• To provide students with a firm understanding of the intellectual content of bioethics. This will require both that the students develop familiarity with the bioethical literature and the underlying philosophical arguments and empirical assumptions that inform it.
• To allow students to understand the institutions and structures of healthcare and how they affect the ethical issues that arise in medical practice. This requires that students develop some understanding of the doctor-patient realtionship, the effect of healthcare teams on the care of patients, and the changing social and political environment of medicine.
• To train students to identify and analyze a range of actual in-the-wards problems involving ethical issues and to prepare them to reflect critically upon the various methods of bioethics employed in the clinical setting, the scholarly literature, and health policy development.
  

All students must complete a 3-credit-hour core Clinical Ethics Rotation. Students are exposed to clinical cases as they arise, to hospital ethics committees and ethics consultation programs, to institutional review boards (IRB), and to hospital policies covering "do not resuscitate" orders (DNR), advance directives, withdrawal of artificial feeding, organ procurement and transplantation, and medical futility. They will become familiar with the clinical, psychological, social, professional and institutional context in which ethical problems arise.

While there will be some didactic and seminar sessions on clinical ethics consultation and hospital ethics policies, students will spend most of their time observing rounds in relevant services (e.g., intensive care units, pediatrics, geriatrics, etc.) with leading clinicians. Schedules will need to be somewhat individualized to meet student needs, allowing for a minimum of 10 hours of clinical experience per week from October to March (six months). One ethics grand rounds will be held each month, featuring faculty and student analysis of interesting clinical cases (one hour). The three locations for this course are University Hospitals of Cleveland, MetroHealth Medical Center, and the Hospice of the Western Reserve. Students observe on rounds, spending a three-month period at each of the sites. A faculty supervisor will be available and responsible for each location.

Students are required to:

• spend 10 hours a week in clinical settings;
• maintain a clinical "log"of experiences on rotation;
• attend five didactic seminars on: competency and informed consent; DNR and treatment limitation; advance directives and the PSDA; ethics committees/consultation; and management, politics and finance
• attend Clinical Ethics Grand Rounds;
• present a case at one Clinical Ethics Grand Rounds; and
• attend ethics committee and IRB meetings at the hospital sponsoring their rotation.