Abstract
Ethical issues arise throughout healthcare, and as such ethics teaching has long-standing been an important component of education for healthcare professionals. While much of the way healthcare professionals have “learned” ethics has been informal, increasingly ethics has been formally integrated into the training programs for such healthcare professionals during their training and beyond. Ethics differs significantly from other components of training, for example, being considered more subjective and encompassing complex moral, philosophical, and personal concepts. While lending itself to interesting and stimulating discussion, ethics can pose challenges for those delivering such education. How such a subject should be taught, when, in what format, and by whom are all important considerations. The purpose and modes of assessment of such a topic are controversial and debated, not least because of a lack of consensus about what the aims of ethics education should be.
This chapter aims to address some of these questions by considering educational theory with a broader discussion of how medical ethics education is and how it ought to be. We consider the theory of ethics education, the practicalities that should be considered in designing and delivering ethics education programs, and finally the challenges faced by ethics educators. We articulate the key issues arising in the phenomenon of ethics education, considering teacher, learner, and higher education institution in a real-world context.
References
Brooks L, Bell D. Teaching, learning and assessment of medical ethics at the UK medical schools. J Med Ethics. 2017;43:606–12.
Carresse JA, Malek J, Watson K, et al. The essential role of medical ethics education in achieving professionalism: the Romanell report. Acad Med. 2015;90(6):744–52. https://doi.org/10.1097/ACM.0000000000000715.
Charon R, Fox RC. Critiques and remedies: medical students call for change in ethics teaching. JAMA. 1995;274:767–71.
Chartered Society of Physiotherapy. Code of Members’ professional values and behaviour. 2011. https://www.csp.org.uk/publications/code-members-professional-values-and-behaviour. Accessed 7 May 2019.
Clark PG, Cott C, Drinka TJK. Theory and practice in interprofessional ethics: a framework for understanding ethical issues in health care teams. J Interprofessional Care. 2007;21(6):591–603. https://doi.org/10.1080/13561820701653227.
Consensus Statement by teachers of medical ethics and law in UK medical schools. Teaching medical ethics and law within medical schools: a model for the UK core curriculum. J Med Ethics. 1998;24:188–92. https://doi.org/10.1136/jme.24.3.188.
Cribb A, Bignold S. Towards the reflexive medical school: the hidden curriculum and medical education research. Stud High Educ. 1999;24:195–209.
Diekema DS, Shugerman RP. An ethics curriculum for the pediatric residency program: confronting barriers to implementation. Arch Pediatr Adolesc Med. 1997;151:609–14.
Dowie A, Martin A. Ethics and law in the medical curriculum. AMEE guide: curriculum planning. Europe: Association for Medical Education; 2011.
Eckles RE, Meslin EM, Gaffney M, Helft P. Medical ethics education: where are we? Where should we be going? A review. Acad Med. 2005;80(12):1143–52.
Eisner EW. Five basic orientations to the curriculum. In: Eisner EW, editor. The educational imagination: on the design and evaluation of the school programmes. 2nd ed. New York: Macmillan Publishing; 1985. p. 61–85.
Emmerich N. Medical ethics education: an interdisciplinary and social theoretical perspective. 1st ed. London: Springer; 2013. Preface, pvii-ix.
Engward H, Papanikitas A. Interprofessional ethics in everyday healthcare. In: Wintrup J, et al., editors. Ethics from the ground up: emerging debates, changing practices and new voices: London: Red Globe Press; 2018. p. 5–16.
Freeman JW, Wilson AL. Virtue and longitudinal ethics education in medical school. S D J Med. 1994;47:427–30.
General Medical Council. Good medical practice. 2013. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice. Accessed 29 May 2019.
General Medical Council. Learning materials. n.d.. https://www.gmc-uk.org/ethical-guidance/learning-materials. Accessed 19 May 2019.
Goldie J. Review of ethics curricula in undergraduate medical education. Med Educ. 2000;34:108–19.
Goldie JGS. The detrimental ethical shift towards cynicism: can medical educators help prevent it? Med Educ. 2004;38:232–8.
Goldie J, Schwartz L, McConnachie A, Morrison J. The impact of a modern medical curriculum on students’ proposed behaviour on meeting ethical dilemmas. Med Educ. 2004;38:942–9.
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861–71.
Hanson S. Teaching health care ethics: why we should teach nursing and medical students together. Nurs Ethics. 2005;12(2):167–76.
Hoskins K, Grady C, Ulrich CM. Ethics education in nursing: instruction for future generations of nurses. Online J Issues Nurs. 2018;23(1):Manuscript 3. https://doi.org/10.3912/OJIN.Vol23No01Man03.
Institute of Medical Ethics. Core curriculum for undergraduate medical ethics and law. 2019. http://www.instituteofmedicalethics.org/website/images/IME_revised_ethics_and_law__curriculum_Learning_outcomes_2019.pdf. Accessed 7 May 2019.
Institute of Medical Ethics. Core content. n.d.. http://www.instituteofmedicalethics.org/website/index.php?option=com_content&view=section&id=2&Itemid=3. Accessed 19 May 2019.
Jameton A. Nursing practice: the ethical issues. Englewood Cliffs: Prentice Hall; 1984. p. 6.
Joint Royal Colleges of Physicians Training Board. Specialty training curriculum for palliative medicine 2010 (Amendments 2014). 2014. https://www.jrcptb.org.uk/sites/default/files/2010%20Palliative%20medicine%20%28amendments%202014%29.pdf. Accessed 5 June 2019.
