Readers’ Theater (RT) is a unique vehicle for introducing ethical, cultural, and social issues in medicine to academic, professional, and community audiences. It brings alive the characters in a story in a way that silent reading or reading a story aloud cannot. Audience members experience what is, in essence, a case report acted out “on stage” rather than reading or hearing someone report on a situation second hand. RT has an immediacy about it, a compelling aspect, that makes listeners pay attention and mentally participate in the action. It draws people into the story, engages them. The oral reading and subsequent open discussion combine to educate audience members about the topic of the story and the variety of ways one can interpret the story’s message. This article describes the long-standing RT program at the Brody School of Medicine (BSOM) at East Carolina University (ECU) and some of variations on RT that people have developed around the country.

Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities. In 1996, the Medical Student Section of the American Medical Association (AMA) introduced a resolution calling on the AMA to adopt a policy in support of exemptions for students with ethical or religious objections. In that report, students identified abortion, sterilization, and procedures performed on animals as examples of activities that might prompt requests for conscience-based exemptions (CBEs). In response to the student initiative, the Council on Medical Education recommended the adoption of seven “principles to guide exemption of medical students from activities based on conscience.” The House of Delegates adopted these principles in their entirety.

There has been a fair amount of recent discussion about the implications that advances in neuroscience will have on the law and, in particular, legal responsibility. This discussion has been varied and includes, for example, the potential impact of neuroimaging techniques to reveal whether a defendant or witness is telling the truth, and consideration of whether our growing knowledge of brain function will warrant a revision in the law to make it more psychologically relevant.

Several bioethical topics received a great deal of news coverage here in Scotland in 2009. Three important issues with transatlantic connections are the swine flu outbreak, which was handled very differently in Scotland, England, and America; the U.S. debate over healthcare reform, which drew the British National Health Service (NHS) into the controversy; and the release to Libya of the Lockerbie bomber, which at first glance might not seem particularly bioethical, but which actually hinged on the very public discussion of the prisoner’s medical records. On a national level, there have been attempts in both Scotland and England to change the law on assisted suicide, where success looks more likely than ever. This paper discusses each of these issues and hopefully will raise awareness of how these issues were dealt with in the United Kingdom and its component countries.

Dutch medical ethics policy is renowned for being highly liberal, due largely to the Dutch law on euthanasia. The Netherlands is one of the very few countries in which euthanasia performed by physicians and physician-assisted suicide (PAS) has been legalized. Acts of euthanasia and PAS go unpunished, provided certain conditions are fulfilled.

Ethics education is recognized as an integral component of health professionals’ education and has been occurring in various guises in the curricula of health professional training in many countries since at least the 1970s. However, there are a number of different aims and approaches adopted by individual educators, programs, and, importantly, different health professions that may be characterized according to strands or trends in ethics education.

In several papers, John Harris has argued that if

1. i) it is morally permissible to engage in reproduction, whether natural or artificial, despite knowledge that a large number of embryos will fail to implant and quickly die, then

2. ii) it is morally permissible to produce embryos for other purposes that involve killing them, for instance, to harvest stem cells that may be used to save lives.

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience itself needs a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.

Formal teaching of ethics in health science programs at the entry level and postprofessional level in the United States and Canada has been documented in the professional literature for more than 30 years, yet there are significant differences in the way it is taught and how much time is devoted to the subject. Numerous teaching and evaluation methods have been used in ethics education, such as lectures, written examinations, debates, role-playing, small group discussion, and case study analysis. Most instruction in ethics in the health sciences has been geared toward ethical analysis of case studies, that is, the student is asked to read a case or discuss a case with others, identify the ethical issues verbally or in writing, propose different resolutions supported by principles and theory, and select the best course of action. Yet, analysis of a case is an unlikely route to develop skills in coping with the uncertainty and emotional nature of ethical issues commonly encountered in clinical practice, nor does it give us an indication of what students would “really do” when they encounter an actual ethical problem.

In an editorial to a recent issue of Neurology, Richard Dees expresses the same criticism in an even more rigorous epistemic tone: “Slippery slope arguments are always fallacious, and they always hide an agenda. However they are used, they are meant to make us accept a conclusion that we would otherwise reject.”

