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This module is intended to help you reach a deeper understanding of one aspect of good clinical decision-making within a social context: ethical deliberation. The module will focus on difficult topics that arise in medical practice, using, wherever possible, patient cases to introduce the topic and to guide group discussion.  For each ethical issue, the module hopes to illustrate both the dramatic "life and death" cases and the "every-day" situations that call upon physicians to exercise good ethical reasoning.

The (separate) epidemiology course should also equip you for decision-making, by helping you learn to evaluate the research data. Obviously, most decisions depend upon estimates of what is likely to happen. The next module in the SCCD course, policy, will point out the relationships between individual doctor-patient decisions and the way society is organized (for instance, the way the United States allocates its health care resources).  The policy module will also address one important ethical issue, justice and fairness in the way that health care resources are provided for and distributed throughout society.

In the final module, the integrative exercise, you will demonstrate your ability to use ethical, epidemiological, and policy analyses to solve practical health problems in the community.

Few of you will wish to become "experts" in medical ethics (teachers or consultants). But all of you will face difficult decisions in practice, and will have to make reasoned decisions within institutional contexts that involve other physicians, nurses, social workers, chaplains, and other professionals as well as patients and family. Moreover, many institutions are responding to these challenges by forming ethics committees; and you may well be asked, as part of your professional duties, to serve on such a committee. The overall goal of this module is to teach you the basic knowledge and skills you will need to become a productive, contributing member of an institutional ethics committee. The same skills you need to be a good committee member will help you to work productively with patients, family, nurses, etc. to make the required ethical decisions within your own practice.


The Ethics module, besides serving the needs of the SCCD course, is intended to be a part of the Professional Development curriculum of CHM.  The goal of the Professional Development curriculum is to produce the "virtuous student physician" and to give all members of the CHM community an opportunity to reflect on just what that means and how it relates to a life long commitment to high professional standards.  The small group dialogues within the Ethics module of SCCD should be one among several opportunities for sustained and critical reflection on professional virtues and professionalism. 

You'll recall that the specific virtues around which the Professional Development curriculum is organized are:




Respect for Others

Professional Responsibility

Social Responsibility

As you work through the cases and topics in the Ethics module, it may appear that we are getting away from this list.  Instead of talking about your personal development as a professional, we are talking about "rules" about how to treat patients and "duties" that physicians owe to their patients.  In extreme cases, it may seem that we have left you, the person, out of the equation-- it does not matter who you are or what sort of person you are; just follow the ethical rules and do your ethical duty, and all will be fine.

But this, we think, is a very impoverished view of medical ethics.  We assume that the personal integrity, character, and virtue of the physician are part and parcel of all ethical behavior.  So be sure to use the group discussion time in this module to clarify for yourself how the list of professional virtues relates to all of the ethical topics in patient care that the module addresses.  Be especially ready to speak out if it seems that following one of the "rules" being proposed by the class discussion, or in the readings, would somehow violate your own sense of integrity.  It may be that this conflict is imaginary once you fully understand what the "rule" requires of you; or it may be that there is a real conflict which must somehow be negotiated or managed.  In either case your reflecting on this will enrich the discussion for everyone.


The module will consist of one week of large group presentations, followed by seven 2-hour small group sessions with 8-10 students and a faculty preceptor. In some sessions, the time will be devoted to discussion of background readings and cases. In others, there will also be a group role-play exercise, followed by group debriefing and discussion. During some weeks there will also be a large group presentation to supplement the small group discussions. 

For certain weeks, viewing of a videotape OUTSIDE OF CLASS TIME is required.  In addition to a large group showing, the tapes will be available through the Echt Center for you to view at your convenience.