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Call for Abstracts - ICCEC 2018

The Organising Committee of the 14th International Conference on Clinical Ethics Consultation (ICCEC) invites you to submit abstracts that address the conference main theme or any of the sub-themes.

Abstract Guidelines

1. General Conditions

  • The deadline to submit abstracts is Friday 15th December. Abstracts received after this date will not be accepted.
  • Only abstracts submitted in English will be reviewed.
  • Abstracts should be original work that has not been previously submitted for publication or presented at another conference
  • A maximum of two (2) abstracts may be submitted per presenting author (including symposium presenters).
  • Abstracts must not exceed the word limit stated below for the respective presentation type.
  • All abbreviations must be spelled out on first use.
  • To be formally accepted, the presenter (or all presenters for a symposium) must be registered and have paid to attend ICCEC 2018 by 31st March 2018

2. Abstract Themes

Each submission should be classified into one of the following themes: Within these themes the committee will consider a broad range of content. We have provided some examples of areas that might fit within each theme for general guidance only –we encourage you to submit abstracts outside of these examples.

  1. a.Ethical challenges in the clinic: impetus for research and learning

Example

  1. i.Innovation at the boundary of treatment and research What counts as innovation, and which ethical models and values should apply.
  2. ii.Rationing in clinical practice. How resource limitations influence practice and the ethical implications of different coping
  1. b.Theoretical foundations and conceptual frameworks

Example

  1. i.Different models of CES arising from different philosophical positions and traditions
  2. (How) can ethical theory improve CESS? Is theoretical knowledge a prerequisitefor quality in CESS?
  1. c.Empirical ethics emerging from and informing practice
    1. i.Evaluation of CES
    2. ii.Research on ethical challenges in specific clinical areas
    3. iii.Does clinical ethics mitigate moral distress?
  1. d.Translating across global contexts
    1. i.Can/should curriculums and models of CES be transferred to different global settings and cultures?
    2. ii.Medical research in low income settings creating clinical ethical dilemmas?
    3. iii.Does autonomy engender bioethical imperialism?
  1. e.Translating to advocacy and policy
    1. i.Developing/influencing policy on treatment of asylum seekers and other migrants
    2. ii.The role of clinical ethics in national policy debates eg Physician Assisted Suicide, Organ transplantation, use of gene therapy

 

3. Types of Presentation

The preferred mode of presentation can be selected during abstract submission. The final mode of presentation for the accepted abstracts will be determined by the Scientific Committee.

Oral Presentations and case studies

  • Presenters will be allocated 20 minutes to present and engage in discussion
  • Abstract Word limit: 300 words

Case studies

  • Presenters will be allocated 30 minutes to present and engage in discussion
  • Abstract Word limit: 300 words

Symposium

  • Presenters will be allocated 1 hour for a panel discussion
  • Up to 4 panellists, in addition to the Chair, are permitted for the symposium.
  • Abstract Word limit: 500 words (inclusive of a summary of each panellist’s topic)

Poster Presentation

  • There will be a dedicated area and timeslot for poster presentations and interactions with delegates
  • Abstract Word limit: 300 words

Registration for Abstract Submission

Please have the following details of the Author and Co-Authors ready for the abstract submission

  1. First Name
  2. Last Name
  3. Country
  4. Institution/ Organisation
  5. Profession

Abstract Submission is open at http://ime.datawareonline.co.uk/Abstract-Submission/Submission-Form  (please note that you will need to either log in to the website or register before you can submit an abstract)

 

Abstract Receipt Confirmation

Upon successful submission, the main author will receive an automated acknowledgement via email.  No further action is required. 

Following the conference accepted abstracts will be published in the Journal of Hospital Ethics with the authors consent.

Important Dates

Important dates

Closing of abstract submissions

Friday 15th December 2017

Notification of acceptance

Friday 23rd February 2018

Confirmation of acceptance

Friday 9th March 2018

Launch of early bird registration rate

Friday 5th January 2018

Deadline for bursary applications

Friday 23rd February 2018

Deadline for early bird registration rate

Friday 20th April 2018

Deadline for standard registration rate

Friday 15th June 2018



IME 2017 AGM

The IME AGM will take place at 6.45pm on 26th September 2017 in the Henry Wellcome Auditorium at the Wellcome Collection, 183 Euston Road, London NW1 2BE.

The AGM will be preceded by the Lewis Headley Lecture, delivered by Professor Richard Huxtable, Professor of Medical Ethics & Law, and Deputy Director of the Centre for Ethics in Medicine at the University of Bristol who will present ‘A Balance of Opposites? Ethics, Judges and Minimally Conscious Patients’.

