FACULTY DIALOGUE. Throughout their studies, from the first cycle to the third cycle, our students must practice handling ethical issues. We should also focus on building up our own expertise in medical ethics. This is according to Christian Munthe, professor of practical philosophy, at the General Academy Meeting on “Ethics in the Academy” – a subject to which our faculty forum will return.
Anna Karlsson, vice dean for third-cycle studies, introduced the first meeting in a series focusing on “Ethics in the Academy.”
“The Academy must clearly and transparently highlight ethics to maintain high-quality research and education. For this reason, we are now beginning a discussion on today’s subject: ‘Basic issues and challenges for ethically sustainable research and education.’”
The invited speaker was Christian Munthe, professor of practical philosophy, Department of Philosophy, Linguistics and Theory of Science at the University of Gothenburg. He researches ethics and value issues, and teaches these topics at the medical school and several other programs in our faculty. He also serves as an expert for several assignments in medical ethics in Sweden.
The conditions of the academic environment
“Ethics is an enormous field and is essentially about how we should and should not live. It’s about what regulations there are, systems that should be built up, procedures we should have and so on. It’s about complex value and norm conflicts at different levels. This comes up all the time in health and medical care, research, and health and care policies,” explained Christian Munthe.
He argued that the various professional groups we train at the faculty must be thoroughly knowledgeable, qualified and prepared to handle ethics issues. This is done by practicing reflection, discussion and communication, and even practicing making equally important and recurring decisions. Such training should already be included in first-cycle programs, and then throughout the education, including specialist and third-cycle education.
Our organization, which is large, must also be skilled at participating in public debates and contributing our expertise, as well as able to handle our own inner ethics challenges in education and research.
“The university setting is a complex landscape filled with different values from various directions. It is a place where moral and political ideals must co-exist. We have to manage so many things, including collegiality, consideration for the department, finances, brands, personal convictions and our public mission, to name just a few,” continued Christian Munthe.
“Then we have to connect all of this to all the other clusters of national and international actors in society and their regulations, ideals and approaches. They might think differently and see our mission through a different lens than we do,” he said.
What expertise is required in the organization?
“We need an overview of what kinds of real and potential ethical problems and value conflicts may arise in our operation. And we need basic knowledge about how to understand and assess these problems and conflicts from different perspectives,” he explained.
Obviously, knowledge of the laws and the application of norms and guidelines in the organization are also required.
“Then there are specific abilities that are important to have as a doctor, including recognizing when you are or are not facing an ethical problem. You have to be able to critically analyze why it can be an ethical problem, and then be able to communicate that to others who are involved both in your own ranks and beyond them. If you want to improve and develop your abilities in this field, there are tools for doing so,” said Christian Munthe. He then explained different classical elements of ethical values and skills.
He also addressed the chain of responsibility, reviewing who is responsible for what, the responsibility of individuals and professional groups, and what must be determined together.
“Evaluating the structure is at least as important when things go well as when they go badly. That’s how you achieve favorable and sustainable development.”
Challenges for sustainable ethical expertise in the organization
“Sustainable professional ethics expertise requires having the necessary and relevant competence, preferably among several people and over time. Research ethics, science and honesty, along with the relevant normative laws, are areas where you can practice and in which you should stay continuously up to date to retain and develop this expertise. You should also be familiar with current political issues, because health and medical care is constantly surrounded by major debates to which, as health professionals, you should be able to contribute your expertise.”
“True, it costs resources to have ethics training in your programs. I don’t think you should bring in external experts; that’s not how to achieve stability and preparedness. Instead, I think you should obtain this competence in-house. That would give you your own experts, hopefully with your own research, who could be part of the entire operation and participate in various interdisciplinary programs and continuously strengthen the organization.”
He concluded by stating that we should have academic, quality-assured ethics expertise that can withstand review, with knowledge in medical ethics, bioethics and research ethics. These are currently well-established research and academic disciplines internationally, but have not been as self-evident in Sweden.
An open discussion continued
After the lecture, the floor was opened for discussion about the conditions for ethically sustainable research and educational settings at Sahlgrenska Academy/Sahlgrenska University Hospital.
Some people questioned the idea of in-house expertise, which Christian Munthe countered by stating, among other things, that other countries have much more rigorous legislative situations than we have today. But that could ultimately change, even in Sweden, because health and medical care no longer attracts the same high level of confidence as in the past. The public and society do not trust health care and research as much anymore; they want to keep tabs and call things into question. Improving ethical knowledge would boost opportunities and preparedness for meeting the increased demands and could initiate a constructive dialogue.
Anna Karlsson asked for examples of how good research groups function out in the organization. Christian Munthe had none off the top of his head, but explained how a good research group functions in general: it lets science take time; it is not controlled by money; it has an open discussion climate where everyone may speak. Problems arise when people do not dare to get into controversial discussions, but are afraid of being punished somehow.
The discussion touched upon the ethical impact resulting from the cultural problems that can arise in closed research groups, as well as how departments have changed in pace with their growth, and that the amount of resources coming into the organization are significantly greater today. Business community and university domains have also changed, and at the same time, the conditions have changed for how people should be able to function well within the framework of informal systems. Renewal brings transformation that must be taken seriously and evaluated.
The fact that the university should participate in and confront debates in the media was also addressed. It is common to be misquoted and misinterpreted, and it is difficult to know how best to handle this situation.
The dilemma of money governing activities and research and how to balance and prioritize this was an additional subject, as well as what role ethics can play in this arena. The need for regulations for directing research, is this a solution? Or how to get researchers to pause and reflect over ethics.
General Academy Meetings are a forum for dialogue among employees at Sahlgrenska Academy and the Academy’s leadership. This article provides some of the views aired at the meeting, but is not a comprehensive record of the meeting.
