Bioethics Education Research Articles

Bioetička edukacija na teološkim fakultetima Univerziteta u Sarajevu

U okviru Univerziteta u Sarajevu egzistiraju dva teološka fakulteta, Fakultet islamskih nauka i Katolički bogoslovni fakultet. Obje visokoobrazovne institucije dugo vremena nisu bile u sastavu navedenog sveučilišta, budući da su obitavale isključivo pod okriljem religijskih institucija. Na navedenim fakultetima izučavaju se, pored teoloških, i svjetovni moduli, te je primjetno da se polju bioetike daje posebno mjesto kao jednome od neophodnih suvremenih segmenata odgojno-obrazovnog procesa. Analogno rečenome, u tekstu je načinjena razdioba studijskih programa, tj. istaknuto je gradiranje znanstvenih i stručnih ciklusa u obrazovnome procesu, kako na Fakultetu islamskih nauka, gdje se nastava izvodi na dodiplomskom, diplomskom te doktorskom studiju, tako i na Katoličkom bogoslovnom fakultetu, gdje je ustaljen integrirani studij teologije, pored kojega je već nekoliko godina još zastupljen diplomski studij Međureligijski studij i izgradnja mira, koji se provodi u suradnji s Fakultetom islamskih nauka i Pravoslavnim bogoslovskim fakultetom Sv. Vasilija Ostroškog iz Foče. Pravoslavni bogoslovski fakultet je zapravo sastavnica Univerziteta u Istočnome Sarajevu, stoga nije uzet u razmatranje u ovome radu. Autori rada razmatranju bioetičkih problema pristupali su iz pozicije praktičke filozofije, tj. njene grane etike, koristeći pri tome interdisciplinarni i pluriperspektivni pristup. Na osnovi silabusa načinjena je analiza bioetičkih problema primarno iz filozofskog (etičkog) motrišta, analizirani su predmetni udžbenici i literatura. Naravno, vodilo se računa o radovima nastavnika s ovih institucija, koji su pisani iz polja bioetike. Bez obzira na različito religijsko fundiranje bioetičkih problema na ova dva fakulteta,u smislu različitih epistemičkih polazišta islama i kršćanstva, u zaključcima rada ukazano je na točke zajedničkog ,,bioetičkog“ interesa, ali i razilaženja među njima.

Editors' Note.

Editors' Note James M. DuBois, Ana S. Iltis, and Heidi A. Walsh This issue marks the end of NIB's tenth year in operation. We are pleased to publish the final issue of volume 10 of Narrative Inquiry in Bioethics (NIB). The symposium includes 12 personal narratives by people who have navigated challenges with discharge from hospitals. Elizabeth Pendo, the symposium editor, along with members of the NIB editorial staff, wrote the call for stories and invited three commentary authors, Beth Prusaczyk, Kristi Kirschner, and Lisa Iezzoni. Dr. Prusaczyk is an implementation scientist who specializes in improving healthcare for older adults and other vulnerable populations by understanding how to better implement existing research findings into real-world practice and policy. Dr. Kirschner is a physician who specializes in physical medicine and rehabilitation and has a particular interest in disability issues and marginalized populations. Dr. Iezzoni is a medical researcher who conducts health services research focusing on healthcare experiences and outcomes of people with disabilities. The research article in this issue, entitled "A Qualitative Study of the Views of Individuals With Type 1 Diabetes on the Ethical Considerations Raised by the Artificial Pancreas," was written by Ariane Quintal, Virginie Messier, Rémi Rabasa-Lhoret and Eric Racine. An artificial pancreas is being developed to automate and simplify the management of type 1 diabetes, which requires regular blood glucose measurements and tailored insulin administration. The artificial pancreas raises psychosocial and ethical issues that could impact its uptake, despite its clinical benefits. The authors conducted semi-structured interviews with people with type 1 diabetes and characterized various psychosocial and ethical issues with the artificial pancreas using a thematic analysis approach. In general, participants were in favor of the artificial pancreas, despite having highlighted key ethical considerations, specifically control and empowerment in care; identity and relationships; safety, security, and cybersecurity; public and private coverage; patient selection criteria; and consent in research. The researchers concluded the study with suggestions to add functionality to the pancreas to allow for user autonomy (such as the option to suspend infusions), and improve the design and aesthetic of the pancreas (a concern that disproportionally affected the women interviewed). To foster its success, the considerations raised need to be addressed in the development of the artificial pancreas and in clinical practice guidelines and coverage policies. The case study in this issue was written by Anji E. Wall, Liza Johannesson, Giuliano Testa, and Ann Marie Warren, and is titled, "Two Cases of Pregnancy Following Uterine Transplant: An Ethical Analysis." As the number of uterine transplants increase worldwide, a common narrative of critique has been that the benefits are not worth the risks—that the pregnancy will be so unlike a "normal" pregnancy that it will not satisfy the recipient's wishes. Reasons given include that the pregnancy will be highly medicalized (with frequent tests to manage the higher risks), and that the mother will not be able to feel movement of the fetus or contractions because of detached nerves, thus creating a feeling of estrangement from both the organ and the child. In this case study, researchers conducted [End Page v] in-person interviews with two uterine transplant recipients in the United States. The purpose of the interviews was to gain a fuller picture of the benefits of gestation after uterine transplant, so that those benefits can be weighed against the risks more accurately. Both women reported that they "felt" pregnant, experienced many common pregnancy symptoms, and felt the baby move during their pregnancy. Both experienced bonding with their child during the pregnancy, and credited their pregnancy will encouraging nesting and preparation for the child's arrival. Overall, the differences inherent in gestation after uterine transplant did not detract from the value each parent placed on her pregnancy experience. News about Narrative Inquiry in Bioethics The NIB Foundation was established in 2010 to foster education and research in bioethics and related fields through publishing and other activities. The NIB website includes a section on education, which contains abstracts of all cases studies with discussion questions, a guide for facilitating narrative discussion groups, and two sample narrative discussion guides, "Exploring Stigma and Bias in the Care of Patients: Stories from Patients" and...

