Bruce Maxwell

Challenges of educating for medical professionalism: who should step up to the line?

Context  The teaching of professionalism has recently become an important issue in medical education. Medical professionalism remains controversial, but several recently published institutional documents on professionalism seem to express an implicit, yet broad consensus on three points: that professionalism mainly consists of adherence to a specific set of professional attributes constitutive of medical role morality and readily identifiable as virtues of medical professionalism (VMP); that medical education needs to focus on the endowment of these attributes, and that medical ethicists should play a central role in assuming this educational responsibility.

Deep brain stimulation and ethics: perspectives from a multisite qualitative study of Canadian neurosurgical centers.

OBJECTIVE Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. METHODS Health care providers working in Canadian DBS surgery programs participated in a semistructured interview to identify and characterize ethical and social challenges of DBS. A content analysis of the interviews was conducted. RESULTS Several key ethical issues, such as patient screening and resource allocation, were identified by members of neurosurgical teams. Providers described challenges in selecting patients for DBS on the basis of unclear evidence-based guidance regarding behavioral issues or cognitive criteria. Varied contexts of resource allocation, including some very challenging schemas, were also reported. In addition, the management of patients in the community was highlighted as a source of ethical and clinical complexity, given the need for coordinated long-term care. CONCLUSIONS This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation.

Navigating the enhancement landscape. Ethical issues in research on cognitive enhancers for healthy individuals.

Research into the efficacy and safety of cognitive enhancers for recreational or lifestyle use has not been done. Should society pay for studies that might improve the lives of already healthy people?

Imitation, imagination and re‐appraisal: educating the moral emotions

No observer of research currents in the human sciences can fail to detect a new appreciation for the contribution of emotions to descriptions of such wide‐ranging psychological phenomena as moral judgement, personal and social development and learning. Despite this, we claim that educating the emotions as a dimension of moral education remains something of a taboo subject. As evidence for this, we present three categories of interventions that fit unmistakably into the category of the education of the emotions, but which go generally unrecognized. In the light of the fact that emotional education is held not just to be possible, but is in fact commonplace, we present an error theory to explain its general occlusion. Next, we argue that the taboo surrounding the education of the emotions helps to explain the lack of recognition that relevant kinds of emotional reactions, especially guilt and shame, seem indeed to be a better measure of successful moral education than moral acts. This, we take it, is one of the suppositions of the old classroom management device called the ‘shame corner’. In the last section we propose a comparative analysis of the shame corner and its pedagogical descendant, the ‘time‐out corner’, in terms of their assumptions about the structure of moral judgement and the significance of moral emotions. Without recommending the reinstitution of the shame corner, we conclude that, far from constituting progress in moral education, the time‐out corner is, from this perspective, apparently wrong‐headed and confusing.

Teacher as Professional as Metaphor: What It Highlights and What It Hides.

This article is concerned with the downsides of using the language of professionalism in educational discourse. It suggests that the language of professionalization can be a powerful rhetorical device for promoting welcome and necessary changes in the field of teaching but that, in doing so, it can unintentionally misrepresent the work that teachers do. Taking as a theoretical framework Lakoff and Johnsons metaphor theory, the article argues that ‘teacher as professional’ should be seen as a metaphor of teaching on par with other metaphors familiar from the history of educational thought. What metaphors of teaching have in common, the article advances, is that they systematically highlight certain aspects of teaching while hiding others. The significance of this conclusion is twofold. Appreciating the limits of the ‘teacher as professional’ metaphor provides guidance about how to use more effectively ‘professionalism’ as a normative standard for promoting change in teaching and teacher education. Second, appreciating the metaphorical character of ‘teacher as professional’ has heuristic value in that it offers a novel explanation for the controversial trend towards conceptualising teaching in narrowly instructional terms.

