Good afternoon! This afternoon, we are here to talk about bioethics at the Institute of Clinical Ethics Francisco Vallés. On my left I have the collaboration of an UE student, who I had the pleasure to give classes to in second year in the subject of IPC. When I saw him prior I did not recognize him, but after I read his surname I did — Jack Kanouzi, right?


He is a Student in his fifth year of medicine and is doing the clinic part of the career in the hospital — which hospital is it, Jack?

Hospital Asisa Moncloa

Jack is a medical student and is here collaborating with the Institute, in a conversation about bioethics, because as a student, he has a very interesting experience to tell you about, and it might be important for you. We'll see why. He's been out of the country in interesting places and can tell us what things can be very important to know but that we haven´t lived. First of all, how is ethics viewed from the standpoint of the student?

First of all, good afternoon everyone and thank you for inviting me. In relation to the question, as students, it is important for us to emphasize the fact that bioethics is not given the importance it should be given, because, from the medical point of view, any decision or reasonable judgment by the physician has a series of criteria based on bioethical concepts, and the sooner we start learning these concepts, the better prepared we will be when we get to the residency (specialty). Many people haven´t realized that ethics is the basis of any decision, even patient treatment during clinical trials, and even in our private relationships.

Sure, surely that's true. I’ve found that also, because I teach in the first year of medicine on the subject of bioethics and medical humanities. Maybe this is the justification for why we should teach that in the first place. We commented on this before we were on the air, and you agreed.

Yes, I believe it is essential to be taught, in the early stages of our training, what bioethics is and how it can be used as a tool during our career and our development in our profession. If it wasn´t that important for our basic education, it would be taught in the fifth or sixth year. It is important to have this knowledge, since, from the first day of training, we are using confidential data, eliciting informed consent, and doing practices in public centers where information has to be handled according to ethical criteria. Ethics is also important for the issue of teaching and research, so it is essential to start working with ethics from day one.

That's true, and your mind, from the standpoint of future doctors, is not yet molded in first year, so planting the idea is important, because it becomes part of an ideology. It has to be molded when you are in the early stages, because with future clinical subjects you will be in touch with bioethics issues which can be important; for example: embryology, gynecology, transplantation, dignified death, and appropriate treatment selection for each situation.

Learning ethics is a way to remodel your mind. This subject is treated in the course on medical humanities, which gives us a cultural and humanistic perspective. You cannot talk about ethics without knowing pre-ethics, which is a very old and important discipline, so I think we did right to put it in the program first.

In my career, I did not study ethics; it was assumed that you had encountered ethics already in your upbringing. We didn´t study it, and if you weren´t ethical in your decision-making you were considered to have moral problems. So we have created this course and created the Institute Francisco Vallés to be the spokesmen of a scientific ethical discipline that will determine a way of acting and doing things well.
Jack, I wanted you to comment on one thing in particular. Considering that this subject is given in the first year in our program, remembering what you have been though in your career so far, give us your opinion on the best time to start considering ethics.

Ethics is used throughout all stages of a career in medicine: from clinical research trials—any clinical trial must be assessed by ethics committees—to teaching slides that we use in class—all the material cannot be used without permission; we must have consent and obtain it legally. We must have ethical criteria when using material for teaching and know when you cannot use patient data without their permission. So ethics is essentially based on rational judgment and taking the right actions—not only in moral judgment but with regard to legislation. We cannot make decisions using criteria that we merely believe is okay and correct; it has to be in accordance with the laws of today´s society.

One very important thing is that not all societies are the same; here is where the importance of the concepts of globalization and multicultural environments come in. You asked earlier about the international experience I had. I'll mention now that it was a very important aspect of my development, because it offered great multicultural and international enrichment in bioethics.

Let’s discuss this now; you have been in a very important university. You will finish next year, and then its time to move on: the MIR exam; the decision-making that comes with being a graduate. Have you ever thought about, while being outside of Spain and working in a hospital, which situations would make you have the most anxiety in relation to decision-making that is related to ethics?

Well, as the saying goes, we can sometimes be wrong but you should never have a doubt in making decisions, so we shouldn´t be afraid of anything. In relation to making decisions, it is important to have good knowledge; you cannot make decisions without having knowledge as a basis.

So knowledge is required to apply ethics? In my era, ethics was already part of your upbringing, and someone without ethics was considered an immoral person, whether they studied bioethics or not. What amount of ethical knowledge is just in your DNA, and how much do you have to learn? Does everyone have the same ethics if they study in the same conditions, or may it vary depending on your DNA?

I think it's essential in the way we are taught at UE that teachers explain every clinical situation from an ethical and rational point of view. We don´t realize it but, unconsciously we are being prepared thanks to good training we are given here, and it enables us to making good decisions without even noticing we are making them. We are told what is right and what is wrong regarding the situations we will face daily in the hospital, but also returning to what we had said before, this isn´t only about moral judgment; it has to be according to the laws of each health system, and this is taught both in the classrooms and in the hospitals. We cannot have innate ethical judgment; it is acquired.

Indeed. Going back to what was said before, within a year and a half or two years, you will find yourself in real ethical situations and you will ask yourself, “What can I do here?” In a surgical procedure, helping someone reach a diagnosis may all come from book-learning, but in relation to ethics, how can you prepare for future scenarios?

As a physician in the near future, ethical situations not only take place in hospitals as people think but also outside of them, in everyday life. You mentioned earlier about the MIR exam, but I think my future will rather be in the US. I like the cultural system there, and how much everybody helps help each other. But something about US culture has caught my attention—and I don´t know if this correlates much or not, but it is an ethical issue outside of hospitals, in everyday life. Imagine this situation: We are driving down the street and the car in front of us gets into an accident. As Spanish citizens, we are obligated by law to stop to help, but in the US as normal citizens, we wouldn´t be expected to unless you are a ¨public worker¨ like a policeman, or a doctor.

