Giving voice to values as a professional physician : an introduction to medical ethics

131 Pages·2019·2.355 MB·English

by  Bedzow, Ira

Bedzowprovidesacompellingandpracticalframeworkforhealthcareprovidersto
act on their professional values. He goes beyond an analysis of actual cases to
giving us the skills to speak up so we do the right thing for our patients. This is a
book that anyone committed to creating an ethical culture of continuous
improvement should read.
Lisa Soleymani Lehmann, MD, PhD
Harvard Medical School and Veterans Health Administration
In a remarkable confluence of scholarship and practical wisdom, Bedzow’s short
book manages to be academically rigorous but much more than an academic
treatise. He has woven together several contemporary views of medical pro-
fessionalism, along with the powerful vision of the Giving Voice to Values para-
digm, to create a novel take on virtue ethics that will be of special value not only
to medical students but to clinicians at every career stage.
Matthew K. Wynia, MD, MPH Director, Center for Bioethics and Humanities
Professor of Medicine University of Colorado, Anschutz Medical Campus
Inaddressingvalues,ProfessorBedzowhasmovedthediscussionandtheteachingof
ethicsinhealthcarefromtheoriesandprinciplestopractice.Thisbookoffersatool-
box for recognizing and managing conflicting ideas in medical ethics in order to
achievepractical,patientfocusedsolutions.Inthatregard,aswellasothers,itishighly
innovativeandcriticallyimportant.
T.ForchtDagi,MD,DMedSc,DHC,MPH,FRCSEd,FAANS,FACS,FCCM
Distinguished Scholar and Professor The School of Medicine Queen’s
University Belfast, Northern Ireland
Dr. Bedzow has identified one of the biggest challenges in clinical ethics education:
narrowingthegapbetweentheoreticalandpractical.Thisoutstandingandthoughtful
textempowersstudentsandclinicianstofullyunderstand,embrace,andpracticetheir
values,ultimatelyoptimizingthecareofpatientsindifficultethicalsituations.
Megan K. Applewhite MD, MA John A. Balint, MD, Chair and Interim
Director Alden March Bioethics InstituteAlbany Medical College, Albany, NY
Dr. Bedzow has identified one of the biggest challenges in clinical ethics education:
narrowingthegapbetweentheoreticalandpractical.Thisoutstandingandthoughtful
textempowersstudentsandclinicianstofullyunderstand,embrace,andpracticetheir
values,ultimatelyoptimizingthecareofpatientsindifficultethicalsituations.
Megan K. Applewhite MD, MA
John A. Balint, MD, Chair and Interim Director Alden
March Bioethics Institute Albany Medical College, Albany, NY
Ira Bedzow’s innovative approach goes beyond traditional medical ethics to the per-
sonhoodofpatientandphysicianandthevaluesoftheirrelationship.Heteachesnot
only moral decision-making but also strategies for effective moral action – essential
skillsforallhealthcareprofessionals.
Elizabeth A. Rider, MSW, MD, FAAP, FACH
Department of Pediatrics, Harvard Medical School
Lead, International Charter for Human Values in Healthcare Initiative
Bedzow’s book is a valuable resource for both medical students and educators.
Clinically-relevant cases prepare students to communicate effectively and ethically
when faced with challenging situations. It bridges the gap between traditional
bioethicsandcommunicationprograms.Ihighlyrecommendit!
Dr Heidi Waldron MBChB (Otago), Dip CCH, Dip HPED, AFANZAHPE
Medical Educator and Curriculum Designer,
Communication and Clinical Practice Domain
School of Medicine Fremantle, The University of Notre Dame Australia
By offering strategies for acting appropriately under complex circumstances, this
short text provides a promising method to augment conventional approaches to
teaching ethics and professionalism to medical students so they will be better pre-
pared for the realities of clinical practice.
Jeremy Sugarman, MD, MPH, MA
Harvey M. Meyerhoff Professor of Bioethics and Medicine
Johns Hopkins Berman Institute of Bioethics
GIVING VOICE TO VALUES AS A
PROFESSIONAL PHYSICIAN
Giving Voice to Values as a Professional Physician provides students with the theore-
tical background and practicalapplications for acting on their values in situations of
ethical conflict. It is the first medical ethics book that utilizes the Giving Voice to
