Physicians’ e-learning course for ethical reflection in social security medicine in Norway Solli, Hans Magnus, MD, PhD, Vestfold Hospital Trust, Tønsberg Elvsåshagen, Harald, MD, Norwegian Labour and Welfare Administration, Tønsberg, and General Practice, Stavern Blaasvær, Sverre, MD, Norwegian Labour and Welfare Administration, Skien Reime, Nina Thunold, MD, Norwegian Labour and Welfare Administration, Skien

Social security medical ethics by e- learning COURSE INNOVATORS: The four experienced physicians were appointed by The Norwegian Society for Social Security Medicine TARGET GROUP: Attending physicians and social insurance medical officers in Norway. SERVICE PROVIDER: A well-established physicians’ firm providing e-learning in Scandinavia, now established also in Germany (Deximed). TIME FRAME: Hopefully going during 2017

Aim: To get to know the scope and content of professional action To support physicians’ reflection on FACTS AND ETHICAL VALUES – i.e., knowledge about European and national history of social security Concepts and models of functioning (ICF), agency perspective, relational health and sickness (Nordenfelt) Five universally recognized ethical principles Context of national legal framework – with its a paternalistic structure that overrules confidentiality. Not part of the course: Clinical/epidemiological knowledge

Ethical principles of the course (Beauchamp & Childress 7 th ed 2013, UNESCO 2009) 1) JUSTICE in a history of social justice concerning work disabled people in Europe. Impartiality and objectivity Distributive justice – principles of need and of equality Compensatory justice – a basic principle of social insurance -> Criterion of “damage to the person’s body” Bismarck put the physicians in charge in the 1880’ies

Justice in practice How to practice impartiality and objectivity when writing certificates about own patients?

Ethical principles continued 2) RESPECT FOR HUMAN DIGNITY Basic dignity: Human beings are equal to each other and have objective and intrinsic value – independent of particular properties and achievements in life – Try to treat all claimants with equal respect (person neutrality). Use your empathy to understand the life-world of the patient. Support the patient’s efforts and rights to participate in all social arenas - the work market is one of them. Press the employer’s duty to adjust the conditions of work!

Ethical principles continued 3) AUTONOMY Inform the patient about the dual role as treating doctor and expert – and the basic aims of social insurance Practice cooperation and know how to deal with sensitive information To consider: Writing all certificates in the patient’s presence

Ethical principles continued 4) BENEFITS: Work for the patient’s best Support functioning – know the basic concepts of the ICF and how to assess functioning Support work ability – reflect on barriers and facilitators, abilities and competences, wishes and goals Be paternalistic in a good way – try to motivate, to explain the value of work in a longer perspective, to help the patient clear up own values.

Ethical principles continued 5) AVOIDING HARM: Reflect on problematic paternalism – which overrules the persons’ own well-considered view. Report and explain when return-to-work efforts could harm your patient

Steps in making an e-learning course Formulate specific goals for learning Make tasks that the course participant has to carry through: Which article or other text to study. Make tasks to test the course participant’s knowledge.. which have to be answered in different multiple choice ways The course participant gets a diploma when all the tests are passed (part of The Medical Association’s scheme for Continuing Medical Education)