106. Ethics in Medical Education
Department of Anatomy, All India Institute of medical Sciences,New Delhi 110029
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!
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.
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
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
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.
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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