Plan for ethics education

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Plan for ethics education

GD Ravindran


World Health Organization. Facilitators' guide for teaching medical ethics to undergraduate students in medical colleges in the South-East Asia Region. New Delhi: World Health Organization, Regional Office for South-East Asia; 2010.

This guide is the culmination of regional consultations on teaching medical ethics in the WHO South-East Asia Region (WHO SEARO) consisting of Bangladesh, India, Indonesia, Myanmar, Nepal and Sri Lanka. A review conducted by WHO in 2008 concluded that the subject is in a state of infancy in these countries and recommended that measures be taken to improve the situation.

One of the constraints noted was a lack of resources and faculty. To remedy this situation, the WHO constituted a committee to produce this book, the main objective of which is to help medical teachers use the module for the curriculum developed by WHO SEARO and endorsed by the medical councils of the region.

The module is divided into core areas and specific areas. The former consist of an introduction to the principles and history of medical ethics, professionalism and codes of conduct and etiquette, medical negligence, the doctor-patient relationship, and ethical dilemmas.

Core ethical dilemmas that have been identified are: dealing with the pharmaceutical industry and other providers of healthcare; ethical issues in healthcare provision by the private sector; ethical challenges facing medical students; reproductive health, and treating patients with HIV/AIDS. Specific topics dealt with include genetics, organ donation and transplantation, mental illness, child care, public health and health promotion, equity and social justice, ethical issues in resource allocation, dealing with alternative systems of medicine, and research ethics.

It is necessary to note that the ethics of healthcare provided by private practitioners cannot be different from that of government doctors. Instead, the topic should have been the commercialisation of medical services.

The module envisages 21 hours of teaching. Out of this, 15 hours will be devoted to theory and an additional six hours for ward- or community-based discussions. It puts the onus of teaching on the department of forensic medicine and the department of medical education. It lays emphasis on a multidisciplinary team and recommends that country-specific changes be made, and that teachers be free to make changes and expand the teaching methods. It recommends WHO publications and some articles from the Indian Journal of Medical Ethics as resource materials.

Each topic lists the learning objectives and methods of teaching and the duration of teaching. The learning objectives are elaborate and detailed. All possible teaching methods have been incorporated so as to make the presentation 'politically correct'. Didactic lectures, group discussions, case studies and role plays are recommended. The teacher has to choose what is appropriate for the class.

The time recommended for the course - 21 hours - is grossly inadequate. The committee recommends that the teaching should be in the wards as well as in the community. However, it is difficult to discuss ethical issues in front of the patient as the subject is delicate, in addition to which the privacy of the patient is involved. Instead, the module should have recommended case studies that can be used. A typical undergraduate ethics course needs to be of at least 40 hours duration for any meaningful impact.

South-East Asia has great religious traditions. These traditions make an impact on medical ethics. Sadly, the book does not make any reference to religious issues and their impact on medical practice.

Young students look for role models. Clinicians are the role models that they seek to imitate. An ethics course needs to be taught by clinicians to make an impact. By making forensic medicine the nodal agency, the impact on the students will be lost; moreover it will become more about law than ethics. I feel that if a multidisciplinary approach has to be applied, a department of ethics must be created in the college or be handled by the medical education cell for better coordination. The more clinical teachers are involved in teaching of ethics, the more likely it is that ethical practices will be taught and understood by students.

This book will help teachers to plan their ethics teaching better. Teachers can use the objectives for their classes. They need to select the best teaching method that is appropriate for their local situation. Libraries should keep a copy of this book to aid teachers in planning their classes well.

About the Authors

GD Ravindran

Professor of Medicine and Medical Ethics

St John’s Medical College, Sarjapur Road, Bangalore 560 005 India

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