Values methodology to instruct students in medical ethics and professionalism.
In doing so, it shifts the focus of ethics education from intellectually examining
ethicaltheoriesandconflictstoemphasizingmoralaction.Eachsectionofthebook
explains how moral decision-making and action can be implemented in the
healthcare arena. Medical ethics cases are provided throughout in order to assist
studentsin giving voice to their values and developing skills for professional action.
TheGivingVoice toValuesmethodology,andthecasesinthisbook,donotfocus
on the big questions of academic ethics, but rather on the ethics of the everyday,
even if the challenges presented are difficult. In other words, the ethical questions
students will have to face, in this book and in medical education and practice, are
about how to interact with others, whether they be patients or colleagues, who
might have different ethical positions.
The book provides a unique guide for professional identity formation and the
teaching of ethics in medical schools.
Ira Bedzow is the director of the Biomedical Ethics and Humanities Program at
New York Medical College and Senior Scholar at the Aspen Center for Social
Values. He is the author of numerous books, articles, and chapters on law, ethics,
and social values.
GIVING VOICE TO VALUES
Series Editor: Mary C. Gentile
The Giving Voice to Values series is a collection of books on Business Ethics and
Corporate Social Responsibility that brings a practical, solutions-oriented, skill-
building approach to the salient questions of values-driven leadership.
Giving Voice to Values (GVV: www.GivingVoiceToValues.org ) – the curricu-
lum, the pedagogy and the research upon which it is based – was designed to
transform the foundational assumptions upon which the teaching of business ethics
isbased,andimportantly,toequipfuturebusinessleaderstoknownotonlywhatis
right – but how to make it happen.
Giving Voice to Values in the Legal Profession
Carolyn Plump
Giving Voice to Values in Accounting
Tara J. Shawver and William F. Miller
Giving Voice to Values as a Professional Physician
Ira Bedzow
GIVING VOICE TO
VALUES AS A
PROFESSIONAL
PHYSICIAN
An Introduction to Medical Ethics
Ira Bedzow
Firstpublished2019
byRoutledge
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©2019IraBedzow
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ISBN:978-1-138-35349-7(hbk)
ISBN:978-1-138-38834-5(pbk)
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CONTENTS
List of tables ix
Acknowledgements x
Preface xi
1 Ethics, professionalism, and Giving Voice to Values 1
The uniqueness of professionalism education 6
Professionalism as a value not a competency 8
Giving Voice to Values 12
Starting assumptions to give voice to one’s values 16
2 Making moral decisions 22
The gut reaction 26
Moral awareness: bias check 29
Conformity bias 30
Obedience to authority 32
Framing 34
Recognizing and prioritizing facts and values 35
The patient–physician relationship 36
Patient autonomy 37
Physicians’ professional goals 37
Physician authority and professional integrity 37
One note on values 39
Ethical frameworks 39
Deontological (Kantian) ethics 41
viii Contents
Consequentialist (utilitarian) ethics 43
Value(s) comparison between deontology and consequentialism 45
Principlism or the Four Principles approach 47
3 Acting on moral decisions 50
Moral (inaction): Rationalizations check 50
Personal–professional profiles 51
Considering other stakeholders 53
Organizational and systems-based levers 54
Creating scripts 55
4 Cases 58
Case 1: Confronting a superior 57
Case 2: HIV mothers and breastfeeding their newborns 62
Case 3: Reporting a colleague 68
Case 4: Talking to family members about a patient’s medical
information 73
Case 5: Speaking to a colleague about a patient’s complaints 76
Case 6: Complementary and alternative medicine 82
Case 7: Talking to patients about assisted reproductive
technologies 87
Case 8: Withdrawing treatment and right to die 91
Case 9: Determination of death 95
5 Conclusion 101
Intended audience and how to use this book 103
Example action plan and script for Case 1 112
TABLE
A1.1 Script and Action Plan Assessment Rubric 110