The legitimacy of embryo research, use, and destruction is among the most important issues facing contemporary bioethics. In the preceding paper, Ingmar Persson and Julian Savulescu took up an argument of John Harris and tried to find some new ways of avoiding its dramatic consequences. They noted that: “John Harris has argued that if … it is morally permissible to engage in reproduction … despite knowledge that a large number of embryos will fail to implant and quickly die, then … it is morally permissible to produce embryos for other purposes that involve killing them, for instance, to harvest stem cells” and suggest that this argument fails.

Charles de Gaulle once famously complained about the difficulty of governing a nation with 250 different kinds of cheese (now estimates range from 400 to 1,000). His comment is a true description of France’s diversity and its population. We are like a loud, unruly family always arguing among ourselves. However, as much as we disagree, there is one thing on which we French stand united—we love our healthcare system and do not want it changed, even as economic realities make it increasingly difficult to maintain.

These CQ Sources were compiled by Bette Anton.

Professionalism is demonstrated through attitudes and behaviors. Medical education is concerned with teaching and evaluating it among students. It is often bioethicists who teach professionalism to medical students. Most bioethics curricula use lectures and group discussions to introduce principles and theories, but there is variation in number of credit and contact hours, placement in the curriculum (which year(s) and alongside which courses bioethics is placed), the extent of individual mentoring, and the emphasis placed on any particular philosophical approach. Bioethics curricula also vary in whether and how explicitly and extensively they address topics, including professionalism, cultural competence, medical humanities, spirituality, death and dying, and community service, and in the number and topics of vignettes, controversies, assignments, and course activities.

The current practice of late termination of pregnancy in Germany has been criticized by the German Medical Association as well as several sociopolitical groups. The controversy has especially concerned the time limit for the termination of pregnancies and the counseling process prior to that intervention. The criticism, in part, originates from the reform of the German Abortion Law in 1995, and demands for change led to legislative initiatives in 2008.

In any healthcare system in which demand exceeds supply—which means any typical public healthcare system—patients cannot always get the care they want or need when they want or need it. It is also unrealistic to suppose that it will ever be otherwise. There have been such advances in medicine and growth in the population that even if we forgot about all other goods such as education, roads, social services, and so forth and put the entire budget into healthcare, there would still be a gap between supply and demand. Moreover, even if we could by that expedient make them match and had eyes only for health, we still should not. For it is now understood that healthcare is the least important determinant of health, lining up well behind poverty and social status. But if suboptimal care is to be our destiny, we must plan how it is to be delivered.

The predominant influences on health are social or upstream factors. Poverty, inadequate education, insecure and toxic environments, and inferior opportunities for jobs and positions are inequitable disadvantages that adversely affect health across the globe. Many causal pathways are yet to be understood. However, elimination of these social inequalities is a moral imperative of the first order. Some physicians by word and deed argue that medical doctors should oppose the “structural violence” of social inequalities that greatly shorten lives and wreak so much suffering.

These words were written by ethicist Jonathan Glover in his paper “Future People, Disability and Screening” in 1992. Whereas screening and choosing for a disability remained a theoretical possibility 16 years ago, it has now become reality. In 2006, Susannah Baruch and colleagues at John Hopkins University published a survey of 190 American preimplantation genetic diagnosis (PGD) clinics, and found that 3% reported having the intentional use of PGD “to select an embryo for the presence of a disability.” Even before, in 2002, a controversy was generated by the case of Candace A. McCullough and Sharon M. Duchesneau, a lesbian and deaf couple from Maryland who set out to have a deaf child (then, Gauvin) by intentionally soliciting a deaf sperm donor.

The Mental Capacity Act 2005 came into force in England and Wales in 2007. Its primary purpose is to provide “a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves.” Examples of such people are those with dementia, learning disabilities, mental health problems, and so on. The Act also gives those who currently have capacity a legal framework within which they can make arrangements for a time when they may come to lack it. Toward this end, it allows for them to make advance decisions (in effect, refusals of consent to certain forms of treatment) or to appoint proxy decision makers with lasting powers of attorney.