Transcript Teaching values to medical students?

Teaching values to medical
students?
Prof.dr.R.Rubens
Dept Endocrinology
University Gent
Medical ethics in the curriculum
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Tradition: Hippocrates, Galenus,
Positivism XIX century
Revival end XX century
“medical deontology”= regulations,
etiquette, corporative tradition, legal
obligations.
• Medical ethics → based upon
deontological or consequentalistic ethical
theory
Aims of medical ethics
• To teach physicians to recognize the humanistic and
ethical aspects of medical careers.
• To enable physicians to examine and affirm their own
personal and professional moral commitments.
• To equip physicians with a foundation of philosophical,
social and legal knowledge.
• To enable physicians to employ this knowledge to clinical
reasoning.
• To equip physicians with the interactional skills needed
to apply this insight, knowledge and reasoning to human
clinical care.
Miles et al; Academic Medicine;1989;64;705-14
Consensus of Expectations of
teaching medical ethics
• In a pluralistic society no single moral
viewpoint.
• Does not create a sound moral character .
• Equip young students of sound character
with knowledge and skills required to
practise good medical care.
• No simple solution to the deshumanising
aspects of modern technological medicine
Goldie J.; Medical Education; 2000;34;108-119
Principilism and Prima Facie
• Autonomy: Locke, Kant
• Benificence : Asoka, Christ, Seneca,
Maimonides.
• Non-Maleficence: Hippocrates
• Justice.: WW II
Beachamp TL, Childress JF Principles of Biomedical
Ethics, 5th Ed, OUP, 2001
De Camp/Gillon recommendations
for content of medical ethics course
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Moral aspects of medical practice
Valid consent or refusal .
Patient is partially or fully incompetent
how to proceed if patient refuses treatment.
The ability to decide when it is morally justified to
breach confidentiality
• Knowledge of the moral aspects of caring for the
patient whose prognosis is poor.
Culver et al; NEJM;1985;312;253-256
Gillon R., JME;1996;22;323-324
Goal of medical ethics education
• Creating virtuous physicians ↔ decline in
moral reasoning
• Training in skills of ethical analysis
• Empirical results: negative Kohlberg
progression
Teaching Methods
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Ethicist ↔ Physician
Integrated
Lectures ↔ Small group discussions
Cases or Film
Student centered
Progressive
“Gent” system
• First year: Lectures 6 hour, 2 hour group discussion, 6
hours small group discussion basic principles, standard
problems : written exam
• Third year: lecture 2 hours experiments on humans:
MCQ questions
• Fifth year: Interactive lectures about legal, deontological
and ethical aspects(16 hours)
• Sixth year : four days interactive discussion: choice of
care, medical incidents, genetics, beginning and end of
life.
• Seventh year : Additional guest lectures (10 hours) and
writing of critical paper about ethical subject
Conclusions
• Medical ethics is a central and obligatory part of a
medical curriculum.
• Medical ethics cannot by itself give the correct sense of
morality necessary for the medical profession.
• Medical ethics can learn students to analyse ethical
problems.
• Medical ethics can confront the analysis of the clinical
problem with human rights.
• But: Best training is the visibility of the virtuous
physician or “rerum omnium magister usus”(the
habit is the master of all things)