Biomedical Ethics I (undergraduate level)

Unedited student evaluations of the course from their final reports at undergraduate level

 

Biomedical Ethics I, required, 21 hours, undergraduate level, School of Integrated Health Science, Faculty of Medicine.

 

  • (1) On the first half of the course: Last year I was studying in the Law department, so this was a very interesting course to take, and I enjoyed it very much. Up until now, I had thought that the “What should be done?” argument was something for those in the humanities to claim exclusively, while the scientists were relegated to their argument about “What is the truth?” However, in the field of healthcare, the argument about “should” was made clear to me. This is because, although medicine and nursing as academic fields of study are constantly trying to find “What is the truth?”, medical care is required to take those accomplishments and ultimately transfer them to people. At the interface of people and academic findings, ethics is necessary. The resume clearly stated what was going to be argued, and it was highly polished. The explanations were also clear and easy to understand.(2) On the group work in the latter half: Thoughts on the group work. I participated in the group work after having argued within myself to completion, and the many differing opinions, judgments, and contrasts were very invigorating. There were some people with perspectives that I would not have thought of on my own, which was very educational. Especially by having those from other departments bring in their own unique perspectives, the group work was enriched, and this was very good. This experience alone taught me the importance of listening to other’s opinions, and was perhaps just as helpful to me as the ethics content.
  • In each class period we had an SGD, and it was wonderful to be able to exchange opinions actively with one another. Having different group members each time also allowed us to come in contact with varying opinions throughout the entire course, which was very beneficial. As I realized once again through the discussion, issues related to ethics are difficult to resolve because each person prioritizes different things. However, running away because of the difficulties will not help solve the many biomedical ethical issues in the real world. Even to find the best possible answer, discussion among a lot of people is necessary, so ethical thinking should be promoted through things such as incorporating it into the early stages of required education, such that no one will ever respond “I don’t know” in an opinion survey—that should be our number one goal, I think.
  • In thinking through several issues related to biomedical ethics, I realized that there is a gap between simply thinking that something feels right and responding through doing. One of the representative examples of this was the topic discussed in an SGD about whether or not to put restraints on an elderly patient. At first glance, the thought of putting restraints on someone does not feel right, but there may be unavoidable circumstances such as nursing staff shortages that may require this to happen. I discovered that the difficulty of biomedical ethics is that the answer is not there. In the SGD, we were able to experience the process in which the best possible way is found, and that was incredibly meaningful.
  • For me, the most memorable class of the entire course was the first one. I had taken other classes on ethics prior to this one, but it was the first time for me to think about the most appropriate ways in biomedical settings, and in the class, the issues we dealt with were from actual cases, and some with answers in the form of a trial verdict, so this was surprising to me. I was under the impression that when studying ethics, you think through in your head about what is appropriate, but with biomedical ethics, you have to think about a variety of things that are occurring on-site, and it is not just about thinking about what is best for the patient—of course this is taken for granted in practice, but it was remarkable to me. The thing that surprised me the most at the first class was hearing that there was a problem with the method in which a nurse would wait by the patient’s bed and watch over them until they slept, but when they became busy and couldn’t do so, they would switch over to using the restraints. According to this method, the treatment method is being changed halfway through according to the hospital’s convenience, which means that it is difficult to explain this to the patient’s family or the rest of the world—this was a new perspective for me. One other thing that left an impression on me was the trolley example. I remember dealing with the same issue in a high school ethics class, but in that class, after hearing students’ opinions on the matter, I remember the teacher went through and stated the merits and demerits of each, and then class was dismissed. I know that there is no clear right answer, but it was impressive and shocking at the same time to be able to listen to opinions from students in the same position as myself. In addition, when facing this problem head-on, I thought that rather than choosing according to what I am able to decide is correct, I think that I would have instead done nothing, paralyzed by the fear of the responsibility of pulling the lever or taking another human life. This is not limited to just the trolley question, but other various issues related to healthcare settings. I don’t know if I would be making those choices to save my own skin, or because of my own beliefs, and would be confused about so many issues. In those instances, I felt that this theoretical structure in ethics could be very helpful to provide some objectivity.
  • Each class had very timely content, which was interesting. In addition to being applicable to my own life, the content was about issues that I very well may run into in the future, so it served as valuable time to look at my own priorities and thought processes. Having the SGD each class period helped me stay focused. It was also nice to have frequent breaks. I liked that the lectures did not seem to be unidirectional. Personally, this class was in the top 3 for me this semester. Thank you.
