Case Studies In Ethics In Teaching

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Case Studies In Ethics In Teaching

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Conclusions and Recommendation: A case study in the ethics and law module for Obstetrics And Gynaecology Residency Programs improves the ability to make clinical decisions that are dilemma and medicolegal-related. Case studies become a learning model for the achievement of ethical and legal competencies. Download article PDF. Corresponding Author. Nasrudin Andi Mappaware. Published by Atlantis Press. Cite this article ris enw bib. These individuals were not necessarily experts or individuals with special training in ethics, but they had some prior interest and motivation in the subject.

How much of the material to share with students or participants in in-service continuing education sessions is left to the discretion of the group instructor. The World Health Organization WHO in published case studies in public health research which addressed the associated ethical issues [ 8 ]. A few years later the Public Health Ethics Unit of the US Centers for Disease Control and Prevention CDC included an approach to public health ethics education and training focused primarily on in-service public health workforce training programs. In , Population and Public Health Ethics: Cases from Research, Policy, and Practice published by the University of Toronto Joint Centre for Bioethics [ 12 ] compiled 16 realistic cases from across public health research, policy, and practice contexts in Canada and internationally.

Case studies covered a range of topics, including outdoor smoke-free policies, mandatory immunization policies for health workers, malaria control initiatives, and inequities in health for aboriginal populations. A largely Canadian effort, this book extended the work of earlier casebooks by including example analyses for each of the cases written by individuals with expertise in both ethics and public health, which provides practical issues as food for thought, discussion, and debate.

The casebook is being used as a resource in several public health courses in Canada and the United States. Building on the Canadian effort, the US CDC formed an international partnership to develop new case study materials useful for public health ethics education. This group concluded that although the practice of public health has always involved consideration of ethical issues, the field of public health ethics as a discipline is a relatively new and emerging area. Despite previous efforts relatively few practical training resources for public health practitioners are available, especially resources that consider ethical issues likely to arise in the practice of public health. The casebook assembles a broad range of cases that highlight global perspectives on the ethical challenges of public health and approaches specifically designed for addressing these challenges.

The purpose of the PHEICSG casebook is to raise awareness and provide teaching material for the understanding of public health ethics and the value of ethical analysis in public health practice. This includes, but is not limited to, ethical considerations for public health policy development, implementation, and evaluation, public health decision making in national and international field settings and training programs, and applied public health research. The cases highlight ethical issues and dilemmas that arise in the practice of public health, drawing attention to similarities and differences in cross-cultural perspectives on frequently encountered public health ethics concerns. Finally, the casebook is a tool to support instruction, debate, and dialogue regarding public health ethics that delineates approaches specifically designed to address ethical challenges encountered in public health practice.

The primary audiences for the casebook is public health practitioners, including front-line workers, field epidemiology trainers and trainees, managers, planners, and decision makers who have a responsibility and interest in learning about how to integrate ethical analysis into their day to day public health practice. The casebook is also useful to schools of public health and public health students, as well as to academic ethicists who can use the book to teach public health ethics and distinguish it from clinical and research ethics.

The format of the cases consists of a background section that provides context regarding the public health selected topic, a description of the case, and up to five questions to stimulate discussion of the ethical aspects of the case. The CDC casebook will also include introductory information on public health ethics and several chapters providing overview ethical analyses highlighting issues raised by the cases. The intended use includes public health courses or workshops on public health ethics in various settings.

The casebook is expected to be published in This type of ethics analysis can be used retrospectively to discuss past decisions in order to identify ways that the decision-making could have been improved. As the process of developing these various international resources indicate, discussion of case scenarios or hypotheticals can be an effective technique in ethics education and the case analysis method of pedagogy can be an effective tool for ethics educators in public health. Cases provide a specific way to connect the scientific details and social context of public health policies and practices with more general ethical principles, rules, and values.

Cases provide learners with a focus for their own ethical assessment and evaluation for decisions and actions that they might confront in their work. Cases also provide learners to reflect on past actions by professionals and to reassess them in light of various ethical perspectives. If cases are to function educationally as described above , it is important that both experienced public health practitioners and those trained in ethical theory collaborate in the development of teaching cases and implementing courses.

