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Introduction to the Project on Bioethics for Informed Choices - page 58 / 115

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588Challenges for Bioethics from Asia

for the future challenge of making decisions in facing real world situations.

In this trial, one of the interesting goals is to review the proper roles of teachers in bioethics teaching. According to our experience in university, to give space and facility for learning is very important. And the concrete task for the teacher is to answer the real-life quandary in the class. For example, when giving summary and supplementing the topic in telling the truth, the teacher may suggest key points of communication skills in telling the truth. If students questioned the next step to help patients when the truth is disclosed, the teacher may introduce options other than traditional medical care such as hospice care and concept of natural death. The teacher may also talk about the real situation in hospital settings such as the similar case of the four contexts of dying awareness (Glaser and Strauss 1965). On the whole, the backgrounds of bioethics teachers may be various; however, the bioethical maturity and the compassion for life sciences are essential factors in the success of a bioethics education.

The influence of culture was another important finding that emerged from the classroom activities. Family paternalism in medical decisions, death as a taboo, filial piety as a social norm to protect elderly from the truths, and customary use of alternative and folk therapies were cultural factors that strongly influenced the intuition of telling the truth or not in our society. Many students considered those as barriers to a value commitment toward open awareness. Telling the truth about terminal cancer should be emphasized in every level and style of education.

The chapter on telling the truth has lead to the achievement of the goal of bioethical education that is; encourages respect for life, considering risks and benefits, and understanding diversity better. It can also play an important role in guiding people to think about their own death, to reflect on the personal experience of death and to prepare for their future profession. In conclusion, it is most appropriate to teach the chapter on truth telling in first or second year general education classes in medical universities.

Materials

Bioethics curriculum units from the Kennedy Institute of Ethics. http://www.georgetown.edu/research/nrcbl/hsbioethics/units.html;

Glaser.B.G. & Strauss A.L.(1965) Awareness of Dying. Aldine, New York.

Discussion

Konishi: Thank you, I enjoyed your talk very much.  After the class you did a survey on telling the truth and the percentage of people who answered yes increased as influenced by didactic teaching. What content did you include in your class?

Hsin: Actually we just let them read the article, ask them about their opinion. And they just decide what kind of activity they want to do. And we just listen and summarize what has been discussed. We are more considerate more of their presentation. If we take a look at this slide, less than 30% say that they will tell the truth, maybe because they consider more.

Leavitt: Do you have any courses that deal with coping with the dying patient?

Hsin: We have courses on life and death, terminal care, oncology nursing, medical ethics in nursing school.

Shoji: In my research, we used the phrase, what would you do if you had three months to live, not weeks.  There was no big difference between elementary school and high school and university students.  But one big difference could be seen from adult samples.  The characteristic comment was that if they had three months to live, they will divorce.

Hsin: Those young students they don’t have that kind of thinking yet, but those young students they want to stay with their parents. I’m impressed with that. Before, young students are against family authority, but in that time they want to stay with their family.

Aksoy: If I’m not wrong, the figures went up if you want to know , 60-90% said yes, for close relatives 30-50%, 70% won’t tell. Is that right? Your education has a false effect because it is truth learning not truth telling.

Hsin: Of course we are not trying to dominate their decision after our education. But, it is a little

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