American Univesity of Beirut

Doing Ethics

​Physicians Patients and Society II (PPS-II) course: 3rd-year medicine students discuss contemporary issues and real case scenarios and relate them to legal, social, ethical and religious considerations (2012-2013): 
The PPS-II course has been going on for a number of years at AUBFM. From a purely face to face course to a blended course, it has proven to give the students the chance to see that the patient is not only a disease but an illness, not only a patient but a human being in all his/her different dimensions. With the varied sessions and lectures, ranging from ethical issues in surgery, pediatrics, allocation of scarce resources, genetics, ethics and the pharmaceutical industry, research ethics and others, students learned to appreciate the complexities of moral decision making and what comes with it. The PPS-II course is a one year course coordinated by Dr. Thalia Arawi and is currently being given by a team of 13 faculty members.

What do physicians say?
“I benefited from the involvement in the course in several aspects. The course forced me to update my knowledge in the field and to reflect more on how to better serve and act as a role model in ethical behavior for the students. My interaction with the students has been extremely positive and I was challenged and stimulated by their thoughts, questions, and enthusiasm for the subject. I feel this course has made a tremendous difference to the students and my hope is that their generation is now sensitized to the various ethical dilemmas that practicing physicians grapple with on a daily basis and will grow to become a better generation of physicians”.  (Dr. Faek Jamali, Associate Professor of Surgery & Vice Chair for Clinical Affairs; Program Director, General Surgery Residency)

"An integral and essential role in our residents’ education is clinical medical ethics. This cannot be done solely in a classroom but has to be incorporated in our daily teaching rounds. Not only will it make of us better physicians but it will also improve the process and the outcomes in patient care". (Dr. Marianne Majdalani, Director of Pediatric Critical Care)

"It was a teaching experience for me first. The more I was exposed to different groups of students, leading the discussion among them and debating as if in a political talk-show setup, the more I knew how much the sky of ethics doesn't seem to have an end and the more I discovered how ignorant I am in this subject. Thus, I started digging more into the concepts of ethics, built more restrictions on my research team, engaged myself and my research into more communication with the IRB people in our institution, and I found myself assuming responsibilities in related committees like DNA and stem cell research where ethics is there sitting behind the curtains and hiding between the lines but surely guiding the whole process and directing the bigger scene and ultimate goal: Human dignity and confidentiality rights". (Dr. Rami Mahfouz; Associate Professor, Director, Histocompatibility and Molecular Diagnostics)

“The course was an excellent example of process improvement. The presentations and discussions made the students and others become aware of ethical issues. The increased awareness resulted in the students’ ability to quickly notice any unethical unacceptable behavior of a few individuals. When this unethical behavior was reported or demonstrated in a role-play activity, it was then used for feedback which is known to result in improvement. (MD., name withheld upon request)

What do students say?
“I believe that course is a fundamental part of our medical education because as we get more experience in medicine we realize that it is a multidisciplinary field. Although many of us might have complained that the bioethics course took away from "valuable time for studying", but it is an indispensable part of our training. It provided me with the tools and means to communicate with patients, to approach them and to deal with their concerns in an "ethical" and compassionate way. Several instances I find myself unconsciously using the principles we learned in the course to deal with a patient who is financially unable to cover AUB expenses, or diagnosed with cancer and thinks he is receiving antibiotics, etc...” (Victor Chedid, Med IV)

“This course allowed me to get exposed to a variety of thoughts that people may hold concerning ethical issues. It also allowed me to express my ethical concerns about several dilemmas I face in my daily practice and to discuss them with my colleagues. Finally, this course gave us the eyes that will recognize ethical issues that may arise and that can be missed!” (Name withheld upon request)

“PPS-II is one of the best experiences of med school. The course is like a soul mate that accompanies you in your first year in clinical medicine, a time when you are still very fragile, challenged by the many ethical dilemmas. It carves you into a great physician who holds professional and ethical values that you would never compromise.” “It should seriously be considered over Med-IV.”(Akel Fahed, Med IV)

“It was really interesting to get introduced to the different types of ethical issues that we could face in the different specialties, and to have the opportunity to discuss what we face in the hospital.” (Name withheld upon request)

