Essay on Teaching Medical Ethics

Concern over the teaching and learning of medical ethics has evolved over the past 30 years. A “coming of age” process is described in two national reports on the emergence and establishment of medical ethics education and continues today.

Medical ethics literature is often more exhortative than empirical. When based on the qualitative experiences of the writer(s), it does not usually meet the criteria required of qualitative research. Medical schools describe competence in both the scientific aspects of disease and the humanistic aspects of patient care as necessary outcomes, but wide variation exists in the weight and priority given scientific v. humanistic values in the curriculum.

On the other hand, while the literature on medical ethics education is sparse in comparison to medical literature that is disease or technique related, I believe that it must also be noted that biomedical education literature is equally or more limited. No clear consensus exists on the content or the approach best able to imbue students with its desired outcomes. For example, several studies found that pre-clerkship ethics instruction that was illness-specific (e.g. AIDS) and provided identification of personal support systems for the medical student was effective in minimizing or avoiding concerns that resulted in discrimination and bias when providing treatment. Unfortunately, “new” illnesses cannot be anticipated.

Nor can new technologies that will raise ethical questions about existing illnesses or evolving support methods such as internet support groups. It is important to identify and minimize existing problems, but a problem for medical ethics education is that it must also be proactive toward fixture actions. It must also identify ways to successfully prepare future physicians to deal with new issues that arise over the course of their careers. Prior to 1967 when an ethics program was instituted at Pennsylvania State University College of Medicine, neither medical ethics nor medical humanities existed as a field of study.

Initially, most medical schools began formal instruction in ethics by incorporating ethics content into the professional curriculum as units of other courses. The current trend is for schools to require separate courses in medical ethics in increasing numbers. However, no consensus exists on this trend or the other options. Should medical ethics education support the trend away from an embedded approach? Is it better to incorporate specific classes on medical ethics into existing basic medical course plans?