technologies. (shrink)

A high level of professional integrity is expected from healthcare professionals, and literature suggests a relationship between unethical behavior of healthcare professionals and poor academic integrity behavior at medical school. While academic integrity is well researched in western countries, it is not so in the Middle East, which is characterized by different cultural values that may influence students’ academic integrity conduct. We conducted a cross-sectional study among health-professions students at a university in the Middle East to assess perceptual differences on (...) various cheating behaviors, as well as to explore the reasons underlying the cheating behavior. A validated survey instrument disseminated among first and second-year undergraduate students resulted in 211 complete responses and this data was analyzed using descriptive and inferential statistics. Pearson’s Chi-square/ Fischer’s exact test was applied to test the association of various factors with academic misconduct. The major determinants of academic misconduct were investigated using Binary Logistic regression model. The conducted analysis and the results showed that preceding cheating behavior was the only factor significantly associated with cheating in the university (p. (shrink)

In this study we compared the ethical attitudes of a group of experienced, predominantly female, registered nurses (n = 67) with those of a group of final year, mixed sex, medical students (n = 125). The purpose was to determine the basis of differences in attitudes that could lead to ethical disagreements between these two groups when they came to work together. A questionnaire developed to explore ethical attitudes was administered and the responses of the two groups were compared using (...) t-tests. Because of the preponderance of females among the nurses an analysis of variance of the gender-adjusted scores for each group was also carried out. On comparing the responses, the nurses differed significantly from the medical students in a number of ethical domains. A potential source of conflict between these two groups is that the nurses were inclined to adopt the perspective of patients but the medical students identified with their profession. When corrected for the effects of gender, the differences persisted, indicating that it was discipline that determined the differences. We recommend that students of nursing and medicine receive ethics education together, and that more open dialogue between doctors and nurses with respect to their different ethical viewpoints is needed in the work setting. This article will be of interest to educators of students of medicine and nursing, as well as to doctors and nurses who are eager to improve their professional relations and thereby improve patient care. (shrink)