Ethics Education in the Health Professions

Abstract

Health professions education can benefit from the embodiment of a diversity of perspectives; this is because critical engagement with one’s own orientation toward health practices helps one understand the perspectives of those one serves, and better situates one to reflect on and improve one’s own practice. Ethics education is no different; however, it can raise two additional complexities. First, because the philosophical theories that underlie ethical principles are complicated, there is a temptation to avoid their engagement in educating health professionals and restrict ethics content to professional norms, or to engage theories at a superficial level. Second, because health professions students often find themselves less versed in philosophy, their interests are seen to align with that superficial engagement. This chapter responds to these two complexities by highlighting key ideas within three ethical approaches that undergird health professions practices: deontological, consequential, and virtue-focused theories. Theoretical connections are drawn, first to a principle, second to a broad field, and finally to a self-reflective educational feature, allowing for a scaffolding of educational complexity. The hope of this chapter is that educators will embrace philosophical complexity, instead of shying away from it, and that health professions students will be all the better for it.

15.1 Introduction

Health Professions education can benefit from the embodiment of a diversity of perspectives. This is because critical engagement with one’s own orientation toward health practices better situates one to understanding the perspectives of others—especially patients and clients—that one serves, as well as placing a practitioner in a better situation to reflect on, revise, and improve their own practice. Ethics education in the health professions is no different; however, it can raise additional complexities on two fronts. First, because the philosophical theories that often underlie ethical principles germane to the health professions are complicated, there may be a temptation to avoid their engagement in educating health professionals and restrict ethics content to professional norms and codes or to engage theories at a superficial level. Second, because health professions students often find themselves less versed in philosophy than other areas, their interests are seen to align with (and they are understood to benefit from) the aforementioned superficial theoretical engagement.

This chapter attempts to respond to these two complexities by highlighting key but intuitive ideas within three philosophical ethical approaches that undergird or influence health professions practices—deontological, consequentialist, and virtue-focused theories. This chapter does not offer a deep dive into any of these theories; rather it frames each within a basic discussion of the structure of human action. First, a deontological, rule-focused approach is discussed and connections to a common principle within healthcare—autonomy—is illustrated. Second, a consequentialist (or outcome-based) approach is discussed and connections to a common (and increasingly weighty) health field, public health ethics, is illustrated. Finally, a virtue-focused approach is discussed and connections to a health professions education is illustrated. The discussion of theoretical connections—first to a principle, second to a broad field, and finally to a self-reflective educational feature—allow for a scaffolding of educational complexity; this complexity is mirrored in the way in which each theory is discussed. The hope of the chapter is that educators will embrace this complexity, instead of shying away from it, and that health professions students will be all the better for it.

15.2 The Structure of Human Action

The complexity of philosophical theories and the interconnectedness of features of large philosophical systems can offer a daunting task for health professions students and a heavy lift for health professions educators in teaching ethics courses. Each can, unfortunately, reinforce the other, resulting in a perception that a superficial engagement with ethics ideas, or the jettisoning of ethics sources in favor of unmoored professional norms, are viable options for ethics education in the health professions. However, even those of us who recognize the complicated nature of much philosophical argumentation and believe that careful philosophical arguments repay rereading and the time devoted to them should admit that complexity builds as ethics deepens, and that an introductory course in ethics for the health professions need not (and should not) be a graduate seminar for dissertation-level philosophy students.

A case in point is the philosophical subfield of action theory. Though deep, wide, and with a great deal of nuanced implications for ethical theory and practice, one can take a simple insight from a focus on human action and frame a reasonably deep and understandable ethics education session or course. Consider the insight that every human action is made up of a person who performs it, the thing that is done, and what results from what is done.¹ Though there are a host of potential ways to complicate this picture, remaining at this level of complexity can help us organize three influential ethical theories and apply them to health professions ethics. This structure also offers a reasonably straightforward framework for students to understand and to classify or categorise other theories and approaches that they might take up, vis-à-vis “the big three.” Consider the following threefold organizing suggestion:

• 1. Health professions students (and practitioners) most interested in the person, or the agent, performing the action might be drawn toward the virtues of practitioners of their chosen health profession;

• 2. Health professions students (and practitioners) most interested in the action that is performed by such practitioners might be drawn toward the rules or duties governing their chosen health profession;

• 3. Health professions students (and practitioners) most interested in the outcomes or achieving the best results regardless of who specifically they affect and how they are brought about, might be drawn toward ways to optimize the effects of their chosen health profession’s practices.