A Novel Peer-Directed Curriculum to Enhance Medical Ethics Training for Medical Students: A Single-Institution Experience.

Background:The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees’ own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting.Objective:Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students.Methods:Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one’s own professional communication skills.Results:The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting.Conclusions:Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.

Current Situation of Homoparental Adoption in Latin America: A Bioethical Problem of Discrimination, Rights and Social Justice

This article raises the current situation of homoparental adoption in Latin America. The problem of discrimination-exclusion and social justice. This work exposes the need to integrate the secular bioethical perspective in the public discussion and the contrast of conservative and liberal arguments on homoparental adoption. Likewise, the article exposes the urgent need to legislate in favor of children and not against same-sex couples or gay individuals who are trying to adopt. We recommend the promotion of bioethical education and social awareness to prevent violence and discrimination against vulnerable minorities through the teaching and practice of tolerance, respect, dialogue, and the bioethical principles of non-maleficence, dignity, integrity, and vulnerability.

Fritz Jahr as Methodological Paradigm in Bioethical Education

The paper examines Fritz Jahr as a possible role-model in bioethical education. It consists of two parts. The first part builds upon the acknowledged data and theories about how Fritz Jahr proposed the bioethical imperative and changed his way of thinking. It provides arguments for and against known claims and expands the knowledge background with the focus on reconstructing the thought process and some presumptions that led to the formulation of bioethical imperative. The second part uses these results to infer five features to show how we can extract and define methodological features from Jahr’s personality and activity, which confirm and enhance integrative projects. An attempt has been made to understand that something, such as “Jahrian methodology”, might be sensible enough to provide scientific knowledge and cultural orientation without simplifying the bios, but that it is pointless without integration with educational models, and to emphasise this I conclusively consider the role of bioethicists in the 21st century.

The Possibility of Introducing Bioethical Education to High Schools and Faculties in North Macedonia

Abstract Bioethics is a very important and complex contemporary field of thinking and activity. Knocking strong on our doors, various problems of health, environmental pollution, violence, conflicts, human indolence, criminal deeds, as well as bad behaviors of all different kinds, come to the core of humankind. All these problems require a serious and rapid human action. That is why it is very important to introduce bioethical education to all people. This paper is dealing with the issue of implementing ethical and bioethical education in the North Macedonian school system. It offers a brief review of the activities in this field so far, and it attempts to contextualize some theoretical approaches for ethical and bioethical education. The main thesis is that at the basic level ethical and bioethical education should be organized as moral education, but at the level of secondary school and faculty teaching the approach should be through critical thinking as the most appropriate for that age.

Team-Based Learning in Bioethics Education: Creating a Successful Curriculum for Residents in an Era of "Curricular Squeeze".

