Call for Submissions: Essays due to email@example.com by 8:00 a.m. March 12, 2018
Monetary Awards: 1st Place- $1,000; 2nd Place- $300; 3rd Place- $200
This prestigious annual award includes a cash prize recognizing the best essay by a UT Health San Antonio medical student on a bioethics topic. The essay topic will be chosen by the medical student, and all submitted essays will be assessed by a panel of health care ethicists and knowledgeable physicians. All medical students are eligible, and the prompts are provided merely to stimulate ideas. No special preference will be given to essays that follow these prompts as opposed to a completely original topic.
First, a definition is in order: What is Bioethics? Bioethics is a branch of applied ethics that studies the philosophical, social and legal issues arising in medicine and the life sciences. It is chiefly concerned with human life and well-being.
In the course of practicing medicine, physicians often encounter tension between their duties to individual patients and to society (e.g., concern for public health or public/professional norms).
Select one of the following topics and write an essay that identifies and illuminates – through examples, data, case studies, and informed moral reasoning – how physicians should discharge their ethical responsibilities to both the individual patient and to society.
Prompts you may consider:
- The Electronic Medical Record (EMR) emerged in the 1960s to improve physician documentation, communication and billing. In 1991, the Institute of Medicine recommended universal implementation of the EMR as a way to improve health care. Yet, many physicians are concerned that EMR-related responsibilities undermine the care of individual patients. Has the EMR achieved its goals and at what price to patient-doctor relationships?
- The care of patients with serious illness has evolved in recent decades. Palliative care and hospice are increasingly available and integrated into the practice of medicine. These services are recognized as promoting patient well-being and respecting patient rights. One controversial trend at the state level has been the legalization of Physician Assisted Death (PAD), a practice that does not have the united support of palliative care specialists. Proponents argue that PAD is an essential tool for ensuring that comfort and autonomy are available to the most vulnerable members of society. Opponents raise concerns about professionalism and unintended consequences. Should the medical profession embrace PAD as an option for patients with serious illness?
- Maternal mortality is rising in Texas, while the rest of the world is reducing maternal deaths significantly. Recent studies indicate that the poor and minorities are disproportionately affected, and that many of the underlying risk factors are preventable. What is role of the physician in advocating for reduced maternal mortality? And, how can physicians ensure that relevant ethical considerations inform health-related policymaking at the state level?
- Two of the largest immigrant detention centers in the United States are located 75 miles south of San Antonio, in Dilley and Karnes City. Asylum seekers released from these facilities en route to sponsors elsewhere in the country routinely traverse San Antonio, where they may stay in shelters for 3-5 days. Bexar County physicians who are obligated to act as stewards of local resources, including taxpayer dollars, may encounter sick asylum seekers with neither the residency status nor the funding to lay claim to these local resources. What is the nature and what are the limits of moral responsibility for physicians to provide health care to this transient population? Are there ethical or biological hazards associated with disregarding the health needs of these patients? Discuss this question from the perspective of health, human rights and social justice.
The essays will be judged on the following rubric:
Applicability of topic/Educational value to health care professionals
Identification of ethical issues in topic
Shows how topic relates to health care
Quality of writing
Uses proper grammar & spelling
Comprehension of issues
Demonstrates knowledge of chosen topic
Provides evidence to support thesis & arguments
Draws appropriately on external resources
Demonstrates original thought (rather than just restating what others have said)
Clarity of discussion & conclusions
Shows a clear logical flow of argumentation (e.g. thesis; arguments; supporting evidence)
Stays on topic
Makes a logical conclusion for action, thought, or research
Because medicine is a profession and physicians are professionals, it is important to have a clear understanding of what "professionalism" means. As a physician-in-training, you will be developing a personal sense of what it means to be a professional. This topic page outlines some common features. Please see the topic page on the Physician-Patient Relationship for further discussion of the professional responsibilities of physicians.
What does it mean to be a member of a profession?
The words "profession" and "professional" come from the Latin word "professio," which means a public declaration with the force of a promise. Professions are groups which declare in a public way that their members promise to act in certain ways and that the group and the society may discipline those who fail to do so. The profession presents itself to society as a social benefit and society accepts the profession, expecting it to serve some important social goal. The profession usually issues a code of ethics stating the standards by which its members can be judged. The traditional professions are medicine, law, education and clergy.
The marks of a profession are:
- Competence in a specialized body of knowledge and skill;
- An acknowledgment of specific duties and responsibilities toward the individuals it serves and toward society;
- The right to train, admit, discipline and dismiss its members for failure to sustain competence or observe the duties and responsibilities.
What is the difference between a profession and a business?
The line between a business and a profession is not entirely clear, since professionals may engage in business and make a living by it. However, one crucial difference distinguishes them: professionals have a fiduciary duty toward those they serve. This means that professionals have a particularly stringent duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Professions have codes of ethics which specify the obligations arising from this fiduciary duty. Ethical problems often occur when there appears to be a conflict between these obligations or between fiduciary duties and personal goals.
What are the recognized obligations and values of a professional physician?
Professionalism requires that the practitioner strive for excellence in the following areas, which should be modeled by mentors and teachers and become part of the attitudes, behaviors, and skills integral to patient care:
- Altruism: A physician is obligated to attend to the best interest of patients, rather than self-interest.
- Accountability: Physicians are accountable to their patients, to society on issues of public health, and to their profession.
- Excellence: Physicians are obligated to make a commitment to life-long learning.
- Duty: A physician should be available and responsive when "on call," accepting a commitment to service within the profession and the community.
- Honor and integrity: Physicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession.
- Respect for others: A physician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows.
These values should provide guidance for promoting professional behavior and for making difficult ethical decisions.
A Physician Charter: Medical Professionalism in the New Millennium was issued jointly by the American Board of Internal Medicine, the American College of Physicians and the European Federation of Internal Medicine in 2002. Subsequently, 90 professional associations, including most of the specialty and subspecialty groups in American medicine have endorsed the Charter. The fundamental principles of professionalism are stated as (1) the primacy of patient welfare; (2) patient autonomy; (3) social justice. Professional responsibilities that follow from these principles are commitment to competence, to honesty with patients, to confidentiality, to appropriate relationship with patients, to improving quality of care, to improving access to care, to a just distribution of finite resource, to scientific knowledge, to maintaining trust by managing conflicts of interests and to professional responsibilities.
Is professionalism compatible with the restrictions sometimes placed on physician's judgments in managed care?
One of the principal attributes of professionalism is independent judgment about technical matters relevant to the expertise of the profession. The purpose of this independent judgment is to assure that general technical knowledge is appropriately applied to particular cases. Today, many physicians work in managed care situations that require them to abide by policies and rules regarding forms of treatment, time spent with patients, use of pharmaceuticals, etc. In principle, such restrictions should be designed to enhance and improve professional judgment, not limit it. For example, requiring consultation is ethically obligatory in doubtful clinical situations; penalizing consultation for financial reasons would be ethically wrong. Also, requiring physicians to adhere to practice guidelines and to consult outcome studies may improve professional judgment; requiring blind adherence to those guidelines may be a barrier to the exercise of professional judgment. The presence of rules, policies and guidelines in managed care settings requires the physicians who work in these settings to make such judgments and to express their reasoned criticism of any that force the physician to violate the principles of professionalism.