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Facial Plast Surg 2018; 34(04): 343-349
DOI: 10.1055/s-0038-1667026
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Plea for Ethics: Suggestions for Implementation in the Medical Curriculum

Hade D. Vuyk
1   Facial Plastic and Reconstructive Surgery, Vuyk Medical Centre, Huizen, Holland
,
D.P. Engberts
2   Section of Health Care Ethics and Health Care Law, Leiden University Medical Centre, Leiden University, RC Leiden, The Netherlands
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Publication History

Publication Date:
24 July 2018 (online)

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The aim of education is to enable individuals to continue their education.

The object and reward of learning is the continued capacity for growth.[1]

Ethical issues do pervade our daily practice.[2] [3] People interact with doctors because of existential problems which may be threatening to them. On these crossroads, choices have to be made. The sometimes far-reaching consequences of these choices imply a moral responsibility which is ours to live up to. But we may not always be sensitive to the moral issues at hand. And we may lack the competence to deal adequately with them. Several available avenues have already been used with the common objective of making ethics an inherent and inseparable part of good clinical medicine. The main thrusts lie in ethics research, teaching, as well as committees and consultation activities. Clinical ethics teaching encompasses a vast field of cognitive and behavioral skills, including examination of individual character virtues.[3] Officially, ethics is considered an essential prerequisite for medical education up to the level of specialist accreditation.[4] [5] However, medical specialists in general seem at a loss when asked how ethics must be taught. What indeed are the effective means of imparting professional values, attitudes, and behaviors within a health service that is increasingly sensitive to society's expectations including the financial pressures posed on the current health care system.[6]

In practical terms, a medical professional must demonstrate concern for the best interests of the patient as a whole, and must in addition be able to reflect on his own behavior, comprehend the reasons for choices, and be able to explain those to others.[7] Already we expect our residents to carry out their professional responsibilities while being sensitive to a diverse patient population, and in accordance with ethical principles.[4] [8] Appropriate questioning supports self-reflection and enhances communication with others. It is no longer sufficient just to ask if the things that are done, are done correctly. It is also imperative to ask if the right things are done. To grapple for the best possible alternative, ethics is concerned not only with what (reflecting goals and results), but also with how and why (reflecting motives).[7]

The central paradox in medicine is the tension between self-interest and altruism

Although it is probably true that the majority of young physicians in training are acquainted with medical ethics, the need for advanced formal training has been recognized and will be instituted. The ideal practical ethics teaching program can be summarized with the “5 C's” of clinically based teaching, using cases as the focus, establishing continuity throughout the medical curriculum, coordinating the teaching with the learner's other objectives, and utilizing clinicians as instructors and role models.[3] [9]

Focused curricula can be developed that have a measurable impact on medical house officers and resident's knowledge and confidence in addressing ethical issues.[8] [9] Other teaching modes, such as strong role modeling and mentoring by more experienced teachers, open the ever-present possibility of favorable behavior-influencing actions and reinforcement during periods of residence and fellowship programs.[5] The objective of this article is to demonstrate current issues and the pitfalls of ethics teaching. Suggestions will be made to enhance critical ethical reflection for both trainees and established doctors.