Medical Education: Professionalism, Ethics and Communications

In recent years, many medical schools around the world have formally established professionalism education as part of their standard curriculum. While the call to prepare future doctors to behave ethically and professionally is not new, what is new is the emphasis on identity formation in the context of the expanding online universe. Nonetheless, role modelling the professional image is challenging in the digital age, especially when cultures and customs across disciplines and generations collide. Against the backdrop of hyper-vigilance about our professional image, this paper explores whether the hidden professionalism curriculum may inadvertently stifle creativity and humanity. It proposes the positive use of social media as relational or pedagogical tools in teaching learners about work-life balance and responsible online behaviours.

In recent years there has been an increase in the number of requests for“mercy killings” by patients and their relatives. Under certain conditions,the patient may prefer death to a life devoid of quality. In contrast to thosewho uphold this “quality of life” approach, those who hold the “sanctity oflife” approach claim that life has intrinsic value and must be preservedregardless of its quality. This essay describes these two approaches,examines their flaws, and offers a “golden path” between the two extremepositions.We discuss the halachic and the secular views, arguing for a balancebetween the sanctity of life and the quality of life. We argue that, indeed,such a balance exists in practice, and that life is important, but it is not sacred. Life can be evaluated, but quality of life is not the solecriterion.

The greatest cause of human disease is human culture, and the solution is to change that culture and the way we live. It has nothing to do with animals. A medical industry dedicated to animal research is corrupted by cruelty and cannot be a truly healing profession.

To assess the satisfaction level of students of Doctor of Physical Therapy (DPT) regarding their field of education. To
identify the causes responsible for dissatisfaction of students with their field of study. Physical Therapy is an emerging
and growing field in Pakistan and currently is passing through its stage of infancy. Five year program of Doctor of
Physical Therapy (DPT) has been now introduced resulting in increased influx of students. Yet unawareness among the
students as well as society still prevailed that resulted in confusing the minds of young undergraduate students of
Physical Therapy. A cross-sectional study was conducted in the Institute of Physical Medicine and Rehabilitation,
Peshawar. Total 100 students of Doctor of Physical Therapy. Were interviewed through structurally designed
questionnaires. Ethical consideration was taken into account. The response rate was 78%. 55.1% students were found
satisfied with the field, 7.6% were dissatisfied while 37.1% were unable to analyze whether satisfied or dissatisfied
majority being basic sciences students. Students highlighted certain factors as responsible for their
dissatisfaction.Majority of the students satisfied from their field of education belonged to clinical sciences which
indicate their well-aware attitude about the significance of this field. Moreover, the students held disrespectful attitude
of society, Limited facilities and job opportunities and Incapable Physical Therapists imparting bad name to this
profession responsible for their dissatisfaction.

Study abroad has become a common experience for American social work students. However, there is little guidance for facilitation of such courses in an international context. As a result, there is a risk that students and facilitators can perpetuate the privileged and Ugly American image. Providing guidance for prevention of such mistakes, the authors present a conceptual model for international learning, based on an ethical framework founded on personal values and supported by traditional ethical principles and values. Included are the pillars of boundaries, self determination, dignity and worth of the person, community capacity, social justice and human rights, facilitative learning, competence, and integrity. Finally, consciousness-raising as professionals, respectful engagement in context, and intercultural competence are discussed.

Professionalism is a priority for the medical students, physicians and medical educators because it is an important
component of medicine's contract with society. The authors wish to share the experience of the operationalization
of current teaching, learning and assessment tools of professionalism course. The authors also desired to share
proposal as a future direction.
A detailed description is provided about the current practice for inculcating in the students the best professional
attitudes, communication and management skills and knowledge. Furthermore, a comparison of the proposed
future plan with the current practice is also attained.
The authors believe that adopting the evidence based practices need time and gradual improvements which in
turn pave a path to have the best professional care for the patients.

This article recounts the development of the Professional/Problem-Based Ethics (ProBE) Program, the original physicians' professional ethics remediation course. Since 1992, more than 1,200 healthcare professionals of many disciplines have been mandated to attend ProBE by licensing boards and other oversight entities. Using a small-group, interprofessional setting, the ProBE Program assists participants to discover and articulate ethical underpinnings violated by their misconduct; appreciate professional responsibilities that are societal, regulatory, and ethical; and recommit to professional ideals. The authors describe the rationale for developing ProBE, its curriculum, participant demographics, and infractions and reconsider medical professionalism in light of two decades of ProBE.