In this way, an insight can be drawn from what is a complex philosophical field of study and employed to aid health professions students in orienting themselves toward an ethics approach and offer deeper resources than they may otherwise have engaged. The following sections take up a theory connected to each point about the structure of human action, as mentioned above, beginning with rules, moving to outcomes, and concluding with virtues.

15.3 Rules in Ethics

Encounters between healthcare professionals and patients or clients can be some of the weightiest interactions in a person’s life. Persons hold their health very dear, albeit among other things, and they often seek the care of health professionals when their health is compromised or put in jeopardy. Approaching another person from a state of vulnerability—both in terms of a weakened state, but also the commonly vast difference in knowledge² regarding illness—is not easy and thus places a burden on health professionals to take particular care in responding. One common guide for proper response is to follow the rules that govern one’s profession or the ethical rules that might govern this particular kind of interaction. One feature of ethical care that health professionals, who are interested in ethical rules, must reflect on, is the autonomy-paternalism spectrum.³ Educators might find that this spectrum is also helpful in conceptualizing ethics sessions for students. What this approach suggests is that ethical rules for health interactions (as well as educational ones) are created in response to the specialness of particular persons, those who are sick (or who seek learning) and who can give rules to themselves and follow those rules (hence the connection to autonomy). Three points frame the remainder of this section; first, context: history matters; second, knowledge: understanding the perspectives of others is necessary but not always easy; third, patients (or students) as persons: to avoid ethical pitfalls, seek to see the patient (or student) as a person.

15.3.1 History Matters

Healthcare professionals are in the challenging position of aiding others without possessing complete information or full control; educators can find themselves in similar positions. Though the former (information) can be remedied to varying extents depending on the situation, the latter should not be. Health professionals are not merely technicians, though technical abilities are important,⁴ they are also people who practice with patients, as members of a broader profession, within multiple traditions of practice, and often focusing on one of a variety of specialties. Were health professionals technicians, then taking care to respect the autonomy of their patients and guarding against overly paternalistic approaches to their practice with a patient would be of less concern. Patients, as persons, possess values, goals, and interests that might be very different from the physician with whom they share in the therapeutic endeavour; this can also be said of teachers and students, though there may be a unifying cause in their shared engagement in a particular profession. Each patient has their own life history, relationships, understandings of the world and their place in it, and reasons that they have sought out the care of a health professional. Because the patient is a person and not merely a problem to solve, even if perfect technique is displayed, the health professional has not satisfied their ethical obligations (and it is worth noting here that rule-based ethics are often deontological in nature, that is, they focus on duties). It is important to highlight that though healthcare practices bring great goods to many, ethical violations within their history strengthen the need to treat patients as persons and to follow rules that arise from engagement with something so special⁵; as does the overall change in context, helpfully summarized by Kilbride and Joffe (2018) in a recent piece in the Journal of the American Medical Association (JAMA) about members of one health profession, physicians:

The rejection of medical paternalism in favor of respect for patient autonomy transformed the patient-physician relationship. Historically, medicine and society subscribed to the ethical norm that the physician’s main duty was to promote the patient’s welfare, even at the expense of the latter’s autonomy. A central assumption of the paternalistic framework was that physicians, because of their medical expertise, knew best what was in the best interest of patients (1973).

Before turning to the challenge of perspective taking and the need for autonomy-affirming strategies, it is worth highlighting lessons that can be drawn for education. Attending to students as people opens up an educational space wherein teacher and student are partners—“joint adventurers”, to borrow a phrase from the ethicist Ramsey (1970) who coined the term “patient as person”—suggesting flexibility in small things, like examples to be used, and large things, like delivery methods. This kind of approach would not be aligned well with a banking model of education—dropping facts to be memorized into a student’s head (for a detailed exploration of resistance against the banking model of education, see Chapter 4)—but rather, as with health-focused work, it is important to place students (or patients) in the best possible position for them to succeed (learning material and applying it, or living a healthy life). Bringing these two areas together, even suggests—in a concrete way—specific questions around which to theme sessions. For example, attending to context and history, might suggest an assignment like this:

Familiarize yourself with a few situations throughout the history of your future health profession in which you believe ethical rules were violated or where a patient or client was not treated as a person; describe two such situations.

