UNESCO Chair in Bioethics

The establishment of the Chair

On June 24th 2001 an agreement was signed by the Director-General of UNESCO and the Rector of the Haifa University, Israel, concerning the establishment of a UNESCO Chair in Bioethics at the International Center of Health, Law and Ethics, University of Haifa.

Article 2 of the Agreement defined the purpose of the Chair. To coordinate and stimulate an International Network of Institutes for Medical Ethics Training (NIMED), associating higher education institutes in both the developed and developing countries, and to develop an up-to-date syllabus for medical ethics education which will satisfy the requirements of medical schools in the world.

The reason for that important initiative resulted from two international researches carried by the International Center in 1996 and 2001 under the guidance of Prof. Carmi (see below). The aim of the project was to check whether the lack of proper study of ethics in medical schools was one of the reasons for the deterioration phenomenon in the relationship between doctors and patients. Apparently, the findings offered a validation to this assumption and brought about the establishment of an international Steering Committee that undertook the mission of preparing a new method for ethics education. The first meeting of the Steering Committee was held in Geneva in July, 2000. The Committee consisted of six members: Prof. A. Carmi (chairperson), Prof. M. Cotler (USA), Mr. S. Fluss (UK), Dr. G. Kutukdjian(France), Prof. A. Okasha (Egypt), and Prof. N. Sartorius(Switzerland). The Committee was assisted by a scientific sub-committee: Prof. J. Arboleda- Florez (Canada), Prof. J. Kegley (USA), Prof. T. Le Blang (USA) and Prof. A. Piga (Spain), and by a team of reviewers: Prof. R. Beran (Australia), Prof. J. Blaszezuk (Poland), Prof. M. Guerrier (France), Prof. S. Kietinun (Korea) and Prof. I. Shamov (Russia).

The first research on the importance and quality of education in ethics in medical colleges and faculties all over the world was performed in 110 medical institutes. Statistically,the subject of ethics was found to be taught in 105 (95%) of these institutions. Although, on the face of it, this situation is almost ideal, in actual fact it lends support to a major premise, namely that something must be fundamentally wrong with the methods by which the subject is taught in a considerable number of medical schools and since many physicians fail to practice ethically in spite of their study of, or concerning ethics, the methods by which they have been trained are questionable.

Secondly, it appears that although in 88% of the medical institutions the ethics courses are compulsory, this imposition does not guarantee that students’ conduct will always be guided by ethical values.

A problem of no less serious relevance is the number of hours allotted to the teaching of ethics. The research indicates that 9% of the institutions devote up to ten hours to tuition of the subjects; 29% – ten to twenty hours; 33% teach between twenty to fifty hours; 7% between fifty and a hundred hours, while in 8% of the institutions over one hundred hours are taught.

One should logically deduct that the problems stem not so much from the quantity as from the quality of the tuition.

It would appear that the more time is spent on the teaching of ethics, the longer it stretches over the whole course of the students in medicine, the better the results should be. However, even if such a recommendation is universally accepted, it will not be strong enough to challenge and eliminate the problem of ineffectual teaching methods which are crying out for modernization and radical reform.

In brief conclusion, there is abundant evidence to prove that many medical schools will sincerely welcome guidance in the teaching of ethics. They will send physicians to courses; they will welcome novel methods of teaching the subject, they will adopt a new syllabus either in its entirety or insofar as it suits their environment. As for the hundreds of silent institutions it may not be too much to expect that many of them will realize that a 21st century ethical approach by physicians to their colleagues as well as to their patients will strengthen the efficiency of the medical profession.

The need for change 

In recent decades medical education curricula have undergone many modifications for a variety of reasons. In spite of these changes, ethics education has not received adequate attention in medical schools throughout the world.

There is an emerging need for introduction of teaching medical ethics as a consequence of several social and scientific processes:

• Health-care consumers emphasize nowadays not only the need for health but the need for quality of life. Patients expect professionalism, effectiveness and quality, along with empathy, reliability and devotion.
• Health-care providers are detached from traditional concepts of idealistic medicine, adopting a contractual and consumer paradigm.
• Medical technology has created new dilemmas (e.g. procreation, euthanasia, intensive care, medical genetics and bio-technology), while at the same time causing previous ethical resolutions to become obsolete (e.g. definition of death, family composition).
• Specialization and sub-specialization in medicine have encouraged technicality at the expense of patient-physician relationship and communication skills, thus creating a growing gap between physicians and their patients and between medicine and society at large.
• Growing social concern, suspicion and demand for closer inspection on medical activities is filling this gap. The demand has materialized in the form of ample litigation, increased health-related legislation and formulation of international declarations, conventions, charters etc., creating new ethical and legal frameworks and new obligations for the practicing physician.
• Resource allocation in face of growing monetary constraints creates a substantial effect on the everyday practice of medicine.
• The need to adhere to ethical norms in scientific research and experimentation (human cloning, pharmacology etc.) remains a constant challenge.

The new curriculum.