In this article we explore the ethics of manipulating verbal information for the sake of influencing health-outcomes through placebo and nocebo responses. Recent scientific research on placebo and nocebo effects has drawn attention to the ways in which communication by health professionals may modulate the symptoms of patients across an array of highly prevalent conditions such as pain, depression, anxiety, insomnia, irritable bowel syndrome, migraine and Parkinson’s disease. The positive and negative effects of clinicians’ communication on patient outcomes pose important ethical issues, which we describe in this article under the label of “the ethics of therapeutic communication” (TC). We begin by reviewing available evidence supporting the claim that doctor-patient communication has therapeutic effects. We then identify in truthfulness, helpfulness and pragmatism three morally relevant considerations that can guide clinicians in therapeutic communication with their patients. Finally, we examine the ethics of using TC to enhance the effectiveness of proven medical interventions and open-label placebos.

It is observed by the author that Sri Lankan clinical psychologists, contrary to international standards, can, at times, be prevented from independent practice by psychiatric colleagues. This paper suggests reasons for the sometimes strained relations between clinical psychology and psychiatry and discusses the future of the profession in Sri Lanka. An important step would be the establishment of separate departments of clinical psychology in the health system, rather than psychologists being situated within departments of psychiatry.

This paper is an excerpt from the book “The young Lawyer, Ethics & Practice” by Ashu Hailshamy. It is a chapter of the said book and was carefully chosen by the author to share more knowledge on the lawyer’s duty to the court.  As Counsel, you owe a compelling duty, to treat the Court with utmost courtesy and respect. This duty includes respect to all persons with whom you have professional contact with such as Judges, colleagues, staff of Court and parties to litigation including witnesses, etc. This is Ethics compels you to conduct yourself properly before the court because before being a lawyer for your client, you are first and foremost a lawyer and officer of the court. You must bear in mind that, you owe a duty to the court to assist at all-times whether as instructed counsel or as Amicus Curiae. This is the reason you are considered an officer of the court,  a disciple of Justice working in and for the temple of Justice. 


Ashu Hailshamy  ESQ.
(LL.B Hons University of Buea, B.L Hons The Gambia Law School)
Barrister and Solicitor of the Supreme Court of The Gambia
Institute for Human Rights and Development in Africa (IHRDA), Banjul The Gambia.
Email: [email protected]
Tel: +220 2615598

Streszczenie. Cel pracy to identyfikacja cech profesjonalizmu ratownika medycznego w Polsce. Materiał i metoda:
Przeprowadzono badanie ankietowe w grupie studentów ratownictwa medycznego (studia licencjackie stacjonarne
i niestacjonarne), czynnych zawodowo ratowników medycznych (żadna z wyżej wymienionych grup nie została poddana
szkoleniu mającemu na celu pracę nad profesjonalizmem w zawodzie) oraz przedstawicieli grup zawodowych najbliżej
współpracujących z systemem ratownictwa medycznego w Polsce (straż pożarna, pracownicy szpitalnych oddziałów
ratunkowych). Ankieta zawiera pytania z szacunkową skalą Likerta pomocną do oceny wagi poszczególnych cech
profesjonalizmu i wyszczególnionych zachowań w pracy ratownika medycznego. Wyniki: Wszystkie zachowania i postawy
zdefiniowane przez autorkę kwestionariusza jako profesjonalne są ważne w pracy ratownika medycznego poprzez unikanie
wartościowania w najniższych stopniach skali Likerta. Wnioski: Konieczne jest przeprowadzenie badań na większej grupie
badawczej i udoskonalenie narzędzia badania.
Słowa kluczowe: profesjonalizm medyczny, rat

Misconduct in the health care profession should be taken seriously as it costs lives and money. Social scientists (especially sociologists and criminologists) are interested in the issue as it falls in the realm of white collar crime in the professions while the interest of health care professionals and nurse educators relates to concerns regarding patient safety and teaching nursing students. Misconduct by health professionals can be directed at patients, co-workers, or the employer. Operating within federal and provincial legal frameworks, health care providers, like many other professions, are governed by organizations that largely regulate themselves. This paper presents the results of disciplinary hearings involving registered nurses in a Canadian province. We analyzed the content of publicly available data and the resulting disciplinary actions, paying particular attention to gender differences regarding the types of misconduct and the RNs found to have engaged in them. In addition to our research findings, we discuss the status of social scientific knowledge on white collar crime in the medical profession and explore policy implications.

The learning experiences of medical students happen in diverse settings. Logbook is a long known tool to manage and guide these experiences but the studies had varying results this study is an attempt to examine the educational benefits of logbooks . Methods: In this quasi-experimental study the externs were divided into to equivalent groups as intervention and control group. For the controls the routine program was delivered while logbook was used in addition to routine learning activities for intervention group. The students was examined with an OSCE and MCQ exam at completion of rotation. The results were compared. Results: Of 53 subjects, 28 were assigned in control groups and 25 were placed in intervention groups. The intervention groups' performance on OSCE was not significantly different from control group (14.84±1.87 vs 13.93.2.15, P > 0.05). The intervention groups performance on 5 stations of OSCE assessing clinical skills compared with the control groups performance on these stations showed a significant difference of 6.4 out of 20 (P < 0.0001) while the intervention groups performance on 7 stations assessing factual knowledge compared with the control groups performance on these stations showed no significant difference (0.2, P > 0.05). Conclusion: The introduction of logbook was associated with increased clinical skills while no improvement of factual knowledge was observed.