15.3.2 Knowledge and Perspective Taking

The historical change in orientation from healthcare professionals, as those with knowledge of what is in a patient’s or client’s best interest and informing them what the course of treatment would be to a relationship of shared decision-making that has been described by terms like therapeutic alliance or “joint-adventurers”, is due, in part, to an emphasis on the concept of autonomy. Autonomy is one of the “four principles” of bioethics (Beauchamp and Childress 2019)⁶ and, some argue, the most important of the four (Post and Blustein 2015). The concept’s role in ethics has its roots in philosophy, is connected with a rules-focused approach, and is especially at home within the Kantian Tradition.⁷ A focus on the concept highlights that persons are self-governing or, according to the Greek roots of the term, that they give the law unto themselves. Such persons are described in the Belmont Report, an early document codifying healthcare practice and research norms, as those “…capable of deliberation about personal goals and of acting under the direction of such deliberation” (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979, 4).⁸ It should be clear that a health professional-patient relationship defined solely by the health professional would not respect the patient as a person because they would not have an opportunity for self-rule. Rather, a hallmark of autonomy-affirming practices would be the offering of reasons to a person to evaluate for themselves and then the opportunity to act on those reasons; this respect is exemplified through the informed consent process.⁹ In fact, the Belmont Report translates the principle of autonomy (which it refers to as “respect for persons”) to the application of informed consent. The converse of this approach is often described as paternalism, which is frowned up in healthcare because paternalistic practices fail to treat patients as persons. This is not to say that good health professionals do not exemplify some virtues also possessed by good parents, the image at its linguistic roots of paternalism, such as care, compassion, and even great effort to safeguard. Rather, as William May (2000) suggests, “the healer overreaches when he or she justifies overriding the patient’s wants, wishes, decisions, and judgment on the grounds that the adult patient is a child, incapable of knowing his or her own good” (39). Similarly, this can occur in education when views or approaches are forced on students or taught as the only option, instead of allowing students to adopt an approach based on the best available data and arguments, given their own situation.

Paternalistic relationships suggest that the “parent” figure knows best, and models for health professional-patient relationships often fail, ethically,¹⁰ as noted above, because even if they are technical experts in their craft, health professionals are not rulers over their patients’ goals and aims. As highlighted in Cavanaugh’s (2018) recent medical ethics text on the Hippocratic Oath, “A technique, in itself, does not include determination toward an end and away from what opposes that end while an ethic necessarily does” (141). Shared decision-making models are most fruitful because they bring together the expertise of both the health professional and the patient and can be guided by ethically sound rules. Health professions students attracted to a rules-based approach should keep in mind that the patient is the ultimate decision-maker, thus rooting their approach in the recognition that patients are (or are capable of) self-governing. This approach is also epistemologically stronger (for discussion of the term ‘epistemology’, see Chap. 10) because even if a patient were to share a good deal of information about her life history, health professionals would still not possess sufficient information to act paternalistically. Even if such decision-making were ethically acceptable, health professionals cannot fully embody the perspective of their patients. A good (ethically rule-following) health professional will learn enough about a patient to be empathetic, but not enough to decide for them.

15.3.3 Patient as Person

Simply put, an ethical approach to medical encounters requires that practitioners see their patients as persons. Failure to do so, not only by practitioners but by the healthcare and societal institutions of which they are (and have historically been) a part, has led to unethical treatment of patients. One feature of treating patients as persons is to respect them as autonomous agents. In so doing, physicians should work toward relationships with patients that are defined by shared decision making and not by paternalism. Ethical physicians are neither purely technicians, nor do they fall into the trap of playing God; a healthy respect for autonomy aids in maintaining that balance.

15.4 Outcomes in Ethics

Though all health professionals are interested in good outcomes, students most interested in good outcomes—and less interested in who does what to achieve those outcomes—might be drawn toward a consequentialist approach to ethical practice. In this section, an outcome-based ethic is described and the prominent role it can play in public health ethics is discussed.