Jonsen A, Siegler M, Winslade W. Clinical ethics: a practical approach to ethical decisions in clinical medicine. 7th ed: McGraw-Hill Education/Medical, London; 2010.
Kleinman CS. Ethical drift: when good people do bad things. JONAS Healthc Law Ethics Regul. 2006;8(3):72–6.
Knight S, Hayhoe B, Frith L, et al. Ethics education and moral decision making in clinical commissioning: an interview study. Br J Gen Pract. 2020;70:690.
Kong WM, Knight S. Bridging the education–action gap: a near-peer case-based undergraduate ethics teaching programme. J Med Ethics. 2017;43:692–6.
Machin LL, Bellis KM, Dixon C, et al. Interprofessional education and practice guide: designing ethics-orientated interprofessional education for health and social care students. J Interprof Care. 2018;26:1–11. https://doi.org/10.1080/13561820.2018.1538113.
Mattick K, Bligh J. Teaching and assessing medical ethics: where are we now? J Med Ethics. 2006;32(3):181–5. https://doi.org/10.1136/jme.2005.014597.
McDougall R. Combating junior doctors’ “4am logic”: a challenge for medical ethics education. J Med Ethics. 2009;35:203–6.
Miles SH, Lane LW, Bickel J, Walker RM, Cassel CK. Medical ethics education: coming of age. Acad Med. 1989;64:705–14.
Misselbrook D. The BJGP is open for ethics. Br J Gen Pract. 2012;62(596):122.
Molyneux D. Learning from the assessment of ethics in UK general practice. In: Papanikitas A, Spicer J, editors. Handbook of primary care ethics. Boca Raton: CRC Press/Taylor & Francis Group; 2018. p. 269.
Morley G, Ives J, Bradbury-Jones C, Irvine F. What is ‘moral distress’? A narrative synthesis of the literature. Nurs Ethics. 2019;26:646–62.
Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. https://www.nmc.org.uk/standards/code/. Accessed 21 May 2019.
Papanikitas A. The contributions of general practice as a profession. In: Papanikitas A, editor. From the classroom to the clinic: ethics education and general practice. PhD thesis, Kings College London. 2014. p. 96–101.
Papanikitas A. Education and debate: a manifesto for ethics and values at annual healthcare conferences. Lond J Primary Care. 2016;8(6):96–9.
Papanikitas A. Accounting for ethics: is there a market for morals in healthcare? In: Feiler T, Hordern J, Papanikitas A, editors. Marketisation ethics and healthcare. London: Routledge; 2018.
Papanikitas A, Spicer J. Teaching and learning ethics in primary healthcare. In: Papanikitas A, Spicer J, editors. Handbook of primary care ethics. Boca Raton: CRC Press/Taylor & Francis Group; 2018. p. 229.
Pellegrino ED, Thomasma DC. The virtues in medical practice. New York: Oxford University Press; 1993.
Reeve J. Interpretive medicine: supporting generalism in a changing primary care world. Occas Pap R Coll Gen Pract. 2010;(88):1–20, v.
Roberts LW, Warner TD, Green Hammond KA, et al. Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics. Acad Psychiatry. 2005;29(3):301–9.
Royal Pharmaceutical Society of Great Britain. Medicines, ethics and practice. Edition 42. 2018. https://www.rpharms.com/resources/publications/medicines-ethics-and-practice-mep. Accessed 7 May 2019.
Savulescu J. Conscientious objection in medicine. BMJ. 2006;332:294–7.
Shelton W. Can virtue be taught? Acad Med. 1999;74:671–4.
Siegler M. Lessons from 30 years of teaching clinical ethics. Virtual Mentor. 2001;3(10). https://doi.org/10.1001/virtualmentor.2001.3.10.medu1-0110.
Sokol DK. William Osler and the jubjub of ethics; or how to teach medical ethics in the 21st century. JRSM Open. 2007;100(12):544–6. https://doi.org/10.1177/0141076807100012010.
Sokol D. What to tell junior doctors about ethics. BMJ. 2010;340:c248.
Sokol D. Teaching medical ethics: useful or useless? BMJ. 2016;355:i6415.
Stirrat GM, Johnston C, Gillon R, et al. Medical ethics and law for doctors of tomorrow: the 1998 Consensus Statement updated. J Med Ethics. 2010;36:55–60.
UK Clinical Ethics Network. Educational resources. n.d. Overview. http://www.ukcen.net/education_resources. Accessed 19 May 2019.
United Nations Educational, Scientific and Cultural Organization. Bioethics core curriculum. 2016. http://unesdoc.unesco.org/images/0016/001636/163613e.pdf. Accessed 29 May 2019.
Whelan K, Thomas JE, Cooper S, et al. Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians. J Human Nutr Dietetics. 2005;18:461–6. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-277X.2005.00650.x
Whiting D. Should doctors ever be professionally required to change their attitudes? Clin Ethics. 2009;4(2):67–73.
Wiles K, Bahal N, Engward H, Papanikitas A. Ethics in the interface between multidisciplinary teams: a narrative in stages for inter-professional education. Lond J Prim Care (Abingdon). 2016;8(6):100–4. Published 2016 Oct 24. https://doi.org/10.1080/17571472.2016.1244892.
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Knight, S., Papanikitas, A. (2021). Teaching and Learning Ethics in Healthcare. In: Nestel, D., Reedy, G., McKenna, L., Gough, S. (eds) Clinical Education for the Health Professions. Springer, Singapore. https://doi.org/10.1007/978-981-13-6106-7_43-1
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