Turfing" denotes a patient transfer or triage from one physician to another when the care of that patient feels more troublesome than it is worth.A widespread phenomenon in medical training programs, turfing appears to allocate patient care to meet physicians' rather than patients' needs. Although turfing reportedly causes inter-physician discord and inter-specialty stereotyping, its deeper consequences are poorly understood.Turfing is an interpersonal conflict masquerading as a medical issue. After examining turfing alongside other patient-related slang, I analyze the distinction between "the turf," a person, and "to turf," a practice. Several explanatory models from medical practice are explored in order to illuminate turfing's implications for medical professionalism, ethics, and patient care. I suggest that a physician's medical specialty or practice type-that is, professional culture-may link to that physician's degree of altruism. If so, then what it means fundamentally to be a physician might vary across medical specialties. Such a link calls for a new notion of cultural competence, one that physicians may apply not to patients but to each other.

Sourcing Buber and Levinas, this is a project in dialogical ethics in which I offer a constructive critique of the discourse of intersubjectivity and its failure to consider shame as proper and fitting to every human relation.  Current shame literature predominantly relegates the emotion of shame to a curious epiphenomenon of subjectivity, perhaps adaptive in evolutionary terms, but more probably psychopathological.  This thesis denies the claims that shame is reducible to brain states, or constituted by beliefs.  Rather, shame as a moral emotion is a pre-thinking apprehension of what is real in human relation.  Shame is an apprehension of asymmetry in the dyadic relation; shame gives the conscious subject information about her relations that can be, but need not be, secondarily conceptualized.  In these relational apprehensions is the very origin of moral responsibility, and so it is not only a dangerous but a catastrophic move to ignore the experiences of shame and their ethical implications.

I will suggest that intersubjectivity is not a metaphor for relation, but is a literal space between two human beings in dialogue, where their consciousness resides during the activity of being present to each other.  I situate this claim within an externalism model of consciousness:  the meeting of subject and object involves a between where consciousness of the subject meets the object.  In the case of intersubjectivity, I am speaking not just of subject-object relation, but of the special case of two conscious subjects who meet each other and establish an intentional between of dialogue.  This dialogical relation need not be of two conceptualizing, self-conscious subjects; indeed, I will argue that the fundamental moral ground occurs in the between of naïve sayings to and apprehensions of each other.  Shame is one of those naïve apprehensions of the relational between; specifically, it is an apprehension of asymmetry and distance between the two. 

If shame were the only mode of intersubjective awareness, then relation could not be maintained.  Shame would constantly push the dyad apart with its apprehensions of the distance that comes with asymmetry.  I suggest that empathy is the other mode of participating in and apprehending intersubjectivity, and that empathy apprehends the symmetry and mutuality of subjects in relation.  But if empathy was the only mode of apprehension, the relation would also collapse into a state of indistinguishable alikeness of the two.  Instead, in every particular relation, both apprehensions are in play.  Shame and empathy exist in a dialectical tension that maintains the relation of intersubjectivity.

The claim that unrestrained empathy can lead to a failure in relation and moral responsibility might seem counterintuitive, particularly in light of contemporary praise for empathy as a moral emotion par excellence.  In this thesis, however, I will suggest that empathy is not sufficient for ethical deliberation.  Empathy is an apprehension that the proximate other is a person like me, but this accesses only half of the metaphysical reality of relation.  When engaged by the thinking self, empathy without shame leads to the belief that others are like me; this projection is at its core a reduction of the other.  Apprehensions of the difference, distance, and asymmetry of the vulnerable other in relation balance the mutuality that occurs when the subject apprehends the other’s similarities.  In other words, shame is the ground for subsequent understanding that the other is not like me, such that response and responsibility demonstrates proper discretion as the complement to mutuality.  Shame apprehends the alterity of the other, and this moral fact must moderate an inordinate enthusiasm for what is revealed by empathy.

Human beings do not always exist in intersubjective meeting.  There are several alternatives to intersubjectivity in conscious living.  The subject may move from a naïve openness to the relation to conceptualizing the other as object rather than as another person.  In this move, the intersubjective space is transformed by the thinking subject to a subject-object relation.  Or, the subject may move away from the other to engage non-human objects in the world or ideas in her own mind as objects for her intentionality.  These are natural forms of consciousness.  But moral consciousness requires attending to the moral facts of the relational between. 

