Ethics in Medical Education

What is the place of ethics in medical education?

A 62-year-old airline pilot wants his medical tests “off the record” so you won’t have to report his health status to aviation authorities. A 14-year-old asks for a referral for abortion and requests you don’t tell her parents. The province you work in is faced with choices about funding expensive new cancer drugs while at the same time money for psychiatric inpatient services is cut year after year. Your patient refuses to take an HIV test unless you can promise no one will be told the results. A tough treatment choice has to be made and your patient’s 12-year-old son is the only one available to translate. A patient’s parents offer an expensive gift—to you or to the hospital—when their child is on a waiting list for an MRI. A patient exhibiting symptoms of paranoia is refusing treatment for cancer; he interprets your recommendation of surgery as part of a plot to kill him. A pharmaceutical company rep shows up at noon in your practice with a box lunch in hand—you’re very hungry and behind in your appointments. Your last three patients have taken home prescriptions you know they won’t fill because they can’t afford the medication. A patient asks you at a social event about her recent ALS diagnosis—isn’t there anything a physician can do for them to help her choose her time of death? When you look at the day’s headlines, you see that the government is considering legislation that will force healthcare workers to serve in an infectious epidemic. And another headline proposes changes to the fee-for-service model by which you get paid for each patient you see or procedure you do.

Ethical issues are fundamental in healthcare: the practice of medicine has an enormous impact on people, at birth, at death, and at many intimate, important, and often vulnerable moments in between. The potential to do good—and to do harm—is ever-present. Beyond that, good health is fundamental to people’s abilities to work, to take part in family life, to enjoy their leisure. Inequalities in health and healthcare access quickly translate to socioeconomic inequalities, while socioeconomic factors in turn determine health. A concern justice is also at the core of the practice of medicine.

Doing the right thing is important—but it’s not always obvious what the right thing is, and, contrary to the slogan, it’s not enough just to do it. Healthcare professionals need to be able to describe and justify their actions and choices in practical, scientific, and ethical terms, to account for the impact such choices have on patients and on society as a whole—and to engage in social debates about values in healthcare and the healthcare system.

Practicing ethically requires lifelong learning. The Department of Bioethics in the Faculty of Medicine at Dalhousie University is committed to and engaged in developing innovative and effective approaches to ethics education from the first days of undergraduate medical education through to postgraduate training and on to professional practice.