Bioethics Education in Croatia (Rijeka model)

- Nada Gosic, Ph.D. and Ivan Segota, Ph. D.
Department of Social Sciences

Faculty of Medicine, University of Rijeka, CROATIA
Email: Ivan.Segota @mamed.medri.hr

Eubios Journal of Asian and International Bioethics 11 (2001), 105-106.


The Faculty of Medicine, Rijeka was the first in Croatia to introduce a required course of Medical Ethics in the medical curriculum and in the curriculum for senior staff nurses, medical laboratory officers, senior physiotherapists and radiographers, and Introduction to Bioethics as an elective course for the studies of stomatology and graduated sanitary engineers. During seven academic years the Faculty has been developing the phase of pre-clinical teaching with great ambitions to extend this teaching to become a component of clinical teaching in the near future. Lectures, seminars and workshops are methods used in medical ethics education at this Faculty.

Lectures

Lectures are directed to the acquisition of theoretical knowledge of ethics, offering conceptual and historical attitudes in medical ethics and they are focused on the development of the awareness of complexity of moral conclusions in modern medicine. Out of the total teaching hours for a course of medical ethics, with prior evaluation of didactic advantages and disadvantages, it was assessed at the Department of Social Sciences that 35% of teaching activities should be dedicated to lectures with 65% to group work. Situated in a large lecture- room, the students of the whole generation follow the presentation by a lecturer which is sometimes accompanied by conversation or studentsL questions. As a response to what is being lectured, students send verbal and non-verbal messages to the lecturer about how much they understand him and how much they are motivated to follow his presentation. The Department of Social Sciences, aware that sitting, listening and watching should be made as interesting, dynamic and attractive as possible, organized team lectures when several lecturers (only two of them for the time being) alternately present ethical issues, while permanent invitation is open to clinicians and representatives of other social and life sciences to participate in these lectures. On the model of some medical schools in the world (3), lectures are supplemented by documentary or feature films covering themes such as AIDS, abortion, transplantation, human organ and tissue procurement, human experimentation etc.

The experiences we have gained up to now point to the following merits of lectures as a method of bioethics education: 1) understanding the extension and complexity of a moral problem; 2) illustration of matters that are real, vivid and dynamic in ethics, as well as the setting that surrounds the person who is to reach an ethical decision; 3) stimulation of moral imagination and empathy (9) in students and the emphasis on interdisciplinary character of bioethics; 4) economy of time, space and didactic facilities.

The participants in bioethics education are offered by lectures an interdisciplinary view on a certain ethical problem or concept, yet, they are not at the same time given a possibility to express their attitude or experience about it. We support a right of each student is to state his personal and subjective experience, then to explain his positive or negative attitude, to confront it to other studentsL attitudes, as well as to learn to respect other opinions. That is why the fifth characteristic of lectures is perceived in the function of preparation for discussion in smaller groups.

Seminars

Group work in bioethics education is performed through seminars and ethics workshops. The goal of seminars is the recognition and definition of ethical problems and introducing the skill of analysis to students (8). In seminars students acquire the understanding of attitudes and form opinions about: the nature of bioethics; bioethics theories, regulations and principles, ethical problem of communication in medicine; duties of doctors and other health-care providers; attitudes to life, to oneLs personal life as well as to the life of others; cultural, civilization and historical distinctions in issues related to traditional and new medical ethics.

Whichever teaching technique in used in bioethics education, it is considered a crucial task to introduce students to standard bioethics literature. So, in seminars they are instructed about the existence of literature with a problem-based and systematic approach to bioethics and that a knowledge of this literature is useful in the long term.

By interpreting and reproducing ethical topics from bioethics literature, students gain understanding of ethical problems and relevant issues, but also the ways of solving ethical dilemmas. Students use written sources and perceive contraries between what they think about an ethical problem and how it has been dealt with by bioethics scholars. By quoting and explaining the scholars thoughts, students and teachers learn to recognize, define and analyse an ethical problem. In this activity they also express their own sensibility, and thus already in seminars they become co-creators of bioethics.

Workshops

Situated in the premises which ensure sitting in a circle and conversation "face to face", participants in bioethics education proceed with their work in ethics workshops. Although their creativity, which has always had a special significance in ethics education, was initiated already through interpretation and reproduction, it develops to its full extent in ethics workshops.

