Bioethics Education@CUHK

This course provides an overview of the major areas of bioethics, including the historical foundation of bioethics, the four principles, health beliefs and bias in medicine, and ethical dilemmas related to distribution justice, confidentiality, and the right to know. Case discussions will be extensively used in the course, allowing students to understand and explore the cause of ethical dilemmas in clinical scenarios and the underneath social dynamics, and develop their analytical and problem-solving skills for these dilemmas.

Course assessment includes: (a)lecture participation, (b)tutorial discussion, (c)module exercise, and (d)term-end essay. Students must pass all individual components in order to pass the course. Failure to meet one of the assessment components will result in a “Fail” for the whole course.  

By the end of this course, students will be able to:

• describe the fundamentals of argument construction and evaluation;
• apply normative theories in ethical analysis;
• illustrate competing interest and the principles in tension;
• discuss the relationships between humanities and the bioethics;
• communicate ideas and arguments in a clear and concise manner.

This course builds on the foundational subject areas introduced in Year 1, and discussed contemporary issues in medicine and biomedical science. It is designed to help students develop systematic strategies and analytic frameworks for identifying and examining bioethical issues and for resolving bioethical dilemmas and problems. The teaching methods for this course are lecture and tutorial format. That is, students are expected to prepare thoroughly for class by reading the assigned material so that rigorous and insightful discussion can occur during class. All tutorial attendance are mandatory. Remedial work will be assigned to unexcused absentee. Students are also required to attend four out of seven lectures. The score will be given on a pro-rata basis.

Upon completion of the course, students should be able to:

• Understand the fundamentals of argument constructions and evaluation;
• Learn and apply normative theories in ethical analysis;
• Recognise competing interests and principles in tension;
• Recognise the relationships between humanities and bioethics; 
• Communicate ideas and arguments, verbally and in writing, in a clear and concise manner.

With the theme of “The Bioethics Discourse on Culture, Moral Values, and Professionalism”, this course builds on the foundational knowledge to explore contemporary issues as well as advanced topics using different social and cultural angles. It covers end-of-life issues and palliative care: physician-assisted suicide, withdrawing and withholding life-sustaining treatment and advance medical directive, clinical definition of death and organ transplant. These will then tie with topics providing an overview on professional conduct, breach of duties and disclosure of medical errors, which bridge students to the scenarios to be covered in clinical years and future practices.

The course includes a series of lectures given by clinicians, nurses, lawyers, and bioethicists. Students will be introduced to the substantial debates simulating the disciplinary hearing or those in a court setting, and exposed to guided discussions about the current policies and guidelines related to their future practices.

By the end of the course, students should be able to:

• Identify and discuss the critical trends, social and political events, cultural and scientific factors that have shaped and influenced the development of bioethics and medical practice;
• Recognise and cogently discuss significant questions in the humanities and social sciences;
• Present clear, concise and carefully reasoned arguments in writing and presentation.

The course builds on the foundation of Years 1-3 studies in bioethics to consider physician obligation expressed in law, regulations, professional codes and widely held norms of medical ethics. Areas considered include the doctor-patient relationship, patient capacity, consent, confidentiality, medical error and negligence, forensic pathology and related medical-legal issues, blood transfusion, end of life care and issues on the beginning of life. Attention is also devoted to presenting a general framework of the legal system, in understanding the difference between civil law and criminal law, branches of the law, the hierarchy of laws, the court system and the law making process.

Students will study and consider the distinctions and possible conflicts among law and regulation, professional standards, and generally recognized normative ethical obligations.

• Understand the Hong Kong legal framework governing selected ethically complex topics in clinical practice and policy;
• Recognize governing bodies and professional standards for selected ethically rich topics in clinical practice and policy;
• Understand generally accepted normative standards and requirements in relationship to selected ethically rich topics in clinical practice;
• Consider and gain insight into the ethics of patient care in the overlapping contexts of Chinese and modern biomedicine;
• Consider challenges and gain initial skills in demonstrating respect and empathy in the clinical setting.