“Very good course because it opens our eyes to many ethical issues in medicine and also gives us the opportunity to share our ideas and opinions and to listen to those of others.” (Name withheld upon request)

“At the beginning of the course, I thought it's just a burden, an additional thing to worry about, an unnecessary load...but as the Med III year progressed, I found that it is intimately related to our daily lives in the hospital. We encountered so many cases that raised many of the ethical dilemmas we were discussing during the sessions. The forum was a space for my personal catharsis; it also helped me see things from other people's perspective. In the vertiginous life inside the hospital, the conscious ethical thinking may be numbed, so you need to train your unconscious mind to always see beyond the raw medical cases. This is what I learned to do...” (May Daher, Med IV)

"After this course, you will no longer be worried about questioning another doctor's behavior, attitude, or judgment. You will have some pointers to lean on when taking your own decisions, and when adjusting your own attitude and judgment. You will be prepared and capable of defending your choices, as well as accepting peer criticism. " (Julien Sukkar, Med IV)



Med II students debate ethics cases (2012-2013):
The class which consists of around 94 students was divided into 7 groups. Each group was given a different case which highlights an ethical dilemma. Students were given time to discuss the case and to report the way they would have handled the issue had this been their own case. This session took place after a 40 minutes presentation by Dr. Arawi on what it means to be a member of the medical profession, the symbols of medicine, the role of the physician and the main principles of medical ethics. Students were engaged, enthusiastic and lively discussions resulted. This session is part of a series of lectures in medical ethics given to med II students.



Case Presentations and Role Plays (2010 - 2011)
As part of their Med II medical ethics course, students were asked to come prepared to present a case which is an example of either “humane doctoring”, “inhumane doctoring” or one that poses an ethical dilemma that needs to be resolved. The case should be one which they encountered on the wards (during their OPD rounds, while shadowing a physician, or from personal experience). During the sessions, students lively presented their cases in groups and some engaged in role play. The engaging student in role play furthers active learning while students and audience enjoy themselves. In addition, medical faculty were present to give their feedback and comments on the cases that were presented. Students found this exercise to be very useful. Below are some comments: 

“I did find these sessions quite useful. Applying what we learn by contextualizing it is the best way to learn something so in that regard I found the session beneficial.” 

“I found the assignment useful. It allowed me to review the concepts of medical ethics & to identify them in real life situation. We found it easy and straight forward. It was also fun”. 

“I found this exercise useful in that it allowed us to look at the case from a different perspective, not from a superficial way; that is, when we tried to dissect it into the four principles of humane doctrine and acted it in front of the class, we even become more aware of how a "good" physician must interact and communicate with his physicians in a non-condescending manner and how to respect their rights to know the truth and to choose the mode of treatment. Personally, the only remark which I want to share is the lack of time because we were restrained by our busy schedule and did not find the adequate amount of time to better prepare for the presentation and play”. 

“I have found this exercise to be very nice and useful mainly because I got to see while working on my project and when I listened to others about the different approaches people have when handling issues that have to do with medical ethics”. 

“I found the exercise to be very useful and helpful. First, if all on an academic level we really had to discuss the ethical principles, down to their essence to see where they really fit in the different scenarios. 
It was also helpful to see the pitfalls of practicing physicians, and the patients' experiences in the process. It opened my eyes to the appalling breaches taking place. It feels like a future preventative measure against any unethical principle I might unintentionally breach”. 



Med II Student Medical Ethics SPEC Activities (2009 - 2010)
In 2010, Students of Med II discussed complex medical ethics cases during Student Centered Problem Based Experiential and Collaborative Learning (SPEC) sessions and reported how they would deal with these ethical dilemmas to their colleagues using posters of their making during class. The class was divided into 8 groups and each group was given a different complex medical case with a moral dilemma. Groups were given 15 minutes to discuss the case and a student and 10 minutes to report on the case to the class. The discussions were lively and full of debates. Beauchamp and Childress principles of medical ethics were used as well as Sigler’s and Jonson's four boxes approach to a clinical dilemma. 


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