Team-based learning has been utilized inside and outside of medical education with success. Its use in bioethics education-particularly in graduate medical education-has been limited, despite its proven pedagogical strength and the critical importance of ethics and professionalism. From 2015-2018, we created and administered 10 TBL bioethics modular exercises using L. Dee Fink's "Principles of Significant Learning" and the evidence-based methodology of TBL (with some modifications, given the nature of graduate medical education) to pediatric residents. We evaluated the TBL curriculum and report satisfaction scores and qualitative thematic analysis of strengths and weaknesses. Pediatric residents, despite a perception of "curricular squeeze" and lack of interest in ethics, were highly engaged and satisfied with a TBL-only-based bioethics curriculum. We were able to successfully adapt the TBL structure to the situational factors surrounding the rigors and unpredictable nature of clinical graduate education. We offer four "Lessons Learned" for creating and implementing TBL exercises in graduate medical education. TBL can be used in bioethics education successfully, not just for individual exercises, but also to create a comprehensive ethics curriculum.

National pecularities of teaching bioethics in the medical university

The article discusses the problem of the demand for bioethical education for medical students. This problem is connected with the negative tendency to curriculum reduction of humanitarian disciplines. This point of view appeals to the strengthening of the professional component that determines the profile competencies of a specialist. In particular, it is proposed to reduce the teaching time for bioethics in medical higher schools for its use in teaching operational techniques, so-called practical skills. As an opposing point of view, the analysis of the fragment of the bioethics course developed by UNESCO on the issue of providing medical care to under-age patients in the field of cosmetic surgery is proposed. Students are shown the complexity of an ethical solution, seemingly formally resolved by the rules of the law of the problem. The very process of discussion, the discussions that arise, the decision of the judge convince future doctors of the ambiguity of ethical decisions making, as well as the ambiguity of ethical content of the legal norms in the field of health. This problem raises a number of other ethical dilemmas, initiating students' interest in the ethical side of professional activity. The results of sociological research of students of medical higher school [n = 92, average age (19,2 ± 1,01) years] are presented in the article. Despite the fact that 54,3 % of respondents believe that a 15-year-old patient cannot give consent to cosmetic surgery alone, 27,5 % of students found it difficult to answer, just doubting the possibility to make adequate decision at the age of 15. The data obtained demonstrate the general ethical problems raised by the proposed case in the UNESCO bioethics course. Despite possible discrepancies in the legal norms of national laws, cultural, confessional or atheistic peculiarities of countries, the ethical problems of professional activity are of a general nature.

Common medical ethical issues faced by healthcare professionals in KSA.

ObjectiveThere are growing concerns about ethical issues in the healthcare system. This study was conducted to determine the nature of common ethical issues faced by healthcare providers in a tertiary-care hospital in KSA.MethodThis cross-sectional study comprised a self-administered questionnaire given to the physicians working at King Abdulaziz Medical City Hospital-Riyadh, Ministry of National Guard Health Affairs (KAMC-RD, MNGHA). We used a convenience sampling technique during symposia and conferences.ResultsWe distributed 240 questionnaires amongst the physicians and recorded a response rate of 80%; 68% (136) of the respondents were men, while 82.5% were Saudis. The mean age of the group was 34.08 ± 10.43 years. Only 69% (138) of the physicians had ever received any formal teaching in bioethics. Most physicians (77.5%) demanded clear guidelines to help them to take appropriate ethical decisions on therapeutic futility, whereas 54% felt that they sometimes overtreat their patients.ConclusionThis study reported a lack of knowledge in certain healthcare-related ethical issues in a significant proportion of the physicians. There is a need for a standard educational agenda for medical ethics for healthcare providers, not only during medical school but also after graduation and during clinical rounds.

STUDENTS ATTITUDE TOWARDS MEDICAL ETHICS EDUCATION

Medical ethics (ME) and bioethics education are integrated in many medical schools, as a discipline, which aims to help future doctors to recognize ethical issues in healthcare and develop ethical decision-making skills. The main purpose of this paper was to explore students’ attitude towards medical ethics and bioethics, as a course of their education curriculum in the Medical University of Sofia in Bulgaria. The goal was to find out students expectations for the contribution of the acquired knowledge to reflect upon the ethical dimensions and human rights considerations of medicine, healthcare and science after the end of their ME course. A paper questionnaire was distributed to medical students with a letter indicating the purpose of the study. All the students were anonymous and voluntarily participated in the survey. Completed questionnaires were received from 344 medical students. According to the results, the majority (94%) of the participants are familiar with the principles of medical ethics and bioethics and supports (86%) the necessity of studying Medical ethics. Most of the students (87%) think that medical ethics education will help them in their future work and believe (86%) that this course will improve their professionalism, while their opinion (70%) is that medical ethics will lead to effectively co-working with other medical professionals.

