Professor Raanan Gillon
Imperial College, London, UK
The four principles approach- an international and intercultural basis for health care ethics
In this lecture Raanan Gillon will outline and defend the ‘four principles approach’ (the 4pa) to medical ethics, now usually (and in his view regrettably) called ‘principlism’, introduced by the Americans Beauchamp and Childress in the 1970s and quite widely accepted internationally- but also vigorously criticised by some. He will explain that almost all the doctors, medical students and others whom he has taught about the approach over the last forty years find that they can accept within their own moral approach a prima facie moral commitment to benefiting at least some others (‘beneficence’), to trying to avoid harming others (‘non-maleficence’) , to respecting other people’s deliberated or thought out choices for themselves (‘respect for autonomy’), and to being just or fair in their dealings with others. Explaining two major and admitted inadequacies of the approach (dealing with conflicts between the principles and their specifications, and deciding on their scope- to whom or to what do they apply and to what extent?) Professor Gillon explains that the 4pa is by no means an ethics panacea and can certainly not provide ethical algorithms. But he will ask participants if they too accept those prima facie principles in their own moral approach whatever that may be, and if not to explain why not in the discussion that will follow his lecture. He will argue that the 4pa seems to be widely acceptable to individuals internationally and interculturally and is compatible with the universalizable claims of all ‘overarching’ philosophical and religious theories of ethics that he has studied, including the major religions and the three most widely accepted philosophical approaches of deontology, utilitarianism and virtuism or virtue ethics. The 4pa can thus provide an internationally and interculturally acceptable basis for health care ethics. In considering objections to the approach he will pay especial attention to the compatibility and the interrelationship of the 4pa with virtue ethics.
Raanan Gillon is a hybrid of retired NHS GP and philosopher/medical ethicist. He is Emeritus Professor of Medical Ethics at Imperial College London, and still does a little teaching, mostly tutoring medical students and also on the Imperial College annual one week intensive course in medical ethics which he started in 1983. He is past chairman and now honorary president of the Institute of Medical Ethics. He was editor of the Journal of Medical Ethics for 20 years and a part-time NHS GP for 28 years. He has published extensively on medical ethics and his elderly book 'Philosophical Medical Ethics' is in its 13th print (with a possible second edition in ‘prolonged gestation’). He was senior editor of and contributor to a massive and prize winning multi-author textbook, Principles of Health Care Ethics. In 1999 he was a co-recipient of the American Hastings Center Beecher award for contributions to ethics and the life sciences. He is an enthusiastic proponent of 'the four principles approach' for both medical ethics and for ethics in general. His career-long association with the British Medical Association, of which he was President for 2019-20, included long service on its Medical Ethics Committee, its International Committee and also as one of its representatives at the World Medical Association and at the Standing Committee of European Doctors (CPME).
Professor Richard L. Street, Jr.
Texas A&M University, USA
Modeling Pathways from Communication in the Medical Encounter to Improved Health
Does better communication produce better health outcomes? This research on clinician-patient communication reveals mixed results. For example, some studies have reported that communication factors—such as more active patient participation, physician information-giving, and use of participatory decision-making—predicted better biomedical (e.g., metabolic control, hypertension) and psychosocial (e.g., less anxiety) outcomes. Yet other studies, using similar measures, did not. This inconsistency in findings is in part due to the practice of using communication measures to predict health outcomes (a direct path), rather than also studying how communication could indirectly contribute to better health through its positive effects on factors (e.g., commitment to treatment, better self-management skills) that in turn lead to better outcomes. This presentation first describes a conceptual model identifying direct and indirect pathways linking communication to improved health. Second, different approaches to assess indirect pathways are discussed (e.g., through mediation effects, or descriptively). Examples of different pathways are described by reviewing findings of previous research. Third, when using communication variables as predictors researchers must also consider the best way to measure the variable of interest (e.g., patient self-report, observational measures). The presentation concludes with implications of this model for future research and clinical practice.
Richard L. Street, Jr. PhD, is Professor of Communication at Texas A&M University and Professor of Medicine at Baylor College of Medicine. His research focuses on clinician-patient communication, pathways linking communication to improved health outcomes, and strategies for increasing patient engagement in care.
He has led advancements in modeling pathways through which clinician-patient communication processes contribute to improved health outcomes. In this research, he has employed a diverse set of methodological approaches to analyzing communication, including discourse analytic methods whereby the function and content of effective patient participation, information exchange, and shared-decision-making are captured.
He has published over 240 articles and book chapters, as well as a number of books, and monographs. As a graduate advisor, six of his advisees have secured tenure track positions, two at R1 universities, since 2014. In 2003, he was named Outstanding Health Communication Scholar by the International Communication Association. In 2008, he received the L. Donohew Health Communication Scholar Award from the University of Kentucky. In 2010, he was awarded the Texas A&M Association of Former Students Distinguished Achievement in Research Award. In 2012, he was given the George L. Engel award by the Academy on Communication in Healthcare for career contributions to the research, practice, and teaching of effective healthcare communication skills.
Professor Robyn Woodward-Kron
Department of Medical Education, Melbourne Medical School, University of Melbourne, Australia
Learning healthcare through interaction: A language perspective on clinical education
Much of healthcare is facilitated through interactive talk and writing: diagnosing, collaboratively making treatment decisions, carrying out treatment, coordinating care, handing over care. For health professional students, learning the influential patterns of talk and writing, the discursive practices of healthcare, is integral to becoming a health practitioner. When students transition from classroom to clinical learning, the texts and communicative events in which they engage will have the primary goal of doing healthcare rather than learning to do healthcare. Part of this transition involves learning how to learn when teaching is not overt but experiential, which is immersive and unpredictable.
In this presentation, I identify intraprofessioanl, interprofessional, and health professional-patient communicative events or activities in the clinical setting that are potentially pedagogically rich for health professional students. Through the lens of genre and activity theory – an approach to discourse analysis that distinguishes between text types or communication events according to their social purpose and contextual variables. I will discuss how clinical supervisors can scaffold valued discursive practices for student learning. I also intend to argue that there are bi-directional benefits for patients and students when students can engage in meaningful, authentic communication.
Robyn Woodward-Kron is a Professor in the Department of Medical Education, Melbourne Medical School at the University of Melbourne. Informed by her PhD in educational linguistics, her research interests are at the intersection of language and communication and health professions education, with a particular focus on intercultural communication. In addition, she has long-standing collaborations with clinician researchers, for example, to develop resources to promote inclusiveness for culturally and linguistically diverse people in clinical trials; and in translational research in a range of clinical settings including critical care, dementia, cancer education, and osteo-arthritis. She was made a Fellow of the Australian and New Zealand Association of Health Professions Education in 2019. She was also very pleased to convene with colleagues the COMET 2013 Conference in Melbourne.