This course introduces ethical dilemma arising from some special circumstances in the clinical practice of each discipline.

In the Family Medicine module, students will learn about issues in common clinical encounter, including taking a sexual history, truth-telling, breaking the bad news, and dealing with clinical errors. Through small group teachings, students able to observe and discuss challenges with experienced local practitioners.

In the Obstetrics and Gynaecology module, students will learn about ethical issues through the interactive student forum and seminar, such as termination of pregnancy, reproductive autonomy in the face to emerging technologies, as well as obstetricians’ role in the decision-making between pregnant women and the potential human — fetus.

In the Paediatrics module, students will learn about bioethical considerations that paediatricians face while treating children for health conditions. For children, unlike for adult patients, healthcare decisions are often made by someone other than the person to be treated, i.e. by the parents/primary carers. Issues of patient confidentiality, consent for treatment, and child protection require the treating doctor to be aware of the specific needs and desires of the child, and to be able to respect and adequately address situations when the child’s and parents’ views and needs diverge.

In the Psychiatry module, students will learn about common and unique bioethical considerations that psychiatry faces while treating patients with mental health conditions, such as patient confidentiality, consent for treatment in psychiatric illness, and capacity determination.

In addition, students are required to attend the annual Lanson Lecture hosted by the CUHK Centre for Bioethics.

• To develop moral sensitively to identify the ethical problems that arise in day-to-day clinical practice;
• To determine the right course of action when unethical practices or behaviours are observed in clinical practice.

The year six medical school curriculum emphasizes clinical teaching through hospital rotations in medicine, surgery and other specialized disciplines including anaesthesia and intensive care, clinical oncology, and orthopaedics and traumatology. Besides the relevant medical knowledge necessary for day-to-day care, students must also learn to navigate the complex and multifaceted terrain of healthcare relationships between all stakeholders and the ethical challenges that arise therein.

Parallel to clinical teaching, the year six bioethics course will enable and allow students to apply the theoretical models of clinical ethics in healthcare delivery. The curricular design leverages clinical experiences towards ethical decision making and resolution of dilemmas. In so doing, students will develop tangible critical thinking skills in the prevention and resolution of doctor-patient conflicts, a critical step in the transition to medical professional. Emphasis is placed on navigating difficult interactions at the bedside arising from ethically complex circumstances in the practice of each discipline. Students are expected to identify ethical issues in the patient experience inclusive of the descriptive steps required to forego or resolve ethical issues.

• To learn advanced ethical theories and moral reasoning practices for recognition, prevention and resolution of ethical dilemmas in the clinical setting;
• To acquire the reasoning abilities to identify the root causes of ethical dilemmas;
• To gain appreciation of the multifaceted nature of the doctor-patient relationship exercised through skilled communication tailored to the needs of each patient and family;
• To demonstrate critical thinking in the application of clinical ethics theories via patient and family communication that in resolves clinical conflict;
• To develop and display professional and ethical behaviours in the clinical settings, with emphasis on understanding the importance of these skills as they relate to patient interaction.

This course aims to introduce the basic concepts of bioethics and explore the ethical issues that arise from biomedical sciences and clinical research, as well as during clinical diagnosis and therapeutic treatment. The examined topics cover diversified aspects from historical to recent concerns, including research conducts, embryonic stem cells, designer baby, and genetic screening, etc. Through interactive case discussion activities, students are taught to think and analyze the ethical dilemmas based on some guiding principles and theories, to respect the perspectives of different stakeholders, and to make justified actions. These practical skills could help students develop the competence to respond to various ethical challenges in their future career.

By the end of this course, students will be able to:

• identify the ethical issues or dilemmas in a given situation;
• evaluate the decisions and practices of others in cases demonstrating violation of ethics;
• use the ethical principles as guidance to make justified decisions in resolving ethical questions;
• consider and respect alternative viewpoints of contentious issues.