Cases can also serve as a resource for more general discussions of public health values among the general public. Public health ethics for professionals and for citizens in a democratic society can converge, and cases are one important bridge that can facilitate a common understanding of ethical issues. Lee and colleagues report only modest progress over recent decades in incorporation of PH ethics studies in educational programs such as MPH in the United States [ 15 ]. A parallel study in Europe [ 16 ], discussed by Royo Bordenado and colleagues elsewhere in this issue [ 17 ], showed similar findings.

Training current faculty on PH ethics issues should be encouraged by schools of public health in order to incorporate ethics topics into existing courses of formal educational programs. Philosophical expertise in ethics should go hand in hand with expertise and experience in professional public health practice. The teaching of ethics requires interdisciplinary competence on the part of instructors. Ethical theory and conceptual analysis are essential in the teaching of practical ethics. Moreover, integrating ethical theory into educational programs for students and practicing professionals requires careful preparation and planning. It is important to develop critical reasoning about philosophical concepts, otherwise ethical principles and norms are only used in a somewhat mechanical and rote fashion, and become an additional jargon that practitioners use rather than effective tools for analysis and decision-making.

Many ethics educators in public health find group discussions of ethics and values frustrating and difficult because such discussions seem to have no sense of progress and forward movement and no satisfying resolution or conclusion. Yet, ethics discussions need not be like this; they can—and should—follow an orderly progression of steps. And they can end, if not always with firm, agreed-upon conclusions, then at least with the sense that something has been clarified—people have been led to think.

The goals of ethics education in public health remain a subject of controversy. Moreover, while professional ethics codes, rules, and regulations are very important, typically ethics education does not focus on them alone, and the purpose of ethics education should not simply be to familiarize practitioners with such documents. Instead of being merely formalistic or legalistic in this way, most public health ethics courses today adopt an analytic approach and focus on complex situations where numerous ethical rules and values come into play and may conflict. Some of these situations involve legal and regulatory functions meant to protect individuals and societies from avoidable injury, illness or premature death.

The use of cases for discussion facilitates the development of these analytic reasoning skills because they can readily exemplify trade-offs among important values and interests and take seriously initially counter-intuitive positions. Cases involving child health and parental decision-making rights, for instance, can portray situations in which parental decisions can endanger their own or other children, such as in withholding immunizations [ 18 ], or parental refusal of vitamin K for newborns rsulting in preventable bleeding disorders, as reported in Tennessee in leading to brain damage in 4 children including one death [ 19 ]. In sum, the study of public health ethics is an essential element of preparation of practitioners and policy makers to address population health issues.

The aim of ethics education in public health should be to enhance the ability of public health professionals, policy makers and citizens to reason intelligently about the moral dilemmas and value conflicts inherent to human rights, social justice, and the application of knowledge and technology in the health sciences. In pursuit of this aim, ethics education in public health should attempt to stimulate the moral imagination and broaden critical reasoning skills; ethics education should elicit a recognition and sense of personal and civic ethical responsibility; and ethics education should develop a capacity to cope with moral ambiguity and to value tolerance and social diversity in a pluralistic society.

Group discussion built around the ethics cases can model this form of deliberative communication. Directed group discussion can demonstrate that progress can be made in reducing disagreement, or at least in gaining a narrower, and perhaps more manageable, area of disagreement. Such discussions can, and often do, lead to a manageable way forward. It is important to emphasize that ethics education is primarily a discipline of reasoning, not a corrective for deficient ethical motivation or character. Improved reasoning ability as a goal of ethics education does not presuppose any specific moral belief or conclusion, but it does require recourse to general standards of logic, consistency, and empirical claims that are supported by reasonable standards of evidence.

