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Upcoming Presentations

October 26, 2019

American Society for Bioethics and Humanities

Discharging to the Street: When Homeless Patients Refuse Safer Options

Abstract: The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often sending patients who might otherwise recover right back into the intensive care unit (ICU). But clinicians do not have significant control over this unjust distribution of resources. While they might stretch inpatient stays beyond acute need and exhaust resources searching for an alternative discharge option, they must also consider the cost of using an ICU bed for someone without ICU level medical needs. And when a homeless patient refuses a safer option (e.g. skilled nursing facility or adult family home), then clinicians may be faced with the solitary option of discharge to the street. Here, we investigate the different forms of injustice that play out in a particular case of a patient who continues to refuse safer discharge options, consistently returning to the ICU for further care. We offer a map of the interwoven ethical responsibilities of clinicians, clinical institutions, and broader society. Ultimately, we argue for a process that is cognizant of different avenues of injustice and grounded primarily in care ethics.

October 27, 2019

American Society for Bioethics and Humanities

Ethics Training in Medical School: Working Against the Tide of Intuitionism

Abstract: Developing ethics curriculum for medical school is challenging, not the least because many students and clinicians think of ethics as intuitive and not requiring the same rigor as clinical science. With little coursework and assessment in ethics, alongside a more recent push to minimize pre-class work for students, it is not surprising that ethics is seen in this light. Both students and clinicians in the current sociopolitical climate are demanding more. However, a diversity of formulations of ethics curriculum across the U.S. has only complicated the ability to respond to this demand. This panel will explore a recent curricular revision at our university that allowed the ethics curriculum to begin from scratch. This forced a reexamination of the goals of ethics education in medical school in light of changing social, political and educational climates. In the process, we have arrived at a more basic goal for ethics education and a combination of traditional and nontraditional methods for achieving it. We hope to foster further discussion through four brief presentations: (a) an overview of the changes made to our current curriculum, (b) a perspective on the goal of ethics training in medical school, (c) an analysis of the obstacles faced in designing a new ethics curriculum, and (d) how to best assess ethics training in this setting.

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