A fitting shame has been misunderstood and unappreciated in current ethical discourse of relation.  Too often shame is confused with either shaming or thinking about shame, both of which interfere with naïve being-in-relation.  I will suggest that neither is shame proper, but rather misplaced shame, inordinate shame, or second-order thinking about shame, all of which to varying degrees compete with a sustained participation in relational reciprocity.  My intention is to return shame to its proper place in dialogical ethics, while still accounting for the many forms of unfitting “shame” that are of concern in their own right.

There have been a number of conversation partners of assistance in this project, with the richest contributions coming from the works of Emmanuel Levinas.  Levinas is keenly aware of the naïve sayings of the other that present in the form of accusation.  Accusation apprehends and reinforces the asymmetry of the dyadic relation.  In a dialogue of accusation, both shame-disgrace and shame-discretion are present as forms of apprehending the accusation; these forms of shame delineate the terms of moral responsibilitiy.  But accusation and asymmetry are only part of the story when constructing a relation of reciprocity.  I draw in particular from Martin Buber and his articulation of the I-Thou relation to comment on the role of mutuality in dialogue.  I suggest that Buber’s mutuality involves empathy as an apprehension of the other, complementary to fitting shame.  By placing the dialogical concepts of Levinas and Buber in proximity, I suggest that there is a fuller appreciation for the sayings of each to the other in dynamic reciprocity:  co-subjects, as dyad, speak shame and empathy to each other in the very origins of being-in-relation.  In that very speaking is moral response and responsibility.

In each chapter of this thesis, I have offered specific case studies about physician-patient relation and medicine.  This serves two primary purposes.  The first is to provide a specific relation that is marked by readily observable asymmetries, so that the importance of shame to relation is more apparent.  It can be too easy to consider dialogical ethics in terms of relations more prominently marked by mutuality, such as friendship or kinship; notably, shame is also properly present to relationships with strong mutuality and empathy, if not so easily discerned.  The case studies are meant to illustrate particular instances of asymmetry in a conceptually-accessible kind of relation.  The second purpose is to consider the application of my thesis to a specific kind of relation and its community.  Can a thesis on moral shame and its fittingness to relation give guidance to understanding moral responsibility in the physician-patient relationship and in medical professionalism? What ethical considerations arise for physicians who do or do not experience fitting shame in their patient relations and in the medical community?  These questions represent just the beginning of testing theoretical claims in actual practice.

My hope is that my analysis will help restore shame to its proper place in dialogical ethics, and counteract a troublesome trend towards malignant, intrusive empathy as a solitary justification for certain ethical judgments and actions.  Empathy is an insufficient ground for personal and community responsibility.  Our ethical responsibilities as subjects and co-subjects in community must be better responsive to fitting disgrace and discretion in our primary relational spaces.  It is shame that is spoken by the face of the vulnerable other, inviting me to a genuine dialogue with another who is like me in certain respects, but unlike me in a way that is revelatory of who and what I am, and also of my potential for and call to responsibility.  I end with the suggestion that shame prompts the request that the vulnerable other remain present to me in speaking and provoking shame, so that I habituate the disposition of responsibility for her sake and for my own.

Undergraduate rehearsal of the oral case presentation is examined as an opportune context for guiding medical students' perceptions of social accountability through a critical understanding of the psychosocial history, and for the autonomous expression by prosocial students of social justice advocacy in health care and health improvement.

Özet (TR)

