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An Interview with Dr. Frederick Paola on Medical Ethics and Humanities

An Interview with Dr. Frederick Paola

author of Medical Ethics and Humanities

(Nehrenz) Tell me about your new book and the approach you take toward teaching and discussing medical ethics?

(Paola) Our new book is entitled, perhaps a bit unimaginatively, Medical Ethics and Humanities. It is published by Jones and Bartlett and has been out for a few months now. The book is a survey of medical ethics and humanities geared to medical and allied health students such as PA students. The book explains the various approaches to ethical analysis, and illustrates their application through the use of cases. It’s a paperback, about 400 pages in length, and is divided into five sections: I) an introduction to the study of ethics, which introduces the reader to a number of ways of thinking about ethical issues; II) a section on the provider-patient relationship, which explores a number of key concepts in ethics, including confidentiality, competency and informed consent; III) a section on ethics across the lifespan, from life’s beginning to life’s end; IV) a section on law; and V) a section on humanities in medicine.

The book has a number of features that I think course directors and students will find attractive. First, the book’s editors collectively have formal training in clinical ethics, medical humanities and the law. Second, the editors have each been involved in teaching medical ethics and humanities to medical students and residents for over fifteen years, and to physician assistant (PA) students for the past three years. Third, the book’s content has been tried and tested over the years at the University of South Florida College of Medicine and at the Nova Southeastern University Physician Assistant Program Southwest Florida. Fourth, the book specifically addresses ethical and legal issues of concern to medical students and allied health students. Fourth, the book and its supplements have been designed with course directors in mind. Thus, in order to make this book attractive for use by course directors and students, we included chapter objectives that can be used as lecture objectives in course syllabi; chapter summaries; illustrative cases/examples; and review questions at the end of each chapter as a study aid for students. Powerpoints and a test bank are also available.

(Nehrenz) Tell me about your co-authors.

(Paola) My co-authors are Robert Walker, M.D., and Lois LaCivita Nixon PhD, MAT, MLitt, MPH. Dr. Walker received his M.D. from Louisiana State University. He completed fellowship training in ethics at the MacLean Center for Clinical Medical Ethics at the University of Chicago. He is Associate Professor of Medicine and Director of the Division of Ethics, Humanities and Palliative Care at the University of South Florida College of Medicine in Tampa, Florida. He is also the chairman of the Tampa General Hospital (TGH) Ethics Committee and a member of the Ethics Consultation Service at TGH. Dr. Walker is board certified in internal medicine and is a practicing internist, as well as a Medical Director with LifePath Hospice. His academic interests focus on ethics at the end of life, information ethics, and ethical issues associated with the HIV epidemic.

Dr. Nixon received her M.Litt. from Middlebury College. She is Professor of Medicine and a member of the Division of Ethics, Humanities and Palliative Care at USF College of Medicine. Dr. Nixon is also a member of the ethics committee at Tampa General Hospital. She is Director of the Master’s Degree Program in Bioethics and Medical Humanities at USF College of Medicine. Her areas of study include medical ethics and the humanities, women’s issues, aging and the impact of globalism on health care. Her publications include: On Doctoring (1st, 2nd and 3rd editions, with Reynolds, Stone, and Wear); Trials, Tribulations, and Celebrations: African-American Perspectives on Health, Illness, Aging and Loss (with Secundy); and Literary Anatomies: Women’s Bodies and Health in Literature (with Wear).

(Nehrenz) When do you feel is the appropriate time in the physician assistant education program to teach medical ethics, and how do you make it meaningful?

At the NSU PA Program SW FL, we usually begin the ethics curriculum with a lecture on professionalism to the incoming class during the first few weeks. We teach a course on legal and ethical issues in health care during the fall semester of the didactic year, not unlike what is done in medical school, and I suppose that’s as good a time as any to start. I have found that one doesn’t have to try very hard to make the course meaningful—the subject matter is intrinsically meaningful and interesting, particularly if the material is discussed in the context of clinical cases, which the students find very engaging. Including materials from the humanities is also helpful.

(Nehrenz) Does your book reach out to more than physician assistants and medical students?

(Paola) We think the book was written in such a way that it will appeal to all students of allied health and nursing, although the book was written, because of the background of the editors, with medical students and PA students in mind.

(Nehrenz) What do you see as the biggest challenge in teaching medical ethics to students?

Perhaps the greatest challenge is preventing the phenomenon that Coulehan and Williams1 have referred to as "vanquishing virtue,” where students during their early clinical years unlearn—or, more correctly, are implicitly untaught—many of the moral lessons that they learned pre-clinically. Preventing that requires the presence of clinical preceptors who understand the importance of ethics in clinical practice and who can serve as ethical role models for trainees. Additionally, I think it’s important to have some type of ethics program in place during the clinical year of PA education.

(Nehrenz) Is ethics covered sufficiently in medical education throughout the country?

That’s a hard question to answer. As an ethicist, my bias is that more ethics in the curriculum is better, although I understand that competition for curricular hours is a zero-sum game. We do need to leave time for students to learn about the art and science of medicine—we’re training health care providers, after all, not ethicists. I guess I’d like to see a more robust ethics presence during the clinical year(s).

Footnotes:

1. Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76(6):598-605.

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