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      Frankenstein; or, the modern Prometheus: a classic novel to stimulate the analysis of complex contemporary issues in biomedical sciences

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          Abstract

          Background

          Advances in biomedicine can substantially change human life. However, progress is not always followed by ethical reflection on its consequences or scientists’ responsibility for their creations. The humanities can help health sciences students learn to critically analyse these issues; in particular, literature can aid discussions about ethical principles in biomedical research. Mary Shelley’s Frankenstein; or, the modern Prometheus (1818) is an example of a classic novel presenting complex scenarios that could be used to stimulate discussion.

          Main text

          Within the framework of the 200th anniversary of the novel, we searched PubMed to identify works that explore and discuss its value in teaching health sciences. Our search yielded 56 articles, but only two of these reported empirical findings. Our analysis of these articles identified three main approaches to using Frankenstein in teaching health sciences: discussing the relationship between literature and science, analysing ethical issues in biomedical research, and examining the importance of empathy and compassion in healthcare and research. After a critical discussion of the articles, we propose using Frankenstein as a teaching tool to prompt students to critically analyse ethical aspects of scientific and technological progress, the need for compassion and empathy in medical research, and scientists’ responsibility for their discoveries.

          Conclusion

          Frankenstein can help students reflect on the personal and social limits of science, the connection between curiosity and scientific progress, and scientists’ responsibilities. Its potential usefulness in teaching derives from the interconnectedness of science, ethics, and compassion. Frankenstein can be a useful tool for analysing bioethical issues related to scientific and technological advances, such as artificial intelligence, genetic engineering, and cloning. Empirical studies measuring learning outcomes are necessary to confirm the usefulness of this approach.

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          Most cited references73

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          Putting the altruism back into altruism: the evolution of empathy.

          Evolutionary theory postulates that altruistic behavior evolved for the return-benefits it bears the performer. For return-benefits to play a motivational role, however, they need to be experienced by the organism. Motivational analyses should restrict themselves, therefore, to the altruistic impulse and its knowable consequences. Empathy is an ideal candidate mechanism to underlie so-called directed altruism, i.e., altruism in response to anothers's pain, need, or distress. Evidence is accumulating that this mechanism is phylogenetically ancient, probably as old as mammals and birds. Perception of the emotional state of another automatically activates shared representations causing a matching emotional state in the observer. With increasing cognition, state-matching evolved into more complex forms, including concern for the other and perspective-taking. Empathy-induced altruism derives its strength from the emotional stake it offers the self in the other's welfare. The dynamics of the empathy mechanism agree with predictions from kin selection and reciprocal altruism theory.
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            The patient dignity inventory: a novel way of measuring dignity-related distress in palliative care.

            Quality palliative care depends on a deep understanding of distress facing patients nearing death. Yet, many aspects of psychosocial, existential and spiritual distress are often overlooked. The aim of this study was to test a novel psychometric--the Patient Dignity Inventory (PDI)--designed to measure various sources of dignity-related distress among patients nearing the end of life. Using standard instrument development techniques, this study examined the face validity, internal consistency, test-retest reliability, factor structure and concurrent validity of the PDI. The 25-items of the PDI derive from a model of dignity in the terminally ill. To establish its basic psychometric properties, the PDI was administered to 253 patients receiving palliative care, along with other measures addressing issues identified within the Dignity Model in the Terminally Ill. Cronbach's coefficient alpha for the PDI was 0.93; the test-retest reliability was r = 0.85. Factor analysis resulted in a five-factor solution; factor labels include Symptom Distress, Existential Distress, Dependency, Peace of Mind, and Social Support, accounting for 58% of the overall variance. Evidence for concurrent validity was reported by way of significant associations between PDI factors and concurrent measures of distress. The PDI is a valid and reliable new instrument, which could assist clinicians to routinely detect end-of-life dignity-related distress. Identifying these sources of distress is a critical step toward understanding human suffering and should help clinicians deliver quality, dignity-conserving end-of-life care.
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              Empathy and quality of care.

              Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting.
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                Author and article information

                Contributors
                irene.cambra@uvic.cat , irenecambrabadii@gmail.com
                Journal
                BMC Med Ethics
                BMC Med Ethics
                BMC Medical Ethics
                BioMed Central (London )
                1472-6939
                23 February 2021
                23 February 2021
                2021
                : 22
                : 17
                Affiliations
                [1 ]GRID grid.440820.a, Chair in Bioethics, Centre d’Estudis Sanitaris I Socials (CESS), , Universitat de Vic – Universitat Central de Catalunya, ; Carrer Miquel Martí i Pol, 1, 08500 Vic, Spain
                [2 ]GRID grid.440820.a, School of Medicine, , Universitat de Vic – Universitat Central de Catalunya, ; Vic, Spain
                Author information
                http://orcid.org/0000-0003-1233-3243
                Article
                586
                10.1186/s12910-021-00586-7
                7903598
                33622293
                17c28891-3f12-4816-b7bd-54e2aa20c362
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 November 2020
                : 16 February 2021
                Categories
                Debate
                Custom metadata
                © The Author(s) 2021

                Medicine
                health sciences,science fiction,bioethics,frankenstein,scientists’ responsibility,teaching
                Medicine
                health sciences, science fiction, bioethics, frankenstein, scientists’ responsibility, teaching

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