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.

105. On Medical Ethics and Medical Education

Annabelle Rajaseharan
Dept. Clinical Pharmacology, Madras Medical College, Madras - 600 003
(E-mail: petit/

While students all over the world discuss various finer issues of ethics like euthanasia, gene therapy and abortion, about which decisions have to be made on a few occasions by people other than doctors.

What is going on in the world of Medical Students

India has a population on 955 million people and 40% of the people are estimated to fall ill at least once a week, necessitating a visit to the doctor. Ethical practice of medicine therefore becomes an issue of paramount importance, so ethical values have to be deeply implanted in the minds of all doctors.

What is the role of Education regarding Ethics?

Like religion, ethics cannot be taught, however it could be introduced into the everyday routine of medical students, especially in their laboratory work and their ward work. Both teacher based and learner based activities could be carried in the form of discussions, lectures, debates and field work to inculcate a humane attitude towards patients, keeping in mind the patient's right to confidentiality and autonomy.

There are hundreds of medical colleges in India. In Tamil Nadu, a state situated in the southern part of the peninsula with a population of 56 million, there are 12 medical colleges and nearly 1200 students graduate each year from them. As in Sri Lanka (1) , here too Medical Ethics is taught as a part of Forensic Medicine. Knowledge of ethics is evaluated by essay type questions or questions requiring short brief answers.

Objectives Of Education

Evaluation T/L Methods

In the Educational spiral (2) even after setting ideal objectives for teaching Medical Ethics, the Teaching/Learning methods depend on the method of evaluation. The following issues are to be considered.

STUDENTS: Entrance into Medical Colleges, especially the Self Financing Colleges entails a large investment by the Student/Parent as capital fee. Tuition fee structure in these institutions is also very high. Therefore the student is under pressure to ensure adequate return on the investment on graduating from the institution. This leads to high consultation and hospital bills and unethical practices like "Package Laboratory Tests"

TEACHERS: It is not mandatory for the teaching staff of any college professional or otherwise to undergo teacher's training. Hence the staff are expected to be "Excellent Teachers " by teaching "instinctively".

TEACHING / LEARNING METHODS: This is also by didactic lectures 90% of the time. This is true for almost all colleges except for a few colleges in the country. Almost all these exceptions are Private Christian Medical Colleges, which have taken it as the Institutions' goal to teach Ethics and Communication skills.

EVALUATION METHODS: Since the evaluation is only through one or two questions in the theory paper of the University final examination the ethical values become impersonal.

SPONSORSHIPS: For conducting medical education by disseminating information through seminars, guest lectures, workshops etc., funding is usually from pharmaceutical companies interested in increasing sales of their products through advertisements or from laboratories where investigations are carried out. (In India there are many such laboratories not attached to any hospital.). The ethics of such funding would have been questioned vigorously in yesteryears but is accepted nowadays.

NEED FOR CHANGE: This has been felt in many countries (3,4,5,6). Academic medical education must impart to the student the ethical approach to studies, from dissection of cadavers to the examination of patients, from the taking of only relevant history to the conducting of the relevant investigations. In short , the students must learn to balance in a logical and humane manner , their need for hands-on training , with the rights of patients to receive the highest quality of care. This would result in the students becoming excellent as well as humane doctors.

What Changes?

Changes in T/L methods alone will not be sufficient as acquiring knowledge is very much linked with the evaluation techniques. The students would have the urge to do better if they are suitably rewarded at the end of the learning session . Marks could be awarded wherever possible in the practical examinations (Laboratory experiments to Clinical examinations ) for ethics . Students could be encouraged to form " Core Ethic Groups " as a part of their extracurricular activities .

Students should be actively encouraged to take part in social activities like "Ethics Awareness Day" which could be celebrated under the auspices of the University and the local Government.

In summary much has to be done to make medical ethics more in touch with reality for the medical students . This could be achieved through changes in teaching as well as evaluation methods for educating medical students.

1. Babapulle - Teaching of Medical Ethics in Sri Lanka, Medical Education. 26 (1992), 185-9.
2. WHO Manual - Training of Teachers of Medical Profession. 1992
3. Mitchell et al- Teaching Bioethics to Medical Students: The Newcastle Experience, Medical Education 26 (1992), 290-300.
4. Silverman - Narrowing the gap between rhetoric and the reality of medical ethics. ( review ) Academic Medicine. 71 (1996), 227-37.
5. Myser al - Ethical reasoning and decision making in the clinical setting: assessing the process. Medical Education. 29 (1995), 29-33.
6. Shorr AF et al- The effect of a class in Medical Ethics on first year Medical students. Academic Medicine 69 (1994), 998 - 1000.

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