Time for training in psychiatric ethics

Psychiatry is often fraught with uncertainties and complex situations which give rise to particular ethical issues. However, there is still a dearth in formal training in psychiatric ethics. In this perspective by a clinician, researcher and bioethicist, a case is made for a special status in medical ethics and the need for the incorporation of a structured educational programme in psychiatric ethics during residency training. This educational process should also include the acquiring of certain virtues and competencies.

Evaluating the effects of an integrated medical ethics curriculum on first-year students

<p><b>INTRODUCTION</b>An integrated biomedical ethics track was implemented as part of the new medical undergraduate curriculum at the National University of Singapore Yong Loo Lin School of Medicine in academic year (AY) 2008/2009. This study analyses the effects of the new curriculum on fi rst-year students' knowledge, confidence and opinions in relation to the subject.</p><p><b>MATERIALS AND METHODS</b>In a cohort-based quasi-experimental study, we administered a pre-course and post-course questionnaire to a group of fi rst-year students in AY2008/2009 who underwent the new biomedical ethics curriculum. The same questionnaire was carried out with the fi rst-year cohort of AY2007/2008, who had received only ad hoc teaching in biomedical ethics. The questionnaire focused on the students' opinions on selected taught topics in biomedical ethics and law, and formal ethics education; their confidence in relation to specific clinical ethical competencies; and their knowledge of selected taught topics in the fi rst-year syllabus.</p><p><b>RESULTS</b>The experimental cohort acquired more knowledge and confidence. They rated more positively formal ethics teaching and assessment as a requirement of medical education. Attitudes were found to have been 'professionalised' within the experimental group, with significantly greater receptiveness towards ethical codes of the profession and the regulatory role of the Singapore Medical Council. They were found to be more conservative with respect to legislative changes in healthcare.</p><p><b>CONCLUSION</b>The pioneer biomedical ethics curriculum had significant effects on the ethical development of fi rst-year medical students. Longitudinal research through further phases of the integrated curriculum is needed to identify learning issues that affect the consolidation of knowledge, confidence and attitudes in medical ethics, law and professionalism.</p>

Live or let die: ethical issues in a psychiatric patient with end-stage renal failure

Medical co-morbidities are very common in patients with psychiatric conditions. Although respecting one's autonomy to make treatment decisions is the ethical default position, the capacity to make such decisions may need to be assessed, especially when patients are in relapse of their psychiatric condition, and/or when the decisions made are high-risk and possibly fatal. This case report highlights the ethical issues of refusing potential life-saving treatment in a patient who is in relapse of her schizoaffective disorder. In particular, the assessment of decisional capacity and the role of the doctors (if the patient lacks capacity) are discussed. Recommendations are also made on how to better manage such situations.