Medical education,palliative care and moral attitude: some objectives and future perspectives

CONTEXT: Adequate medical education has 3 interrelated aspects: theoretical knowledge, practical skills and the personal attitude of the doctor. The current emphasis on medical science diverts attention from the importance of the attitude aspect of medical education. We argue that the integration of palliative care into medical curricula can correct this imbalance between knowledge, skills and attitude. In our view, incorporating palliative care into medical training not only improves the quality of palliative care, but also contributes to the moral quality of the doctors being trained. To support our argument we emphasise the moral aspects of attitude. Moral attitude focuses on the capacity to respond to others in a humane manner and can be compared with the way a virtuous doctor acts. We show the crucial role this moral attitude plays in palliative care and the surplus value palliative care education can have in general medical training. PERSPECTIVES: We suggest that clinical experience in palliative care, supplemented by reflection on narratives about chronically ill or dying patients and mourning or ageing processes, offers prospects for developing palliative care education. These perspectives can contribute to the transformation of the present 'hidden curriculum' of contemporary medical education, which implicitly shapes the student's moral attitude, into a future more explicit enculturation into the medical realm. Ultimately, this will improve health care as a whole.     

Gender in medical ethics: Re-examining the conceptual basis of empirical research

Conducting empirical research on gender in medical ethics is a challenge from a theoretical as well as a practical point of view. It still has to be clarified how gender aspects can be integrated without sustaining gender stereotypes. The developmental psychologist Carol Gilligan was among the first to question ethics from a gendered point of view. The notion of care introduced by her challenged conventional developmental psychology as well as moral philosophy. Gilligan was criticised, however, because her concept of two different voices may reinforce gender stereotypes. Moreover, although Gilligan stressed relatedness, this is not reflected in her own empirical approach, which still focuses on individual moral reflection. Concepts from social psychology can help overcome both problems. Social categories like gender shape moral identity and moral decisions. If morality is understood as being lived through actions of persons in social relationships, gender becomes a helpful category of moral analysis. Our findings will provide a conceptual basis for the question how empirical research in medical ethics can successfully embrace a gendered perspective.This revised version was published online in October 2005 with corrections to the Cover Date.     

CYCLICAL ABSENTEEISM AMONG PRIVATE SECTOR,PUBLIC SECTOR AND SELF‐EMPLOYED WORKERS

This research note analyzes differences in the number of absent working days and doctor visits and in their cyclicality between private sector, public sector and self‐employed workers. For this purpose, I used large‐scale German survey data for the years 1995 to 2007 to estimate random effects negative binomial (count data) models. The main findings are as follows. (i) Public sector workers have on average more absent working days than private sector and self‐employed workers. Self‐employed workers have fewer absent working days and doctor visits than dependent employed workers. (ii) The regional unemployment rate is on average negatively correlated with the number of absent working days among private and public sector workers as well as among self‐employed men. The correlations between regional unemployment rate and doctor visits are only significantly negative among private sector workers. Copyright © 2012 John Wiley & Sons, Ltd.     

Individual differences in moral judgment competence influence neural correlates of socio-normative judgments

To investigate how individual differences in moral judgmentcompetence are reflected in the human brain, we used event-relatedfunctional magnetic resonance imaging, while 23 participantsmade either socio-normative or grammatical judgments. Participantswith lower moral judgment competence recruited the left ventromedialprefrontal cortex and the left posterior superior temporal sulcusmore than participants with greater competence in this domainwhen identifying social norm violations. Moreover, moral judgmentcompetence scores were inversely correlated with activity inthe right dorsolateral prefrontal cortex (DLPFC) during socio-normativerelative to grammatical judgments. Greater activity in rightDLPFC in participants with lower moral judgment competence indicatesincreased recruitment of rule-based knowledge and its controlledapplication during socio-normative judgments. These data supportcurrent models of the neurocognition of morality according towhich both emotional and cognitive components play an importantrole.     

Medicine,morality and mothering: public health discourses on foetal alcohol exposure,smoking around children and childhood overnutrition

Over the past few decades, three issues have emerged as threats to the health of infants and children in western, industrialised countries: the developmental impact of alcohol use in pregnancy (Foetal Alcohol Spectrum Disorder, or FASD), children's exposure to second-hand smoke in the home, and childhood overnutrition and obesity. The definitive role of drinking during pregnancy, exposure to second-hand smoke and overnutrition on negative health outcomes in infants and children remains the subject of considerable debate. Nevertheless, all three issues have been medicalised and criminalised: framed as looming health emergencies that require immediate intervention and, increasingly, legislation. However, it is our contention that the alarm these health ‘threats’ currently generate has many of the characteristics of a moral panic. In this paper we unpack the discourses surrounding these three issues, and explore the common focus on maternal responsibility and the ways in which these movements serve to covertly marginalise and stigmatise particular groups of women.     

医学院校图书馆的医德教育职能

 

论述了医学院校图书馆在实施医学生医德教育中的重要意义，分析了医学院校图书馆在医学生医德教育中的优势，并提出了医学院校图书馆开展医德教育的契合点。

     

试论医德医风建设中的六个转变

从医院改革与发展出发，对医德医风建设工作实行六个方面的转变作了阐述。六个转变为：从一般教育向系统教育转变；从动员式运动式工作向规范性经常性工作转变；从局部建设向整体建设转变；从提高个体素质向提高整体素质转变；从部门工作向全院一体化工作转变；从德治向德治、法制等综合治理转变。     

Gatekeeping versus direct‐access when patient information matters

We develop a principal‐agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non‐gatekeeping approaches to health care when patient self‐health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non‐gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self‐health information is neither highly inaccurate (in which case the patient's self‐referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly). Copyright © 2009 John Wiley & Sons, Ltd.