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College of Physicians and Surgoens

Ethics & Values Unit
Unit Directors: Barron Lerner, M.D., Ph.D., David Rothman, Ph.D.

  Schedule, Fall Semester 2006 (PDF, 84K)

Overview:

Although issues of ethics and values have always been a part of medical practice, a major change occurred at the beginning of the 1960’s with the advent of the bioethics movement. As a result of technological advances occurring within medicine and social and cultural changes occurring outside of medicine, the public began to pose new questions that raised ethical issues. Who should make decisions at the bedside – the physician or the patient? What should be done in cases where the patient lacks the capacity to participate in such decisions? How should the new technological resources – such as kidney dialysis, transplant organs and ICU beds – be allocated? Moreover, was it appropriate to devote major financial resources to expensive scientific advances, particularly when so many Americans lacked basic health care? Finally, if medicine was now able to prolong life much longer than ever before, was this always the correct choice?

In addition to raising these clinical issues, the recent upsurge in interest in bioethics has prompted a reexamination of the proper professional role of the physician. Becoming a physician entails the establishment of professional relationships not only with patients but also with colleagues, employers and government. In an era of rising health care costs and growing managed care arrangements, these relationships are coming under increasing scrutiny. How should physicians balance their fiduciary responsibility to patients with growing demands to limit financial expenditures? Should physicians accept gifts from pharmaceutical companies or do such gifts undermine their clinical objectivity? Should physicians be able to refer patients for diagnostic evaluations at medical facilities in which they have a financial interest?

These sessions on ethics and values are designed to introduce you to the myriad complex issues that constitute contemporary bioethics. One result of the growth of bioethics has been the increasing participation of specialists, known as “bioethicists,” in clinical decision-making. These individuals include philosophers, theologians and lawyers, as well as physicians and other health care providers. Most major medical centers now have standing ethics committees to address difficult ethical issues and provide consultation on specific cases. Although bioethicists provide important expertise at the bedside, it is incumbent that all future physicians become comfortable dealing both with ethical problems in the clinical setting and in professional medical ethics. These sessions will serve as the first segment of ethics and values training that you will receive during your four years at P&S.

Objectives:

  1. To explore the historic role of ethics and values have played in the practice of medicine, and to learn about the rise of bioethics.
  2. To discuss what it means to be a doctor in the 21st century. How are the privileges and responsibilities of the physician to be balanced with the growth of patient autonomy and managed care medicine?
  3. To look at the ethics of clinical experimentation. How should the competing pressures to create therapeutic innovations be balanced with the care of the patient?
  4. To discuss the probable impact of health care reform and managed care on the physician-patient relationship, the academic medical center, and the careers of physicians.
  5. To explore the ethical implications of the physician-patient relationship. How should physicians respond if they suspect that their colleagues are impaired or performing unsatisfactory work?
  6. To understand medical ethics in the context of birth and death. When does the ability to prolong life become a burden to patients as opposed to a benefit? Who should decide when such a point has been reached?

  Schedule, Fall Semester 2006 (PDF, 84K)




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