Bioethics in Faith and Practice, Volume 4, Number 1

Is Medical Education Ethical? 6 Beneficence is an active process, not just a passive one. This means that we are called to advocate for our patients, and to actively seek opportunities to provide better care for them. This goes above and beyond making the best treatment decision when the opportunity arises. Beyond choosing treatment A or treatment B, beneficence demands that we look outside of the current situation and provide exemplary care. This may mean checking on our patients more often, and caring for needs not bounded merely by test results and patient outcome measures. This may entail sacrificing our own time and needs to go beyond the dictates of mere duty. In the language of moral philosophy, most of our actions are morally neutral, such as what shirt we should wear on a given day, or what route to take on our way to work. Some acts are morally obligatory, and always required. In a medical context, this might include performing CPR for a patient in cardiac arrest, or urgently providing medication to a patient in overwhelming pain. There is, however, a third type of act, one that is supererogatory , or heroic. This entails going the extra mile, going above and beyond the dictates of mere duty. 4 In this way of looking at it, non-maleficence corresponds with simple obligation, whereas beneficence is supererogatory. If so, then the medical profession is largely a heroic enterprise. It is active, not passive; it is sacrificial, not ordinary. Whereas for most people, a heroic act is a free choice, for doctors, it becomes a professional obligation by virtue of the Oath. In this light, physicians no longer have a choice in the matter; they must always be heroes. Once we recognize the obligatory nature of supererogatory beneficence in medicine, we can understand its relationship with medical education. Beneficence is arguably the most important part of medical principlism, necessitating adherence to the other three core principles. To do the most good for our patients, we must respect their autonomy and allow them to be a part of the decision-making process. We must also allocate resources justly to do the most good for the most patients. Most notably, to do this kind of good we must avoid harming our patients. Herein lie the unique opportunities for beneficence in medical education. Medical students face a paradox: they must be beneficent toward patients while having only a few of the skills to do so. But in the paradox, we have the freedom to do what is best for them. While it may be true that we have fewer skills, this necessarily means that we take care of fewer patients, giving us more time to learn. We can capitalize on this opportunity and provide individualized and focused care to each assigned patient. An attending physician is constrained by a large patient load, while we can focus on our patients one-on-one. This will give us a greater understanding of each one’s symptoms, history, and fears. Medical students have the unique chance to provide a holistic approach to patient care, filling in gaps that busy attending physicians don’t have time for. For each patient, we can set their minds at ease and provide them with personalized attention and to make them feel more comfortable navigating an uncertain and often frightening time in their lives. The extra time afforded to medical students is also an opportunity to learn the disease state and master its pathophysiology and treatment. This benefits patients, because they have a medical advocate intensely studying their case and ensuring that the treatment is up to the current standard of care or better. These seems like a covenantal relationship, very compatible with the Hippocratic tradition. Yet we can take this case even further. If medical education can be beneficent toward our current patients, then it will also benefit our future patients. The obvious yet important value of the medical education system is the first-hand knowledge and understanding of unique cases that will equip us to treat future patients. During these formative years of our career, we can appreciate the details of each case. Comparing one with another will give us a comprehensive view of medicine and how diseases are related. All of these experiences will prepare us to provide personalized and evidence-based care to our future