Following the AGM there will be a drinks reception and an opportunity to network.

Please find links below to an agenda for the 2017 AGM, a copy of the minutes of the 2016 AGM, and some statistics showing IME activity during 2016.

Best wishes,

The IME team

2016 AGM Minutes

2017 AGM Agenda

2016 Statistics

2016 Accounts



Elective Bursaries: Transitional round of bursaries to be awarded for 2018

(If you are already in receipt of an IME bursary, this notice does not apply to you.)

After careful consideration, we are changing the dates for the award of our elective bursaries to reflect the change in the timing of the electives in the majority of medical schools.

 

To allow this to happen as smoothly as possible, we will be working to the following transitional timeline for bursaries to be awarded for 2018:

Closing Date: Midnight Monday 2 October 2017

Students to be informed of outcome by: Friday 24 November 2017

A permanent bursary timeline for 2018/19 onwards will be circulated in due course.

The latest application form and guidelines for this transitional round are available on the awards page of the website, along with an additional document entitled Research methods in medical ethics - IME guidance for Elective Bursary Projects which we would encourage applicants to read. Please use only these documents for this transitional round.



Speaker slides & delegate handbook now available to view: Ethics Education after Medical School 5 June 2017, St Catherine's College, Oxford

Click on Resource centre to view.



Undergraduate conference report by IME grant recipient, Simrit Kudhail

KUDHAIL Image_presentationSimrit is a 4th year student at University of Birmingham who was awarded IME funding to enable him to attend & present at the UNESCO 12th World Conference in Bioethics on 21-23 March in Limassol, Cyprus

The UNESCO Bioethics conference was established to provide academics and healthcare professionals from a wide range of fields with a forum to discuss prevalent and emergent issues of bioethics, healthcare ethics and medical law. Conference attendees represented many different countries and professions, allowing cross-disciplinary and cross-cultural presentations and discussions of these issues, with the aims of raising awareness and presenting novel ideas or possible solutions to a range of ethical issues.

I attended the conference to present the research I conducted during my Healthcare Ethics and Law intercalation year at the University of Birmingham, in which I discussed whether religious patients should be considered autonomous in their decision-making. I hoped that by discussing my research with experts in the field, I would gain a valuable insight into the strengths and limitations of my work, allowing me to develop it further before aiming for a publication. I also hoped to hear others' research on autonomy and see whether my notions of autonomy were similar that of the other presenters, and also whether my research was applicable to their presentations. In this report I reflect on the presentations concerning patients' autonomy and their implications on my own research.

My main area of reflection concerned the difference in the use of autonomy between myself and the other presenters; where my research intended to provide a theoretical revision of autonomy as a rational concept, others' presentations concerned autonomy as a practical principle that all patients ought to have. One such presentation by a Sudanese doctor discussed the rights of adolescents in decision-making in Sudan (Ebtihal Eltyeb, Saudi Arabia). Her presentation eluded to the use of something similar to Gillick-Fraser competence, but it was interesting to hear her attempts to establish a criteria by which adolescents could be given the right to their own healthcare decisions whilst also managing complex cultural traditions (for example examination by doctors of the opposite sex). Another presentation by a British academic discussed the use of a new toolkit (the Mental Capacity Assessment Support Tool, M Jayes, University of Sheffield) which allows healthcare professionals to ensure patients have the capacity to make their decisions. Once again this used autonomy as a practical principle, using Beauchamp and Childress' concept of autonomy as freedom from external influence, achievable through capacity and informed consent.

In this respect, my research was significantly different. I felt a to think theoretically to determine if religious and cultural beliefs were philosophically compatible with autonomy by critiquing whether philosophical accounts of autonomy allowed external influences on decision-making. To do this, I had to move away from the use of autonomy as freedom from external influence, as religion and cultural traditions are themselves external influences. All of these accounts suggested autonomy needed some rational aspect in the decision-making process, whether it is hierarchical desires, coherence with other beliefs, or normative competency. Therefore my research concluded that theoretically, religious or cultural beliefs that have undergone some rational critique can be considered autonomous – a process which I called rational consideration. Thus my presentation was theoretical instead of practical, and concerned autonomy itself rather than the practicalities of decision-making.

