Speaking Up: An Ethical Action Exercise.

Problem: Health care professionals encounter situations in which they need to speak up to prevent harm, ensure better care, and/or address unprofessional behavior. Speaking up is often difficult, especially for medical students; nonetheless, it is a skill students must practice, so they can better advocate for patients.

Approach: The authors have designed an ethical action exercise and incorporated it into a required bioethics course that meets concurrently with third-year clerkships.

Deception, discrimination, and fear of reprisal: lessons in ethics from third-year medical students.

Purpose: To systematically examine ethical conflicts reported by all State University of New York Upstate Medical University third-year students, compare them with conflicts reported in the literature, and identify content areas that compel new or renewed emphasis in national educational objectives, standard curricula, and texts.

Method: From 1999 to 2002, all third-year students submitted papers for a required bioethics course. These papers depicted ethical issues arising during clinical clerkships.

Common variable immunodeficiency and breast cancer.

We describe two women with early onset breast cancer (at ages 31 and 38) who were found to have common variable immunodeficiency (CVID). Both women had a history of frequent and unusual bacterial infections. The incidence of breast cancer in young women and of CVID are both low, and the coincident diagnosis in two patients from a relatively small population base suggests the possibility of a pathophysiologic or causal relationship.

Discussing religious and spiritual issues at the end of life: a practical guide for physicians.

As patients near the end of life, their spiritual and religious concerns may be awakened or intensified. Many physicians, however, feel unskilled and uncomfortable discussing these concerns. This article suggests how physicians might respond when patients or families raise such concerns.