A medical ethics curriculum ought to reflect the changing faces of medicine and should govern the following fields, each having multiple sub-categories, with varying ramifications:
A. The relationship between health-care providers and their patients.
B. The choice of medical intervention for the individual patient.
C. The choice of public health interventions.
D. The evaluation of effects of health-care interventions.
E. The collaboration between teams engaged in health care activities.
F. The choice of goals and methods of medical research.

The International Center for Health, Law and Ethics at the University of Haifa has initiated an international project, the aim of which is to form a new, modern curriculum of medical ethics to be taught in medical schools all over the world. The need for a modernized curriculum derives not only from the fact that many of the existent curricula are antiquated and completely out of tune with the intricacies of recent scientific developments, but also from the safeguards which we require in the form of educational innovations which will inseminate ethical values in our students, in spite of this materialistic age in which we live. The UNESCO Chair adopted the idea and undertook the mission.

The Aim of the project

The aim of the project is to ameliorate the current tuition of ethics in medical schools. The project will intervene in several fields. It will:-
1. solicit conceptual changes in medical faculties,
2. form modern curriculum for education of ethics,
3. train the potential teachers for instruction of ethics,
4. create modern educational tools and materials.

The International Project:
1. The establishment of a network of universities and research centers committed to disseminating, improving and monitoring education in ethics in medical schools. The work will be bolstered by an international advisory committee.

The following achievements are expected: An increase in the number of ethics courses in medical schools, additional time devoted to ethics during medical school years and the introduction of ethics courses in faculties lacking them. On-line assistance and support for the implementation of ethics courses in medical schools.

2. Preparing an updated and modern curriculum, reflecting the need for integration of ethics in daily practice, increasing interest and respect to values involved in health care delivery and raising awareness for competing interests. Students will be introduced to various non-medical facets of medicine: sociology, economics, and public administration. Special emphasis will be given to international consensus, declarations and resolutions, providing common grounds for accepted morals, values and legal norms. New chapters will be added to present curricula coping with new dilemmas, accommodating medical and scientific progress.

3.The creation of training programs for teachers and instructors of ethics in medical schools. Periodic and non periodic seminars for teachers will be held for evaluation, further elaboration and amendment of the subject matter and methodology of the syllabus. Additionally, development of novel, modern and sophisticated educational tools and materials will facilitate attractive teaching. The accessibility and availability of these means will encourage extended incorporation of ethics education in medical schools curricula.

The Chair’s Series of books

The UNESCO Chair in Bioethics is engaged in preparing a completely new and modern course of studies in ethics to be offered to the world’s medical schools which will need to either introduce a considerable number of study hours devoted to medical ethics into their syllabuses or increase the number of hours already allocated to the subject.

Under the guidance of a Steering Committee, with the assistance of 130 members of the Chair’s International Scientific Committee and sponsored by the members of its Network of (70) Universities, it was decided that a series of training manuals should be compiled for use by the teachers of ethics in the medical schools. It is intended that each manual should contain actual cases, up to thirty in number, which have presented ethical problems to members of the medical profession all over the world. Groups of cases are to be preceded by a general description of the type of ethical problems involved and each case is followed by general guidelines for the edification of students who must themselves, under the guidance of their lecturer, study the case, discuss the possible solutions and reject what they consider unsuitable before reaching their own decision.

“Informed Consent”, the first of these manuals, contains thirty cases supplied by doctors in nineteen countries. The manual has been translated to fifteen languages and distributed, free of charge, to medical schools all over the world.

Work on additional companion manuals, each edited by experts in specific spheres of medicine, has already begun. The following books dealt with ethical dilemmas in the fields of psychiatry (2) and reproduction. Two additional books deal with class communication and moral games. Four teams are preparing additional manuals in the fields of medical research, transplantations, harm and benefit, and dignity. List of books published by the UNESCO Chair in Bioethics

Informed Consent (English)
A. Carmi
Translations:
French, Arabic, Rumania, Turkish, Russian, Chinese, Bulgarian, Polish, Spanish, Portuguese, Slovak, Hebrew, Italian, Croatian, Macedonian

Classroom Communication
D. Keidar (English)
Translations:
Spanish, Chinese

Reproductive Health (English)
B. Dickens, R.Cook, E. Kismodi
Translations:
French, Chinese

Moral Games for Teaching Bioethics (English)
D. Macer

Psychiatric Ethics and the Rights of Persons in Institutions and the Community (English)
M. Perlin, H. Bursztajn, K. Gledhill, E. Szeli

Teaching Ethics in Psychiatry (English)
A.Carmi, D. Moussaoui, J. Arboleda-Florez
Translations:
Hebrew, Arabic, Chinese

Ethics in transplantation medicine – case vignettes and movies for teaching bioethics Silke Schicktanz,Claudia Wiesemann, Sabine Wohlke (eds)   English

 

International Conferences:

The establishment of the UNESCO Chair in Bioethics was discussed at the First International Conference on Ethics and Education that was initiated and held by the International Center in Eilat, Israel on 2000.

The next International Conferences on Ethics Education were held by the UNESCO Chair in 2002 (Eilat) 2004 (Eilat), 2005 (Haifa), 2007 (Eilat), 2009 (Zefat), 2010 (Zefat), 2011 (Singapore)2012 (Kinar), 2013 (Naples).

 
 

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