Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To continue (...) the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

Robert Coles' sentiment characterizes well the moral tenor of medical education today. Indeed, medical educators are frequently “seized by spasms of genuine moral awareness,” as they try to cope with the massive social and economic problems that face medical schools and teaching hospitals. The perception among educators that we currently fail to adequately teach several core aspects of doctoring, including professional values and behavior, constitutes one such spasm. In this case, the proposed remedy has generated considerable enthusiasm, but whether the (...) “core competencies” curriculum will make a difference, or simply “accommodate to the prevailing rhythms of the world we inhabit,” remains to be seen. (shrink)

Ethical principles play an important part not only in the promulgation of regulations but also in their application, i.e., enforcement and adjudication. While traditional ethical principles – promotion of welfare, freedom, and fairness – play an important role in both elements of regulation, some other kinds of ethical principles are significant as well. Principles governing the structure of decision processes should shape the structure and actions of agencies; principles of wise application should govern the work of those whose responsibility it (...) is to apply regulatory language to particular situations. These points are demonstrated by investigating a case study: federal regulations designed to protect children involved in scientific research applied to a placebo study of the effects of recombinant human growth hormone on children of extremely short stature. Keywords: ethics, interpretation, regulation, research CiteULike Connotea Del.icio.us What's this? (shrink)

I have contended that acting on some principle and complaining when others act in accordance with the same principle in similar circumstances is morally improper. By wrongdoing one forfeits the right to claim the right (s)he disregards in interacting with others. This is not equivalent to a view that one's acting in a certain way justifies others acting in that way, i.e. that by wrongdoing one forfeits rights (s)he disregards in interacting with others. It may still be morally improper to (...) treat malfeasors in the same way they treat us but, I have argued, they cannot themselves claim a right not to be treated in that way.This analysis of the right to claim rights can help explain the change in moral status of wrongdoers in two important ways. First, if there are some non-forfeitable human rights, the loss of moral standing of one who disregards those rights in others can be explained. Second, and perhaps potentially more important, if having a right implies the right holder's being justified in claiming it, we have a basis for saying all human rights are forfeitable.This second position would require a tightening of the link between the right to X and the ancillary right to claim the right to X. I have not undertaken that burden here. Instead, I argued that the loss of the right to claim is, itself, a significant loss. (shrink)