Análisis de la maduración del juicio moral en el proceso de aprendizaje de la bioética / Analysis of the maturation of moral judgment in the learning process of bioethics

Objetivo: Medir el razonamiento moral de los estudiantes de medicina antes y después de recibir formación en bioética en dos ámbitos culturales diferentes (Zaragoza y Doha) y de los residentes al inicio de su residencia (MIR1), correlacionando el razonamiento moral con el ámbito cultural y el ambiente de aprendizaje. Sujetos y métodos: Estudio observacional transversal del razonamiento moral con estudiantes de medicina y MIR1 y de intervención con seguimiento longitudinal del razonamiento moral antes y después de la formación en bioética, utilizando el test de razonamiento moral de Lind. Resultados: Se obtuvieron 273 cuestionarios iniciales de estudiantes (200 de Zaragoza y 73 de Qatar) y 141 de MIR1. Se tiene información antes y después de 122 estudiantes (44,7% del total), una quinta parte de Qatar. Antes de bioética, la media del C-score era de 14,24 ± 8,698 (n = 273). Después, la media era de 14,30 ± 10,111 (n = 194). La diferencia media antes-después fue de 0,79 ± 12,162 (n = 122). No hay diferencias del C-score por región, pero sí al dicotomizarlo en preconvencional (< 10) y convencional-posconvencional (> 10): 49% < 10 en Qatar frente a 30% en Zaragoza. También hay diferencias significativas en las respuestas dadas a los dos dilemas que conforman el test de razonamiento moral entre ambas regiones. Los MIR de Zaragoza muestran el mismo patrón de respuestas ante los dilemas que los estudiantes, pero su C-score es significativamente inferior (10,4 frente a 14,3). Conclusiones: Se confirman las hipótesis iniciales, aunque conviene profundizar en esta línea de investigación durante más cursos académicos, o incluyendo otros campus universitarios de las mismas zonas culturales

Aim: To measure the moral reasoning of medical students before and after training in bioethics in two different cultural settings (Zaragoza and Doha), as well as MIR1s in Zaragoza, correlating in both cases the possible changes in their moral reasoning with their cultural and learning environment. Subjects and methods: Observational study of moral reasoning with medical students and MIR1 and intervention with longitudinal follow up moral reasoning before and after training in bioethics, using Georg Lind's Moral Judgement Test. Results: There were 273 initial questionnaires of students (200 from Zaragoza, 73 from Qatar) and 141 MIR1. There were information before-after 122 students (44.7%, of which 1/5 from Qatar). Before bioethics training the average C-score was 14.24 ± 8.698 (n = 273). After training, the average was 14.30 ± 10.111 (n = 194). The mean difference before and after was 0.79 ± 12.162 (n = 122). No C-score differences by region were found, but the dichotomization in preconventional (< 10) and conventional-postconventional showed differences between Qatar and Zaragoza (> 10): 49% < 10 versus 30%, respectively). There were also significant regional differences in the responses to the two dilemmas that compose the Moral Judgement Test. The MIR of Zaragoza showed the same pattern of responses to the dilemmas than students but their C-score is significantly lower (10.4 versus 14.3). Conclusions: We confirm the initial hypothesis, although this line of research should be furthered to more academic years and more university campuses

Truth-telling and cancer diagnoses: physician attitudes and practices in Qatar.

There is limited information regarding physicians' attitudes toward revealing cancer diagnoses to patients in the Arab world. Using a questionnaire informed by a seminal study carried out by Oken in 1961, our research sought to determine present-day disclosure practices in Qatar, identify physician sociodemographic variables associated with truth-telling, and outline trends related to future practice. A sample of 131 physicians was polled. Although nearly 90% of doctors said they would inform cancer patients of their diagnosis, ∼66% of respondents stated that they made exceptions to their policy, depending on patient characteristics. These data suggest that clinical practices are somewhat discordant on professed beliefs about the ethical propriety of disclosure.

The hidden and implicit curricula in cultural context: new insights from Doha and New York.

The authors report their longitudinal experience teaching a clerkship in clinical ethics and palliative care at the Weill Cornell Medical College campuses in New York and Doha. This course uses participant observation and reflective practice to counteract the hidden curriculum when learning about clinical ethics and end-of-life care. The authors consider how this formal element of the curriculum is influenced by the implicit and hidden curricula in different cultural contexts and how these differing venues affect communication and information exchange, using the anthropological concept of high- and low-context societies. The authors' analysis provides additional information on Weill Cornell's educational efforts in the medical humanities, bioethics, and palliative care across the curriculum and across cultural settings. By contrasting high-context Doha, where much information is culturally embedded and seemingly hidden, with low-context New York, where information is made overt, the authors theorize that in each setting, the proportion of implicit and explicit curricular elements is determined by the extramural cultural environment. They argue that there are many hidden and implicit curricula and that each is dependent on modes of communication in any given setting. They assert that these variations can be seen not only across differing societies but also, for example, among individual U.S. medical schools because of local custom, history, or mission. Because these contextual factors influence the relative importance of what is implicit and explicit in the student's educational experience, medical educators need to be aware of their local cultural contexts in order to engage in effective pedagogy.

Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective.

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations.

Death, dying and informatics: misrepresenting religion on MedLine.

BACKGROUND: The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the three major monotheistic religions. METHODS: We searched MedLine using PubMed in order to retrieve and thematically analyze full-length scholarly journal papers or case reports dealing with religious traditions and end-of-life care. Our search consisted of a string of words that included the most common denominations of the three religions, the standard heading terms used by the National Reference Center for Bioethics Literature (NRCBL), and the Medical Subject Headings (MeSH) used by the National Library of Medicine. Eligible articles were limited to English-language papers with an abstract. RESULTS: We found that while a bibliographic search in MedLine on this topic produced instant results and some valuable literature, the aggregate reflected a selection bias. American writers were over-represented given the global prevalence of these religious traditions. Denominationally affiliated authors predominated in representing the Christian traditions. The Islamic tradition was under-represented. CONCLUSION: MedLine's capability to identify the most current, reliable and accurate information about purely scientific topics should not be assumed to be the same case when considering the interface of religion, culture and end-of-life care.

El derecho a la eutanasia: problemas de un enfoque equivocado / Euthanasia right: problems of wrong focus

Este artículo plantea la necesidad de cambiar de enfoque en el debate sobre la eutanasia, sobre todo si ella se plantea como posible derecho. Para ese fin, luego de una introducción general, el trabajo delimita el campo histórico y semántico sobre el que se desarrollará. A partir de allí, se exponen algunos de los fundamentos que suelen darse para sostener la eutanasia como derecho. Se profundiza luego en la idea de que las circunstancias médicas y sociales en que los enfermos solicitan la eutanasia son un producto humano, médico y social, y se insiste, además en que ellas no son moralmente neutras, por lo que debe dirigirse una mirada crítica hacia ellas para, sobre esta base, reorientar el debate y la acción (AU)