A Review of Social and Relational Aspects of Deep Brain Stimulation in Parkinson's Disease Informed by Healthcare Provider Experiences

Background. Although the clinical effectiveness of deep brain stimulation (DBS) in Parkinsons disease is established, there has been less examination of its social aspects. Methods and Results. Building on qualitative comments provided by healthcare providers, we present four different social and relational issues (need for social support, changes in relationships (with self and partner) and challenges with regards to occupation and the social system). We review the literature from multiple disciplines on each issue. We comment on their ethical implications and conclude by establishing the future prospects for research with the possible expansion of DBS for psychiatric indications. Conclusions. Our review demonstrates that there are varied social issues involved in DBS. These issues may have significant impacts on the perceived outcome of DBS by patients. Moreover, the fact that the social impact of DBS is still not well understood in emerging psychiatric indications presents an important area for future examination.

Should empathic development be a priority in biomedical ethics teaching? A critical perspective.

Biomedical ethics is an essential part of the medical curriculum because it is thought to enrich moral reflection and conduce to ethical decisionmaking and ethical behavior. In recent years, however, the received idea that competency in moral reasoning leads to moral responsibility “in the field” has been the subject of sustained attention. Today, moral education and development research widely recognize moral reasoning as being but one among at least four distinguishable dimensions of psychological moral functioning alongside moral motivation, moral character, and moral sensitivity. In a reflection of this framework, medical educators and curriculum planners repeatedly advance the idea that educators should be concerned with supporting empathy, and this, very often, as a means of improving on and broadening medical ethics education’s traditional focus on moral reasoning.

Naturalized compassion: a critique of Nussbaum on literature as education for compassionate citizenry

Martha Nussbaum and others claim that the study of literature can make a significant contribution to political education by nurturing empathic capacities. In Nussbaums reading of the situation, the need to promote the creation of bonds of compassion‐based solidarity between co‐citizens provides material for an argument to restore the study of novels, in particular the realist social novel, to its former place near the centre of the curriculum in higher education. This paper argues that the unrivalled educational value that Nussbaum ascribes to the study of novels in this regard is compelling only when one fails to appreciate that rich imaginative involvement in anothers aversive state is only one of many other psychological routes to compassion. The paper begins by sketching out Nussbaums curricular proposal. After explaining how it presupposes what is labelled the perspective‐taking/compassion hypothesis, I go on to catalogue the various psychological processes which are recognized in social psychology as playing a mediating role in the experience of compassion. In closing, I argue that the educational imperative of building up of bonds compassion‐based solidarity between co‐citizens calls for a curricular response more varied than Nussbaums.

A Five-Country Survey on Ethics Education in Preservice Teaching Programs

Despite a broad consensus on the ethical dimensions of the teaching profession, and long-standing efforts to align teacher education with wider trends in professional education, little is known about how teacher candidates are being prepared to face the ethical challenges of contemporary teaching. This article presents the results of an international survey on ethics content and curriculum in initial teacher education (ITE). Involving five Organisation for Economic Co-Operation and Development (OECD) countries—the United States, England, Canada, Australia, and the Netherlands—the study’s findings shed light on teacher educators’ perspectives on the contribution of ethics content to the education of future teachers and provide a snapshot of how well existing programs line up with their aspirations. The results showed that 24% of the ITE programs surveyed contain at least one mandatory stand-alone ethics course. The meaning of the results vis-à-vis opportunities for expanding ethics education in preservice teaching programs is also discussed.

Are psychopaths morally sensitive

Philosophical and psychological opinion is divided over whether moral sensitivity, understood as the ability to pick out a situations morally salient features, necessarily involves emotional engagement. This paper seeks to offer insight into this question. It reasons that if moral sensitivity does draw significantly on affective capacities of response, then moral insensitivity should be characteristic of psychopathy, a diagnostic category associated with pathologically low affectivity. The paper considers three bodies of empirical evidence on the moral functioning of psychopaths: (1) psychopathy and the moral/conventional distinction; (2) psychopathy and social perspective‐taking competency; and (3) psychopathy and social information processing models of aggressive behaviour. On the basis of this evidence, the conclusion is reached that psychopaths are morally sensitive in the operative sense. Thus, conceptions of moral perception that include affect in their definitions are questionable, as are educational interventions that claim to develop an affective aspect of moral functioning by improving skills in situational moral perception.