The difference in definition was made clear after my presentation, as the first questioner asked "but is autonomy actually rational?" To me, this made it clear that many people do not see autonomy as a property in its philosophical sense, and instead use the word autonomy as a synonym for the patient's own choice which does not necessarily involve a rational component. Thus my reply to the question had to make it clear that I felt our current view of autonomy has moved too far from its philosophical origin, as autonomy is necessarily rational, and I therefore felt non-rational decision-making cannot be considered autonomous. Replying to this question sensitively was one of the hardest aspects of the presentation, and this stressed the importance of making this ethical distinction clearer in my development of this research.

Alongside talks on autonomy, I also attended the sessions run on medical ethics education, disaster ethics, and ethical implications of end of life treatment. One of these presentations - 'Mediating Religious Objections to End-Of-Life Care' (Kartina Choong, University of Central Lancashire) - explored the use of mediation between families and medics as a way to overcome possible conflicts between the religious beliefs of the patient or the patient's family and the medical team. Interestingly this research reached a similar conclusion to my own, in suggesting accepting dissent of treatment on the grounds of their perceptions of their religious belief is not necessarily the right option. Instead, the process of mediation allows the medical team and the patient's family to explore the beliefs in question, and discuss the best outcomes for the patient. This process is in essence similar to the process of rational consideration which I suggested was necessary to ensure decision-making based on religious influence can be considered autonomous; the difference being that the rational process in Choong's research is done by a group on behalf of an individual, whereas rational consideration as I described it is done by the individual themselves.

Whilst this report focuses on autonomy and religious belief, it was inspiring to see a wide range of people discussing a variety of topics concerning medical ethics. Attending a conference with the primary aim of exploring issues in bioethics, healthcare ethics and law across the world has made it clear that medical ethics is incredibly relevant in today's society, and it is becoming more significant globally Yet the cultural diversity we see means that one solution for a given problem isn't always possible, and cultural beliefs and practices affect the ethical issues we will face. Thus it is important we discuss these issues globally in an attempt to find the best solutions possible at that time, and plan for future developments in medical ethics.



Postgraduate conference report by IME grant recipient, Helen Smith

Helen is a PhD student, University of Bristol, who was awarded IME funding to enable her to attend CEPE/ETHICOMP 2017: Values in Emerging Science & Technology on 5-8 June in Turin, Italy

Ethicomp is a series of conferences which consider computer ethics conceived broadly to include philosophical, professional, and practical aspects. It has held conferences since 1995 in Europe and Asia. CEPE (Computer Ethics and Philosophical Enquiry) has been running since 1997 and is more narrowly focussed on the philosophical aspects of computer and information ethics. The CEPE/Ethicomp 2017 was the third joint event which they have held, this time kindly hosted by the Department of Law at the University of Turin, Italy, from 5-8 June 2017.

Around 100 delegates attended; I met professionals, students and academics from Europe, Asia, Australia and North America. The interdisciplinary ethos meant that there were contributions brought from a variety of sectors such as computer scientists, policy makers, lawyers, ethicists, philosophers, social scientists, gaming as well as health technology. The warm, friendly and supportive attitude within the attending community encouraged space for constructive feedback after presentation of each contributor's paper.

Those presentations which were specifically relevant to the medical ethics community included:

Katleen Gabriel's presentation "Between 'Entertainment Medicine' and Professionalization of Healthcare: An Interview Study of Belgian Doctors" identified the rise in enhanced selfcare utilising new technology e.g. blood pressure monitoring, blood sugar monitoring. Her study asked Belgian GPs and Cardiologists how they'd felt about the rise of the use of digital tracking. Patients wanted more dialogue with their doctors and did not wish for the technology to surpass their physician's expertise. Unreliable tech had made one cardiologist angry as it was taking his time away from people who had genuine needs. Drs did not feel that they were losing their authority to tech, but were afraid of the data overload and loss of context. Overall, with data gathered, one can have a clear and more accurate conversation with patients. But the time saved will probably get used to see extra patients rather than spending more time with the individual patient.

Frances Shaw's presentation of "Ethics in the design, research, and evaluation of mHealth and eHealth solutions for mental health: a qualitative study of a research institute" reported on the ethical development she has been doing for the Socialize App (a smartphone app which associates changes in social networks over days/weeks may indicate mental health problems developing) which is in early prototyping. There is concern for the maintenance of privacy as GPS data discloses the home and workplace of individuals and that this data creation is passive and opposite to the act of active and willing disclosure of illness; that disclosure is made on behalf of the individual rather than by the individual which interferes with the person's agency. She identified that Big Data is shaping our state of being and that we should anticipate the development and then theorise the ethics before application rather. For example; there is no identification of the responsibility of initiating the intervention for the person who has been identified as being at risk of being mentally unwell- who should respond once the app has raised the alarm?

