Introduction: Health care professionals encounter moral issues multiple times each day, from the most straightforward discussion of informed consent to the most intimate details of end-of-life consultation. Indeed, every encounter with a patient, family member, another health care team member or related person is an ethical encounter, an “interplay of values,” but learners arrive at health care professional schools with varying levels of information, interest, and comfort related to the ethical dimensions of patient encounters. This resource provides teaching material for an interactive conscience-sensitive approach to ethical and professional practices. The resource provides a coherent translation of evidence-based moral developmental psychology not only to moral decision making and moral dilemma resolution but also to personalized harm-prevention planning. Methods: As medical students progress through this resource, they encounter conscience-sensitive tasks in the form of operationally defined exercises that expand mindfulness of intuitive, tacit, or implicit moral decision-making processes, and strengthen insightful and deliberative processes. Learners navigate these by: rendering images of personal conscience, constructing and sharing moralized genograms, composing letters of gratitude or apology to imaginary individuals who have helped or who have been harmed, learning to use the Value Matrix, and (while using a template) engage in and present their ideas for personalized demoralization and harm-prevention plans. Results: To measure effectiveness, a study was conducted to determine the degree of change before and after the above described educational intervention. The responses were collected over a 2-year period from the first-year medical students participating in the Introduction to Medicine-I (ICM-I) small groups. Each of 16 ICM-I students responded to a moral dilemma case before and after the educational intervention. Conscience-sensitive criteria were developed which expanded upon competency criteria related to moral reasoning and ethical judgment, level 1. Responses were transcribed and coded. The average responses pre- and postintervention were 6.7 and 10.7, respectively, representing a positive change of 4.1 with a standard deviation of 4.9. The median pre- and posttest scores were 6.5 and 9.8, respectively. The sample size was not deemed large enough to do a meaningful test of statistical significance. Discussion: The resource has been incorporated in an Introduction to Medicine (Doctor-Patient Relationship) course, in a senior elective course in ethics, and in continuing medical education courses. It provides a stepwise progression from an appreciation of the domains of moral psychological development to an awareness of these in contouring personal conscience and thence to the reflective shaping of professional conscience. It provides techniques useful in conscience-sensitive approaches to patient interviewing and in acquiring deeper knowledge of and respect for the values of those served.
By the end of this session, learners will be able to:
- Engage in conscience-sensitive tasks.
- Participate in a group discussion of each accomplished task.
- Explore the essential domains of conscience.
- Appreciate change and diversity in the contours of conscience across the lifespan and among individuals.
- Bridge their understanding of the relationship of psychological nature of conscience to bedrock human values, and of bedrock human values to healing professional values.
- Promote recognition of moral dilemmas and identify some strategies to manage their resolution.
- Understand demoralization and harm-prevention planning.
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Galvin M, Gaffney M, Stilwell B. Conscience centered psychiatric ethics. Workshop presented at: American Psychiatric Association 151st Annual Meeting; June 1998; Toronto, Ontarion, Canada.
Galvin M, Gaffney M. Conscience centered professional ethics. Workshop presented at: Pleasant Run/Hamilton Center Alliance Family Service; February 15, 1999; Indianapolis, Indiana.
Galvin M, Gaffney M, Stilwell B. Conscience centered professional ethics in child psychiatry. Workshop presented at: The Academy of Child and Adolescent Psychiatry Annual Meeting; October 23, 1999; Chicago, Illinois.
Galvin M, Gaffney M. Conscience centered professional ethionscience centered professional ethics. Workshop presented at: Annual Meeting Association for Moral Education; November 18, 1999; Minneapolis, Minnesota.
Gaffney M, Galvin M, Stilwell B. A conscience sensitive approach to ethics and teaching caring attitudes. Presented at: Boston Colloquium for Philosophy of Science, 46th Annual Program, The Robert S. Cohen Forum: Contemporary Issues in Science Studies: Values, Ethics, and Medical Science: The New Medical School Curriculum; September 23, 2005; Boston, Massachusetts.
Gaffney M, Galvin M. Conscience and medical education. Presented at: Seventeenth Annual Meeting Association for Practical and Professional Ethics; February 22, 2008; San Antonio, Texas.
Gaffney M. A conscience sensitive approach to ethics in early childhood fields. Presented at: Thirteenth Annual Meeting of the Indiana Association for Infant and Toddler Mental Health; August 12, 2011; Indianapolis, Indiana.
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