  • Because of this biomedical ethics class, I was able to decide that I will think about these issues using a theoretical structure, in comparison to the superficial manner that I had been thinking up to this point. I have not mastered this, but I learned that there are very many perspectives from which these issues need to be considered. The thing that I felt was the most difficult about bioethics and biomedical ethics issues was making judgments and decisions, such as assessing the situation, moral judgments, and decision-making in clinical settings. Thought processes must move forward on a foundation of so many ethical theories and principles. Also, because there is no ideal right answer that is applicable to that situation, there will likely be situations in which you second-guess yourself about whether your decision was good. I also learned that social and legal evaluations become valuable. Up until this point, I had only been able to think about moral issues from one aspect, and so I was rarely able to agree with other opinions from those around me, but through the SGD, I listened to how other students were thinking, what they were basing these thoughts on, we exchanged opinions, and we were able to respect each other’s opinions. I was surprised that the final judgment that I came to after hearing other opinions was different from my initial judgment. This made me realize that my initial way of thinking was really quite shallow. By thinking about a lot of different issues, I began to question things that I had taken for granted up to now: What is equality? What is the role of a physician? What is healthcare? What is a value? In particular, issues with surrogacy, genome editing, and euthanasia tied into issues with money, and I feel that people are becoming products. Because of progress in medical care and science, we are able to live longer, and diseases can be cured, and honestly, the way we are born, the way we die, and our dying period can now be controlled. Through genome editing, we could make humans like robots, in the way we want them to be. Can we call this a human being? I always thought that the natural way was best for humans, but then, if I were to contract a disease from which I might not recover, I would probably ask for the treatment. In this manner, before I knew it, I was contributing to the process of human beings becoming products—this was a discovery to me. I would really like to continue thinking deeply about healthcare issues. As technology progresses, more and more problems will likely emerge. In those instances, I think that some difficult issues will always be there, such as whether or not I will be able to face those head on, and how many people will be able to face those head-on.
  • I would like to look back on this course. 1) First, I learned about the role of ethics in society as well as its limitations, what is important when considering ethical issues, and the four principles of biomedical ethics. In the SGD on how to handle patients with symptoms of delirium, I realized that when making judgments in an actual clinical setting, it is not necessary to ensure that each of the four principles is prioritized equally, which means that practical and realistic judgments have to be made; the difficulty of this was made clear to me. I also thought that the most appropriate treatment objectives are largely swayed by the patient and the various situations surrounding them (whether the kidney function is decreasing or not, whether the nursing staff is sufficient or not, etc.), so generalization of the ethics is difficult, and each individual case requires careful consideration. In addition, I learned that it isn’t good for the provided services/treatments to be changed due to the hospital’s convenience—for example, even though the initial objective was to have a nurse attending the patient, the plan changed later to incorporate drugs and restraints. 2) I learned how to think about ethical theory focusing on deontology and utilitarianism, or how to make a four-box chart for ethics in a clinical setting. In the SGD on pneumonia treatment for Patient Altman, who had been bedridden for several months due to a stroke, with no friends or family who could be contacted, we focused on how to make an objective decision on this case. For example, the nurse that thinks life-prolonging treatment is unnecessary because the patient seems to have no desire to continue living, and the physician who thinks of giving the patient antibiotics in this day and age when pneumonia is no longer “the friend of the elderly.” Even among medical caregivers attending the same patient, depending on the person, their thinking varies. Also, when the patient to whom this all applies has unclear intentions, it is not acceptable for a third party to make decisions on their behalf. When a patient’s judgment capacity (or the lack thereof) is unclear, I felt it necessary to create a structure that can be applied to various cases in order to extract the patient’s wishes. 3) I learned about Public Health Ethics and the problems therein, and details about various stances on political philosophy and the public policy rules applying to each. In the discussion about colorectal cancer screening tests, I found it highly interesting that opinions were split within the group and within the entire class. In the materials handed out in class, the results from the survey targeting those in the general population showed that opinions were essentially split down the middle among constituents, biomedical ethicists, and experts on medical decision-making. In addition, in this case, the target population was those with a low risk of developing colorectal cancer, so even the new option to perform neither Test A nor Test B fulfilled the criterion of equality, and I thought that this would be good because the money could be used to fund other public healthcare programs. Thinking about healthcare policy for the entire nation from a government standpoint requires careful consideration of how to distribute the limited funding in a way that is agreeable to the national population, which seems like a fulfilling task.