УДОСКОНАЛЕННЯ ДОБРОГО ВРЯДУВАННЯ НА ЦІННОСТЯХ І ЗАСАДАХ БІОЕТИКИ В КОНТЕКСТІ ПУБЛІЧНОГО УПРАВЛІННЯ

УДОСКОНАЛЕННЯ ДОБРОГО ВРЯДУВАННЯ НА ЦІННОСТЯХ І ЗАСАДАХ БІОЕТИКИ В КОНТЕКСТІ ПУБЛІЧНОГО УПРАВЛІННЯ

Factors Influencing Respect for Life and Will of Korean Nursing Students

The purpose of this study is to investigate the factors influencing the willingness of nursing college students to have respect for life and to use them as basic principle to help develop an effective bioethics education program for nursing students. A descriptive study was used with 442 nursing students. Data were collected with a structured questionnaire and analyzed using descriptive analysis, t-test, ANOVA, Pearson correlation coefficients, and Multiple regression. The result showed that factors affecting respect for life and will were meanings of death, death anxiety, death concern and these three variables explained about 43.6% of respect for life and will. It is necessary for nursing students to understand the meaning of death and to reduce death anxiety by improving understanding of meanings of death. It also suggests the need to develop an educational program that can improve the respect for life and will by establishing their own views on death and improving the involvement of death in nursing a dying patient and family.

Enseñanza de la Bioética en la Educación Universitaria

Se revisa el tema, considerado al inicio como ética, y su realidad académica en la Universidad Se fundamenta la necesidad de la enseñanza de la bioética, su desarrollo, en todas las profesiones y no sólo en salud. Que su objetivo, es generar conocimientos, aprendizajes, reflexiones, actitudes y comportamiento ético sociales. En su metodología resalta el aprendizaje basado en problemas, por favorecer el razonamiento ético, cambio de actitudes y trabajo en equipo; los Seminarios y los estudios de caso como más usados. Se concluye que en la universidad es imprescindible la formación en bioética para mejorar la calidad educativa, promover comportamientos éticos con sentido, personal, profesional y social; que el aprendizaje basado en problemas, seminarios, estudio de casos, entre otros, permiten aprendizajes que respetan, valores, derechos, democracia y ambiente. Así mismo que la responsabilidad social de la calidad educativa es función de la gestión institucional y de sus actores.

La Inclusión de la Bioética como eje transversal en la EBR

La sociedad peruana, enfrenta situaciones en que las personas manifiestan humillación por la vida humana sin ningún tipo de remordimiento; es posible descubrir que la gran mayoría de veces, los autores de estos actos lesivos provienen de hogares disfuncionales, de un ambiente de violencia familiar, e incluso, muchos de ellos no terminaron la educación básica regular, nos refiriendo al proceso que requiere compromiso y entrega, no solo de parte de los docentes, sino también de los padres o tutores, quienes reforzarán en casa lo que a sus hijos o pupilos se les enseñe en las instituciones educativas. El importante papel que juega la educación, no lo es sólo en el aspecto de avances o descubrimientos científicos y tecnológicos, sino de calidad humana de las personas, a sus principios éticos, bioéticos y sus valores morales que se aprenden durante la etapa escolar. El ámbito de acción de la bioética se ha amplificado, hoy en día, abarca no solo la ética médica, la ética ambiental, los debates sobre los derechos de las futuras generaciones, el desarrollo sostenible, etc. Para incluir el eje transversal de la bioética en la educación, se tendrán que tomar en cuenta la parte que conforma la esencia de la bioética, sus principios y la humanización de la educación.

