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Key Ethics Term: Value

The term ‘value’ distinguishes descriptive statements/beliefs (e.g. the world is spherical) from normative statements (e.g. clinicians ought/should be compassionate). In the latter case we are making evaluative judgments or calling something good/bad.

Sometimes we take value to be intrinsic (e.g. we might say happiness is valuable in itself, not for some other goal), and sometimes we take value to be extrinsic (e.g. when we say x job is good because it pays well, or e.g. empathy is good because it helps patients heal more quickly).

We can also say that value is subjective or objective. For instance, wealth may be a subjective value that one person holds but not another (the value is relative to the subject/person). Whereas, we might say that compassion is objectively valuable because we all agree to its value, or because there is evidence that it makes persons and communities live well/ flourish, or because it is dictated by religious text, etc. (though some might disagree about whether compassion is an objective value, or whether anything can have objective value).


Review these Key Ethics Terms:

Read: Excerpts from Aristotle’s Nicomachean Ethics

Reading Aristotle is hard! But we think you can do it! It will create some discomfort for everyone. We do NOT expect you to master these concepts – it is more important in this session to be open, brave, vulnerable, and interested in growth than it is to be ‘right’. See what you can gather from the reading and use the PDF’s highlighting and prompts to guide you if you’re having trouble.

Consider: the role of empathy in medical student education while reading Walking a mile in their patients’ shoes:empathy and othering in medical students’ education. The article discusses the barriers for medical education to promote empathy and offers up a paradigm that may help trainees deal with these barriers and possible ideas of how they could be surmounted.

 

Read over this Facebook Post and reflect on how values and virtues can or cannot be demonstrated on social media.

 

If you’re feeling eager for more… explore this article on How to Teach Doctors Empathy which talks about the growing emphasis on empathy training for health care professionals and describes a few such trainings across the country.

Honoring the Individual: Narrative and Cultural Humility

This New York Times article, written by Harvard Professor of Economics Sendhil Mullainathan discusses how our identity shapes how we think about inequality and our advantages and disadvantages.

To Help Tackle Inequality, Remember the Advantages You’ve Had, by Sendhil Mullainathan

This PBS Newshour video and brief accompanying article by Kamaraia Roberts about young Black Republicans suggests that individual identities can be challenged by society and peers.

The stigma of being young, black and Republican, by Kamaria Roberts

Watch this compelling YouTube video by Director Vivian Chavez.  Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility and the need for cultural humility to improve provider to patient interaction and care.

Cultural Humility, by Vivian Chavez

History of Public Health

We aim to explore historical trends in human health and life expectancy and to discuss how public health has evolved over time. To learn the history of a major cause of morbidity and mortality that has declined in importance due to public health efforts, please watch segment 04:30-49:30 of the film “The Forgotten Plague” The significance of tuberculosis in the development of America’s public health system is outlined, as described below:

“By the dawn of the 19th century, the deadliest killer in human history, tuberculosis, had killed one in seven of all the people who had ever lived. The disease struck America with a vengeance, ravaging communities and touching the lives of almost every family. The battle against the deadly bacteria had a profound and lasting impact on the country. It shaped medical and scientific pursuits, social habits, economic development, western expansion, and government policy. Yet both the disease and its impact are poorly understood: in the words of one writer, tuberculosis is our “forgotten plague.”

For students who are interested in history or would like more information on the history of public health, please read the New Yorker article entitled “Sick City.” This article describes the past and current public health threat related to cholera, and highlights how environmental forces, the built environment, the adequacy of water and sanitation systems, and global travel are critical elements shaping our health risks.

History of Medicine as a Profession

ABIM Medical Professionalism: A Physician Charter

This document reviews the importance of professionalism is the basis of medicine’s contract with society and that understanding the principles and responsibilities of medical professionalism is key to physicians social contract with society.

Why Does Professionalism Matter? : Trust, Transparency and Accountability

This video (3:34) shows senior physicians from around the country exploring why professionalism is integral to physicians maintaining trust with patients. It stresses that trust and accountability are key focuses to continue to keep at the center of physicians practice. At 1 minutes 30 seconds, the provider talks about how at times there will be conflict when there are competing needs but that it is important to embrace and face the conflict to better understand it.

Association Between Physician Burnout and Identification With Medicine as a Calling

This research paper which seeks to evaluate the association between degree of professional burnout and physicians’ sense of calling. Study identifies that physicians who experience more burnout are less likely to identify with medicine as a calling. It implies that loss of the sense of medicine as a calling may have adverse consequences for physicians and patients

 

 

 

Bridging Difference: An approach to conflict with colleagues

Conflict is frequent and inevitable in healthcare.  Why?

