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Ethics and Law in Medicine

Ethics and Law in Medicine is a major theme integrated through the four-year medical curriculum. Through case exercises, lectures and small discussion groups, it provides a basic foundation in bioethics and health care law. Students explore the interrelationships among ethics, law and medicine and acquire the theoretical framework to analyze ethical dilemmas common in clinical practice. Specific learning objectives relate to a wide variety of topics, including end-of-life decision making, informed consent, research, reproductive issues, conflict of interest, medical malpractice, and forensic medicine.

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Medical Humanities Seminars

In the integrated Double Helix curriculum, as part of the first-year program, students are required to take one Medical Humanities Seminar, and are welcome to take a second. Students in their second year are similarly required to take one seminar, but are encouraged to take another. Each seminar meets weekly for 8 weeks. The seminars are taught by clinical and academic faculty within the medical school, and in collaboration with faculty and graduate students from departments of History, Anthropology, Visual and Cultural Studies, and English Literature.

Each year, the Division offers up to thirty different seminars from classical humanities disciplines (history, philosophy, comparative religion, literature), and the social sciences (cultural anthropology, sociology, political theory and public policy). The seminars contextualize medicine as a profoundly human enterprise, and invite students to consider what physicians are, and what they do in a broad social, cultural, political, and intellectual context. The seminars provide a forum in which students can reflect and shape their own evolving understanding and experiences of the practice and art of medicine.

For more information on any of the Medical Humanities seminars, contact Stephanie Brown Clark, course director.

MEDICAL HUMANITIES SEMINARS for First-Year Students

SESSION 1:  Tuesdays, Jan 9 – Feb 27, 2007

1-1) LATINO HEALTH Part I

Instructor: Cesar Flores

Co-Course/Pathway Coordinators: Deepak Sobti, Brooke Shuster

Learning Objectives:

  1. Learn basic Spanish greetings and introductory vocabulary
  2. Knowledge/use of verb conjugation in present and past tenses
  3. Begin to make simple conversations in Spanish

Course Description: This course is designed for those students interested in learning basic Spanish skills, as a prerequisite for the Medical Spanish course in the second session. During this course, students will learn basic verb conjugation and the appropriate use of past and present, while also focusing on vocabulary enhancement. This is a basic skills course designed as an introduction to the Latino Health and Culture pathway. (Those interested in the Pathway whose Spanish skills are beyond the scope of this course may place out and begin the Pathway in Latino Health (http://www.urmc.rochester.edu/smd/MedHum/path.cfm) during the Latino Health Part I course in the second session. This will be determined by the course instructor.)

Because students have very diverse levels of written and spoken Spanish fluency, we would like students to sign up for the seminar appropriate to their abilities For those students whose spoken and written Spanish is intermediate or above, and who wish to be exempt from the Beginners and Part I seminars, you will need to take a short fluency exam with Dr. Daniel Yawman before the Christmas vacation.

1-2)  Transplant Issues in Film

Instructor:   Richard A. Demme, MD, Associate Prof. of Medicine & Humanities, URMC

Learning Objectives:

  1. Identify ethical Issues about transplantation as portrayed in film (e.g., willingness of donation, risk to donor, risk to recipient)
  2. Discuss emotional and psychological effects of transplants as demonstrated in film (e.g., concerns that donor organs carry personality traits or “memories” that can affect recipients)
  3. Examine theoretical concerns about future transplants, such as brain transplants, transplant across species, and/or cloning as suggested by movies from different decades.

Course Description:  The field of organ transplantation has presented a rich source of practical ethics concerns in medicine.  These life and death issues are dramatic, and so have also served as fodder for film-makers.  We’ll watch multiple film segments in class to explore ethical, psychological, and theoretical issues in transplantation.  Students will be required to discuss 2 mainstream films with transplant themes watched outside of class.  (examples: Coma, John Q, Marvin’s Room, Face Off, Island, Bloodwork, 21 Grams)

During class, we’ll watch and discuss segments of films on heart transplant, brain transplant, eye transplant, hand transplant, face transplant, organ thefts, organ sales, cloning, etc., chosen from my collection of over 100 films with transplant themes.

