Is the Biosphere a Luxury?

Wherever did we get the idea that we are no kin to the earth's other inhabitants, and that we can therefore deal with them as we please? Several strains of thought converged to produce this way of thinking, which must now be unlearned.     

The point of a ban. Or, how to think about stem cell research

We might be convinced that the goal of relieving suffering offers a straightforward justification of sacrificing embryos in research. Or we might hold that although embryos merit our respect, the greater the good to be achieved by destroying them, the more respect must give way to research. Or, if we take the notion of respect seriously, we might find that relieving suffering is a real but not supreme imperative.     

Medical screening and the value of early detection. When unwarranted faith leads to unethical recommendations

Medical screening is justified on the strength of the assumption that the earlier disease is detected, the better it is for the patient. On examination, however, the assumption turns out to be severely flawed, and inadequate anyway, since it is not only the patient with whom we should be concerned, but healthy people as well. Instead of making assumptions about the ill, we should prove a test's overall benefit to the individual taking it before we recommend it.     

Access to Health‐Related Goods

There are many good reasons for a merger between bioethics and human rights. First, though, significant philosophical groundwork must be done to clarify what a human right to health would be and—if we accept that it exists—exactly how it might influence the practical decisions we face about who gets what in very different contexts.     

Preparedness of medical education in China: Lessons from the COVID-19 outbreak

Abstract

The COVID-19 outbreak can be seen as a ‘big test’ for China; a summative assessment of its preparedness on multiple fronts, including medical education. Being intimately involved in the coordinated response, the First Affiliated Hospital of Sun Yat-sen University has been a first-hand witness to the strengths and weaknesses of the current medical education system in China. On the one hand, we believe that the distinguished contributions in disease containment efforts by healthcare professionals indicated that our medical education system has achieved its intended outcomes and is socially accountable. On the other hand, we have also identified three major issues that need to be addressed from an educational standpoint: insufficient emphasis on public health emergency preparedness; unsophisticated mechanisms for interdisciplinary cooperation; and inadequate guidance in medical ethics. Whilst these reflections might be seen in its summative form, we would suggest changing it to that of a formative process, where we learn from our assessment through observation and feedback of the gaps, upon which improvement of our present situation can be made. We hope that these lessons may be helpful to our colleagues in the rest of China and around the world, who are engaged in medical educational reform.     

Taking Behavioral Genetics Seriously

Discussions of information produced by genetics research are often guided by two mistaken theoretical moves. Enthusiasts tell us not to worry because genetic tinkering can alter only our body, never our soul; worriers suggest that discovering links between our behavior and our different bodies threatens important democratic ideas like moral equality. If we understand the body and soul to be inseparable and equality to be undiminished by difference, we can begin to take seriously the information produced by genetics research.     

The art of the cover

Often, it's difficult to match up our cover artwork with the subjects of our lead articles and special reports. Of necessity, we sometimes turn to pure abstraction. How else to illustrate technical policy articles on subjects such as changing research protocols or informed consent, or abstract ideas like congruence, duality, imbalance, causality? At such times, we have to be pretty creative, and my search for cover art can be long and challenging. In the end, we hope that the reader will make the connection between cover and content. However, at other times, the subject of a lead article or special report overflows with artistic possibilities .     

Developing research skills in medical students: AMEE Guide No. 69

This Guide has been written to provide guidance for individuals involved in curriculum design who wish to develop research skills and foster the attributes in medical undergraduates that help develop research. The Guide will provoke debate on an important subject, and although written specifically with undergraduate medical education in mind, we hope that it will be of interest to all those involved with other health professionals' education. Initially, the Guide describes why research skills and its related attributes are important to those pursuing a medical career. It also explores the reasons why research skills and an ethos of research should be instilled into professionals of the future. The Guide also tries to define what these skills and attributes should be for medical students and lays out the case for providing opportunities to develop research expertise in the undergraduate curriculum. Potential methods to encourage the development of research-related attributes are explored as are some suggestions as to how research skills could be taught and assessed within already busy curricula. This publication also discusses the real and potential barriers to developing research skills in undergraduate students, and suggests strategies to overcome or circumvent these. Whilst we anticipate that this Guide will appeal to all levels of expertise in terms of student research, we hope that, through the use of case studies, we will provide practical advice to those currently developing this area within their curriculum.     