Public worker? Would that include occupations like lawyers? Or employees of the state? Even jobs not related to danger, or medical training? An engineer, for example?

A policeman, for example, or a physician should. I don't think an engineer would have to, because he isn´t carrying out a public civilian protection function. What caught my attention is that a normal citizen is not required to stop to take care the accident, but if doctors did, we could start talking about the figure of the Good Samaritan.

This is a very good topic to talk about, because I know the story of the Good Samaritan. We’ll take a break for a couple of minutes and then enter fully into the subject of this talk with our very gifted and motivated guest.


As we were saying before the magnificent piece of music by Miguel Angel that you just heard, the “Good Samaritan” Gospel passage tells the story of a person who is assaulted on the road, and a priest and Levite who pass by do not attend to him, but then an enemy who sees him treats him and gets him into an inn, to be protected and healed, even leaving money for the inn to take care of him as needed. That is, even enemies should act as Good Samaritans, according to the Gospel. Let’s go on to our next point, since we only have little time left.

You were at Yale for two months this summer in the state of Connecticut, in a program of bioethics in a partnership with the European University regarding bioethics programs. Tell us Jack; what caught your attention during your experience at Yale University? Would you call it one of the best universities in the world, along with Harvard?

Yes, with Harvard. I'm happy that the European University has realized the importance of this summer program at Yale, and the good preparation students receive there. In fact, the other day I was talking to Carol Pollard, Director of the summer program and something she said caught my attention: she prefers the success of her students before her own. This means a lot, because of the importance that is given to teaching there, especially in relation to the topics of globalization and multicultural relations regarding ethics that we mentioned earlier. You can find all of this directly in-action there, because the students come from various places around the world, all with different opinions, from different societies, with different laws and rules; and there we have the opportunity to compare, discuss, and share different points view.

And have there been conflicts, ideologically or at a religious level?

I think that's a very good question, but I want to emphasize that this is something that is done wonderfully there, and people are completely tolerant in relation to respect toward each other, without discriminating against anyone. Everybody is supported and confident enough to give his or her opinion. This is a wonderful program because everyone has the right to speak and be heard because there are always things to learn from different cultures that we have not been in contact with.

It was an extremely interesting experience, I’m guessing.

I recommend it to everyone, not only medical students; there were also law students, and even philosophy and other disciplines.

What topics did you entertain there? I imagine they were the usual ones, with big content: end of the life issues, etc.?

Well, not just the big issues are covered, but also apart from issues like the end of life, there are also genetic issues and technology issues—even things like robots, abortion, all kinds of topics you can imagine related to bioethics. We even had seminars on bioethics and the law; this is really important because as I said before, any ethical decision must be made according to the law.

It is clear that ethics involves many issues of knowledge from legal, technological, biological, and philosophical angles—without a doubt. Another question apart from talking about these ethical issues that are always present like euthanasia, eugenics, and palliative care, are issues that form the backbone of bioethics—did you do things like that at Yale? Things in relation to the human experience?

I think the program is highly structured, because we have two hours of lecture in the morning every day in which we are taught about various topics and then up to three weekly discussion groups in which each teacher explains a topic. And afterward, students participate in a debate in order to deal with ethical issues; this is very good.

This structure also leaves you free time to devote to other things. Yale University has a lot of cultural importance; the moment you enter the university, you start realizing the importance of architecture there; you feel something special.

The architecture is very European, isn´t it? I got the idea from Harvard, which is very European and very modern with high glass buildings.

Yes, and it’s very old architecture.

Which century—18th century, do you think?

Not only architecture is very important, we can also see the good work that is done with art there, with the number of museums there are. There are galleries of artwork and opportunities through the university to visit different places. We even had visits to different places as part of the bioethics program.

You visited the factory Monsanto. What is Monsanto?

They make transgenic products…

Transgenic, that’s it. You also visited the Connecticut Hospice.

Yes, we even visited the Hastings Center also.

The Connecticut Hospice is related to palliative care; did you see what the terminal-care rooms looked like?

Yes, we did a tour; we were shown how everything was structured, and it’s incredible, the volunteering work and help people carry out there. It is something that is very much a part of America´s DNA, this kind of cultural solidarity, and it is something I really admire because of the importance given to humanitarian and aid issues.

We enter here the topic of the Calvinistic origin of the US, compared to European religious origins—that would be a good topic to talk about another day. It’s a difference that would catch the attention of European people.

I think it would be a good topic to investigate.

Yes, I have already written about it. It’s a part of narrative ethics, because there are so many differences in concepts of death, solidarity, and disease.

You said you also you visited the Hastings Center; what is that?

In this center, you can have a sort of spiritual journey where you can stay there for three weeks, I think it is, which you can dedicate to writing your article or research paper. It is a nonprofit organization and focuses on the investigation of ethical issues and health care.

Investigation—does that involve bringing together research publications?

Yes, basically ¨research.¨

Research in general. And would you suggest any changes to the program or include other visits?

I would say this program is perfectly organized, as it allows you to also have free time in the perfect place to interact with people of different cultures. It is perfectly structured; I wouldn´t add anything.

Jack, it’s been a pleasure having you here. You were my student, and I’ve seen you are very motivated, and the UE is very much about promoting the type of collaborations you have experienced. Thanks for being here.

Thank you. Good afternoon.

Another day, you will come back to tell us more things. Until then. This is your speaker Enrique Vivas and on monitoring, Miguel Angel Vazquez. Have a good day.