Bioethics in medical education

[I wrote this for my medical blog as a practice of saying something coherent about the idea of virtue ethics in medical training. This is one of the reasons I got interested in doing the theology masters. It should be fairly readable to non-medics. Let me know what you think]

Ethics is tricksy.

No way round it.

There are lots of reasons for that, the type of thing that keeps philosophy and ethics departments in good work.

Approaches to ethics in med school are always going to be hopelessly inadequate, it’s perhaps unfair to expect much else.

This paper discusses ethics and how to train people in ethics in EM. And they say lots of good things. It’s just that it’s a tad reductionist for my liking.

Ethics curriculum for emergency medicine graduate medical education. J Emerg Med. 2011 May;40(5):550-6. Epub 2010 Oct 2. PMID 20888722

Fig 1 from the paper

That figure may make a lot of sense to you. It certainly makes sense to me I’m just not sure it’s an entirely appropriate way to teach ethics or indeed practice it.

Or maybe it is. It’s probably a perfectly decent way to teach ethics if you believe that ethics is just another abstracted category to be put alongside physiology and anatomy.

The authors make this quote

a sound understanding of the principles of bioethics is necessary to become a compassionate and effective physician

Here I disagree. I do not know how an understanding of bioethics makes a doctor more or less compassionate.

Compassion in the context of virtue, character and humanity may be a learnable skill through the practice of a life lived but I’m not sure it’s teachable in the sense you can pass an MCQ at the end of it.

They do mention one thing that might be good material for fruitful reflection

Ethics education can be effectively provided, not only through behaviour modelling in the clinical environment, but also in formal didactic instruction

While I think the didactic instruction has its limitations as discussed above I think the “behaviour modelling” is fascinating.

Which brings me to this paper:

A Window on Professionalism in the Emergency Department Through Medical Student Narratives. Ann Emerg Med. 2011 May 28. [Epub ahead of print] PMID 21624702

Medicine is a lot like apprenticeship. In the sense that personalities and relationships are a key part of our learning and skill development. I model the behaviour and knowledge and skills that I find in my seniors.

These guys called the modelled professionalism by seniors “the hidden curriculum” which is kind of a neat name. Basically the students take on the habits of the senors and the practices observed.

I am deeply grateful to the people I have worked with both for the things that they have taught me to do and the things that I have seen them do and vowed never to repeat!

The term “holistic” is in vogue when it comes to talking about patients. It’s unfortunate that it’s become a buzzword as it’s actually a useful reminder that we treat people, not just patients, and certainly not conditions.

To think of ethics training and the practice of medicine as easily definable and teachable components that can be formed in an algorithm is something I find quite inadequate.

Some (tongue in cheek) conflicts of interest:

  • I think medical training is there to produce people capable of caring for the suffering, sick and the dying. These people need to both retain their own humanity and help their patients retain theirs. (This need not be in conflict with the good science and practices that fill medical research journals)
  • As background to this I am not a materialistic determinist. I have problems with a lot of the assumptions modernity has given us. I am a confessing Christian and a big fan of virute ethics. Though I’ll gladly admit Aristotle was a bit bonkers on a whole range of things…
  • I’m starting a masters in theology in the hope of exploring this kind of thing a bit further. And hopefully make it in some way intelligible and not just vague allusions to Macintyre
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