Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.
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106. Ethics in Medical Education

Pushpar Dhar
Department of Anatomy, All India Institute of medical Sciences,New Delhi 110029


Abstract

The recent past has witnessed a great advancement in scientific medical technology and at the same time a steep decline in moral values ranging from fake medicine rackets to organ trading all over the globe. To bridge the gap the role of ethics in education has often been questioned. Some researchers firmly believe that formal education in ethics goes a long way in moral reshaping of an individual while as others strongly oppose the view. The literature points towards an intimate relation between ethics and basic education though an intricate one. Keeping in view the deteriorating moral values, it is argued - since proper education goes a long way in bringing about moral enculturation, steps should be augmented to develop comprehensive curriculum which could be implemented with necessary additions and alterations keeping in mind the diversities in cultural heritage and religious bend of mind provided we are really in search of reforms for the making of personnel who shoulder the responsibility of welfare of others - in need!

Introduction

Ethics in medical education has been a topic of controversy ever since its inception. Though one of the basic requirements for moral conduct it is losing its significance at the cost of modern advances being made in technology. At present, the concept of continued medical education and technology is in vogue all around but the fundamental component of medical education, i.e. ethics is being ignored. According to some educationists:-formal education in ethics plays an important role in moral reshaping of an individual while as the same view is being strongly opposed by others. It is argued that awareness of ethical principles and their application in a revitalized form is badly needed.

Defining ethics

The term "ethics" is a derivative of the Greek word Ethos - meaning custom or practice, a definitive manner of acting along with somewhat constant mode of behaviour in the deliberate actions of man. In Latin, ethics stresses more on manners, morals as well as character of human beings (McAllister, 1959). Technically speaking, ethics is a Science which deals with morality of human acts through the medium of natural reasons. Summarizing the various definitions, it is ethics which teaches us how to judge accurately the moral goodness or badness of any human action. The practicability of this science lies in the fact that once the truth of ethics is known, it morally binds humans to accept and practice it. Medical ethics is one of the various forms of special ethics being concerned with application of general principles to moral problems of medical profession.

Whether incorporation of ethics in medical curriculum is required or not?

The recent past has seen a tremendous decline in moral values associated in particular with medical fraternity and health care delivery. Fake medicine rackets, organ trading and exploitation of genetic engineering are globally prevalent. Chilling incidents like brutal murders, stripping, sexual harassment are being reported off and on from the various medical schools on the pretext of ragging. Especially in this part of the world-the magnitude of the problem is enormous and multifactorial. The diversities with regard to religion, cast, culture, and social set-up play an important role in further aggravating the problem. The indiscriminate sense of urbanization and the increasing influence of the outer world add to the gravity of the situation. A good number of educationists and researchers argue that further deterioration could be overcome if greater emphasis is laid on incorporation of ethics in medical education curriculum.

The universal approach to the problem lays stress on importance of ethics being more in clinical years. However in India - the age at which a student enters a medical school is between 17-19 years. This is in contrast to other countries where students are mature enough (mean age 23.2 years)in first year of medical school and supposed to arrive at medical school with well established ethical perspectives. (Shorr et al. 1994). At this tender age (17-19 years) the student simply jumps from a simpler , comparatively smoother and serene atmosphere of high school to that of medical school, the difference between the two could prove incompatible if not handled properly and in right time. Viewed from a different perspective the students at the time of entrance into a medical school though coming from different and varied backgrounds stand on one platform wherefrom they could be moulded to some extent provided the aims and objectives of ethics in medical education are properly defined.

Though the perspectives of ethics laid down by Hippocrates are as old as two millenia, yet it continues as the cornerstone of modern ethics. It is only in the later half of this century that some interest is being rekindled in ethics. At present also, the Hippocratic Oath, which lays stress on doctor-patient confidentiality, a doctor's responsibility towards his patient and a doctors duty to treat anyone, regardless of their status in society, is being administered very religiously and routinely to every medical graduate but how many of them understand the gravity of the oath and even if they understand how long are they able to abide by it in their long, complicated carrier years?

Hence the objectives of introducing ethics as an important component of medical education curriculum are:

a) to sensitize the students to diverse issues concerning the human race as such.

b) to arouse awareness regarding the psychological, social and behavioural dimensions of health and disease.

c) to provide an integrated approach to problem solving.

Role of time in ethical awareness

As ignorance refers to a state of mind that not only is not aware of how things actually exist, but also misconceives the nature of phenomena (Donden 1986). Ethical orientation from the very beginning in the medical school and its continuity throughout the years of medical school is the pivotal factor for improving the present day status (Hafferty & Franks, 1994). During the period in medical school different aspects of medical issues are faced at varying time periods, hence proper allocation of time to the need of hour is of prime value. Having a very broad base, the principles of ethics could be introduced in a piece - meal fashion: (i) Preclinical years -more stress need to be laid on ethical issues like student-student relationship; student-teacher relationship, respect for cadaver, concern regarding animal experimentation etc.; (ii) Clinical years - more importance is needed to be attached to issues concerning student-patient relationship, student - nurse relationship, student -doctor relationship etc.

Emerging as a medical graduate who is considered to be God in white coat, his relationship to the society as a whole is of immense value. The ultimate goal should be to bring enormous strength to the nation as far as moral leadership is concerned so that success is achieved in improving the quality of life.

This is high time when importance of ethics to medicine should be recognized on priority basis and measures evaluated to enforce its incorporation as an important component in medical school curriculum. Even if it is thought that ethical values cannot be taught yet there is a huge scope for these values to be inculcated in order to enrich the society. At this crucial juncture the educationists, administrators and policy makers should sit together and formulate policies which could be implemented at national and international levels in order to contribute to the thrust of human evolution.

References
1. Donden,Y. in Health Through Balance - An Introduction To Tibetan medicine. p.16, 1986.
2. Hafferty, F W and Fanks,R. Academic Medicine 69 (1994), 861-871.
3. McAllister, JB. in Ethics with special application to Medical and Nursing Professions. p.10, 2nd edition,1959.
4. Shorr, AF., Hayes RP. & Finnety JF. Academic Medicine 69 (1994), 998-1000.


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