Advanced Clinical Ethics

Respect for autonomy is a prominent guiding principle in Western medicine and in medical ethics. Autonomous persons are often in the best position to determine what would be good and bad for them and therefore respect for autonomy generally promotes a patient’s well-being. In order to respect a patient’s autonomy, physicians are thus usually required to defer to patients' own decisions about how to manage their medical care.

But respecting a patient’s autonomy is sometimes easier said than done. The purpose of this course is to explore some of the ways in which physicians’ duty to respect patients’ autonomy can become ethically challenging. First, respect for patients’ autonomy involves more than simply deferring to their wishes, and thus it imposes positive duties on physicians to both take steps necessary to promote autonomous decision-making and to eliminate obstacles to autonomy. What do such duties involve? Second, some patients – perhaps all at one point or another – lack the relevant decision-making capacity when healthcare decisions must be made, and thus someone else must be charged with making decisions on their behalf. On what basis should the surrogate make such decisions? And what are the obligations of physicians when they believe surrogates are not choosing what is in the best interest of the patient? Third, patients’ autonomous choices can at times conflict with physicians’ own autonomy. How should these conflicts be solved? Does the autonomy of patients always trump that of the physician?

Given that clinical practice is varied and complex, we will identify and critically evaluate these questions and challenges by focusing on various areas of clinical practice, from end-of-life decisions, to organ donation, to reproductive choices, to pediatrics.

At the end of this course, you should be able to:

Learning Objectives WCM Core Competencies Assessment Method(s)
Identify and analyze ethical challenges in clinical care, including strategies to prevent and manage ethical problems. P-2; PBLI-3 faculty/resident rating, paper/essay
Describe the principles underlying the care of patients with pain and suffering at the end of life. K-4; ICS-1; P-2; P-3 faculty/resident rating, paper/essay
Demonstrate the ability to navigate difficult conversations with patients, surrogates, and colleagues while respecting cultural diversity and patient values. ICS-1; ICS-2; P-3 faculty/resident rating, paper/essay
Demonstrate an ability to recognize and address clinician moral distress. ICS-2; P-1; P-2 faculty/resident rating, paper/essay
Recognize the contributions of all team members in ethical decision making. ICS-2; P-2 faculty/resident rating, paper/essay

If you have any questions, please contact the Course Director, Ellen C. Meltzer, M.D. (

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