David Krep's and Oliver Burmeister's presentation of "I am a Person" spoke of how we are both radically contingent and unique, that in age related cognitive decline the physical motor accompaniment to our mental and emotional lives begins to deteriorate. Value Sensitive Design (VSD) seeks to explicitly support human values in assistive technologies. Through this, power can be identified in an intentional way which will help with the realisation of a society in which technology is a force for empowerment rather than for domination.

I would like to take this opportunity to thank the Institute of Medical Ethics for making it possible for me to attend this event.



National Student Debate Final 2017

A huge well doneto Queen's University Belfast, who battled it out against University of Warwick to emerge the winners of the National Student Debate Final on Saturday 25 March in Manchester.The motion was: UK medical graduates should either work for the NHS for four years or pay back the cost of their education after graduation.

Congratulations Queen's! ... and well done to Warwick for being worthy opponents.

Thank youtoall the teamswho entered and reached the final: Queen's University Belfast, University of Exeter, University of Manchester, University of Leeds, University of Warwick, Hull York Medical School, St George's University London & University of Sheffield.

Huge thanks too to our panel of judges: Georgia Testa, Bryan Vernon, Pirashanthie Vivekananda-Schmidt, Andrew Papanikitas, Demian Whiting, Sarah Carter, Anne Slowther & Vivienne Crawford.

Details of next year's National Student Debate Competition will be announced later this year.

Queens Belfast_winning_team

Winners! Queen's University Belfast

Exeter runners_up

Runners-up, University of Exeter



Posters by Titilopemi Oladosu, King's College London

Titi is a past recipient of an IME Elective Bursary which enabled her to travel to Nigeria in 2013 for her project entitled: Ethico-Legal Issues and Nigeria's Mental Health Act: Health Workers' Perspectives. This was a qualitative study focusing on health workers' perspectives of the 'lunacy act' in Nigeria, and the ethico-legal issues which arising from implementation (or lack) of the act. Titi's work involved one-to-one interviews with members of the Ministry of Public Health, health practitioners, and NGOs focusing on mental health.

Take a look at her excellent posters below highlightingthe project.

Titi orally presentedat The World Psychiatry Association International Congress, November 2016 in Cape Town, South Africa.

In poster form,her work has been presented at the Royal College of Psychiatry International Conference 2014 and the Royal College of General Practitioners National Conference 2016.

Pathway to Care - Exploring Accessibility & Delivery of Mental Healthcare in South West Nigeria

Mental Health Ethics & Law in South West Nigeria



Elective Report by Laura Shorthouse, 4th Year Medical Student, University of Liverpool

Below is Laura's report following her recentIME elective in Zambia earlier this year ......

A personal reflection of ethical dilemmas encountered, and the cost-benefit analysis to Livingstone Central Hospital in Zambia for hosting my elective in maternal, neonatal and child health.

During my five-week elective I gained hands-on experience in maternal, neonatal and child health at Livingstone Central Hospital, and in three local community districts served by the hospital - Linda, Maramba and Mwandi. Working days contained rich and varied learning opportunities to accomplish my goals and professionally develop, but also, provided powerful ethical dilemmas and lessons in people, life and myself, forever shaping my future medical career and character.

Ethical dilemmas

I was introduced to the labour ward on my first day, which was an unforgettable first impression. From the initial ethical 'horror' I felt and not wanting to return to the ward, to the in-depth personal and professional thinking it evoked, to finally overcoming it- it was a life changing experience in growing as a future doctor and person. In a large curtain-less room three women were giving birth in silence and shouted at when they made a noise. The first delivery I witnessed in Africa was stillborn twins.

They were left for over five minutes unwrapped on their mother's lap while the midwives cleaned the floor. They were then disposed, without any opportunity to say goodbye. I wanted to comfort the mother but felt it an inappropriate first impression. Instead, I stood there shocked holding back tears. I found this opening hour to 'obstetrics in Africa' cruel, insensitive, detached and degrading with no patient empowerment. I did not want to go back and play any further part.

As the initial shock of witnessing a different cultural and geographical approach to labour eased, I shamefully realised I was being judgemental. I was impinging my ideology of ethical practice onto others, disregarding their culture and traditions as though the ' west' approach was best. I was determined to overcome this dilemma by returning to the ward and learning more about their culture and ideology. I came to understand that Zambian women have adopted a tough 'carry on' exterior because sadly losing a baby is more of the 'norm' in their culture than mine, as well as them feeing grateful to still be alive post childbirth- to them it is the best way of moving forward. They prefer silence because it is important for them to introduce their baby into a calm environment. Being silent is their personal, empowering and autonomous choice, rather than the oppressive, degrading and paternalistic one I wrongly assumed. Subsequently whilst this was foreign to me, I had chosen to work here and believed it important to respect their wishes and culture moving forward. I therefore felt I was subconsciously empowering my patients and respecting their autonomy thus providing good medical practice; albeit in a very different way to home.