“Anlatısallık” kuramına göre, anlatarak, deneyimlerimizi öyküleyerek yașamımıza anlam atfederiz;
kimliğimizi, ideolojimizi anlatılar yoluyla örer, gerçekliği betimleyerek özgün biçimde yeniden
kurarız; bir anlatının karakterleri gibi bütünsellik duygusuyla yașar, yașamımızı bu bütünsellik
içinde değerli kılarız. Tikel deneyimlerimizde yatan anlam anlatılarla temsil edilebilir ve iletilebilir,
dolayısıyla anlatıların irdelenmesiyle su yüzüne çıkarılabilir.
Bugünkü genelgeçer anlayıșa göre etik, yabancılar arasındaki ilișkilerin “doğru” biçimde düzenlenmesiyle
ilgilidir. Biyoetikçi, haklarında yorumlarda bulunup kararlar vermesi beklenen durumlara
uzaktan bakan ve eylem seçenekleri önerdiği kișilerin arasına karıșmayan bir yargıç gibi davranır.
Kișilere değil, davranıșlara; değersel anlamlara değil değersel ikilemlere odaklanır. Bu yaklașım,
yalnızca nesnel koșullar altında yapılan değerlendirmeleri geçerli saydığı için öznel gerçekliğe kördür.
Tıp etiği eğitimi, öğrencileri, uğraș yașamları boyunca karșılașacakları etik ikilemleri doğru șekilde
değerlendirme, ilgili argümanları kavrama, kendi argümanını tutarlılık içinde olușturma ve
uygun biçimde ifade edip savunma gibi becerilerle donatmayı amaçlamaktadır. Ne var ki, kișiye
uğrașının değer yapısını sorgulamasını ve “iyi ve insancıl bir eyleme nasıl mümkündür?” sorusunu
yanıtlamasını sağlayacak yetileri kazandırmamaktadır. Tıp etiği eğitimi, sağlık çalıșanı adayını
“iyi bir insan” olma yönünde dönüștürecek ve uğrașının değerlerine ilișkin ona bütüncül bir
görü kazandıracak ise, tıbbın gündelik yașantılarına gömülü olan değersel anlamlara yönelik bir
yaklașım geliștirmek zorundadır.
Tıp etiği eğitimi günümüzde iki anlayıșın belirlenimi altındadır: 1) Tıbbın bilimle özdeșleștirilmesinden
köken alan “kanıta dayalı tıp” yaklașımı. 2) Etik eğitiminin kișilerin analitik akıl yürütme yeteneklerinin
geliștirilmesiyle ilgili olduğu savı. Anlatısallık bu tablonun bir parçası haline gelmeli; tıp
etiği eğitimi anlatısallık kuramından beslenmeli ve belirli ölçülerde onun tarafından belirlenmelidir.

* * *
Abstract (ENG)

According to the “narrativity” theory, we attribute meaning to our lives by putting our
experiences in a story form, namely, by narrating them; we build our personality and ideology
through narratives and describe reality and reestablish it in an authentic way with them; we live
our lives like a character in a story with a feeling of integrality and we make them valuable in
this integrality. The moral meaning embedded in particular experiences can be represented
and communicated with narratives, thus they can be disclosed by analyzing them.
Ethics, as generally understood today, is about organizing relationships between strangers in a
“proper” manner. Bioethicist behaves like a judge who observes situations from a certain
distance about which she is supposed to comment and reach a decision and who never joins
persons to whom she advices preferences for action. She focuses on behaviors rather than
persons, moral dilemmas rather than moral meanings. This approach is blind to subjective
reality, since it considers evaluations made only on objective grounds valid.
Medical ethics education aims to equip students with skills of analyzing ethical dilemmas which
they would confront during their professional lives, comprehending related arguments, forming
their own arguments in consistency, and expressing and defending them in appropriate ways.
However, it makes them gain tools for neither inquiring the moral structure of their profession,
nor answering the question “how a good and humane acting is possible?” If medical ethics
education is supposed to transform healthcare professional candidate towards being “a good
person” and make her adopt a holistic vision on values intrinsic to her profession, it must
develop an approach regarding moral meanings hidden in daily experiences of medicine.
Today medical ethics education seems to be determined by two major conceptions: 1) “Evidence
based medicine” originating from identifying medicine with science. 2) The claim that ethics
education is about developing persons’ ability of analytic reasoning. Narrativity should become
a part of this picture; medical ethics education should be fed by narrativity theory and to some
extent determined by it.

Book Chapter - pp. 13-33

Nursing rooted in Nightingale’s philosophy of care is a professional discipline integrated science and art of healing. This is necessary condition of nursing, but it entails integrity of professionalism and ethics as a complement to have competence. To be competent necessitates deciding and acting morally, establishing good relationships with patients and co-workers besides being good in professional sense. This could be provided with ethics education and andragogic ethics training in undergraduate and post-graduate level having high awareness, at first. In this context, the question what is our main goal in ethics education/training whether growing nurses acting morally as a moral agent or just obeying the ethical principles? should be answered, at beginning. If main goal is to grow nurses as a moral agent, the objectives should be based on recognizing and analysing ethical issues/dilemma with moral reasoning and critical thinking, making ethical decision and behaving morally, primarily. Since being a moral agent involves episteme (knowledge), techne (skills) and phronesis (practical wisdom) and nursing has a holistic nature, the method should be based on the integrity of problem-based learning, team-based learning and value-based enquiry model to fill the gaps of a single model in means of theory and practice wholeness. Moreover, qualifications of the trainer should contain to have competence; philosophical knowledge and skills like systematic, analytic and critical thinking for moral reasoning and awareness to be a role model as a guide. Hence, bases of growing a moral agent could be laid with andragogic ethics education in long period.