1-3)   The Contemplative Mind in Medicine: Mindfulness-Based Stress Reduction for Medical Students

Instructor:   Mick Krasner, MD

Learning objectives:

  1. Provide a forum for learning and experiencing meditation-based stress reduction skills. 
  2. Provide a supportive environment where medical students can examine and reflect on the experience of medical training as it is unfolding. 
  3. First-hand practical experience of mind-body skills that may provide the foundation for a “wholistic” orientation to future patient care.

Course description:   The practice of medicine in the 21st century is becoming increasingly complex. Physicians and physicians-in-training are challenged to balance the changing nature of the physician-patient relationship, which is increasingly more participatory, while remaining competent and knowledgeable about burgeoning technological advances in medical care.  Experiences during undergraduate medical education that promote self-awareness, self-observation, and self-regulation are helpful to meet these challenges.

Mindfulness-Based Stress Reduction is an approach that can provide some of the skills necessary to maintain “wellness” during this challenging period. It can also help oneself to connect more deeply to the unfolding of the experience of medical training in a way that can provide the basis for a lifetime of awareness and attentiveness, and enhance one’s effectiveness not only as a physician but also as a human being.

This course involves intensive in-class practice of meditation skills including: sitting meditation, walking meditation, and mindful Hatha Yoga. This is augmented by facilitated discussion and reflection on these meditative exercises, and a review of stress physiology, stress reactivity, and the effects of mindfulness-based interventions in health and disease. Supplemental readings and at home guided meditations deepen the experience and facilitate the application of mindfulness practice in everyday life.

1-4)   International Health Research Methods Part 1

Instructor:  Nancy Chin, PhD, MPH

Learning Objectives:

By the end of this seminar students will be able to:

  1. Know the global distribution and geographic epidemiology of disease.
  2. Understand the important historical periods in international health development and the major agencies in development (WHO, UNICEF, USAID, Save the Children).
  3. Discuss the ethical challenges involved in international health research.
  4. Have working familiarity with the basic tools of international health research including:

· Principles of Participatory Action Research and Rapid Assessment

· Community Survey Design and Analysis

· Principles of Cross-Cultural Competency

· Ethnographic research, data collection & analysis: participant-observation,  in-depth interviewing, focus groups, mapping, thematic and narrative analysis

5.  Present their field protocol for discussion with their peers.

Course description:  This is a seminar in two parts:  Part I (in JANUARY) is a pre-departure seminar focused on the knowledge, skills, and attitudes that will prepare International Health Fellowship participants to successfully carry out their proposed projects.  Part II (in AUGUST) is a re-entry seminar designed to help returning students re-enter the social world of the US and medical school, analyze their data, and prepare their work for submission to National Conferences and peer reviewed journals.

1-5)    Spirituality in Medicine

Instructors:  Chaplain Robin Y. Franklin and Chaplain Bill Reynolds

Learning Objectives:

  1. To identify one’s own spirituality, including experiences, attitudes and practices, and how spirituality affects one’s personal and professional interactions
  2. To become more comfortable addressing spiritual issues with patients.   
  3. To look at the interface between the physician’s spirituality and the patient’s. 
  4. To understand what resources are available when the patient wants to explore spiritual issues

Course Description:  “What is the role of spirituality in the patient-physician relationship?”  “Should I bring up spiritual matters with patients and under what circumstances?”  “What if my patient wants me to pray for or with her?”  This course will explore these and other questions related to the role of spirituality in our caring for patients and their families.  The course will be divided into two sections.   Part I will focus on:  1) the relationship and distinction between religion and spirituality; and 2) identifying one’s own spiritual autobiography and the significance of spirituality as personally defined and experienced.  Part II will be the practicum part of the course. Participants will shadow one of the hospital chaplains to gain an understanding of what occurs during a chaplain visit and how spiritual matters are addressed in the chaplaincy role. These visits will be written up in case study (verbatim) format and presented to the class for feedback and input with the chaplains.

