In just the past six months months we, the medical community, have been challenged by questions regarding the torture report, #ICantBreathe and #WhiteCoatsForBlackLives hashtags, Ebola research and treatment, the ALS ice bucket challenge, deaths of Brittany Maynard and Joan Rivers, and the Hobby Lobby case. What these events have in common are not their scientific or molecular underpinnings, but rather their push for us to reflect on the current state of medical practice; they force us to think about medicine’s feared six-letter word: ethics.
Across the world, medical schools have extensive curricula developed and explicit guidelines to follow pertaining to the ology’s: pathology, physiology, immunology, microbiology, etc. The same attention is not given to medical ethics and humanities curricula, which are often the first areas to get chopped when universities face time or budget cuts. These courses are unfortunately considered as the add-ons, as opposed to the core courses or the heart of medicine that they once were.
In some schools, medical ethics is substituted by either a society and medicine, professionalism, or medical law type course. Teaching about social determinants of health and the related biopsychosocial model of medicine is incredibly important, but falls short of what is necessary; this adds to the why of medicine, but not the “why.” We are taught that socioeconomic status and race can affect your access to health care services, but we need to dig deeper and express why this is unacceptable in an ethical health care system — how this, for instance, relates to theories of justice, rights, and duties.
In other programs where ethics is clumped into tracks of professionalism, again, something is missed. Although it is important that students and providers act according to the highest professional standards, professionalism cannot be used as a synonym for medical ethics. Medical ethics is broader and focuses on ideas rather than policies. Worst of all is when medical ethics is taught via enumerating current medical legislation. Ethics education should not consist of just memorizing the laws; we must ask questions of “what should be” instead of “what currently is.”
While medical ethics training in medical school should take place partly through didactics in lecture halls or classrooms, it should also take the form of connecting students with individuals from diverse communities to gather many unique perspectives, opinions, and systems of thought.
For example, @BioethxChat has been an experiment in connecting physicians with other health care providers, academics, bioethicists, students, patient advocates, and members of the general public. It is a weekly Twitter chat where individuals can come to discuss questions of medical ethics with an interdisciplinary and diverse community of interested and passionate people. Over the past year, this experiment has highlighted the gap that is present — the lack of honest, philosophical discussion of society’s biggest ethical concerns between health care providers and the public.
A number of free, high-quality resources are also available for those who would like to learn more about medical ethics, if the education at their university is lacking. I encourage students and health care providers to seek out their hospital ethics committee, participate in the free Introduction to Bioethics MOOC offered through Georgetown University, join open sessions provided by the Presidential Commission for the Study of Bioethical Issues, and check out the conferences hosted by the American Society for Bioethics and Humanities.
Health care providers of today need to be informed about past and current medical ethics debates, as these issues have had and will continue to have enormous impacts on both the way and the climate within which medicine is practiced. Within just the aforementioned situations, this year has brought difficult questions about access to birth control, concepts of a dignified death, budgeting for health research, offering experimental treatments, racial inequities, and physician participation in torture. I don’t foresee that ethical challenges will go away anytime soon (or ever).
These difficult questions provide space for health care leaders to step in and impact large-scale cultural and societal change. We need more advocates who are health care providers, and more health care providers who have had solid medical ethics training, and thus the frameworks in place to start decompacting these complex issues. We, medical professionals, must recognize and promote the importance of learning medical ethics alongside our communities; our patients need us to, society needs us to — the future of medicine depends on us.
Jennifer Chevinsky is a medical student and the creator and moderator of @BioethxChat on Twitter.