  • When I heard the term “ethics”, I imagined (I said this in class as well) that this had to do with figuring out how to save those who are the most vulnerable. Maybe this could be described as justice as well. However, after taking this course on biomedical ethics, my image of ethics changed quite a bit. From the first class, it was very impactful. From my original image of “ethics,” to “use restraints on a patient” was really hard to envision. After learning the 4 principles of biomedical ethics, I had to think more about the equality of healthcare resources that aligns with the principle of justice, and I was able to move up to a “maybe there is some truth in that…” level of thinking. However, I tend to gravitate more toward affective reasoning, in that I get emotionally involved with patients and their families, making those judgments really difficult. But from the standpoint of other patients, there is certainly some injustice, so I would like to become better at viewing things from a broader perspective. One other area where I thought it would be difficult to work with affective reasoning was specifying a recipient for organ transplant. When this was assigned as a SGD topic, I got the sense that the opinions of group members were quite varied, and I remember being astonished realizing that people think so differently about a single topic. At this time, I couldn’t help but empathize with the donor, and thought that donor specification should be able to follow the degree of “blood connection” and “emotional connection.” However, reconciling “blood connection” and “emotional connection” was a very difficult issue. For example, compared to a cousin you’ve never met, you may have a friend who you see almost every day who shares a mutual emotional understanding; human relationships differ by individual, and trying to establish some unified standard is not just difficult, it is basically impossible. When talking in a SGD about this issue, I proposed that for blood relationships you could say ‘up to third-degree relatives’ and when specifying those who are not blood relatives, they could apply to a specific institution, but it doesn’t seem like that was a very realistic proposal in the end. The most fun SGD topic was on research ethics. When conducting research, you need to think ahead of time about the incidental findings of subjects that are not directly related to the research itself. Throughout the entire course, I thought that reconciling affective reasoning and equality was very difficult. I had an image of justice up until this class, but I learned that not everything can be explained by emotions alone.
  • There are many theories for ethics in healthcare, but each was separated by a large gap from society in reality, or because of the many things that needed to be thought about, it was difficult to apply these theories to practice—I felt that this was the difficulty. However, I also thought that it is precisely because social sciences and cultural sciences have no laws or theories that thinking on the spot may be so fun and fulfilling. In addition, in each SGD, we were able to take a number of different topics and think about them while offering our own opinions on the matter, which was fun. However, when you’re actually in the healthcare setting, I imagine that having to make these decisions in an efficient way would make that setting that much more stressful. I will likely be in one of those settings sometime in the future, but even when faced with those questions for which there are no right answers, I hope to gain experience in throwing myself into thinking about it fervently so that we can come to the best possible answer. The three-part format of the class was something that I had not experienced much in other courses, with the explanation that “human attention span is inherently 50-60 minutes.” That made sense, and being in the class was never a burden. As I mentioned above, the SGD was fun every time, and I’ll even venture to say that, if possible, I wanted more time. In each class period, we were always using every last minute to summarize everyone’s opinions and ran right up to the presentation time.
  • The format of having the first half as lecture and the second half as SGD was great for deepening our understanding. It was a very interesting class. I also thought the last test problem format was interesting. The most interesting part was the class on the trolley problem.
  • In contrast to the high school ethics class I took, in which the thinkers and their ethics were followed chronologically, this class on biomedical ethics took various ethical issues in modern-day healthcare settings, and had us thinking not just with our gut, but in ethical terms, and was very interesting as a result. From the first SGD, the final conclusion was opposite from what my gut reaction was, and I was anxious during the presentation, but it made me realize that because the conclusion can certainly differ from our gut reaction, we need to debate these issues carefully, using the four principles of biomedical ethics and ethical theory. The structure of two lectures and 1 SGD, with group members being switched around, each group given a projector and computer, with the interpretation being given after the presentation made for fulfilling discussions, and I was able to learn from other groups and the interpretation. At the final class, it came up in our discussion so I thought once more about the trolley problem. During the lecture, I selected the option to not do anything to either the lever or the bridge, because changing the destiny of someone else’s life and death is unforgivable. However, in clinical trials in healthcare, there are many settings in which utilitarianism is used, such as in the cases of a clinical trial in which some patients receive the placebo and others the trial drug. In these, for the sake of many other people, those few in front of the physician are subjected to this utilitarianism. I thought that perhaps I need the courage and preparation to pull the lever or push the guy off the bridge. In ethics, there is no right answer, so there is the fun part about thinking about what is best in that situation; on the other hand, there is the difficulty of facing new problems all the time.