At the beginning of the academic year, teaching methods are agreed on with students. Two rules are usually underpinned. First, not to evaluate negatively, laugh at or ignore any idea presented, and that each idea deserves to be discussed. Second, all students should participate in the realisation of accepted topics. And then, a free choice of topics and issues which the students would like to analyse starts.

Students have shown their interest in the following topics and ethical problems for four successive years: The Hippocratic Oath and Hippocratic Ethics Tradition; Ethical Pluralism and Abortion; Euthanasia; Life Quality and Health; Ethical Issues in Transplantation; Ethics of Human and Animal Experimentation; Ethics in Communication with Patients; Ethical Issues of Relationship to HIV-Infected Patients; Ethics and Genetics; Ethics of Addictions; Religion and Bioethics; Historical Development of Bioethics in the World and in Croatia; Ethics of Death and Dying; Feminist Ethics; Bioethics Theories, Principles and Rules; Ethics of Relationship to the Handicapped and Disabled; Ethics of Environment; Population Bioethics and Ethics of Care.

After having made a list of ideas, their ethical realisation follows. StudentsL creativity in work is reflected in searching a number of solutions for the topic and problem, in finding literature by themselves or with the help of the teacher and in examining cases to support the current significance of the topic. Taking into consideration the recommendation by American and Canadian teachers of medical ethics not to approach all topics in the same way, we chose the application of three variants of group work: programmed teaching, conflicting groups and case analysis.

The strategy of programmed teaching is usually approached through group study of topics dealt with during lectures. At the end of lectures students are assigned to find and analyse in front of their group essential contents which can help reach solutions to ethical issues relevant to the topic lectured before.

The method of conflicting groups is realized by isolating 3-4 students from the group and explaining to them that in the following two lessons they will assume the role of the jury. They have to record all arguments presented in the debate and analyse verbal and non-verbal communication of group members. Then, the group is divided into A and B subgroup. Subgroup A is given the assignment to state arguments FOR, based on literature and other materials used in the preparation of the workshop, while subgroup B is AGAINST a certain procedure (abortion, euthanasia, surrogate motherhood, telling the truth to severely diseased patients etc.). During the following workshop the assignments are exchanged and now subgroup A states arguments AGAINST and subgroup B FOR the procedure. The coordinator of the workshop during the first lesson participates in the work of the first subgroup, and in the second lesson of the second subgroup. After having heard the arguments and counter-arguments, the jury presents a systematized list of reasons for and against and their observations on the way of communication in the group. After that, the whole group discusses ethical pluralism within the assigned issue.

The third mode of work in the workshop includes the examination of essential contents of ethical decision-making through case analysis.

Conclusion

Bioethics education at the Faculty of Medicine in Rijeka is still in the phase of searching appropriate contents and methods of teaching. What has been established so far with certainty is studentsL assessment of the course of medical ethics and bioethics is useful and interesting. They were clear in their statements that the described methods made the contents more interesting and easier to understand. They also pointed out that the course was dynamic because they participated actively in it, from contents design to the realization, and that the debates held were interesting and useful. In the period of sanctioning bioethics in Croatia we consider debates to be an essential prerequisite for its teaching presentation, but simultaneously a challenge to find new approaches and methods of bioethics education.

References

  1. Beauchamp T.L., Childress J.F., (1989), Principles of Biomedical Ethics, (Oxford, Oxford University Press).
  2. Encyclopedia of Bioethics, (1995.) New York.
  3. Jonsen R. Albert (1989) Medical Ethics Teaching Programs at The University of California San Francisco, and The University of Washington, Academic Medicine , pp. 718-723.
  4. Robert P.Craig, Carl Middleton, Laurence J.OLConell, Ethics Committees, (1986), (St. Louis , The Catholic Health Association of the United States).
  5. Pence Gregory E., (1990.) Classic Cases in Medical Ethics, ( New York, McGraw-Hill, Inc
  6. Segota Ivan, (1994.) Nova medicinska etika (bioetika), ( Rijeka, Medicinski fakultet).
  7. Segota Ivan, (1997.), Etika sestrinstva, (Rijeka-Zagreb, Pergamena).
  8. The Teaching of Ethics in Higher Education, pp. 49-50, (The Hastings Center, New York, Project on the Teaching of Ethics 1980).
9. K. Danner Clouser, (1980.) The goals in the teaching ethics, in Danner Clouser, Teaching Bioethics Strategies, Problems and Resources, pp. 48-51. (New York, The Hastings Center).


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