Christy A. Rentmeester

Third and fourth year medical students' attitudes about and experiences with callousness: the good, the bad and the ambiguous

Background: This study solicits third and fourth year medical students’ attitudes about and experiences with callousness. Methods: Medical students were asked to respond to an on-line survey assessing demographic information, their experiences with seeing callousness modeled by mentors and their attitudes about callousness. Participants included 74 students roughly split on gender and year in school. Results: A 2 × 2 between-subjects MANOVA was conducted (dependent variables—attitudes about and experiences with callousness; independent variables—gender and year in school). Significant results were found for gender; follow-up analyses revealed that women hold more unfavorable attitudes about callousness than men. Although students generally regarded callousness as undesirable, they reported seeing callousness modeled by their mentors 20% of the time across a variety of situations. Conclusions: Students’ attitudes about callousness are negative; womens attitudes are more negative than mens. Despite this, students (regardless of their demographic variations) regularly see it modeled by their mentors. Some students’ narrative responses suggest they think being callous toward patients and colleagues can serve them well in some situations. The authors offer several questions to motivate further empirical and ethical inquiry into callousness and urge medical educators to consider its influence on students’ conceptions of professionalism.

Art, Clinical Moral Perception, and the Moral Psychology of Healthcare Professionalism

This essay describes an example of how we—one professor of the elective course Art, Medicine, and Clinical Moral Perception at Creighton University School of Medicine, one Director of Adult Programs at the Joslyn Museum of Art in Omaha, Nebraska, and fourth year medical students—practice perception skills using art objects. This essay presents one example of the journal assignments to which students respond in written narratives about their own perception habits. We also share questions any health professions educator can use to guide students’ study of their habits of perception using art objects.

Regarding Refusals of Physically Ill People with Mental Illnesses at the End-of-Life

This paper explores decision making at the end-of-life for physically ill people with mental illnesses. I suggest reasons to make better use than we typically do of psychiatric expertise in complex cases. I offer one example of an ethically and clinically complex case and canvass some of the relevant ethical concerns including the need to distinguish carefully between the clinical standard of decision-making capacity from the legal standard of competency. I also draw attention to values such as dignity and honoring the patients illness experience by arguing that we should add the concept epistemic authority to capacity and competency as standards by which we regard decisions, particularly refusals, about treating physically ill people with mental illnesses at the end-of-life.

Coercion and polio eradication efforts in Moradabad.

We introduce the problem of vaccine coercion as reported in Moradabad, India. We offer commentary and critical analysis on ethical complexities at the intersection of global public health and regional political strife and relate them to broader vaccine goals. We draw upon a historical example from malaria vaccine efforts, focusing specifically on ethical and health justice issues expressed through the use of coercion in vaccine administration. We suggest how coercion is indicative of failed leadership in public health and consider community-based collaborations as models for cultivating local investment and trust in vaccination campaigns and for success in global public health initiatives.

Cartography of Endurance

This commentary canvasses a few prominent themes of ethical relevance drawn from the stories in this issue. I develop the metaphor of cartography to illuminate critical experiences in the moral lives of parents of children with brain tumors. Relationship transformation within families along the timeline of a child’s illness and recovery is one such set of experiences. Points for consideration in health professions education are also featured: clinical humility regarding “second opinions,” cultivating therapeutic efficacy from the clinician–parent relationship, error, and medical care itself as a source of trauma.

What Are Features of a Good Deliberation Process in Cases of Medically and Ethically Complex Pregnancies

Freedman and Stulberg’s (2013) “Conflicts in Care for Obstetric Complications in Catholic Hospitals” raises several interesting, important, and complex clinical and organizational ethics issues worthy of further exploration. I launch initial inquiry and offer suggestions for future scholarship and research into some of the topics inspired by the physician-subjects’ self-reports about the care they delivered and the deliberations about medically and ethically complex cases in which they were involved.

Good epidemiology, good ethics: empirical and ethical dimensions of global public health.

This paper examines the following ethically and epidemiologically relevant challenges, as yet neglected in public health ethics: how to distribute resources and health risks and benefits, how to define evidentiary criteria that justify public health interventions, and how to define terms in which programme goals, successes, and failures will be assessed and monitored. We illuminate critical intersections of empirical and ethical dimensions of public health work, drawing upon three global public health interventions-inclusion of the Hepatitis B vaccine in the Universal Immunisation Programme, Universal Salt Iodisation, and the Global Polio Eradication Initiative-and suggest strategies for addressing and responding to them.