Ethics have been an integral part of medicine for almost as long as medicine itself has existed. Doctors face dilemmas every day, and their decisions can make the difference between life and death.
For these reasons, doctors say they must constantly be updated on the latest developments in ethics and law. The study of ethics starts early in one's medical education and certainly does not end upon graduation from medical school.
In fact, states require doctors to constantly refresh their knowledge of issues in medical ethics. Massachusetts, for example, requires doctors to take a certain number of courses that deal directly with medical ethics in order for them to renew their licenses to practice medicine.
"It's a requirement in all 50 states," said James Barnat, professor of medicine and director of the Dartmouth-Hitchcock Medical Center's Clinical Ethics program. He added that medical professors as well as doctors are required to take such courses.
Medical schools use a variety of approaches to familiarize their entering students with ethical issues. While some schools require all students to take courses specifically geared toward ethics, the Dartmouth Medical School uses an integrated approach in which topics dealing with ethics are weaved into various courses, Bernat said.
During the first two years, students learn about ethics in an academic setting.
When students first enter medical school, they participate in a "White Coat" ceremony in which they formally enter the profession and are told about their ethical responsibilities as doctors, said Joseph O'Donnell, professor of medicine and senior advising dean and director of community programs at DMS. He said teaching medical ethics is important because students must know how to look at dilemmas and find resources if there are no clear solutions.
In addition to learning in a classroom, students at DMS also attend ethics lectures as part of their requirements. The lectures are given by instructors at the medical school as well as lawyers and sociology professors.
Bernat mentioned a lecture that he gave with an attorney. "We tried to outline the legal issues and separate them with the ethics," he said. "We talked about what it means to follow professional conduct."
During the third and fourth years, many students assist physicians in real-world settings and observe how practicing doctors tackle specific ethical issues.
Brown University's medical school emphasizes the teaching of ethics during the third year. "We know that the heavy-duty learning happens in the third year. That's when students have direct contact with patients," said Steven Beiser, associate dean of Brown's medical school.
According to Beiser, third-year students are required to attend a series of luncheons that are co-taught by a medical professor and a non-medical professor. The luncheons focus on ethics related to specific situations.
"We focus on situations that people encounter every day," he said. "For example, we would say that there's a child in the emergency room. Leaving aside the medical aspect, what would you do?"
Dartmouth offers a course to its fourth-year medical students, called "Health, Society and the Physician," which focuses on various ethical issues.
Some matters discussed in such courses reflect the larger issues being debated in society at the time. For example, an important topic is the concept of informed consent, which mandates a doctor to obtain permission from a patient before providing the patient with a medical service.
"There was a time in this country when consent was not always obtained," Bernat said.
Often when dilemmas arise, doctors can find a variety of resources, O'Donnell said. "People can try colleagues and mentors," he said, adding that every hospital also has an ethics committee that doctors can approach.
There are also lectures that focus on treatment of dying patients, euthanasia and abortion. The idea of paternalism -- when to ignore a patient's consent and focus on the patient's best interest -- is another frequently discussed topic, along with other aspects of physician-patient relationships, according to Bernat.
Beiser also alluded to similar issues and added that an important topic is the decision to refuse life support. Many times, doctors may feel that the actions required of themselves are against their moral values. In these cases, there are set protocols and policies that the Brown medical school teaches future doctors to follow.
While many ethics courses are geared towards medical students, Bernat noted that undergraduates interested in medical ethics can find a limited number of courses at the College. Some courses that have been offered in the past are "Philosophy of Medicine" and a College Course on the Human Genome Project.
Even as the ethical landscape changes rapidly, O'Donnell pointed out that many of the basic principles remain unchanged. "We can do things with technology that we would not have been able to do when I was in med school 25 years ago," he said. "But I think there is a lot that's not changing in terms of the Hippocratic approach to medicine."
