On oaths and ethics

A couple of days ago, Dr. Janet Stemwedel posted an interesting analysis of professionalism and the Hippocratic Oath.  The Hippocratic school apparently relied on ritual and tradition, the most famous of which is the Oath.  Medicine is still a world infused with ritual.  These rituals can be explicitly “ritualistic”, but many aren’t seen as rituals.  Compare, for example, the Oath to the successful passage of pre-med classes.

While the Hippocratic Oath appears to set a high (and specific) moral standard, it is an incomplete introduction to ethical behavior, one that often masquerades as something more.  Dr. Isis has come close to finding the heart of the problem.

The rituals of becoming a doctor begin very early, and are a bit of an ethics-free zone.  Success in pre-med classes such as organic chemistry and physics depends on hard work and competition. Altruism and professionalism aren’t a part of the discussion.  The first formal ritual upon entering medical school is the donning of the white coat, a tangible act carrying, one hopes, significant meaning for each of the students.  What that meaning is, however, isn’t clear.

The Hippocratic Oath, when it is administered at all, usually isn’t taken until the end of medical school.  That is after two years of classroom learning and two years of intensive clinical work, and after having chosen and been accepted into specialty training.  This doesn’t mean that ethics haven’t been formally taught, or that ethical problems aren’t a regular part of clinical work.  But there is no clear discussion of medical ethics before a doctor enters the process of becoming a doctor.

Hippocrates realized that physicians had special responsibilities.   Pre-med students have no mentors to guide them through the ethical process of becoming a doctor, or to help them decide whether their ethical makeup is even compatible with medicine.  If we wish to create more ethical physicians, we need to add a ritual to the process of becoming a doctor, one which will make the later Hippocratic Oath more meaningful.  We need to create, as a requirement for medical school admission, an introspective process, one which will introduce students to an important part of their future.  This could be something as simple as a participatory workshop on medical ethics, or more formal coursework.

It may seem that the burden on pre-med students is already quite high, but what is the point of surviving organic chemistry if you aren’t prepared for the ethical demands of a medical career?

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5 Comments

  1. physioprof

     /  August 9, 2010

    While I am not myself a physician, I love the white-coating ceremony every Fall, and make a point of attending. It is the first time that the medical students are given a real sharp cognitive and emotional nudge away from the pre-med grade- and score-obsessed mindset to their new reality of physicians-in-training. It always brings a tear to my eye.

  2. bsci

     /  August 10, 2010

    This is all well and good on paper, but is it possible to make a course that makes people prepared for the ethical demands of a medical career? I assure you that most of the ethics courses I’ve taken over the years haven’t altered my ethics. The very few ones that were good helped me look at complex problems in a new light, but they probed into complex topics that included ethical issues and weren’t necessarily focused on ethics.

    I think what you are really trying to do is figure out a way to weed out people who can’t handle the ethical issues before admitting them. Looking for plagiarism/cheat is one way, but it’s an imprecise test.

    Once in med school, the schools could probably do a better job teaching ethics by example and observed practice.

  3. DLC

     /  August 10, 2010

    Hm.
    in Engineering you have to do about 10 hours of engineering practices and ethics studies. Or you did back in the 90s when I ran out of money and didn’t finish my degree.

  4. “is it possible to make a course that makes people prepared for the ethical demands of a medical career?”

    Not the real question. The question is “is it possible to make a course that is better than nothing at all?”

    • zuska

       /  August 16, 2010

      Yeah, that seems like a good point. It would be nice to know that future docs had been at least asked to contemplate ethics in some formal manner.

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