'Murder or Mercy?' an innovative module helping UK medical students to articulate their own ethical standpoints regarding end-of-life decisions

Objectives This student selected component (SSC) was designed to equip United Kingdom (UK) medical students to respond ethically and with sensitivity to requests they might receive as qualified doctors in regard to euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and to provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment. Method The module is delivered by specialists from a number of disciplines including law, theology, medicine and nursing, each providing students with a working knowledge allowing them to actively discuss cases, articulate their own views and practise ethical reasoning through group and individual study. Visits to local intensive care units, palliative care wards and hospices are integrated effectively with theory. Student assessment comprises a dissertation, student-led debate and reflective commentary. Module impact was evaluated by analysis of student coursework and a questionnaire. Results Students found the content stimulating and relevant to their future career and agreed that the module was well-structured and that learning outcomes were achieved. They greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to real cases and to debate ethical issues with peers. Students reported an increased discernment of the ethical and legal position and practical considerations and a greater awareness of the range of professional and lay viewpoints held. Student perceptions were confirmed on analysis of their submitted coursework. Many participants were less strongly in favour of euthanasia and assisted dying on module completion than at the outset but all felt better equipped to justify their own viewpoint and to respond appropriately to patient requests. Conclusions The multi-disciplinary nature of this course is helpful in preparing students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position.

Reintegrative and Disintegrative Shaming:Legal and Ethical Issues

Abstract
This chapter considers a range of legal and ethical issues raised by the use of reintegrative and disintegrative shaming techniques (Braithwaite, 1989) with sex offenders. ‘Disintegrative shaming’ labels and stigmatises offenders, ostracises them from the local community and may result in violence directed towards offenders (McAlinden, 2005, 2007). ‘Reintegrative shaming’, on the other hand, focuses on rehabilitating the offender within a supportive community environment and assisting the offender in their efforts to change. The former is evident in the range of recent legislative responses designed to protect the community from sex offenders such as notification as well as the popular demand for measures which ‘name and shame’ known sex offenders. The latter is more clearly related to restorative measures such as circles of support and accountability. This chapter argues that although traditionally at opposite ends of the intervention spectrum, each type of mechanism gives rise to potentially difficult legal and ethical considerations.

A Delicate Balancing Act: Negotiating with Gatekeepers for Ethical Research When Researching Minority Communities

Research and processes of knowledge production are often based on racialised and imperialistic frameworks that have either led to the exclusion or pathologisation of minority groups. Researchers address issues of exclusion by adopting recruitment strategies that involve negotiating with gatekeepers to ensure the inclusion of minority or marginalised groups. This often involves in-depth scrutiny of gatekeepers and requires the researchers to negotiate deals and to make personal disclosures. However, there remains relatively little discussion on the pragmatic ethical issues facing researchers in the field as a result of these interactions.
This paper suggests that interactions with gatekeepers present ethical issues that can be effectively addressed and managed by researchers through the exercise of phronesis. This allows researchers to make critical ethical decisions based on the specific characteristics of the research sites and subjects, not least of which are those issues that emerge as a consequence of researcher positionality. Such decisions are not necessarily identified or accommodated through bureaucratic processes which govern research ethics. We advance the notion of research ethics as an ongoing process that requires researcher skills and engagement, rather than one where it is a one off bureaucratic exercise.