Virtue and care ethics & humanism in medical education: a scoping review.

PURPOSE: This scoping review explores how virtue and care ethics are incorporated into health professions education and how these factors may relate to the development of humanistic patient care. METHOD: Our team identified citations in the literature emphasizing virtue ethics and care ethics (in PubMed, NLM Catalog, WorldCat, EthicsShare, EthxWeb, Globethics.net , Philosopher's Index, and ProQuest Central) lending themselves to constructs of humanism curricula. Our exclusion criteria consisted of non-English articles, those not addressing virtue and care ethics and humanism in medical pedagogy, and those not addressing aspects of character in health ethics. We examined in a stepwise fashion whether citations: 1) Contained definitions of virtue and care ethics; 2) Implemented virtue and care ethics in health care curricula; and 3) Evidenced patient-directed caregiver humanism. RESULTS: Eight hundred eleven citations were identified, 88 intensively reviewed, and the final 25 analyzed in-depth. We identified multiple key themes with relevant metaphors associated with virtue/care ethics, curricula, and humanism education. CONCLUSIONS: This research sought to better understand how virtue and care ethics can potentially promote humanism and identified themes that facilitate and impede this mission.

Learning about Professional Ethics from Inter-Professional Dialogue.

Our society's professions, including the health professions, have long overlooked the possibility that one might learn something valuable about one's own profession's ethics by studying the ethics of other professions. Reflecting on the preceding article by Ritwik, Patterson, and Alfonzo-Echeverri, one can identify important similarities between dentistry's professional ethics and the ethics of the other health professions. But there are also important differences between these professions' ethics that should prompt reflection on the reasons for these differences, perhaps challenge something that has been taken for granted in one's own profession, and in any case facilitate better mutual understanding and more effective inter-professional collaboration.

Nephrologists' professional ethics in dialysis practices.

Although the number of incidents is unknown, professional quality-oriented renal organizations have become aware of an increased number of complaints regarding nephrologists who approach patients with the purpose of influencing patients to change nephrologists or dialysis facilities (hereinafter referred to as patient solicitation). This development prompted the Forum of ESRD Networks and the Renal Physicians Association to publish a policy statement on professionalism and ethics in medical practice as these concepts relate to patient solicitation. Also common but not new is the practice of nephrologists trying to recruit their own patients to a new dialysis unit in which they have a financial interest. This paper presents two illustrative cases and provides an ethical framework for analyzing patient solicitation and physician conflict of interest. This work concludes that, in the absence of objective data that medical treatment is better elsewhere, nephrologists who attempt to influence patients to change nephrologists or dialysis facilities fall short of accepted ethical standards pertaining to professional conduct, particularly with regard to the physician-patient relationship, informed consent, continuity of care, and conflict of interest.

The future of dental ethics: Part 1. What to hope for and the challenge of getting there.

A vision is presented of six ethical skills that every practicing dentist should ideally possess. To achieve this vision will require substantial strengthening in the ethics curricula in dental schools and development of a well-trained cadre of ethics teachers. Ethics leaders must also be developed and programs made available to reach practicing dentists. Finally, the body of scholarship in dental ethics must be fortified. Such a long-range and far-reaching project will require leadership, recruitment and training, and sustained funding.

Finding a voice. Like individuals, organizations are moral speakers and actors.

Though "good people' are important for the life of any organization, it is a myth to think that enough good people will make for a good organization. To break free of this myth, a health care organization, which is made up of numerous persons and groups, ought to be regarded as a single, unitary actor in society. When seen as a single actor, the organization's systems for carrying out its mission can be better assessed and improved if necessary. If the organization's systems are not functioning as they should, then even good people will be hindered in their efforts. It can be said, therefore, that organizational ethics takes seriously the idea that every Catholic health care organization is a moral actor needing to reflect carefully on what it does in relation to its employees, leaders, and the outside community. In an environment where the organization's actions are reflected upon, and its character is carefully and continually shaped according to its mission, individual persons in that organization will be better equipped for making and carrying out good decisions that are aligned with that same regard for the mission.

Ethics, access, and care.

There are two very different ways of understanding access and care that are at work in contemporary American society. One of these is the understanding that our society's health professions have about access and care as they consider their ethical commitment to respond to patients' oral health needs. The other is how these matters are understood within America's public culture. In this view, needs--including health care needs--are no different in kind or ethical significance from unmet desires of any sort. This article will spell out the differences between these two ways of understanding care and access. Comprehending the distance that separates the health professions' perspective from much of mainstream American thinking on these matters is essential to a careful discussion of the ethics of access to oral health care.

Basic oral health needs: A public priority.

Is there a way to support a special ethical status for unmet oral health needs within our pluralistic, liberty-loving American society? Some people in American society, perhaps many people, believe that some kinds of human needs have special ethical importance. But very few people outside the oral health professions have ever considered that unmet oral health needs might belong to this category. This article will examine why some kinds of needs are thought to have special ethical importance and propose that certain categories of oral health care are needs that fit this description. Without thinking these issues through, we who argue for improved access to oral health care will remain unable to provide an adequate answer to a very legitimate question, namely: improved access to what? When this task has been completed, the article will consider some of the implications of such a view for our society.

Hospitals and moral imperatives: hospital ethics.

... Because institutional ethics has been neglected, there is a tendency in our institutional life to apply moral principles with which we are familiar from our personal life. However, principles from individual ethics often distort institutional ethics. Ethical problems in the hospital are not exactly the same as ethical problems that arise when individual doctors treat individual patients. And when the problems are similar, the ethical principles by which we should resolve them are likely to be quite different. To begin to make a case for taking hospital ethics seriously, I briefly examine two familiar principles of individual doctor-patient ethics that look different, or should look different, in the setting of a hospital. I then discuss ethics committees -- one of the most important ways in which hospital ethics is put into practice.

Justice and a universal right to basic health care.

KIE: An "Exchange Theory of Justice" is advanced to argue for a universal right to basic health care in any society able to provide such services. The theory assumes that a just exchange is not possible if one party lacks goods necessary for survival while a second party holds an abundance of those goods. The responsibility to equitably distribute health care lies with the society as a whole. Health professionals are morally obligated only to the extent that they are responsible as members of society for endeavoring to achieve a just social policy.^ieng