Teaching values to medical students?

1. Teaching values to medical students? Prof.dr.R.Rubens Dept Endocrinology University Gent

2. 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

3. 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 Medicine;1989;64;705-14

4. 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; 2000;34;108-119

5. 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

6. 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; NEJM;1985;312;253-256 Gillon R., JME;1996;22;323-324

7. Goal of medical ethics education • Creating virtuous physicians ↔ decline in moral reasoning • Training in skills of ethical analysis • Empirical results: negative Kohlberg progression

8. Teaching Methods • Ethicist ↔ Physician • Integrated • Lectures ↔ Small group discussions • Cases or Film • Student centered • Progressive

9. “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

10. 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)