Keywords: Adult training, andragogic education, teaching methods,
ethics training in nursing, qualifications of trainer

Thus, the failure to address the "values being transmitted within the hidden and informal curriculum [that] are decidedly'unprofessional'in nature" (Hafterty zoooa, z4) is a major cause of students' disdain of the "p-word" and is directly tied to the development of cynicism cited earlier. Yet, the drumbeats for assessing professionalism in students largely ignore these disturbing contradictions, and students notice the conspicuous absence of similar assessment efforts tergeting the same behaviors in attendings (Leo and Eagen zoo8). Instead, students face an environment of "excessive directives, lectures, rules, and moral pronouncements that they ffind] repetitive and patronizing" (Goldstein et al. zoo 6, 871). løs I Wear, Zarconi Ct Garden / Disorderþ Conàuct Tb e ore tic a/ C ons iderations Unfortunatel¡ and at the local medical school level, the term professionalisrn also frequendy denotes a more pragmatic concentrarion on srudenr behaviors, such as punctuality or appearance. In addition, medical educators designing curricula often rurn to the field perceived as the humanizing counterparr to the potendally dehumanizing basic science curriculum and clinical training: rhe medical humanities. Such conrent is often deemed most appropriate for more intensive investigarion (if not outright inculcation) of professionalism, particularly the virtues associated wirh it. Assumptions proliferate here as well, most of rhem unspoken, including how professional virrues can be "taught" directly, and where, and by whom. For many medicai educators, the medical humanities-primarily ethics, lite¡ature, narrative inquir¡ and writing-seem as good a place as any to address

The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at end-of-life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia, and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered.

Historically, a patient's body 'belonged' to the doctor and the medical consultation was a one-way communication where the patient offered up information on the 'body' only on request from the doctor. Today, in a shift towards patient-centered care, individuals are increasingly involved in their healthcare, which relies on an understanding of what is happening to their physical/biological body, in order to make informed decisions with their health professional to develop care plans. While the power dynamic between patient and health professional is hotly debated, the heart of every 'good' consultation is held to be the dialogue between patient and health professional, which is presented as an instrumental tool to enable the exchange of ideas through the spoken or written word or gestures within the enclosed walls of the clinical space. Drawing on fieldwork findings, this article offers an alternative view of the role and nature of shared dialogue within the consultation space, which is complex, dynamic, embodied, and (potentially) transformative for both patient and health professional. Here dialogue moves beyond words/gestures, and our somatic body/senses (can) merge with, and are extended through (though not replaced by), technologies that (can) enrich our understanding of and interaction with the everyday world around us. This article builds on the work of the German hermeneutic philosopher Hans-Georg Gadamer and his concept of dialogue-as-play, within an alternative concept of health, that he reworked for forty years, until his death at the age of 102. At the age of 91, Gadamer stated that he had focused too much on language and not enough on the Lifeworld (Gadamer 2000 [1992]). Building on this statement, in this article, I extend Gadamer's concept of language, and hence dialogue-as-play, beyond only spoken words to include the sensing body and technologies-to-hand, that I argue is not at odds with his overall body of work. Importantly, his work has wider implications for good scientific/ethical practices beyond medicine, as through his concept of dialogue he invites us (as players) to be courageous and courteous, and to learn, think critically and creatively, and develop practical wisdom continuously as we move through our everyday lives.

this is a timely book in the age of vertiginous technological advances in the field of medicine. the author Dr. Herbert Ho Ping Kong makes his observations from the perspective of a clinician who has been practicing internal medicine for fifty years spanning three continents.

This paper aims to investigate the field-level realities of the codes of conduct adhered to by different agencies in Belgium for community interpreters, and the degree of interpreter discretion in the application of these codes. We focus on the specific setting of the health care sector in Brussels, where community interpreters and intercultural mediators sent out by different agencies often operate in the same hospitals. Drawing on data obtained through participant observation, interviews with key actors in the field and desk research, we analyze how the codes of conduct applied by different agencies affect multilingual and intercultural communication in a hospital context, in particular at those levels of the communication process where misunderstandings occur most often.

Despite the convenient and compelling nature of social media, netiquette or good conduct in its use remains a remote practice. Being a primary agent of socialization, the social media is a popular means by which individuals exchange personal information, a situation that requires high morals, integrity and individual discipline to be exercised during such exchange. This study presents a mini review of university students' views of social media netiquette and online safety with particular focus on issues of practice relevant to university students in selected disciplines with a special focus on those in the health sciences departments at Kabianga University. An evolving emergent research design was engaged using the search strategy, Find It with keywords like Face book, Twitter, netiquette, patient privacy and social media, student behavior and internet. Students had what they referred to as favorite applications (apps) on social media where both personal and private issues as well as public debate and discourse were freely exchanged. Notably, with a great variety of clientele visiting such sites, unaware of their impact, there is always the danger of being misinterpreted or revealing confidentialities unknowingly. There is need therefore, to establish national and institutional policies regarding etiquette and privacy in the use of social media in public universities and health institutions. A less generic review addressing particular disciplines and circumstances is also recommended for more input regarding social media.

