Teaching values to medical students?

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Teaching values to medical students?

• Prof.dr.R.Rubens
• Dept Endocrinology
• University Gent

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Medical ethics in the curriculum

• 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

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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 Medicine198964705-14

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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 200034108-119

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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

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De Camp/Gillon recommendations for content of
medical ethics course

• 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 NEJM1985312253-256
• Gillon R., JME199622323-324

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Goal of medical ethics education

• Creating virtuous physicians ? decline in moral
  reasoning
• Training in skills of ethical analysis
• Empirical results negative Kohlberg progression

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Teaching Methods

• Ethicist ? Physician
• Integrated
• Lectures ? Small group discussions
• Cases or Film
• Student centered
• Progressive

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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

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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)