Recommended Curriculum For The Teaching of Professionalism and Ethics in Optometry: Part 1

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There is a growing interest among health care professional schools to include an ethics component in their core curriculum. In addition, the ethical demands upon optometry have been greatly increased by changes in the scope of optometry, alterations in the traditional modes of health care delivery, increased complexity in the methods of reimbursement, and developing national trends toward managed care. All of these factors indicate a need to revise the ethics curriculum in the schools and colleges of optometry.

The goals of an optometry ethics curriculum are to enable graduates to recognize, critically analyze, and resolve the ethical issues that may arise in the practice of optometry. Ethics should be treated as a reasoned discipline in its own right and not simply as either abstract goodheartedness or unquestioning devotion to code of conduct. The curriculum must be structured so as to enable students to deal with new and emerging ethical issues. In addition, the moral basis of the contract between health care professionals, their patients, and society must be clearly drawn. The sources of morality are many and diverse, including religion, the family, education, customs, traditions, history, and the law. Pluralism may be bridged by ethical thinking, which hopefully will lead to clear, consistent, coherent guides to moral behavior.

The major purpose of including ethics in the optometry curriculum is to promote ethical and professional behavior. Such behavior addresses the interests of patients and society first, likewise serving the interests of the professional. This behavior may be fostered by treating ethics as a rigorous intellectual discipline.

Professionalism in optometry includes adherence to the standards of acceptable professional behavior and possession of the virtues to which the professional should aspire. Studying the evolution of optometry as a profession helps the student to understand the environment within which these standards and virtues have developed.

The optometry ethics curriculum should not be strictly theoretical, but should be based on the analysis of cases oriented to the delivery of health care and to the practice of optometry. This case-oriented approach permits ethical theories and principles to be put into useful practice and encourages the development and use of critical thinking skills. Furthermore, the ethics components of health care delivery must be taught and reinforced throughout the optometric curriculum, particularly in the clinical settings.

Educational Goal

The curriculum for professionalism and ethics should develop decision-making skills that will contribute to students' ethical behavior and deepen their understanding of the moral dimensions of the practice of optometry. It should promote students' understanding of and commitment to incorporating the ideals of the optometric profession into all aspects of the practice of optometry, especially as they concern patient care.

Behavioral Objectives

As a result of the curriculum for professionalism and ethics, students will be able to demonstrate a working knowledge of the principles of ethical reasoning and its application to the practice of optometry, consistent with the ideals of the profession.

An Outline of the Core Content of the Recommended Curriculum in Professionalism and Ethics

The Optometric Profession and Professionalism
1. Background Issues
  1. Definitions - profession, professionalism
  2. Profession compared to trade
  3. Social, public & community responsibilities of a professional
2. The Evolution of Ethics in Health care
  1. The Hippocratic Oath (between 5th and 4th Centuries BCE)
  2. The evolution of standards of professional behavior from the period of Hippocrates to the present period
  3. Technology, patients' rights, and modern bioethics
3. The History of Professionalism in Optometry
  1. The history of the profession of optometry
  2. The history of ethics with the profession of optometry
  3. The role of local, state, and national optometric professional organizations
  4. Introduction to the Code of Ethics of the American Optometric Association
  5. The Optometric Oath
4. The regulation of Optometry
  1. Legislative
  2. Adminsitrative agencies
  3. Judicial
Ethics
1. Background Issues
  1. Definitions - ethics, professional ethics
  2. Why study professional ethics?
  3. Distingusihing ethics from law and religion
  4. Ethical judgments: objectivity and relativism
2. Ethical Theory
  1. Making ethical judgments: Appealing to consequences (teleological) or duties (deontological)?
  2. Ethical principles
    1. autonomy
    2. nonmaleficence
    3. beneficence
    4. justice
  3. Interaction of principles in ethical decision-making
    1. beneficience (paternalism) vs. autonomy
    2. rights and duties
    3. distributive justice
  4. Virtues in health care (compassion, honesty, integrity, etc.)
3. Applied Ethics (The ethical doctor)
  1. Responsibilities to patient
    1. truth-telling
    2. confidentiality
    3. informed consent
    4. maintaining competence
    5. fiduciary responsibilities
  2. Responsibilities to colleagues
  3. Responsibilities to society
4. Ethical Analysis of Codes of Ethics
5. Framewotk for Ethical Decision-Making (Moral reasoning/Critical thinking)
  1. Identify the ethical issue(s) or dilemma(s)
  2. Identify the morally relevant facts
  3. What moral principles/ethical codes are involved?
  4. List possible actions (What could you do?)
  5. List possible outcomes from possible actions
  6. Which action is best supported? (What should you do?)
6. Case Studies/Applications