In academic research writing, the way in which an author engages with and positions him/herself in relation to other voices in the discourse, e.g. with the literature and the putative reader, is an integral part of the social practice of communicating research. Understanding how this engagement is realized may have important implications for academic literacy programs, particularly in the development of academic writing skills. In this paper, I investigate engagement in written medical research discourse, by applying the systemic-functional framework of APPRAISAL, a model of evaluative language, to a corpus of English-language medical research articles. Specifically, I present how the corpus has been compiled and annotated according to part of the ENGAGEMENT system, a subsystem of APPRAISAL dealing with writer/speaker resources for intersubjective positioning. These engagement resources include what are generally dealt with under the headings of modality, hedging, and attribution, among others, but they are interpreted here in terms of their dialogic functionality; that is, the role they play in construing for the text a background of different voices (the literature, the putative reader) and different value positions. For instance, a modal Finite such as 'may' not only signals a speaker’s/writer’s degree of certainty or level of commitment, but, from a dialogic perspective, it also ‘entertains’ or allows for the possibility of alternative positions or viewpoints in the discourse. (Consider, for example, 'Reducing LDL cholesterol may reduce the development of vascular disease.') In this paper, I present the different types of engagement features and their interrelations as identified in the corpus, the probabilities of these features being selected, the frequencies of their occurrence, their distributions across the texts, and some of their typical realizations. The findings show that there is considerable variation in the types of engagement resources used as well as in their distributions, both across and within different sections of the medical research article.

Aim: Medical students’ perceptions of professionalism might reflect the impact of the current educational processes on their professional identity development. This study focuses on Ankara University Faculty of Medicine students’ perceptions of ‘good doctor’ along with the factors effective on the formation of these perceptions.

Method: Six focus groups with 59 medical students from Grade-1 and Grade-6 were held. The transcripts of discussions were analyzed thematically.

Results: Results regarding ‘being a good physician’ mostly mirrored the findings of previous studies framing the medical professionalism concept. The thematic pattern of the discussions on the relation between professional development and medical education suggests that students suffer from a gradual erosion of perception during medical education. That the education cannot either change the person for the better or might downgrade the person instead of improving her/him were shared by participants from both grades. Students consider clinical practice and role models two main variables determining the person’s qualification as a professional.

Conclusions: The formal and hidden programs determine the quality and efficacy of the professional education together. Attempts to restructure medical education must recognize the reciprocal dynamics between these two components and, thus, should carefully work out the practical aspect of the educational processes.

Effectively developing professionalism
requires a programmatic view on how
medical ethics and humanities should
be incorporated into an educational
continuum that begins in premedical
studies, stretches across medical
school and residency, and is sustained
throughout one’s practice. The Project
to Rebalance and Integrate Medical
Education National Conference on
Medical Ethics and Humanities in
Medical Education (May 2012) invited
representatives from the three major
medical education and accreditation
organizations to engage with an expert
panel of nationally known medical
educators in ethics, history, literature,
and the visual arts. This article, based on
the views of these representatives and
their respondents, offers a future-tense
account of how professionalism can be
incorporated into medical education.
The themes that are emphasized herein
include the need to respond to four issues.
The first theme highlights how ethics and
humanities can provide a response to the
dissonance that occurs in current health
care delivery. The second theme focuses
on how to facilitate preprofessional
readiness for applicants through reform of
the medical school admission process. The
third theme emphasizes the importance of
integrating ethics and humanities into the
medical school administrative structure.
The fourth theme underscores how
outcomes-based assessment should reflect
developmental milestones for professional
attributes and conduct. The participants
emphasized that ethics and humanitiesbased
knowledge, skills, and conduct
that promote professionalism should
be taught with accountability, flexibility,
and the premise that all these traits are
essential to the formation of a modern
professional physician.

The meaning of ‘professionalism’ in medicine has been subject to much debate in recent years. Many present aspirational views of professionalism that incorporate a commitment to working for public health and well-being of the public in social, as well as clinical, contexts. In response, other commentators suggest this asks too much of professionals qua professionals – advocacy for social justice in health and health care, while laudable, is not constitutive of the duties of a doctor, which should be the proper remit of professionalism.

I argue that the debate between these ‘aspirational’ and ‘minimal’ views on professionalism arises from a conflation of individual and collective responsibility. The obligations of professionalism are commonly said to arise from a ‘social contract’ between the profession and society, which commits the former to promoting justice in social problems that influence health. It is the profession, however, not professionals, that is party to this contract – so the resultant responsibilities are collective responsibilities. Furthermore, given the complex nature of these social problems, discharging these responsibilities requires co-ordinated collective action rather than the actions of isolated individuals – thus this collective responsibility cannot simply be delegated to individual professionals.

