IV. OTHER HEALTH PROFESSIONS

Bioethics education in health professions other than medicine and nursing takes place both in professional schools and in continuing-education settings. The group to which other health professions refers is so diverse that no generalizations embrace all of the professions equally. Some major groups include therapists (e.g., occupational, recreational, respiratory, physical), technologists (e.g., radiologic, medical laboratory), physician assistants, pharmacists, dietitians, dentists, and medical social workers. This entry emphasizes major common themes that have emerged in the content and pedagogy of their educational offerings; it also describes common factors that have led to the introduction of bioethics teaching in these fields.

Common Themes in Content and Pedagogy

A set of guidelines for professional conduct has been one of the first types of documents produced when a new health field emerges. Up until the 1960s the documents often were called codes of ethics, but focused on dress codes and the importance of good manners and a cheerful disposition. They also emphasized the importance of keeping one's proper place in the bureaucracy, so that all documents except those for dentistry stressed deference to the physician's authority. Dedication to one's profession was considered essential. This list served as a foundation for teaching "ethics" to students in that field. The predictable result was that early ethics education was a presentation of a list of "dos and don'ts" that detailed a professional etiquette and morality punctuated by loyalty to one's group.

The educational emphasis has changed, as a result of changes in the focus of ethics documents and developments in the field of bioethics. There is also a growing consensus about the pedagogical methods that should be employed for bioethics education.

Late twentieth century codes of ethics reflect basic ethical principles and virtues relevant to professional practice. For instance, the Code of Ethics of the National Association of Social Workers is designed around the central notion of ethical responsibility. The American Academy of Physician Assistants followed the model of several others by delineating its major types of interactions and specifying principles for each. Many groups provide accompanying guides for professional conduct that attempt to elaborate behaviors consistent with those principles and virtues. For example, the American Dental Association includes "advisory opinions" for most of its principles, and the American Physical Therapy Association issues a separate guide detailing each of its eight principles. Faculty have adopted these documents as a basis for education, with the predictable result that there is less focus on simply indoctrinating students into behaviors and attitudes and more on urging them to think about the ethical principles and virtues that underpin professional roles and responsibilities.

The development of bioethics as a field also has influenced education in these fields. Teachers focus on basic bioethics theory and methods of ethical analysis. Students are taught to think critically, recognize ethical issues, and reflect on them. Character traits or virtues are not simply declared essential; rather, students are encouraged to understand the significance of behaviors and attitudes that express compassion, honesty, and integrity (to name some). Materials introduced from the social sciences highlight how ethnic, religious, age, sex, class, and other differences among individuals and groups influence situations in which bioethical problems arise. In short, the teaching of ethics has evolved to foster analysis of and reflection on practical issues.

There is a growing consensus about pedagogical methods that should be utilized to teach bioethics. Educational programs actively promote the integration of theoretical content with case examples. The case method is especially effective in allowing students readily to recognize key ethical issues as they arise in everyday practice and to grasp the relevance of bioethics to their chosen professions. A larger proportion of bioethics instruction is taking place in small group discussions during the clinical period of professional preparation, so that challenging cases can be highlighted in discussion. Some programs utilize real or simulated patients with the goal of integrating ethical aspects of a patient's situation into the diagnostic, treatment, and social aspects.

There is less consensus about who should teach bioethics. Some schools of thought favor a stronger emphasis on theory, so that persons formally trained in philosophical ethics or moral theology are thought to be ideal. Others argue that an understanding of the clinical peculiarities and "facts" is most important, so clinicians are favored, especially if they have taken advanced work (or even a short course) in bioethics. Another alternative is a teaching team composed of a bioethicist and clinician working together. Preferences for one or another of these approaches seem less profession-specific than idiosyncratic of particular regions or institutions. In spite of the differences of opinion, the debates revolve around the common goal of effectively integrating theoretical and practical dimensions of bioethics.

Common Factors Leading to the Necessity of Bioethics Education

At least three major factors have led to the need for bioethics teaching, with its focus on thoughtful deliberation about complex ethical issues.

The issue of professional autonomy in relation to physicians is the crucial distinguishing feature of bioethics education in the groups being discussed. Their predicament is shared with nurses, and nursing ethics has provided valuable insights into the dilemma that is created. Such groups must gain understanding of their peculiar situation: having moral authority without ultimate decision-making authority. In some states, groups such as physician assistants, physical therapists, and social workers have legal license to evaluate or practice independently. But this does not resolve the thorny questions of how to coordinate care for patients in a system largely centered on physician autonomy. The different levels of progress toward full professional status among the groups compound the issue.

A second factor distinguishing bioethics education for the groups under discussion is that many claim, as the rationale for their very existence, the mastery of a particular technology. Reliance on technology may drastically alter the complexion of the traditional health professional–patient relationship. First, technology may create a detrimental distance between health professionals and patients. Patients and health professionals alike may place unrealistic expectations on technologies to bring about "miracles, " creating dissent and distrust when they fail to do so. And the high cost of many technologies may add undue burdens on patients and families.

Since the professional–patient relationship is at the heart of professional ethics, germane bioethics education is crucial so that health professionals can respond well to the larger human dilemmas created by technology. The types of technology the various professions employ will differ, but the generic challenges are similar for all. A list of "dos and don'ts" will not suffice. The concepts and methods of ethics are needed for thinking through and acting on technology-related challenges.

A third factor is the presence of inequities in healthcare. The tools of bioethics enable students to understand why inequities are morally unacceptable in the healthcare system. They also provide an opportunity to encourage reflection on how professionals can contribute to the advancement of just and fair policies.

Since bioethics education in the professions under discussion in this entry encourages critical thinking, considered action, and the exercise of ethically appropriate character traits, it will continue to be a powerful resource as new developments in healthcare and society give rise to ethical issues.

ruth b. purtilo (1995)

bibliography revised

SEE ALSO: Bioethics; Dentistry; Literature and Bioethics; Narrative; Nursing Ethics; Nursing, Profession of; Nursing, Theories and Philosophy of; Pastoral Care and Healthcare Chaplaincy; Sexism; Teams, Healthcare; Women as Health Professionals; and other Bioethics Education subentries

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