1-6) Dead Bodies:  Perspectives from Medicine, Law, and Literature

Instructor:  Jane Greenlaw, JD, Associate Professor of Medical Humanities, URMC

Learning Objectives:

  1. Recognize the medical, legal and social meanings of death
  2. Analyze how various meanings of death influence people as individuals as well as in cultures, keeping in mind that medicine itself is a culture
  3. Examine the development of a personal conception of death and how it influences one’s development as a physician

Course Description: 

How can someone be alive one minute, and dead the next?  How do we know when a person is dead?  This seminar will utilize an interdisciplinary approach to seek answers to these and other provocative questions.  Beginning with how death is defined in the law and how it is diagnosed in medicine, we will examine such topics as:  How are the cause and time of a death determined?  What happens to a body after death?  How are mysterious deaths solved?  What is the meaning of death -- from the points of view of the dying person, of those left behind, and of those who tried to prevent it?   How influential is a person's first experience with death?  Must death always be the enemy of medicine? 

Readings will include statutes, court opinions, and selections from medical literature as well as from classic and popular literature.  At least one feature film will be viewed.  Guest faculty will include a suicide expert, an intensive care physician, and the Monroe County Medical Examiner.

SESSION 2:  Tuesdays, March 13 – May 7

2-1) Latino Health Part 2

Instructor: Cesar Flores and guest speakers from the Medical Community

Co-Course/Pathway Coordinators: Deepak Sobti, Brooke Shuster

Learning Objectives:

  1. Begin to formulate the vocabulary to conduct a basic history in Spanish
  2. Expansion of knowledge/use of verb tenses
  3. Have a better appreciation the socio-cultural aspects of health care in different Latino communities, both globally and locally

Course Description:  The US Census bureau estimates that there are thirty five million Latino or Hispanic persons living in the United States. In order to better serve our patients, physicians must explore the socio-cultural contexts that shape our patients lives.  Dialogue in a shared language is an essential part of the equation.

This course will provide an opportunity for discussion between students as we try to better understand the patients and community we serve.  The three main components of this course are: language, culture, and community. 

The language component will allow students to practice conversation and medical interviewing skills.  IMPORTANT NOTE: Class participants may vary in Spanish speaking ability. Cooperative peer teaching and learning will be part of the sessions. Advanced speakers may prefer to take a course offered in the second year.

The cultural component will explore the interplay between culture, health, and health beliefs, while delineating the divide between current needs and access to care.  The goal of the community component is to become better aware of local agencies serving Latinos in Rochester.

Because students have very diverse levels of written and spoken Spanish fluency, we would like students to sign up for the seminar appropriate to their abilities For those students whose spoken and written Spanish is intermediate or above, and who wish to be exempt from the Beginners and Part I seminars, you will need to take a short fluency exam with Dr. Daniel Yawman before the Christmas vacation. Please choose the box EXAM if you are seeking exemption. (Deepak Sobti and Dr. Yawman will be in touch with you to make arrangements about times for the exam via email).

For detailed information about the Pathway in Latino Health, please visit the following website: http://www.urmc.rochester.edu/smd/MedHum/latino_health.cfm

2-2)    Creative Writing

Instructor:  Frank J. Edwards, MD

Learning Objectives:

  1. The “principles” of creative writing
  2. Exercises designed to tap the creative impulse
  3. The steps of creation of poetry and fiction

Course Description:  This medical humanities seminar is for first year medical students who may or may not have creative writing experience.  The instructor is an emergency physician who has published fiction, poetry and non-fiction.  The clinical practice of medicine and the act of imaginative writing have many points of contact.   In communicating with patients, a good physician imposes order upon chaos in ways similar to how a storyteller gains the reader’s trust.  This seminar will focus on ways the writer discovers ideas for poems and stories from within and develops them into finished pieces.  Students often ask if we aim in this seminar to write about “the medical experience.”   The answer is no.  Writers develop as writers first and physician writers second. 

