Bioethics in Faith and Practice, Volume 4, Number 1

Bioethics in Faith and Practice ⦁ 2019 ⦁ Volume 4 ⦁ Number 1 5 Bioethics in Faith and Practice vol. 4 no. 1, pp. 5-7. ISSN 2374-1597 © 2019, Jonathan Handy and Dennis Sullivan, licensed under CC BY-NC-ND (http://creativecommons.org/licenses/by- nc-nd/4.0/ ) Is Medical Education Ethical? Jon R. Handy, Medical Student, Indiana University School of Medicine Dennis M. Sullivan, MD, MA (Ethics), Cedarville University Every medical student eventually faces a significant personal dilemma. This is rooted in the very nature of medical education, yet seems contrary to the oath we will take when we enter the profession. It is that face-to-face moment with a patient, when we are about to do a procedure for the first time and we realize we are not qualified for it. We look over to the doctor teaching us, hoping that neither he nor the patient see the fear in our eyes over our lack of skill. That moment came for me early in my medical training, when I was working at a local clinic. The middle-aged woman in front of me seemed perfectly healthy, except for some dental issues that were not our current concern. When we asked her what had brought her in that day, she explained that she had suffered from untreated breast cancer for seven years. After a thorough history, we began the physical exam. This early in my education, I immediately worried about respecting the patient’s modesty and comfort, but she assured me there was no problem. Our exam revealed infected breast tissue surrounding the tumor masses that had developed in her chest. To help me better understand the extent of the disease, my preceptor had me palpate the woman’s breast and feel the difference between healthy tissue and the cancer, including severely affected areas that were necrotic and painful. The whole time I wondered if it was even my place to examine her. Despite her earlier assurances, I felt that I was infringing upon an area of medicine I was not yet fit to be a part of. I feared hurting her by palpating too hard, though my instructor insisted I fully examine her. I began to question the extra discomfort patients go through for medical students’ educational benefit. I also wonder if the extra time it takes to teach students prolongs the situation for patients. All of these things seemed to be a hindrance patient care, purely for learning experience. There is no question that teaching medical students how to be doctors is necessary for the future of medicine and for the population as a whole. But we also know that our skills and knowledge are less than adequate at present. When we stood before our mentors, families, and peers to swear a modern version of the Hippocratic Oath, we vowed to do our best for our patients. In other words, we affirmed the age-old principle of beneficence. So does the whole enterprise of training unskilled medical students contradict this principle? Four hundred years before the time of Christ, an ancient guild of medical practitioners embarked upon their training by swearing an oath to a pagan pantheon of gods, among them Apollo the healer and his son Asclepius, along with Hygieia and Panacea and other deities. The original oath contained specific promises to use treatment to help the sick, but never to harm them. 1 Over two millennia later, these ideas have been formalized as beneficence and non-maleficence , two of the four main concepts (along with autonomy and distributive justice) of medical principlism, the foundation of modern medical ethics. 2 Non-maleficence is the most basic and foundational principle in bioethics that states “at the very least, don’t hurt the patient.” This differs from beneficence, which calls us to a much higher standard of care. Beneficence demands that we not only prevent harm, but that we should leave our patients better than we found them. Though some recent authors have pointed out that these ideas have been diluted in our modern context, 3 the principles demand much more of us than first meets the eye.