Η βιοηθική στην εκπαίδευση

During recent years, bioethics have become increasingly important as it has become clear that citizens of all ages will be called upon to take ethical decisions about the use of science and technology at some stage of their lives. Research shows that there is a global agreement on the need to teach more of these ethical and social issues related to science and technology at all levels of education.This article attempts to investigate the importance and role of bioethics in secondary and undergraduate university education. Examples of primary and secondary education curricula, their goals and their contribution to improving students' understanding of the different aspects of bioethics are presented. Then, it is attempted to review the situation of bioethics in universities curricula. The article analyzes the different philosophies of approaching bioethical education, its relation with human rights and compares the advantages and disadvantages of the teaching strategies of integration and specialization.In conclusion, it seems that bioethics is worthwhile being joined together with other disciplines and integrated into a wider framework of effective and informed decision-making skills, whether the person is a health professional or a modern citizen.

Ethical Dilemmas Expressed by Non-oncology Specialists Involved in Diagnosis and Care of Cancer Patients: A Preliminary Study

Background: Ethical problems routinely arise in the healthcare profession and more so in hospitals providing cancer diagnosis and care. Literature study indicates that almost all studies addressing ethical issues in cancer have been qualitative and reported from the developed countries, while there has been no study reported from developing countries. For the first time, we performed a questionnaire study to quantify the ethical issues plaguing the healthcare fraternity in the diagnosis and care of people with cancer. Method: This prospective study was conducted under the aegis of UNESCO Bioethics Education and Research Unit of the UNESCO Chair in Bioethics, Haifa at Mangalore Institute of Oncology Mangalore, India. The investigators approached the healthcare professionals involved in diagnosis, treating, and caring for patients with cancer and ascertained various ethical issues they faced. Data were tabulated and subjected to frequency and percentage. Result: The results indicated that discussing end-of-life issues with the patient and breaking bad news were the two most difficult ones while discussing end of life issues with family caregivers was the least. Conclusion: According to this study, oncology treatment involves a series of dilemmatic issues and breaking bad news. Based on the detailed studies and emphasis on handling these issues, it is possible to develop a teaching module for training the health care professionals and workers for managing the ethical issues effectively.

Per un’educazione alla solidarietà: dalla bioetica globale all’etica della complessità

L’articolo propone un excursus che va dalla critica all’ideologia dell’homo oeconomicus, all’educazione alla bioetica come formazione alla solidarietà, transitando per la bioetica globale di Van Potter ed evidenziandone la curvatura ecologica, per finire con un accostamento tra la bioetica e l’etica della complessità di Edgar Morin. L’insufficienza etica radicale che affligge l’uomo contemporaneo si fonda infatti su una concezione riduzionistica, che risolve l’uomo nella mera istanza economicistica. Si profila pertanto l’urgenza di un rinnovamento delle ordinarie categorie gnoseologiche e morali, che possa riconsegnare l’uomo alla complessità della sua identità, in cui si trovano inscritti i valori dell’altruismo e della solidarietà. In questa missione, la bioetica e il pensiero della complessità si riconoscono nel comune intento della riforma dell’insegnamento.

Is UNESCO’s Undergraduate Bioethics Integrated Curriculum (Medical) fit for purpose?

In 2017, UNESCO introduced an Undergraduate Bioethics Integrated Curriculum to be taught in Indian medical schools, with an implied suggestion that it could subsequently be rolled out to medical schools...

Newspapers in Bioethics Education: A Case Study

While the idea of using newspapers in education dates back to as early as the 1890's. It has been significantly promoted in various circles since the first half of the 20th century. Newspapers are considered to be important learning materials as they focus on current affairs, address a wide range of audiences, and provide students with a learning environment other than the classroom setting. Increasing numbers of studies highlight the effectiveness of it. The present study investigates the effects of the use of news items from newspapers as learning materials in bioethics education. The internet archives of the newspapers with the highest circulation in the national press were screened for news items on surrogacy. One was selected for the process of bioethics education. The study was implemented with a total of 112 pupils in their tenth year at a public vocational secondary school of health services in Ankara. The bioethics education model developed by [13] was used in the study. At the end of the implementation, semi-structured interviews were held with pupils in order to identify their opinions on the processes of bioethics education and the use of news in the classroom.

The Use of Narratives In Graduate Bioethics Education.

The author considers the role of narratives, specifically end-of-life narratives, in medical education. After addressing the role of indexing and other neurological explanations for the validity of narratives in the classroom, she focuses on one recent memoir that explores the medical experience of an ALS patient. The advantages of using narratives, including the understanding of the patients' perspective and the development of empathy, are two important reasons to adopt this approach.