Thus the aspirational view is mistaken in assuming that a collective professional responsibility for action on social problems entails individual professional responsibilities for the same. However, a collective responsibility for justice in health also demands more from professionalism than the minimal view. I argue that this is best described as noncomplacency toward social problems affecting public health, which I interpret as a disposition, or virtue. I conclude by suggesting that professionalism may be more demanding than both minimal and aspirational views, since the social contract model neglects responsibilities that the profession holds, not as contractual obligations, but as a result of its position in society.

This opinion paper is aimed to suggest an improved set of guidelines for physician-assisted suicide. Thus it is very practical, based on 25 years of research in eight countries and it does not expand on the underpinning theoretical basis for the guidelines. I have been an advocate of physician-assisted suicide and explained the reasoning elsewhere, primarily in The Right to Die with Dignity  and Euthanasia in the Netherlands.  I support the idea that patients should be able to decide the time of their death with the help and support of the medical profession. People have human dignity. At the end of their lives, the medical profession should respect their wishes and help them to the best of their abilities. By ‘dignity’ it is meant worthiness, merit. The Oxford English Dictionary defines it as “the state or quality of being worthy of honour or respect”.  Kant explained that human beings are end in themselves and that for something to be an end in itself, “it doesn’t have mere relative value (a price) but has intrinsic value (i.e. dignity)”.  He further elucidated that autonomy is the basis for the dignity of human nature and of every rational nature.  Kant calls dignity an unconditional and incomparable worth that admits of no equivalent.  All rational creatures have it, by virtue of their reason, and dignity constrains the ways in which we can legitimately interact. In a similar fashion, Dworkin asserted that individuals have a right to dignity because they are human.  I argue that dignity is both objective and subjective concept. It is socially constructed and made up of values and feelings that one feels about oneself, about one’s self-worth and respect.  It is further argued that legislation of physician-assisted suicide is a matter of moral necessity and political expediency.

OBJECTIVE: To examine the language of "turfing," a ubiquitous term applied to some transfers of patients between physicians, in order to reveal aspects of the ideology of internal medicine residency. SETTING: Academic internal medicine training program.

Health advocacy represents an opportunity for physicians and physicians-in-training to respond appropriately to the social determinants of health, health care inequities, and the needs of underserved populations. To better prepare physicians-in-training, there is a need to identify tangible ways of incorporating health advocacy into medical curriculum.

The aim of this paper is to show the inherent contradiction in the Belgian euthanasia practice. While stressing patient's autonomy, medical professionals exhibit paternalism in deciding the patient's fate. First, background information is provided. Then the 2014 Belgian Society of Intensive Care Medicine Council Statement Paper will be considered. Concerns are voiced about euthanizing people who fail to find meaning in their lives, including those who underwent unsuccessful sex-change operation and blind people, euthanizing patients who did not give their consent, and euthanizing people with dementia. Finally, some suggestions designed to improve the situation are offered.

The article presents the Argument from Autonomy and the Respect for Others Argument as pleas for physician-assisted suicide (PAS). The Kantian argument in support of respecting people always as ends rather than means is emphasized together with the principles of concern and care. The author explains who the patients who wish to die are. The importance of comprehensive palliative care is accentuated and objection to euthanasia is expressed, insisting on checks and balances when we wish to come to the patient’s aid. The plea is confined to physician-assisted suicide, where it is the patient who is in control and performs the final act. The plea for PAS is promoted especially for cancer patients, at the end stage of the disease, who express a repeated wish to die with the help of a doctor. Detailed guidelines for physician-assisted suicide are presented, arguing that we need to insist on them as human lives are at stake. Caution is a must to prevent potential abuse.

Dentists' self-reported attitudes towards patients with HIV/AIDS might not reflect their actual behaviour. In this study 2 observers posed as HIV-positive patients and directly evaluated the behaviour of 300 dentists in Tehran, Islamic Republic of Iran. Two months later another observer interviewed the same dentists at their offices regarding AIDS-related knowledge and self-reported attitudes. Only 14.9% of dentists agreed to treat the simulated HIV-positive patients, 78.5% referred and 6.6% rejected them. Older age, longer work experience, graduation from a non-Iranian university and not having additional degrees were significantly related to adverse behaviours. Mean scores were 8.3 (SD 9.7) (out of 18) for knowledge and 17.5 (SD 7.1) (out of 39) for attitude. There were no significant correlations between dentists' knowledge and attitude or between knowledge and behaviour, but there was a weak positive correlation between self-reported attitude and observed behaviour.