84236 - Ethics and Behavioural Sciences

Learning outcomes

Identify the main ethical issues involved in the doctor-patient/family interaction, including confidentiality, informed consent, withdrawal of treatment, chronic illness, age-related cognitive limits, death and bereavement, cultural concerns, and complementary health practices. Recognize the most frequent difficulties in doctor-patient interaction due to age-, personality- and motivation-related variations in the functioning of the cognitive processes (perception, attention, learning, memory and thinking), emotional and interpersonal processes (recognition and control of emotions, verbal and non-verbal communication skills, expectations and attitudes). Recognize the basic components of the strategies of informative and persuasive communication to improve patient’s cooperation and adherence to medical care.

Course contents

Lecture 1. Overview of the course. Patient-doctor relationship. Ethics versus morality. Bioethics and the law. Ethics in medical practice.

Lecture 2. Historical perspective on medical deontology from Hippocrates to the Declaration of Helsinki. Informed consent. Confidentiality. Withdrawal from treatment. Ethics in research. When research is not ethical: an historical perspective (Nuremberg doctors trials. Milgram study. Stanford prisoner study. Tearoom trade study. Tuskegee syphilis study). Human subjects protection and regulation.

Lecture 3. Free will and accountability: specific genotypic traits and aggressive versus altruistic behavior.

Lecture 4. Methods in neuroscience. Brief review of neuroanatomy. Methods for investigating cognitive processes. An historical perspective: from the study of brain lesions to functional magnetic resonance (fMRI). Employment of fMRI for clinical purposes: from localization of brain function before neurosurgery to the study of consciousness in patients in vegetative state.

Lecture 5. Faces as important tools for communications. Why studying face perception: recognition of identity. Detection of signs for clinical diagnosis. Plastic surgery and the ethical issues of face transplant. The neural mechanisms for face perception.

Lecture 6. Understanding others. Emotions and their neurophysiological basis. Neurophysiological basis of empathy and emotions: mirror neurons and the theory of mind areas. Stress and burnout syndrome.

Lecture 7. Communication in medicine. Effective doctor-patient communication. Three separate stages in the interaction with the patient: opening; gathering information and going in depth; summary and closure.

Lecture 8. Effective doctor-patient interaction: preparing oneself to pay attention. Paying attention to interpersonal distance: proxemics. Body language and preparing the patient: touch. Perception of eye gaze. Body posture. First impressions. Perception of facial expressions of emotion and the mirror neurons.

Readings/Bibliography

Books:

A philosophical Basis of Medical Practice: Toward a Philosophy and Ethics of the Healing Professions by Edmund D. Pellegrino and David C. Thomasma

Virtues in Medical Practice by Edmund D. Pellegrino and David C. Thomasma

The following reading assignments will be made available to the students at the beginning of the course:

The following reading assignments will be made available to the students at the beginning of the course:

What makes research ethical.

Belmont report

Nuremburg Code

Jesse's intent by Paul Gelsinger

Ethics and clinical research by Beecher H. New England Journal of Medicine, 1966.

Rizzolatti G, Sinigaglia C. (2010). The functional role of the parieto-frontal mirror cicuit: interpretation and misinterpretation. Nat Rev Neurosci. 11:264-74.

Oosterhof NN, Todorov A. (2008). The functional basis of face evaluation. Proc Natl Acad Sci U S A. 105(32):11087-92.

Haxby JV, Gobbini MI. The perception of emotion and social cues in faces. (2007). Neuropsychologia, 45: 1.

Ekman P, Sorenson ER, Frisen Wv. (1969). Pan-cultural elements in facial displays of emotion. Science, 164: 86-88

Pellegrini S, Palumbo S, Iofrida C, Melissari E, Rota G, Mariotti V, Anastasio T, Manfrinati A, Rumiati R, Lotto L, Sarlo M, Pietrini P. (2017). Genetically-driven enhancement of dopaminergic transmission affects moral acceptability in females but not in males: a pilot study. Front Behav Neurosci 11: 156 (eCollection).

Teaching methods

Lectures with slides. At the end of each lecture a pdf with the powerpoint presentation will be distributed to students. Pdfs with the powerpoint presentations of the lectures will be the material to be reviewed for the written exam at the end of the course.

Attendance to learning activities is mandatory; the minimum attendance requirement to be admitted to the final exam is 66% of lessons. For Integrated Courses (IC), the 66% attendance requirement refers to the total amount of I.C. lessons. Students who fail to meet the minimum attendance requirement will not be admitted to the final exam of the course, and will have to attend relevant classes again during the next academic year.

Absences may be authorized upon receipt of proper justifying documentation, in case of illness or serious reasons. Excused absences do not count against a student’s attendance record to determine their minimum attendance requirement.

Assessment methods

Exam with multiple choice questions.

Teaching tools

The PDFs of each lecture will be available on online after class. Students will have the chance of reviewing the material and ask the instructor to go over parts of the lecture that were unclear.

Discussions among students will be encouraged through in class questions on the subject covered during each class.

Office hours

See the website of Maria Ida Gobbini