Ethics and Human Values (EHV)

The Ethics and Human Values (EHV) curriculum will focus on related topics, content, and pedagogy from health care ethics, professionalism, medical humanities, and other related interdisciplinary areas into the four-year Geisel curriculum and culture. The goal is to ensure that all student-physicians graduating from the Geisel School of Medicine at Dartmouth have the knowledge and skills:

     1) To be aware and demonstrate an understanding of fundamental health care ethics principles and professional standards.

    2) To recognize and systematically address common ethical issues in clinical care through coherent ethical reasoning.

    3) To understand the cultural and social context in which students will be practicing medicine.

    4) To be describe the role and accessibility of ethics resources in health care organizations.

    5) To be attentive and open to varied perspectives and experiences of patients so as to exhibit compassion for patients, colleagues, and oneself.

The EHV curriculum takes a comprehensive, longitudinal, and vertical approach, embedding these topic areas within courses of the core medical school curriculum. This integrated approach will lead students through distinct learning phases: Phase 1, an introduction to the EHV topics noted above, and immersion of the topics as they relate to specific organ systems; Phase 2, application of and reflection of the EHV topics within clinical rotations, and Phase 3, in-depth exploration of themes through capstone projects.

Additionally, EHV activities will be cultivated through Geisel’s informal curriculum, such as a variety of enrichment electives, Geisel Student Ethics Interest Group, Joseph and Olive Swigart Student Ethics Fellowship program, and the Health Humanities Scholars program.

Longitudinal Curriculum Leader

William A. Nelson, MDiv, PhD

Email: William.A.Nelson@dartmouth.edu
Office Location: 229 Remsen Hall

Dr. Nelson is a health care ethicist serving as the Director of the Ethics and Human Values Program; Professor in the Dartmouth Institute for Health Policy and Clinical Practice (TDI), and the Departments of Medical Education and Community and Family Medicine at Geisel School of Medicine at Dartmouth. Dr. Nelson’s extensive teaching at Geisel and TDI, publications, and research is directed toward increasing the understanding that ethics is foundational to the delivery of health care and health. He is the author of over 125 articles, book chapters, and several books. Dr. Nelson has received many awards including the U.S. Congressional Excalibur Award for Public Service. The Department of Veterans Affairs established the annual, competitive “William A. Nelson Award for Excellence in Health Care Ethics” and in 2006, was awarded an Honorary Doctorate of Humane Letters from Elmhurst College. In 2013, Dr. Nelson received TDI’s student teaching award, and in 2018 was elected to the Geisel School of Medicine’s Academy of Master Educators.

Longitudinal Curriculum Objectives

  1. Recognize and demonstrate the physician’s fiduciary relationship in patient care.
  2. Identify basic ethics principles and professional standards related to the delivery of health care. P8 Demonstrate the ability to apply a systematic process in performing an analysis to ethical conflicts.
  3. Articulate ethical reasoning coherently to others.
  4. Describe the role and functions of ethics committees.
  5. Apply shared decision making, including informed consent and refusal of medical interventions by patients.
  6. Identify ethical standards in human subject research, including the role of institutional review boards.
  7. Identify the conflict between the rights of individuals and public in health care policy.
  8. Address challenging patients, and family members, including recognizing that the clinician may be contributing to the difficulty.
  9. Identify the role of health professional’s personal values in the clinical encounter, including rights of conscience.
  10. Describe ethical issues in cross-cultural communication and demonstrate the ability to elicit a cultural, social, spiritual and medical history respectfully.
  11. Use problem-solving skills to optimize ethical decision-making in culturally challenging situations.
  12. Recognize core professional attributes (e.g. altruism, accountability) needed to provide effective care in a multidimensional and diverse society.
  13. Recognize ethical implications of key areas of health disparities driven by race, ethnicity, socio-economic, culture, religion, gender identity or sexual identity, and be able to critically evaluate data describing health disparities.
  14. Identify the ethical issues of social determinants of health that contribute to health disparities and impact the individuals, families and underserved communities.
  15. Recognize the opportunities, challenges, and ethical considerations in promoting of equitable health outcomes, including advocating for our society’s vulnerable populations P5 Demonstrate the ability to focus attentively on an individual patient and elicit patients’ values and preferences.
  16. Demonstrate the ability to communicate with patients, families/significant others, and interdisciplinary healthcare team members in ways that are accessible and appropriate to their needs.
  17. Recognize, address, and prevent common ethical challenges in patient care, including:
    1. Use of reproductive technologies and termination of pregnancy;
    2. Protection of patient privacy and confidentiality and the ethical justification for breaching confidentiality;
    3. Care and decision-making at the end of life, including patient advance directives, withholding and withdrawing life-sustaining interventions, care for the dying, and determination of death;
    4. Role of minors in healthcare decision-making;
    5. Assessing patient decision-making capacity and issues related to surrogate decision making;
    6. Disclosure of information to patients, including medical errors and bad news;
    7. Conflicts of interests in clinical practice, research, and population health;
    8. Addressing impairment, incompetence, and mistakes by colleagues and other healthcare professionals;
    9. Management of trainee issues, including disclosure of student status, tension between education and best care for patients, and moral distress;
    10. Application of pain medication and addiction management;
    11. Seeking an organ donation and the criteria for organ transplantation; and,
    12. Use of genetic screening and genetic engineering

Additional Resources

Geisel’s Swigart Student Ethics Fellowship: https://geiselmed.dartmouth.edu/swigart/