New insights into burnout and health care: Strategies for improving civility and alleviating burnout

What do we know about burnout, and what can we do about it? This article will provide an overview of what has been learned from current research on burnout, and what are the implications of the key themes that have emerged. One theme involves the critical significance of the social environment in health care settings. A second theme is the challenge of how to take what we know, and apply it to what we can do about burnout. What we need are new ideas about potential interventions, and clear evidence of their effectiveness. One example of this perspective addresses burnout by improving the balance of civil, respectful social encounters occurring during a workday. Research has demonstrated that not only can civility be increased at work but that doing so leads to an enduring reduction in burnout among health care providers. Lessons learned from this extensive research form the basis of recommendations for medical education. Specifically, the effectiveness of both the academic content and supervised practice would be enhanced by giving a greater emphasis to the social dynamics of healthcare teams. This perspective can help new physicians in avoiding potential pitfalls and recovering from unavoidable strains.     

Just caring: defining a basic benefit package

What should be the content of a package of health care services that we would want to guarantee to all Americans? This question cannot be answered adequately apart from also addressing the issue of fair health care rationing. Consequently, as I argue in this essay, appeal to the language of "basic," "essential," "adequate," "minimally decent," or "medically necessary" for purposes of answering our question is unhelpful. All these notions are too vague to be useful. Cost matters. Effectiveness matters. The clinical circumstances of a patient matters. But what we must ultimately determine is what we mutually agree are the just claims to needed health care of each American in a relatively complex range of clinical circumstances. Answering this question will require a public moral conversation, a fair process of rational democratic deliberation aimed at defining both just claims to needed health care and just limits.     

Abortion: The Right to an Argument

Our moral puzzles about abortion will not be resolved by resort to compromise positions and adoption of middle ground, for abortion concerns how we understand ourselves as a people and how we define membership in this community.     

Theoretical insights into interprofessional education: AMEE Guide No. 62

In this Guide, we support the need for theory in the practice of interprofessional education and highlight a range of theories that can be applied to interprofessional education. We specifically discuss the application of theories that support the social dimensions of interprofessional learning and teaching, choosing by way of illustration the theory of social capital, adult learning theory and a sociological perspective of interprofessional education. We introduce some of the key ideas behind each theory and then apply these to a case study about the development and delivery of interprofessional education for pre-registration healthcare sciences students. We suggest a model that assists with the management of the numerous theories potentially available to the interprofessional educator. In this model, context is central and a range of dimensions are presented for the reader to decide which, when, why and how to use a theory. We also present some practical guidelines of how theories may be translated into tangible curriculum opportunities. Using social capital theory, we show how theory can be used to defend and present the benefits of learning in an interprofessional group. We also show how this theory can guide thinking as to how interprofessional learning networks can best be constructed to achieve these benefits. Using adult learning theories, we explore the rationale and importance of problem solving, facilitation and scaffolding in the design of interprofessional curricula. Finally, from a sociological perspective, using Bernstein's concepts of regions and terrains, we explore the concepts of socialisation as a means of understanding the resistance to interprofessional education sometimes experienced by curriculum developers. We advocate for new, parallel ways of viewing professional knowledge and the development of an interprofessional knowledge terrain that is understood and is contributed to by all practitioners and, importantly, is centred on the needs of the patient or client. Through practical application of theory, we anticipate that our readers will be able to reflect and inform their current habitual practices and develop new and innovative ways of perceiving and developing their interprofessional education practice.     