Consequentialism is the idea that only (or primarily) the results, effects, or consequences of an action (broadly understood) determine its rightness. According to this kind of philosophical perspective, if a health professional wants to know whether an action is right or not, they should examine the results from performing or not performing some action. Consequentialism is not a full theory, in the sense that it cannot guide a health professional’s actions without first adopting a rubric to evaluate those outcomes; that is, we need a way to determine and measure what good results are. Arguably, the most influential consequentialist theory has been put forth by John Stuart Mill, who advocated for utilitarianism. Utilitarians evaluate the consequences of an action in terms of its utility (a combination of pleasure and the absence of pain) and, though Mill’s utilitarianism and other versions of it get complicated quickly in terms of how to evaluate and measure outcomes, the key to this ethical theory is the maximization of those good results.¹¹

Teaching utilitarianism to health professions students can be aided with the use of a decision matrix. Figure 15.1 is a very basic one:

Fig. 15.1

Decision Matrix

Consider one health professional, say a surgeon, who must decide between performing a standard surgical intervention (A), attempting a new but not experimental surgery (B), or not determining that the patient is not a candidate for surgery and referring them to internal medicine (C). Suppose this action affects three people—the patient (1), her mother (2), and her daughter (3). The numbers in this chart signify pleasure (positive integer) or pain (negative integer). Utilitarians are looking to maximize overall utility and so the correct answer is C. Though overly simplistic, this chart is instructive. It illustrates the main aim of this approach: to maximize the overall utility; not the utility of a particular person or a set of people, but of everyone. This is similar to current trends in public health ethics. For example, consider the recent and ongoing COVID-19 pandemic. Much thinking has focused on all (or at least large groups of people) and not on individuals. An occupational therapist may determine that she will see her clients virtually, even though her diagnostic training and practice were based on in person encounters. If she does this because she is concerned about the spread of the virus, she may be appealing to a consequentialist approach. This raises important questions about telehealth, facile execution of standards of care, and even the weighty philosophical question of “Who counts as one’s patient?” No person, on a utilitarian view, receives any heavier weighting in the calculating of results than another—so health professions students may find this approach’s egalitarian or democratic nature attractive, especially during their early training. However, as they advance in their training and begin their practice, they may be inclined toward other approaches if they develop relationships with clients or believe they owe something to a particular patient “of theirs” as opposed to another. This language suggests a duty-orientation that might return them to a deontological, rule-based approach.

Some negative features of Utilitarianism, which can be gleaned from the matrix, exist, as well. It is an instructive exercise for health professions students to discern these themes on their own and report back to a larger group for discussion and for the sharing of self-reflection. For example, students interested in social justice and health might opt for answer A and find the lack of equity or equality¹² in choice C to be objectionable. Choosing C also means that the decider is comfortable with some persons (Person 3 in this case) being harmed. This is not to say that Utilitarians support harm, but that—as occurs in many public health determinations—they accept that some persons will be negatively affected (be it by direct harm, resources going elsewhere, or other things, such as their liberties, being curtailed) in order that the total utility is maximized.

In addition to this kind of exercise being useful in ethics education sessions, it may also be instructive in framing classroom pedagogy. Given different learning styles, speeds, abilities, and the way that differently abled persons interact with the structures of the world, reflecting on the distinction between individual students and a class of students is useful. Instructors may ask, in reflecting on the success of a session, whether the class did well or whether all their individual students did well? Do they allow for assignment flexibility, or do they require the same assignment as a way to consistently measure performance? Have they succeeded if the class average is greater than in previous years or if the most students pass the relevant professional exam or do base the course’s success on the success of each individual student?

Finally, it is worth noting that there are some conceptual challenges that health professions students—and those relying on the ideas of this section to build a session or theme of a course—should be aware of. First, determining how to measure utility, or whatever the good to be maximized is, can be challenging. Is Person 3 in Action C really at a negative 3? Or could it be a negative 1 or a negative 5? This precision matters in an approach that takes into account an aggregate number to determine the rightness of an action. And it is the rightness of the action that Utilitarians claim; a good Utilitarian does not suggest C, she claims that C is the ethically required action. In the complicated world of healthcare, the importance of nuanced evaluation is clear and very much needed for this ethical approach to be adopted. Second, where do you draw the line? Utilitarians must constantly add in new information to their calculations given that all implications from a decision are relevant to their calculus—recall, it is the consequences that they focus on, including the consequences of those consequences, and so on. Determining what is a relevant consequence is, thus, an important question. Might health professionals evaluate their work in terms of the success of a treatment plan, the overall health of their patient, or the health of members of their community? Even the second option is complicated: Should health professionals work to address climate change or to bring clean water to dry areas or healthy nutrition to food deserts? What if these factors affect their patients’ health? A deeper and richer discussion is needed to address these questions, but in the very least health professionals and those teaching them must arrive at answers about what counts as health, healthcare, and what they aim to maximize if they adopt this view.