2-3)   Deaf Health Part 1: An Introduction to Deaf Language and Culture

Instructor(s):    Vasanth S. Kainkaryam, CC3 and Pam Pollard, ASL Instructor

Coordinator(s):   Vasanth S. Kainkaryam, CC3

Learning Objectives:

  1. To learn the basic foundations of American Sign Language and its structure, and to formulate an   approach for further study of the language.
  2. To gain an introductory exposure to the culture of the Deaf population at Rochester through interaction with guest speakers as well as Deaf individuals.
  3. To become aware of resources available at URMC and at Rochester in general for the Deaf population as well as for medical students when interacting with Deaf patients, specifically with regards to interpreters.
  4. To become familiar withnews and relevant readingson Deaf culture.

Course Description:  This course is a first initiative to bring into the medical curriculum a focus on the Deaf community at Rochester and to provide medical students with a platform to gain exposure of and pursue interest in the Deaf community.

The course will focus on two aspects: culture and language. Deaf speakers and advocates from Rochester will come to talk about their lives and what it means to them to be a part of the deaf community. These will include healthcare practitioners and interpreters working in the Deaf health setting. Relevant news articles and short readings will be provided for an understanding of the larger scope of Deaf health. Students will also be invited to attend the "Eyeth Day" Deaf immersion day event at the River Campus to simulate a Deaf community and understand a context for the ASL they have learned.

The language aspect of the course assumes no previous knowledge of ASL, and will include the instruction of ASL by a Deaf individual with expertise in teaching ASL, with once again a focus on basic conversations with relevance to medical interviewing. Students will be provided a linguistic perspective on ASL, explaining the contrast between "sign language" and "signed English." Moreover, students will learn the etiquette of working with ASL interpreters and patients in a clinical setting, and shadow an interpreter while interviewing a Deaf patient.

2-4)  Differences, Disparities, and Disease:  Perspectives from Medical Anthropology on Race/Ethnicity, Culture and Medicine

Instructor:  Thurka Sangaramoorthy, MPH, PhD Candidate, Univ .of CA—S.F. & Berkeley

Learning Objectives: 

  1. Basic understanding of the importance of the concepts of race and ethnicity in medicine and public health and the current critiques of the ways that these concepts have been utilized
  2. Appreciation of the critiques of the culture of medicine and medical science from the social sciences
  3. Develop practical skills of critical thinking and self-expression to address issues of social difference and medical disparities

Course Description:  The concepts of race and ethnicity are profoundly polemical topics as they are entrenched in the daily lives of so many people.  Medicine and healthcare are areas where these issues are particularly challenging.  This course will briefly outline the ways in which social and medical classifications of race and ethnicity shape and inform each other, and the social and health consequences that follow from this intertwining of difference and pathology.  We will explore a historical account of the idea of race in science utilized today by many historians of science and race theorists and will summarize major developments in the anthropology of race and ethnicity.  We will also examine current debates in health disparities and be attentive to the ways in which medical science and practices re-inscribe notions of race and ethnicity despite arguments that they are not meaningful scientific categories. Through readings drawn from the fields of anthropology, history, and science studies, we shall explore several related processes:  1) how certain kinds of differences come to be medicalized; 2) how certain diseases come to be identified with particular groups of people; and 3) how many people come to identify themselves through medical categories.

2-5) Turning Toward the Body

Instructor: Jennie Lightweis-Goff / PhD Candidate, Department of English

Learning Objectives:

  1. To investigate the current trend toward body writing and embodied history.
  2. To participate in a discourse community within the classroom that critically examines representations of the body.
  3. To develop critical and creative methods to connect and compare discourses about the body from the scientific to the sacred, from the popular to the theoretical.

