Scholarly Concentration in Clinical Ethics

Course Coordinator: Robert Fulbright, J.D., M.A. Robert Fulbright, J.D., M.A. is a Clinical Assistant Professor at the University of Nevada, Reno School of Medicine.

Clinical Ethics

From the time of Hippocrates, the medical profession has always acknowledged the moral context of medicine; however, in simpler times with fewer therapeutic options, physicians and their patients infrequently faced ethical choices. The rapid advance of medical science creates previously unimagined options and intensely difficult ethical decisions.

We will follow the method developed by three clinical ethicists (a philosopher, Jonsen, a physician, Siegler, and a lawyer, Winslade) as a guideline for working through a clinical ethical dilemma in a step-wise manner similar to the "History and Physical" skills all medical students come to use when learning how to address a patient's primary complaints. While this method has deep philosophical roots, what clinicians who use this method like about it is the ease with which it fits into how they normally think about tough medical cases.

Course Requirements

Complete a minimum of 320 hours. Four weeks full-time (160 hours) during the summer between the first and second year of medical school and 160 hours as a 4th year elective. The elective hours are flexible but must be taken in a block.

Summer: The student will participate in a clinical rotation that commonly sees ethical issues, based on areas of interest and availability (eg, palliative care, hospice, hematology/oncology) and will be responsible to read "How Doctors Think" (Groopman) as well as selections from "Clinical Ethics" (Jonsen et. al.,) and "Resolving Ethical Dilemmas (Lo). They will meet weekly with the Course Coordinator to complete and discuss a number of short assignments and case studies. At the end of the summer, the student will be required to submit a reflective writing assignment based on reactions from reading the Groopman book.

4th year elective: The student will attend Saint Mary's and/or Renown's Bioethics Committee meetings (held monthly), will observe clinical ethics consultations if possible, will, in conjunction with further readings in "Clinical Ethics," create three case studies in clinical ethics—the first in partnership with the Course Coordinator—and will present one (20 minutes). The student will also attend de-briefing sessions with the Course Coordinator after ethics meetings. The elective will culminate in completion of a scholarly project and a poster to be presented in the spring. The project will be further defined based on the student's individual interests, but options could include a presentation of a poster at a educational meeting, submission of a research project or case report to a peer-reviewed journal, or development and teaching of an ethics educational module.

Required Reading

• How Doctors Think, Jerome Groopman
• Resolving Ethical Dilemmas: A guide for clinicians by Bernard Lo; Lippincott, Williams & Wilkins; 4th Edition, January 7, 2009
• Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Albert Jonsen, Mark Siegler and William J. Winslade

Curriculum Objectives

• Competence in analyzing and synthesizing clinical ethical issues and concepts as would occur in an ethics consult
• Familiarity with the workings of a hospital ethics committee and hospice care team
• Knowledge of a hospital clinical ethics consult and when to ask for one
• Presentation of an Ethics Workup in writing and orally

Evaluation

Students are required to complete all reading, writing, meeting, and presentation assignments before special qualifications are granted.