Teaching Ethics in the Health Care Setting

1SCOPE

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National Reference Center for Bioethics LiteratureThe Joseph and Rose Kennedy Institute of EthicsBox 571212, Georgetown UniversityWashington, DC 20057-1212888-BIO-ETHX; 202-687-3885; fax: 202-687-6770e-mail: bioethics@georgetown.eduhttp://bioethics.georgetown.edu

Teaching Ethicsin the Health Care Setting

by Mary Carrington Coutts(This is a slightly revised version of a Scope Note was originally published in two partsin the Kennedy Institute of Ethics Journal. Part I: Survey of the Literature. KIEJ 1(2):171-185, June 1991; Part II: Sample Syllabus. KIEJ 1(3): 263-273, September 1991.)

Part I: Survey of the Literature

The last twenty years have brought important changes to health care and health careeducation. and students alike face an enormous number of new fields of study and newmedical technologies. Health care professionals and institutions are also facing newchallenges in the form of shrinking economic resources, and the AIDS epidemic. Theymust also respond to increased patient participation in health care decisions, and publicconcern about abortion and euthanasia. These challenges to the health care professionalhave compelled educators to accommodate ethics within their already overcrowdedcurriculum. Those same dilemmas have influenced health care institutions to becomeactive in health care ethics education.

Medical ethics education gained a foothold in the United States during the late 1960s,when the medical schools of Pennsylvania State University, the University of Florida, andthe State University of New York at Stonybrook established programs in the humanities(74). In 1978 Robert Veatch noted that formal teaching in medical ethics was rare; mostinstitutions that taught medical ethics used “informal instruction in the apprenticeshipmode” (27). However, by 1982 a survey by the American Medical Association (AMA)revealed that all but one of the 127 medical schools had courses that included medicalethics. Thirty eight of these had medical ethics as a required course (30); and by 1989, 43of the 127 medical schools had separate courses in medical ethics, while 100 coveredmedical ethics within required courses. Medical ethics is now an accepted part of themedical curriculum, though it is not fully mature, and its future remains somewhat unclear(21).2

Table of ContentsSurvey of the LiteratureIntroduction....................1Organizational Statements.........3Background Articles.............4Evaluative Articles...............7Technique Articles...............7Program Descriptions.............8Additional Readings.............10Sample SyllabusTextbooks.....................12Casebooks....................13Course Outline.................13Supplemental Readings..........18Syllabus Exchange Project........18

The evolution of ethics in the nursing curriculumhas essentially mirrored that of the medical curric-ulum. A 1977 survey of baccalaureate nursingprograms revealed that only 7 percent of nursingprograms required courses in ethics (58). A decadelater a second survey of undergraduate programsidentified 85 percent of responding nursingschools as teaching nursing ethics either in separateethics courses or within other required courses(11).

Though the precise future of health care ethics maybe unpredictable, there is little thought that the roleof ethics will diminish in importance as the 21stcentury approaches. Ethics is seen as part of alarger plan to develop and enhance the healthprofessional’s human values, social conscience,and interpersonal skills. “This broader effortderives from concerns about the personal attributesand humanistic sensitivity of physicians, the recentoverly ‘scientized’ trend in premedical education,the selection of medical students, and the socializa-tion and cynicism engendered by medical educa-tion” (21, p. 705).

While nearly every medical and nursing school inthe United States now teaches ethics in one formor another, the degree to which ethics is integratedinto the curriculum varies from school to school.

Some ethics courses are required elements of thestudents’ education; some institutions requireattendance at seminars and ethics grand rounds.Other schools offer an array of elective courses intopics that relate to ethics in medicine and nursing(including medical humanities, medicine and thelaw, literature and medicine, history of medicine,patient advocacy, and human values in nursing.)“Brown bag” seminars and journal clubs are alsocommon.