In God's Garden Creation and Cloning in Jewish Thought

The possibility of cloning human beings challenges Western beliefs about creation and our relationship to God. If we understand God as the Creator and creation as a completed act, cloning will be a transgression. If, however, we understand God as the Power of Creation and creation as a transformative process, we may find a role for human participation, sharing that power as beings created in the image of God.     

Animal research,non-vegetarianism,and the moral status of animals--understanding the impasse of the animal rights problem

I offer some reasons for the theory that, compared with human beings, non-human animals have some but lesser intrinsic value. On the basis of this theory, I first argue that we do not know how to compare an animal's claim to be free from a more serious type of harm (e.g., death), and a human's claim to be free from some lesser type of harm (e.g., non-fatal morbidity). For we need to take account of these parties' intrinsic value, and their competing types of claim. Yet, there exists no known way for making such comparison, when a human's intrinsic value is higher than that of an animal, whereas the type of claim an animal has is morally weightier than the type of claim a human has. Second, I explain why utilitarianism is unhelpful in making such comparison. Third, in the case where some animals can be sacrificed for saving a larger number of humans, it is crucial to ask whether animals have the right to life, and I argue that this question is more perplexing than we might think. My conclusion is that the various difficulties mentioned above have a deeper source than we have so far acknowledged, and that this reflects that the moral reality is less tidy and more complex than many theories portray.     

Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 Conference

In this article, we outline criteria for good assessment that include: (1) validity or coherence, (2) reproducibility or consistency, (3) equivalence, (4) feasibility, (5) educational effect, (6) catalytic effect, and (7) acceptability. Many of the criteria have been described before and we continue to support their importance here. However, we place particular emphasis on the catalytic effect of the assessment, which is whether the assessment provides results and feedback in a fashion that creates, enhances, and supports education. These criteria do not apply equally well to all situations. Consequently, we discuss how the purpose of the test (summative versus formative) and the perspectives of stakeholders (examinees, patients, teachers-educational institutions, healthcare system, and regulators) influence the importance of the criteria. Finally, we offer a series of practice points as well as next steps that should be taken with the criteria. Specifically, we recommend that the criteria be expanded or modified to take account of: (1) the perspectives of patients and the public, (2) the intimate relationship between assessment, feedback, and continued learning, (3) systems of assessment, and (4) accreditation systems.     

Open book exams: A potential solution to the “full curriculum”?

Abstract

In this Personal View article, as curriculum designers, we consider whether there is a place for open book exams in Medical School curricula. Specifically, at a time when medical teachers complain about the difficulties of delivering a full curriculum, we propose that open book assessment approaches may help to free up the curriculum as learners become less reliant on memorizing facts. Moreover deeper learning of higher level outcomes can be achieved and more authentic assessment approaches undertaken. We also look at the recent literature and consider reasons, both for and against open book exams, at theoretical and practical levels. Though there are potential challenges with delivering an open book exam, we conclude that the benefits appear to outweigh these difficulties. As part of a balanced assessment strategy it may be necessary and timely to adopt open book exams.     

Visions,Secular and Sacred

As an imaginative vision of life as a whole is a central part of our mental equipment for any serious study, we must be careful what vision we espouse. If science is not furnished with a sensible one, it cannot fail to gather a wild one.     

Autonomy,Beneficence, andGezelligheid

American bioethicists lack the theoretical resources to work in cross‐cultural settings. All we have are two approaches to ethics—principles vs. narratives—that are mostly at odds, and neither of which is up to the job. If moral principles are too abstract to be useful, and if stories cannot provide moral authority, then where do we find our moral norms?     

Prozac, enhancement, and self-creation

A person can be true to oneself even while transforming and even creating the person one is. One's self is not something merely waiting to be discovered, after all. To some extent, part of the human endeavor is deciding and trying to become who we want to be.     

Managed care organizations and the rationing problem

By and large, neither bioethicists nor economists have offered a satisfactory account of how managed care organizations should ration health care. Both disciplines would like to guarantee adequate care to all without defining adequacy. But it cannot be done. The more we rely on market forces to distribute health care, the more we need a national standard of care.