Course Description: What relationship exists between subjectivity and the body? What relationship does the body have to the culture at large? Do investigations of the body necessitate hostility to notions of a soul, personality, or individuality? Though these questions have been instrumental in shaping the course’s syllabus and structure, they will not limit student inquiry within the classroom. The following readings, primarily drawn from popular writing about the body, are designed to provoke student debate. As such, we will examine representations of bodies in contemporary writing, generally drawn from the genre of creative nonfiction. I encourage subjective but critical response to these texts and questions. Each class session will have two distinct parts. The first forty-five minutes of class will be spent with students introducing questions that emerge from their readings of the assigned texts. In the last part of the class, the instructor and students will work as unit to offer potential answers – and, possibly, more questions – to group concerns. 

2-6)  Madness in Film

Instructor:  Andrea Weinstein, MA

Learning Objectives:

  1. To examine whether commonly held “myths” of mental illness are perpetuated in film, and, if  so, how that influences cultural mores.
  2. To examine the role of the institution and its depictions in film.
  3. To evaluate the loss of autonomy, and whether power is always located in the “keeper.”

Course Description: This seminar will examine representations of madness in film over aperiod of more than 60 years. The seminar will particularly focus on various methods of institutionalization; the demands of the institution on those individuals to conform to the institution's needs; if and how public attitudes to mental health are influenced by film; how cultural attitudes to madness change over time and whether that change is reflected in film; the role of gender; and, whether the nexus of power is always in the "keeper." Discussion on these and other topics will follow film showings.

Films will include: The Snake Pit (1948);Three Faces of Eve (1957); Le Roi de Coeur (1966); Marat/Sade (1967);One Flew Over the Cuckoos Nest (1975); Frances (1982); and Girl Interrupted (1999).

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Required Courses

First Year

  • Medical Humanities Seminars: each student takes one (required) or a second (optional) eight-week seminar, 2 hours per week (16 hours required, 32 hours optional)
  • Ethics and Law in Medicine (theme, taught in the integrated courses of the curriculum, approximately 15 hours)

Second Year

  • Medical Humanities Seminars: each student takes one (required) or two (optional) eight- week seminar, 2 hours per week (16 hours required, 32 hours optional)
  • Ethics and Law in Medicine: theme, taught in the integrated courses of the curriculum (approximately 20 hours)

Third Year

Medicine clerkship (six rotations) Clinical Ethics 1 hour
Pediatrics clerkship (six rotations) Informed Consent and Medical Ethics 1 1/2 hours
  Literature 1 1/2 hours
Obstetrics clerkship (six rotations) Informed consent 1 hour

Fourth Year

Intensive Case Study Block Varying content integrated through short and long case study exercises 10-20 hours
Informed Consent Selective (offered twice)   2 hours

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Residency Teaching

Faculty in the Division are involved in residency training, including:

  • ICU clinical ethics teaching rounds: Monthly one-hour sessions in PICU, NICU, MICU, SICU, and Hem/Onc BMTU*
  • Clinical Ethics skills block for Primary Care Medicine 2nd year residents (4 hours)
    • *PICU: Pediatric Intensive Care Unit
    • NICU: Neonatal Intensive Care Unit
    • MICU: Medical Intensive Care Unit
    • SICU: Surgical Intensive Care Unit
    • BTMU: Bone Marrow Transplant Unit

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Electives

Throughout the double helix curriculum are opportunities for students to pursue areas of interest. The Division offers a number of electives in humanities and in ethics, including:

  • Documentary Film Making and Medicine
  • Creative Writing
  • Literature and Medicine
  • Philosophy
  • History of Medicine
  • Art, Medicine and Literature ( Memorial Art Gallery)
  • Independent Research/Creative Project in Medical Humanities
  • Medicine and Law
  • Clinical Medical Ethics (2 weeks full-time, or part-time over 3 - 4 weeks)
  • Clinical Ethics and Palliative Care (4 weeks—available third and fourth year).
  • Clinical Ethics Research

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