Such general standards can be used to evaluate the quality of ethical arguments. When discussing a strategy for ethics education in public health it is important to recognize the audience of ordinary citizens and community members who might participate in deliberations and discussions about ethical issues alongside public health experts and practitioners. Indeed, no discussion of ethics education would be complete without taking seriously the need for civic education to complement it or to prepare social acceptance of public health initiatives that may be offensive to some but have a solid base of effectiveness, safety and cost -benefit. To meet looming health needs, attend to public health crises, and to bring about requisite institutional and behavioral change, public health cannot rely on legal authority or coercion alone to improve population health, it must engage and persuade private individuals, who are considering their individual health interests, and public citizens, who are considering health justice for the entire community [ 20 , 21 ],.

Civic education concerning public health ethics builds on the findings that the fabric of social capital, individual capability, and strong social networks are integral parts of an overall pattern of living that is empowered, respected, just, and healthy. In practice this means that public health programs must have a base in social values and purposes such that the members of these societies will understand as interdependent and relational democratic citizens [ 22 ]. As we have noted, the use of case hypotheticals in civic forums and other kinds of public discussions can facilitate better understanding.

For professionals, cases can bridge the gap between facts and values. For citizens, the discussion of cases can broaden the horizons of their own understanding of their personal interests and their own place in a broader community of shared health vulnerability. Cases shaped by background expertise in epidemiological research and current understandings of the social determinants of health can be devised which will translate statistical knowledge into culturally recognizable narrative and local knowledge. In both its professional and civic settings, public health ethics education is not about the abstractions of philosophical debate; PH ethics concerns concrete issues of health and social justice and the obligation to save lives, prevent harm, and promote the health and well-being of all people and must take into account the context of community acceptability [ 23 ].

Clearly public health involves many stakeholders and actors, including national and state governments, local authorities, advocacy groups, insurance systems, professional associations, academic centers, food and drug manufacturers, health care providers, scientists, regulators, non-governmental organizations, international agencies and donors. In this article we have described current resources available to support the teaching of public health ethics. We have argued that interdisciplinary expertise is important to the subject matter and pedagogy of public health ethics. We have discussed the role and advantages of using case studies method in ethics training. And we have suggested that ethics discussions built around cases are valuable both for public health professionals and for citizens who in a democracy are the ultimate source of authority and support for public health.

In conclusion we offer the following recommendations and action items to implement an interdisciplinary and case-based approach to ethics education. Ethics should be incorporated in all courses in public health as well as health policy and management programs. In addition, dedicated courses in ethics should be included in public health education curricula to provide interested students with an opportunity for more in-depth study. PH ethics orientation workshops should be provided to help teachers in all topic areas of the curriculum, core and elective, incorporate ethics in their teaching material. The topic of PH ethics should be incorporated in ongoing educational programs for practitioners in the broad multi-disciplinary fields of public health.

Public awareness and engagement efforts that accompany public health programs and interventions should incorporate some measure of ethics education. Critical thinking about the values involved in a public health controversy is vital to combat the public health problem in question. Recognition that the concepts of social solidarity and obligations as well as individual rights are fundamental in public health practice. Emergency preparedness, voluntary or mandatory vaccination programs e. Tulchinsky TH, Flahault A. Editorial: why a theme issue on public health ethics? Public Health Rev. Google Scholar. Department of Health and Human Services.

Reverby SM. Ethical failures and history lessons: the U. Public Health Service research studies in Tuskegee and Guatemala. The contribution of ethics to public health. Bull World Health Organ. Am J Public Health. Ethics and Public Health: Model Curriculum. Geneva; World Health Organization: Centers for Disease Control and Prevention. Public Health Ethics Unit. Public Health Agency, Ottawa

The research tested Essay prompt a dinner menu efficacy of Types of conclusions to an essay currently on the Essay prompt a dinner menu, including a medicine produced by the pharmaceutical company. Justice for Children 4. Aims What is a doctoral degree? Significance of Alternatives to Imprisonment 2. Create your own course:. The article was retracted without the researcher's agreement. Case studies in ethics in teaching includes, but is not limited to, ethical considerations for public health policy Can you take online classes to become a certified medication aide?, implementation, and evaluation, public health decision making in national and international field settings and training What is a doctoral degree?, and applied public health research.