Analogous questions arise in the teaching of health professions. What properly falls into the purview of an instructor if she adopts a consequentialist approach as her classroom ethic? Is she on the hook for the maximally happy lives of her students, class, program? Should she draw the line at the passing of the professional licensure test or, more modestly, should she aim to teach a particular set of skills and attitudes which she finds to be the most successful for a practitioner of her craft? In the final section of this chapter, we turn to this last suggestion, which is connected to a discussion of virtue.

15.5 A Virtue-Focused Ethic

The third, and final, approach to be discussed in this chapter is virtue ethics. For those health professions students interested most in the person performing the action in our original tripartite structure or for teachers who focus on students—not a whole class, school, or particular exam metrics—and find the inculcation and support of character traits or dispositions that lead to good health practice to be attractive, a virtue-focused ethic might the right fit. That said, teaching virtues can be more complicated than teaching the other two ethical approaches and it can be trickier to regulate and measure in practice. As with the other two theories, health professions students and teachers are encouraged to adopt the approach that best fits their own aims, profession, and personality.

Philosophical discussion of virtue often focuses on the work of Aristotle. A paradoxical combination of intuitive appeal and complication can be gleaned simply from the question that frames Aristotle’s approach. As opposed to asking how to maximize utility or how to arrive at the right rules to govern ethical action, he is motivated by a more practical question: How do we live a good human life? More recently, Alasdair MacIntyre (2007) has argued for the importance of virtues and health professionals, such as Edmund Pellegrino (1985) have held a similar focus in building an ethic specific to a health profession.

One challenge in discussing a virtue approach to health professional teaching and practice is that particular virtues might be tied, very broadly, to human beings or very particularly to individual professions. Thus, there is a risk of being both too broad and not specific enough in executing the aims of this section. To fix ideas, the remainder of this section draws the reader’s attention to five key features of virtue-focused approaches; the hope of this section is that the reader will indulge any murkiness in conceptual articulation and apply the ideas—as they fit—in their own teaching and practice.

15.5.1 The Five Keys to Virtue Education in the Health Professions

First, experiences matter. Aristotle ([350 BCE] 1999) is quoted as saying in Nicomachean Ethics Book 1, “…a young person is not a proper hearer of lectures on political science; for he is inexperienced in the actions that occur in life, but its discussions start from these and are about these…” (1095). The key to understanding this claim is that it is not about youth, but about the knowledge that comes from lived experience. The seasoned clinician is often able to “see” things that trainees do not.

Second, Aristotle thought that in order to respond well to situations, persons need to be brought up with good habits. Consider any kind of complex activity—diagnosing speech pathology, hitting a baseball, dancing a ballet, overseeing a hospital system—and who might be best situated to make important determinations and perform the needed actions relative to that activity. Someone with experience who has been brought up in the right sorts of ways so that she responds well to unforeseen issues, understands what technical competence in the relevant crafts entails, and whose feedback mechanisms are properly aligned with the endeavor’s goals is the right choice. Such a person will choose well, given her knowledge, expertise, and the lack of conflicts of interest (or, as Aristotle would put it, she feels pleasure at the right sorts of things). More simply put: if you practice good habits, you’re more likely to get things right.

The next key idea is somewhat controversial. Aristotle argued that different beings have different functions and that in order to be happy, one needs to perform one’s function well. This applies to everything: good doorstops hold doors in place, good sailors sail well, good Physician Assistants (or Associates) care for patients well. This notion is controversial when applied to human beings as a whole, but offers a useful lesson, even if intuitive, for practitioners of all sorts. Health professionals who perform their functions well, will gain more joy from their craft. Teachers who construct a course of study and engage students well, will enjoy teaching more.¹³

A related (fourth) key idea involves a description of how one becomes good and about feeling good, which connects to the aforementioned role that habits play in forming our characters and to the subsequent topic of practical wisdom. For Aristotle, persons become good by performing actions in accord with correct reason; that is, a virtuous person must: (1) know that what is she is doing is a virtuous action; (2) decide to do that action; (3) do that action from a firm and unchanging state. In other words, the person of practical wisdom or—for our purposes—an excellent healthcare practitioner—is one who chooses the right option, knowing it is correct, and does so in light of their well-formed character. This is a lesson well known by many teachers: the right answer does not define a successful student; how a student gets to the right answer matters.