The English language, whilst the official language of Zambia and that of medicine, was predominately limited to wealthy well-educated families, or young children benefiting from international volunteering projects teaching English. Consequently there were several occasions, notably obstetrics and gynaecology, where I needed translators. These were not third party impartial translators like in the UK, but either other doctors, the patient's family or their own children. Where possible I would have preferred doctors, however I did not want to ethically burden my overworked and understaffed host, so relied mostly on the latter two. Taking obstetric and gynaecology histories involve asking many sensitive, intimate and personal questions, which I found not only uncomfortable asking others but took longer. I overcame this discomfort by remembering it was necessary to gather information to treat effectively. In paediatrics, I tried to obtain the history from the child which given their good level of English was more possible and I preferred.

Zambian doctors rarely introduced themselves to the patient, asked how the woman or child was, or sought consent appropriately. No curtains separated the beds and handwritten patient notes were left on makeshift tables often next to the wrong person visible for all to see. Doctors would discuss patients loudly for others to hear and examine them in full view on the ward. Whilst I could not change this practice, I conducted myself in the manner I would back home with some improvisation where necessary. I always introduced myself especially explaining why I was working in the hospital, spoke quietly so only the patient could hear, and asked a colleague to hold a sheet up around the patient's bed when I wanted to examine them privately.

Medical tourism: cost-benefit analysis

I believe my elective benefited the hospital and population it served. Livingstone Central is adjusting to a significant time in its history and facing added pressures that come with a tertiary status. I was an enthusiastic and highly active team player getting involved, and providing teaching opportunities for clinicians to undergo professional development especially on ward rounds. I also impacted my knowledge and experience, which having just completed and passed my medical school finals was of a high standard, and therefore, I believe I facilitated a mutual learning environment. I worked within my competency independently clerking and monitoring patients with minor complaints, so senior clinicians could attend to major complaints and emergencies. I therefore crucially alleviated staffing problems safely without compromising reputations or the work of other staff members.

However, despite only asking the doctors to translate when no-one could speak English I felt guilty for creating extra work for them. Subsequently, if patients could speak some English I preferred to spend longer taking a history than asking the doctors. I would advise medical students to act this way, learn some local/ tribal language where possible, and be acquainted with a place's culture/ customs before arriving.

Conclusion

A complex relationship exists between medical ethics and external influences. Successfully navigating cross-cultural medical ethics requires sensitivity, non-judgemental attitude, and enhanced communication and clinical skills. Through a rich and enjoyable personal elective experience, this study supports the evidence-base 8-10 that electives in developing countries can be beneficial to all.

Word count (997- excluding title, acknowledgement, references)

Acknowledgement

Thank you to the 'Institute of Medical Ethics' for a Medical Elective Bursary.

References

The CIA world fact book (2016) 'Zambia' https://www.cia.gov/library/publications/the-world-factbook/geos/za.html. (Accessed 26th August 2016)

World Health Organisation (2012) 'Country cooperation strategy at a glance: Zambia'. http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_zmb_en.pdf (Accessed 26th August 2016)

World Health Organisation (2016) ' Zambia' http://www.who.int/countries/zmb/en/ (Accessed 26th August 2016)

World Health Organisation (2015) 'Zambia: WHO statistical profile' http://www.who.int/gho/countries/zmb.pdf?ua=1 (Accessed 26th August 2016)

Unicef (2016) ' Zambia: HIV and Aids' http://www.unicef.org/zambia/5109_8459.html (Accessed 26th August 2016)

Our Africa (2016) 'Poverty and Healthcare' http://www.our-africa.org/zambia/poverty-healthcare (Accessed 26th August 2016)

Post Zambia ( 2015) 'L/stone hospital starts operating as tertiary medical institution' http://www.postzambia.com/print.php?id=3441 (Accessed 10th November 2015)

Ackerman LK. The ethics of short-term international health electives in developing countries. Ann Behav Sci Med Educ2010;16:403

Hanson L, Harms S, Plamondon K. Undergraduate international medical electives: some ethical and pedagogical considerations. J Stud Int Educ 2011;15 (2):17185.

Banerjee A et al, Medical student electives: potential for global health?Lancet 2011;377 (9765):555.