This course will introduce students to the basic concepts of ethics and law and explore their relevance to professional and clinical public health practices. It will introduce students to the role of ethics and law in promoting and protecting public health. Case studies will be used to highlight contemporary ethical and legal issues in public health in Hong Kong.

• Understand basic ethical concepts and applications;
• Discuss contemporary ethical dilemmas in public health and health care scenarios;
• Understand basic legal terminology and sources of law in Hong Kong;
• Understand Hong Kong’s public health legislation;
• Understand the importance of ethics and law in protecting public health;
• Identify and analyze different approaches to decision-making in relation to public health dilemmas and the relevant ethics considerations;
• Demonstrate an understanding of public health as a public good in Hong Kong.

Students will learn in interprofessional teams on key healthcare topics such as biomedical ethics, global health, artificial intelligence, professionalism, medical humanities and sociology.  Guided team discussions on case scenarios will explore deeper learning of ethics and artificial intelligence.  Community visits and experience learning aim to enhance students’ understanding of medical humanities and sociology.  In additional, students will learn about vaccinations and demonstrate basic clinical skills of intramuscular and subcutaneous injections.  Students are exposed to and discuss these concepts in English, through which their English communication skills are trained.

By the end of this course, student should be able to:

• Describe public health domains and social determinants of health;
• Understand the scope of public health with illustrated examples in infectious disease, environmental health and non-communicable diseases;
• Work collaboratively on topical public health issues;
• Describe and articulate current global health problems and their determinants;
• Appreciate the complexities of issues encountered in healthcare settings and the importance of professionalism;
• Apply bioethical principles and theories in analyzing contemporary public health problems;
• Demonstrate ethical argumentation in a logical and coherent manner;
• Describe how emerging technology and AI are used in medicine and healthcare; and
• Demonstrate proficiency in clinical skills to meet the needs of clients receiving intramuscular and subcutaneous injections.

Different values and beliefs, opposing clinical objectives, and resource limitations are persistent issues in medical and healthcare settings, from which ethical dilemmas could arise among healthcare practitioners, patients, and their family members, who are unavoidably engaged in the decision-making process in difficult health, life, and death scenarios. These scenarios may include but are not limited to organ donation, resuscitation of a terminally ill loved one, withdrawing or withholding life-sustaining and standard curative treatments for an end-of-life patient, active euthanasia and physician-assisted suicide, as well as healthcare rationing. While a well-established legal and health system can provide guidelines for walking through these processes, the values and beliefs of the patients, healthcare workers, and other decision-makers (including family members and guardians) would shape the way decisions are made. Therefore, understanding the factors that may shape or influence one’s values and moral beliefs is crucial for any meaningful discussions to resolve these dilemmas. This course will use a systematic approach to guide students in understanding the moral theories and principles pertinent to the works of bioethics, identifying the morally salient features and arguments of selected clinical, healthcare, and health-related scenarios, discussing and analyzing the main bioethical issues of those scenarios, as well as describing ways to resolve the relevant moral dilemma. Students will be introduced to different simulation exercises and scenarios to realize and reflect on the factors that shape their own decisions as well as moral values and beliefs. The course will utilize lectures, tutorials, case studies, and sharing of hands-on experience to guide students in adopting an all-rounded, holistic, and perspective-based approach to discuss and resolve the bioethical dilemmas related to health, life, and death matters.

After completion of this course, students will be able to:

• Illustrate the relationship between bioethics and moral beliefs in scenarios that concern health, life, and death;
• Illustrate systematically factors that may shape one’s moral decision with regard to health, life, and death matters;
• Understand the relationship between bioethical principles and theories, apply them to reflect on and critique arguments and debates in selected clinical, healthcare, and health-related scenarios;
• Discuss and analyze the main bioethical issues and features of those selected cases and describe ways to resolve the dilemma between them;
• Identify the pressing bioethical issues concerning health and healthcare in Hong Kong, and initiate discussion based on the bioethical principles and theories covered in this course.