The fifth, and final, key point focuses on a moral exemplar: the person of practical wisdom (for a detailed discussion of practical wisdom in health professions education, see Chap. 20). In fact, Aristotle ([350 BCE] 1999) is said to have defined virtue in Nicomachean Ethics Book 2 as “…a state of character concerned with choice, lying in a mean, that is, the mean relative to us, this being determined by a rational principle, and by that principle by which the man of practical wisdom would determine it…” (1106). There is much to be unpacked in this description, but for our purposes the image of the person of practical wisdom for a virtue-focused ethics of the health professions and for those who teach in the health professions will do a good deal of philosophical heavy-lifting. If a health professional aims to do the right thing, according to this approach, they ought to do what the person of practical wisdom would do. A good nurse will care as the best nurse does, not overstepping their bounds while remaining fully attentive to their patient and their patient’s family. They will empathise with their patient, ensure that their patient is fully supported, informed, and advocated for, and that their therapy (and all this entails) proceeds as it should. Thus, a good nurse possesses a host of virtues, including patience, empathy, and care.

Though an analogous description could be offered of a teacher of the health professions, there is a closer connection between the two areas—health practice and the training of health practitioners—through the notion of mentorship. The key insight for health professions instructors and students vis-à-vis the education that they support and take part in, is the importance of mentorship. Mentors—at their best—are Aristotle’s practically wise persons, or the aforementioned “excellent healthcare professionals”. In mentors, ethical practice and teaching come together. If one desires to be a great nurse, one ought to do what great nurses do and to find out what that is—in all of its nuanced detail—one must follow that excellent practitioner closely. It is not enough, on this ethical approach, to follow rules to guide ethical practice or to work for the best results, one can only have acted ethically when one practically reasons well. Thus, the future nurse should see how her mentor practically reasons through medically (and morally) complicated healthcare situations. Aristotle thought that virtues—dispositions toward the good—of these persons reside in a mean and that vices live on either side of this mean. The practically wise nurse bravely enters into the challenging conversation in which they are to disclose a medical error. They do not cowardly hide behind their hospital’s legal team or try to cover up the mistake; nor do they brazenly storm into the family’s home to declare with rashness what has happened. The physician who believes a risky surgical intervention is the best option for a patient, medically speaking, does not bully their patient into the procedure, nor do they fail to share their surgical expertise; but to understand how to do this well involves not only following the rules of informed consent, but the best methods and practices of an empathic, skilled expert involved in a shared decision-making process with a patient.

This approach, like the other two theories, has its own drawbacks. It has been described as perfectionist in always aiming toward excellence and not realistic enough in the necessary accompanying assessments of health professionals and health professions students—many are excellent, but many more are good, and many are serviceable. Might aiming for excellence miss that good practice is sufficient? Secondly, obtaining the right habits and inculcating virtues is not easy nor is it easy to measure, raising questions for training and evaluation in the health professions. A final concern about this approach is that relying on the person of practical wisdom—or the excellent healthcare practitioner—is not as easy or as straightforward as following a set of rules. It lacks, to borrow from the philosophical literature, the action-guidingness that we seek in ethical theories. Those health professions students and teachers attracted to this approach may, nonetheless, seek out mentors and to serve as mentors because they understand the messy, murky, and nuanced arenas that healthcare takes place in and the complicated beings that humans are.

15.6 Conclusion

This chapter has offered descriptions of three ethical theories that could inform health professionals’ practice and the education of health professions students. In doing so, it attempted to satisfy its aim of responding to the complexity of some philosophical material and the lack of familiarity of some health professions students with philosophical approaches by offering clear and intuitive descriptions and avoiding some of the (albeit important) more complex and less practically relevant features of these theories. It highlighted connections between theories and common principles, such as the connection between a rule-based ethic and autonomy, between theories and large fields like public health ethics, and between theories and teaching through the discussion of virtue ethics and mentorship. Health professionals and teachers of the health professions students need not shy away from the theories that should and do inform their professional codes of ethics nor complex philosophical ideas. With the structure of human action as a guide and by reflecting on the three ethical theories connected to different components of it, ethics education in the health professions can be robust, meet the needs of teachers and students, and be an interesting and impactful part of a student’s training (Table 15.1).

Table 15.1 Practice points