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

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

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

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;

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

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; Gillon R., JME;1996;22;

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

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

“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

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)