Almost daily, ethical issues in healthcare grow more complicated. With rapidly advancing science and treatments come moral concerns that were unheard of just a few years ago. Healthcare professionals are on the frontline of these crucial issues, and schools are making efforts to prepare them.
Dr. Rick Boyte, associate professor of pediatrics and chairman of the Ethics Advisory Committee at University of Mississippi Medical Center (UMC), says ethics has become a very important subject at medical schools with a lot of effort devoted to it for the past five years.
“In the past, it was not stressed and typically was not integrated into the curriculum like it is now,” he said. “It was felt that ethics could be picked up through role modeling and mentoring, but the need is so much more than that.”
Boyte also teaches the senior seminar in ethics to fourth-year medical students, a 10-week course that covers a lot of subjects. Another course, Introduction to Clinical Medicine, has components in ethics. This school year for the first time, first-year medical students will take a course in cultural diversity. He says ethics was not taught like it is now when he went through UMC in the 1980s.
“That was when bioethics was the property of philosophy-based teaching, but now physicians are involved in ethics,” he said. “We’re placing philosophy at the bedside.”
Boyte said he didn’t enter medical school thinking his career would include teaching ethics. To better prepare for those teaching duties, he is working on a master’s degree in bioethics, which he believes is becoming more common for physicians.
He credits the late Dr. Nancy Tatum with starting the ethics committee and senior seminar in ethics at UMC. Her background was in bioethics and she led the faculty in addressing ethical issues in clinical practice that included bereavement support, end of life issues, cultural diversity and legal concerns.
“Unfortunately, she died, but the work has carried on,” Boyte said. “We end up in good discussions and it has been well received. I hope it will buttress with what students see every day. They see a lot but don’t always understand what they’re seeing because of their immaturity.”
UMC’s ethics committee consists of 30 members who represent all areas of the organization. According to Boyte, the mission is threefold: to arrange for ethical education for the faculty and hospital staff; to review policy when there is controversy; and to consult with anyone who asks for a review.
“The consultation part is the most active,” he said. “We send someone from the committee to talk to people involved in a situation and give advice.”
The ethics committee chairman says the group is still growing at UMC. He would like to see more research done on ethics and would like to see an ethics center like some hospitals and organizations have.
“The American Medical Association has an ethics link on their Web site with a virtual mentor designed for students and a Web-based journal,” he said. “That’s the way I see it going in the future.”
The future is now for Dr. Shelia Davis, a professor of nursing at UMC, who is launching a Web site this fall that will be for all healthcare professionals. Working with an advisory board, she will be editor-in-chief of the Online Journal of Health Ethics, the only online health ethics publication in the country with a multidisciplinary focus.
“At first I thought it would be a site to display students’ work, but it has grown and taken on a life of its own,” she said. “I want to give a voice to people who are not accustomed to having their voices heard. It gives a broader perspective and a greater world view on issues.”
Eventually, Davis anticipates having the public participate. She chose this method for ethical discussions and postings because it is a vehicle for getting information to the masses quickly and costs less. The medical center has shared space on its server and lent people with computer skills to help with the project.
The project received a big boost in the way of a $10,000 grant from the Bower Foundation, a Jackson organization that Davis said is known for altruistic acts.
She said the Web site is casting a broad net and wants to include any and every ethical issue that may impact healthcare.
“The question of what is life and what is death used to be easy to answer but no longer is,” she said. “There are the subjects of stem cell research, abortion, do not resuscitate, health policies and many more.”
Davis says the project is exciting and scary. She wants the venture to be successful and is getting a very positive response to it.
The journal is already drawing attention in health care circles. An editor of an internationally known publication initially agreed to be on the editorial board but later declined because Davis’ journal will be a competitor to what she is doing.
“After hearing that other people were beginning to see it as something that really had some merit, that just propelled me,” Davis said.
In addition to UMC’s involvement, schools lending advisory or editorial assistance include the University of Minnesota, Columbia University, Yale University, the University of Southern Mississippi and the University of Nebraska.
Dr. Janie Butts, who teaches ethics to doctoral nursing students at the University of Southern Mississippi (USM) in Hattiesburg, is on the online journal’s advisory board. She sees it as a promising thing and says the board wants to publish papers in applied, theoretical and business ethics as they apply to healthcare.
“We want more papers. That’s our biggest need now,” she said.
As an ethics professor, she believes nurses are the healthcare professionals most intimately involved with patients and families. Nurses are often the ones who report many ethical situations.
“It’s about relationships and deciding what is the right thing I need to do in this situation,” she said. “It’s about trust and dealing with situations in the face of organizational constraints. That’s a big, big issue with nurses and they are left wondering what to do.”
Butts, who’s in her 12th year of teaching after many years as a practicing nurse, said this moral dilemma puts nurses in distress and is the reason some burn out in the profession.
“They can’t always do what they think is best,” she said. “In my class, I try to help them come out with skills they need to serve on ethics committees and be policy consultants.”
Butts and one of her doctoral students, Karen Rich, are writing a book on ethics that will be suitable for nurses studying at the bachelor’s degree level. She said there is no textbook on this level and she hopes theirs will fill in the gaps. The book is scheduled for publication in January 2005.
Rich has completed doctoral course work in nursing with an emphasis in ethics at Southern Miss. She feels that ethics pervades all of nursing and that it’s more than the classic bioethical issues that they should think about.
“Nurses don’t have the autonomy to make those decisions,” she said. “The heart of nursing ethics is relationships, the well- being of the patient, relieving suffering and being a facilitator between patients and families and physicians.”
She believes the important issue is for nurses to realize the moral nature of their routine work such as comforting a dying patient or which call bell to answer first. As an adjunct nursing instructor, Rich has tried to infuse students with the philosophy of being mindful and aware of situations in their everyday routines.
“I make it clear to students that it’s more than big ethical issues seen on TV,” she said. “It’s counseling and talking with patients and not using a cookie cutter format.”
Dr. Mary Coyne, director for the school of nursing at USM’s Gulf Park campus, said ethics is directly addressed in professional development classes for nurses on the bachelor’s level. Critical thinking and diversity are also taught. “The faculty provides students with a lot of situational ethics that goes from newborn to the end of life,” she said. “We feel pleased that it’s addressed at all levels. The case study method works well.”
Contact MBJ contributing Lynn Lofton at firstname.lastname@example.org.
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