  • We have different personal and professional values. Moral issues and values often play a role in medical care and decision-making, and the values of individual team members may at times conflict.
  • We may have a different understanding of the same patient or situation. For example, one physician may see a patient as having a potentially treatable illness, while another sees him as someone who is suffering and should be allowed to die peacefully.
  • There is often not a single “right” or evidence-based answer. The different experiences of team members may lead to different approaches to the same patient or issue.
  • We come from diverse cultural backgrounds. Team members – including patients – all bring their personalities and cultures to the table, and icebergs can bump.
  • Working in healthcare is stressful and can cause individual ‘resource depletion’. Fatigue, stress, and burnout all make conflict more likely.
  • We may have inadequate institutional resources, leading to tussles to get our patients what they need – the next operating room, an expensive medication, etc.

Health professionals AND medical students need to have a constructive approach to conflict

  • To provide the safest and highest quality care for patients
  • To create a safe learning and working environment for ourselves and our colleagues
  • To build and maintain relationships with each other. Health care team members often work together for years.  Medical school classmates will be a source of support for each other, and may find themselves in the same residency programs and ultimately practicing together.

Conflict Handling Modes

TKI Conflict Handling Modes

TKI Conflict Handling Modes

Competing

A competing style is higher in assertion and lower in cooperation.  Someone using a competing style might approach the conflict by making as strong a case as they can for their own position.  They may be very amiable and polite about it – competing does NOT mean harsh – but they have a viewpoint that they strongly assert.

Perhaps someone using a competing style is very confident that hers is the correct position.  She may be in a position of power and intend to pursue this course even if it is unpopular with others – a competitive style may avoid wasting time in meaningless discussion if the course is already set.

Collaborating

A collaborating style is both assertive and cooperative.  Someone using a collaborative style might approach a conflict as an opportunity to work together to build the best possible understanding or solution.  He would express his own perspective, but would also elicit and listen to the perspectives of others.

Perhaps someone using a collaborative style knows that each member of the group is likely to have different ideas and input, and that all might be contribute to the group’s understanding of a critical issue, or to solving a challenging problem.  He may want to build strong relationships within the group, even though it might take a lot more time than a less cooperative style.

Compromising

A compromising style is medium in both assertiveness and cooperativeness.  Someone using a compromising style might approach the conflict as an opportunity to meet in the middle, to give and take to find something all group members can live with.

Avoiding

An avoiding style is low in both assertiveness and cooperativeness.  Someone using an avoiding style does not share their own perspective or listen to others – they don’t want to engage with this conflict right now!

Perhaps someone using an avoiding style needs time to process their own thoughts or cool down, and they plan to return to the topic later on.  Or perhaps the issue is unimportant to them, or they don’t think they have the power to make change.

Accommodating

An accommodating style is low on assertiveness, but high in cooperativeness.  Someone who is using an accommodating style is putting the concerns or needs of others ahead of their own.

Perhaps someone using an accommodating style knows that the issue is far more important to the other(s) than it is to them, or that the relationship is more important than the issue.

An Approach to Handling Conflict

Can we insert vital talk web page here?  http://vitaltalk.org/guides/conflicts/  ALT TEAM

 

Key Ethics Term: Expressivist Objection

Some object to prenatal diagnosis on the basis that it ‘expresses’ a discriminatory attitude towards those with (dis)ability. Namely, the act of screening for genetic information that might demonstrate risk for certain forms of (dis)ability (e.g. developmental (dis)ability associated with Down Syndrome) so that one might then choose to terminate the pregnancy endorses normative assumptions that treat those with (dis)ability negatively or as unequal in moral worth.

It is important in weighing this objection against other considerations to consider the perspective of those who have a screened for or similar genetic trait. Likewise, you might consider how you would feel if any genetic trait that you have were screened for regularly and pregnancies were regularly terminated because of it.


For further reading…

  • Boardman, FK. (2014). The expressionist objection to prenatal testing: the experiences of families living with genetic disease. Social Science & Med, 107:18-25.

  • Edwards SD. (2004). Disability, identity and the “expressivist objection”, J Med Ethics, 30(4):418.

  • Kittay, E. and Carlson, L. (2010) Cognitive Disability and its Challenge to Moral Philosophy, Wiley-Blackwell: Oxford.

Social Ecological Model

Social Ecological Model

McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care.  A quick Google search for the social ecological model will reinforce how widely it has been adopted.  There are numerous community, state, national and international organizations that utilize this model in their programs.

Think back to your session in immersion on the social history.  How often do you think beyond the individual and interpersonal factors that influence you and your patients health?

Image result for social ecological model uw

 

From CDC Colorectal Cancer Control Program (CRCCP)