BMJ

The Teaching of Medical Ethics

Author(s): Andrew Smith
Source: Journal of Medical Ethics, Vol. 11, No. 1 (Mar., 1985), pp. 35-36
Published by: BMJ
Stable URL: http://www.jstor.org/stable/27716335 .
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 Journal of medical ethics, 1985, 11, 35-36

GMC: Medical ethics education conference

The teaching of medical ethics

Andrew Smith Department of Family and Community Medicine, Newcastle upon Tyne University

students will know much about

less pregnancy than
Author's abstract
do and out that only two months ago they
they point
Students at Newcastle are exposed to patients during their were waiting for the 'A' level results which got them
to a family
first week at medical school and attached into medical school.
within the first month. The object is to sensitise them to When the students meet their mother they
expectant
patients as people rather than vehicles of disease. Medical talk to her about her feelings, her experience of
ethics is introduced as part of the multidisciplinary Human her of this one and
previous pregnancies, expectations
Development, Behaviour and Ageing Course by a lecturer her relationship with her GP and the midwife and
who shows a film which poses an ethical problem. At health visitor. Sometimes the students actually attend
subsequent tutorials led by the Department of Family and the confinement if mother and father are willing and
Medicine's general practitioner lecturers the the students can be contacted in time. this first
Community During
is discussed as ethical issues arise in the course of term attend lectures
subject they by obstetricians,
their work. and psychiatrists about the physical and
paediatricians
Medical ethics is taught in medical school at Newcastle psychological development of the baby. They continue
in the two years as part of the Human to visit the family for the whole of their first year and
pre-clinical
Course. Students the progress on Denver
Development, Behaviour and Ageing plot baby's developmental
in their first week at medical charts. learn, sometimes surprise, but
with
are exposed to patients They
the that the sooner the with at the beginning of their medical
school, following principle always pleasure
of his studies the career that they can communicate with patients and
learner experiences the end-point
describe their at seminars and
better. they experiences
A patient of one of the general practitioner lecturers in tutorials with their GP tutors.

and Community Medicine In the third term of the first pre-clinical year medical
the Family Department
a common chronic medical ethics is introduced in a formal lecture about its
who is suffering from
condition such as stroke or rheumatoid arthritis, is principles. This is followed by two practic?is in the
in the lecture theatre to the class. He or she first of which a film is shown of a neonatal paediatrician
introduced
and one of the clinical tutors a baby with
is then taken through the history of his illness, by his examining
and then questioned the students about how it spina bifida. The extent of the deformity is
GP, by
next weeks of demonstrated and its effect on the baby's function and
affects his life. Within the few pairs
are introduced in her home to a patient development discussed by the two doctors. Possible
students
a baby within the next three months. Her GP options are put to the students. Should this infant be
expecting
which upon or allowed to die in the ward, or taken
has explained to her the object of the attachment operated
is about people. home by the parents to have palliative treatment when
is to teach students that medicine They
as a necessary? What is the parents' reaction to their baby's
may be ill or anxiousor, case, in her
expecting
What to be said to them? An
baby. It is not just about disease. Her job, we tell the deformity. ought
to treat academic so far. Then the question is posed to
expectant mother, is to help the students question
the assembled class: 'Put yourself in the position of the
as people and to be sensitive to their worries
patients
and fears. paediatrician you have just seen in the film. What

the task with would you say to the parents, who must decide their
The pregnant patients accept
when we tell them that we are child's fate, remembering that most parents will rely
enthusiasm especially
to their heavily upon their doctor's advice? Any one of you
trying to produce doctors who will respond
needs. This strikes a chord. all might some day be the doctor in a similar situation.
patients' Nearly
at some time or another, had experience How would you deal with it?'
patients have,
doctors. We that the Open discussion is then encouraged in the lecture
of impersonal mechanical explain
theatre during which viewpoints range from the belief
Key words that every possible operation ought to be done to keep

ethics medical ethics. the baby alive at one extreme, to the belief that the
Medical teaching;

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 36 Andrew Smith

child ought to be allowed to die at the other. withhold antibiotics if they get an infection.
Emotions aroused and arguments within In vitro fertilisation seems likely to be a major issue
by questions
the lecture theatre are often heated. The students then next term.
break into their GP tutorial where the Students realise that ethical issues are considerably
groups
discussion continues. They have spent three terms easier in the abstract than in real life. The Roman
normal pregnancy and childbirth over the Catholic who starts with absolute certainty that
studying
to
past year and are suddenly confronted by a severely termination of pregnancy is always wrong begins
infant and one whose fate a his opinion when faced with a 40-year-old
handicapped requires modify
decision. This is reality, not theory any longer. They woman or a 15-year-old girl asking for termination.
are made to face a situation which cannot be solved by The rational aetheist begins to wonder if he isn't being
science. Why not? Medicine is a science, or so they too casual about the fate of an unborn child.
have been is a decision In the course
of these two years the concept of the
always told, yet here which will
on the emotional, and moral views of sanctity of life, absolute or relative, the autonomy of
depend religious
parents and doctors. It adds a new dimension to the the patient, the rights of the unborn infant and other
of medicine. issues on which doctors have conflicting views, are
study
discussed and seen not to be subjects for religious
In the second pre-clinical year each pair of students
or iconoclasm or emotions or
is attached to a patient with a chronic disease whom dogma agnostic
prejudice. It is fascinating to watch the changes in
they visit several times. Other ethical issues arise. The
individual students' viewpoints and the maturing of
concept of the autonomy of the patient is one of them.
a particular their attitudes to non-scientific issues.
Should not patient be in sheltered
What sort of medical ethics are we teaching or,
accommodation? Ideally he should but he has always
rather, helping students to think about and discuss? It
been a loner and resists all attempts to persuade him to
must vary with the bias of individual tutors. Mine is
leave his home. But his house is filthy and he abuses
towards the ethics of society as expressed by
neighbours when they complain of the stench. They go
to the social workers who call in the GP. Is there not a Parliament, just as another's may be towards Roman

medical reason for this man's antisocial behaviour? Catholic dogma. Our aim is to encourage students to

answer think about ethics and not necessarily accept

The is no. Should he not be in hospital with that
terrible he's got? His chronic cannot traditional answers. We are conscious of our own lack
cough bronchitis
be treated of formal teaching in ethics and moral philosophy and
any better in hospital, and anyway he does
not want to go there. some of us would like to broaden the teaching team by

Patients raise the of euthanasia. Some including moral philosophers, theologians and
question
the declaration academic lawyers like Ian Kennedy who first publicly
actually produce formal advocated by
the euthanasia Others ask their GP not to questioned the right of doctors to decide their own
lobby.
resuscitate them if they have a heart attack or to professional ethics without consulting those other
people who are their patients.

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