“Character counts at Central High” is the message frequently exhibited on the curbside marquee outside our local secondary school. Its meaning, however, is left to interpretation by those who happen to drive by the electronic display. More than likely, the deceptively simple declaration implies that Central's curriculum and associated activities are value laden, that they somehow address the collective and somewhat ambiguous set of traits we label “character.” It is a hopeful message to those who consider forming the character of (...) the country's future workforce and citizenry to be an important goal of schooling. (shrink)

This special section deals with the new professionalism movement. The interest in the term “professionalism” has been growing steadily in medicine, and the word now seems to be everywhere. However, bioethicists have lagged behind our colleagues in medicine and nursing in explicitly contributing to this movement. This special section adds to the effort to catch up.

As medical education increasingly acknowledges the importance of the ethical and professional conduct of practitioners, and moves towards more formal assessment of these issues, it is important to consider the evidence base which exists in this area. This article discusses literature about the health needs and problems experienced by medical practitioners as a background to a review of the current efforts in medical education to promote ethical conduct and develop mechanisms for the detection and remediation of problems.

Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To continue (...) the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

The Norman Rockwell image of the American physician who fixed the broken arm of a child, treated the father for hypertension, and brought an unborn child into this world is now almost nonexistent. Since the time of the Rockwell portrait, a highly technical medical industry has evolved. Now two-thirds of physicians are board certified in subspecialties, and patients visit an average of 3–4 different physicians per year. Today's physicians see themselves less as “benevolent and wise counselors overseeing the patient's welfare (...) and more as objective scientists applying the latest technical methods to bring about the desired end.” The intimate patient-physician relationship that was once the norm in our society is rapidly disappearing. (shrink)

There is a wind of change about to affect the training of all house officers in the United States. The Accreditation Council of Graduate Medical Education has promulgated a set of general competencies for all U.S.-trained residents, with a major thrust focused on bioethics and professionalism that will likely catch residency directors unaware. The ACGME's General Competencies document globally addresses many relationship-based ethical roles and responsibilities of house officers in healthcare. Of note, this document contains a specific section on professionalism. (...) However, the entire document is woven with a sustained thread of medical ethics throughout its other sections. The intent is to imbue each physician with those skills, rules, and aspects of character that will be a foundation for humane, ethical, professional conduct. Professionalism does indeed go beyond ethical principles, accounting for competency and commitment to excellence and, most of all, implying a virtue ethics account of medical practice. The need to address the central place of virtue ethics in house-staff education is apparent, and we now have the right tool for the job—the ACGME General Competencies. (shrink)

In this keynote speech to the American Society for Bioethics and Humanities in October, 1999, Hilfiker suggests that the underlying goal of teaching ethics should be to develop in those who care for others an empathy with the outsider. Unless care givers cannot see the world from the victim's point of view, they will have a difficult time developing an ethical framework in which to work. In this paper, Hilfiker tells the story of how he came to find the victim's (...) point of view through his own experiences as a physician and through the work of Dorothee Sölle, René Girard, and John Rawls. (shrink)

Most contemporary moral philosophy is concerned with issues of rationality, universality, impartiality, and principle. By contrast Laurence Blum is concerned with the psychology of moral agency. The essays in this collection examine the moral import of emotion, motivation, judgment, perception, and group identifications, and explore how all these psychic capacities contribute to a morally good life. Blum takes up the challenge of Iris Murdoch to articulate a vision of moral excellence that provides a worthy aspiration for human beings. Drawing on (...) accounts of non-Jewish rescuers of Jews during the Holocaust Blum argues that impartial principle can mislead us about the variety of forms of moral excellence. (shrink)

One question in moral psychology concerns the role of emotions to motivate moral action. This question has recently become more urgent, because it is now clearer that cognitive developmental theories cannot offer a complete explanation of moral functioning. This paper suggests that emotion, as is typically understood in psychology, cannot be seen as the basis for an acceptable explanation of moral behaviour and motivation. However, it is argued that it is possible to understand emotions as embedded in agentic processes, and (...) regulated by conscious concerns. So understood, emotions acquire an important role in the person's moral life. These conclusions are reached through an extensive review of psychological and philosophical conceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved). (shrink)

Being empathetic (or compassionate) is an important trait that allows for those working in health care professions to successfully analyze cases and provide patients with adequate care. One standard and enormously important way to try and teach empathy involves the use of case studies. The case-study approach, however, has some unique limitations in teaching empathy. This paper describes an activity where students are asked to imagine that they have contracted a specific disease (one that lasts the entire semester) through a (...) process of random (or lottery) assignment. Having contracted a disease, students are then tasked with taking on the persona of that patient. In writing and adopting the perspective of that patient, students are better able to learn the kind of empathy needed to be a successful health care professional. (shrink)

BackgroundMost medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning (...) between school years among medical students and residents.MethodsQuestionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan.ResultsPIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires.ConclusionThis study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan. (shrink)

Are our efforts to help others ever driven solely by altruistic motivation, or is our ultimate goal always some form of self- benefit (egoistic motivation)? This volume reports the development of an empirically-testable theory of altruistic motivation and a series of experiments designed to test that theory. It sets the issue of egoism versus altruism in its larger historical and philosophical context, and brings diverse experiments into a single, integrated argument. Readers will find that this book provides a solid base (...) of information from which questions surrounding the existence of altruistic motivation can be further investigated. (shrink)

Emotions shape the landscape of our mental and social lives. Like geological upheavals in a landscape, they mark our lives as uneven, uncertain and prone to reversal. Are they simply, as some have claimed, animal energies or impulses with no connection to our thoughts? Or are they rather suffused with intelligence and discernment, and thus a source of deep awareness and understanding? In this compelling book, Martha C. Nussbaum presents a powerful argument for treating emotions not as alien forces but (...) as highly discriminating responses to what is of value and importance. She explores and illuminates the structure of a wide range of emotions, in particular compassion and love, showing that there can be no adequate ethical theory without an adequate theory of the emotions. This involves understanding their cultural sources, their history in infancy and childhood, and their sometimes unpredictable and disorderly operations in our daily lives. (shrink)