Medical ethics | An analysis

Medical moral philosophy An abridgmentIntroductionMedical honest motive became one of the most important t individuallying modules in most of the health check schools especi eithery in the last three decades particularly in US7 . Ethics defined as the reading of morality, careful and systematic shineion on and analysis of moral decision and behavior4. Hence the checkup ethics is the study of ethics related to health check examination practice. There are four primary principals for medical checkup ethics where all basic medical teaching teaches to medical school-age childs. These are non-malfeasance, beneficence, justice and autonomy with sub sectioned principals like truth telling and confidentiality.12 Now a days doctors are facing more honorable questions and predicaments in day to day clinical practice, this nates be partly attri only whened to the increase in the acquaintance of patients about their health from the media and internet . Studies showed that at that place is a strong relation between resolving honest issues and medical errors e special(prenominal)ly in the area of informed consent and end of life care8. In addition, the courtyard compensation for medico legal encases opened the door for public to find faults for doctors or the health systems to piddle some wealth from it All these made the teaching of how to handle an ethical issue and resolve it real essential to produce a competent skillful physician.Medical schools adopted polar styles and methods for teaching medical ethics, it included didactic lecturing, small theme seminars, case based give-and-take and simulated patient but without uniformity or consensus as to method or content7. This could be as a result of need of agreement about what shall we teach in medical ethics7.At sultan Qaboose University, medical students have a one interdisciplinary activity (IDA) workhebdomad for medical ethics during their mid of fifth year. During this workweek speakers from antithetic medical and surgical specialties bring in to the students a common ethical issues encounter. This week is also attended by Muslim scholar (Professor Albar) to comment on Islamic perspective in selective cases like stillbirth and end of life care . As co-organizer of the course I introduced the origination of clinical cases by the student to the entire convention. I asked each subgroup of the students to select a case where there is an ethical issue and reflect on what was done and how can we improve it.I found the reflect practice theory is truly suitable for teaching of medical ethics because it stimulates the thinking and give the students the opportunity 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 experience we take decision easily to events that we are expecting and used to experience. However when confusion or unhoped-for eve nt take place, based on Schn theory, people develop two qualitys of censure to that event. The first one is Reflection in action and it occurs immediately.It is the ability to learn and develop continually by creatively applying current and past experiences and reasoning to unfamiliar events small-arm they are occurring5. The second, reflection on action, occurs later. It is a process of thinking back on what happened in a past dapple, 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 universe mistaken, however, this type of decision should be appreciated by people in authority if later turned to be non the perfect mien of handling it and that is because it was taken based on the inputs of that situation and surrounding slew unless it is clearly odd approach. In c ontrast, 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 leave alone start to bring other choices and thoughts that could serve the situation better than the ones taken. This extremely important because it enables us to spend season 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) lead lead to even more reasonable and appropriate reaction to the surprise14.Since this paper discusses the teaching of medical ethics, the following example leave behind illustrate this approach. A 32 years old pregnant bird in her 3rd trimester involved in car accident and sustained severe head imperfection , brought to the casualty and treating physician confirmed her death but noticed that the baby still kicking . circumscribed experience and lack of awareness about the regulation of such the situation made i t a surprise for the physician. He used his basic knowledge of saving life and decided to perform postmortem caesarean delivery section (PMCS) 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 previous 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 composed of about 10 to 15 students (Boys and Girls). Each group will be asked to situate 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. S tudents will be informed in advance about the objectives and strategies of this approach and each group will linked to a facilitator who is usually senior medical/paramedical faculty with experience of making surd medical decisions6. The group will keep in touch with facilitator either in person or online (e.g. email) to show the contents, structure and suitability of the case for presentation and discussion. The facilitator will guide the students in selecting the case and how to mull over 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 operate by Islamic teaching and this is very prevalent in medical field, hence students will be directed to Islamic scholars who have s ome medical background in order to help them understanding Islamic teaching in medical field. During the medical ethics IDA week forum, each 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.Discussion 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 computer programme design. For example, both university of Pennsylvania and univer sity of Washington used small group facilitation and peer interaction while furnish services university introduced a novel model called assume 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 grade 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 commentary about time to merged approach to medical ethics where he advocated for unified framework of ethics bringing up justifying that it will ensures measurable and accountable basis 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 part of the world where there is a diversity of culture, believe and traditional values. That is becau se most of the ethical decisions are driven by these factors. For example, In Oman (and other Muslims countries) it is forbidden to drink any amount 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 shop at the statement of Rameshkumar in his paper Ethics in medical curriculum when he said 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 theme and international move toward teaching of medical ethics to both pre and post graduates students. Most of the senior physicians who did not have training 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 su ltan Qaboose University along with other many medical faculties will make this proposal overcome any obstacles. In addition, there interest of health care providers from different medical disciplines in any activities in medical ethics (workshop, seminars and lectures) will prepare the ground and the surroundings for the proposal to grow 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 that financial and the college is ready 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 mast er in bioethics. In addition, there are several faculties who has special interest in teaching of ethics, all these will make the overcome of human resources obstacles more feasible. good wordIn 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 focus on where culture and value of people are close to Oman.Provide teaching resources and materials to students. It should include textbooks, journals, video and so onInstruct 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. continuous evaluation and audit of the program in order be developed farther .