The reuse of genetic information in research and informed consent.

Important advances in genetics research have been made in recent years. Such advances have facilitated the availability of huge amounts of genetic information that could potentially be reused beyond the original purpose for which such information was obtained. Any such reuse must meet certain ethical criteria to ensure that the dignity, integrity, and autonomy of the individual from whom that information was obtained are protected. The aim of this paper is to reflect on these criteria through a critical analysis of the literature. To guarantee these values, ethical criteria need to be established in several respects. For instance, the question must be posed whether the information requires special attention and protection (so-called genetic exceptionalism). Another aspect to bear in mind is the most appropriate type of consent to be given by the person involved, on the one hand favouring research and the reuse of genetic information while on the other protecting the autonomy of that person. Finally, there is a need to determine what protection such reuse should have in order to avoid detrimental consequences and protect the rights of the individual. The main conclusions are that genetic information requires special care and protection (genetic exceptionalism) and that broad consent is the most practical and trustworthy type of consent for the reuse of genetic information.

Evaluando la enseñanza de la bioética: formando «médicos virtuosos» o solamente médicos con habilidades éticas prácticas / Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills

Objetivo: La bioética se ha incorporado en la formación de las Facultades de Medicina las últimas décadas. Diversos estudios analizan el desarrollo ético-moral de los estudiantes y el efecto de la educación ética, midiendo la evolución del razonamiento moral de Kohlberg (médicos virtuosos), y la sensibilidad ética para resolver casos clínicos (médicos con habilidades éticas). El objetivo del estudio es valorar el impacto de la formación en ética en estas dos variables en nuestro ámbito. Diseño: Estudio observacional transversal. Emplazamiento: Facultad de Medicina, Universidad de Lleida. Participantes: Un total de 175 estudiantes de tercer curso de medicina (78 antes de realizar bioética y 97 después de realizar bioética, en diferentes cursos). Intervención: Formación reglada en bioética. Mediciones principales: Se administra un cuestionario sociodemográfico, el Defining Issue Test de Rest como medida del razonamiento moral, y el Problem Identification Test de Hébert como medida de la sensibilidad ética. Resultados: Se halla una relación consistente y significativa entre razonamiento moral y sensibilidad ética. Las mujeres presentan mayor razonamiento posconvencional, es decir, mayor desarrollo moral. No se aprecian cambios en el estadio de razonamiento moral global de Kohlberg con la formación ética. Sí se incrementa de forma significativa y global la sensibilidad ética, medida en forma de Problem Identification Test. Conclusión: No se hallan diferencias en el desarrollo moral de estudiantes de medicina antes y después de la formación reglada en bioética, pero sí con respecto a las habilidades en resolución de casos. Se plantea si esta mejora es suficiente para formar médicos preparados para los nuevos retos

Objective: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. Design: Observational cross-sectional study. Site: Faculty of Medicine, University of Lleida. Participants: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. Intervention: Bioethics course. Main measurements: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. Results: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. Conclusion: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges

[Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills]. / Evaluando la enseñanza de la bioética: formando «médicos virtuosos¼ o solamente médicos con habilidades éticas prácticas.

OBJECTIVE: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. DESIGN: Observational cross-sectional study. SITE: Faculty of Medicine, University of Lleida. PARTICIPANTS: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. INTERVENTION: Bioethics course. MAIN MEASUREMENTS: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. RESULTS: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. CONCLUSION: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges.

Cross-Validation of the Spanish HP-Version of the Jefferson Scale of Empathy Confirmed with Some Cross-Cultural Differences.

CONTEXT: Medical educators agree that empathy is essential for physicians' professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners. METHODS: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and 13 Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis (PCA) with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis (CFA). Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons. RESULTS: A total of 715 (80%) surveys were returned fully completed. Cronbach's alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p < 0.001). CONCLUSIONS: The findings support the underlying factor structure of the Jefferson Scale of Empathy (JSE). The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research.