Ethics Teaching in Medical Schools
Li, Benfu, The Hastings Center Report
Today's students with knowledge of medicine will be tomorrow's medical practitioners. They will face not cold stones or objects, but patients with flesh and feelings. They must provide not only technical skills and therapy, but also compassion and care. The philosophy that medicine is a humane art has roots in Chinese culture: the famous Tang Dynasty physician Simiao Sun (541-682 B.C.), noted that "a respectable physician is expected to be both skilful and honest.
The industrial and technological revolution in Western medicine that began in the fourteenth and fifteenth centuries brought great changes in perspectives on health and disease, leading to the biomedical model and its belief that "chemical and physical languages can eventually explain biological phenomena." The biomedical model has accelerated the development of medical science, but has separated the physical from the natural, psychological, and social dimensions of human illness and well-being. Disease was isolated from the human body as a whole; medical practice became disease-centered, and the patient is neglected as a human being. At the same time, medical training stresses knowledge and skills preparation, while overlooking the orientation of professional values. Such developments led G. L. Engel, of Rochester University School of Medicine, to propose the "bio-psycho-social" model in 1977, which stresses the integration of biological, psychological, and social dimensions of illness. In response, a new model of patient-centered practice is evolving, one that enhances both scientific and ethical values in medicine.
The extensive application of high technology in clinical practice has produced positive results. But if falsely managed, it can also harm the patient's well-being. This too has led to re-examination of the ethical values at stake in high technology care and even of the general goals of medical profession. These focus our attention on the need for continuing the reform in medical education and especially on the importance of comprehensive character development of medical students. Much emphasis is put on the humane and social values of the profession. As a result, much importance is attached to ethics teaching in order to provide the society with medical practitioners both intellectually and behaviorally competent.
Objectives of Ethics Teaching
Medical education in China is generally offered in two connected and progressive phases. The first phase emphasizes basic medical knowledge in the classroom, while the second phase focuses on clinical training in teaching hospitals, which covers the last few years before graduation. Ethics teaching goes through the two phases and extends into continued education after graduation. It includes ethics courses taught by teachers of ethics and development of professional character under the supervision of clinical teachers. The objectives of both phases are the same, namely, (1) to develop good morals and professional values for the establishment of good interpersonal relationships, especially between patients and physicians, (2) to develop the ability to judge and analyze ethical problems as the foundation of decisionmaking, and (3) to call attention to the ethical problems evolved by high technology in medical practice and minimize its negative consequences.
Formal Ethical Courses. Formal ethics courses offered to students include: (1) general ethics taught in the pre-clinic phase, (2) medical ethics taught during clinical training, and (3) seminars on special topics during clinical internship.
Training and development of ethics teachers. Teachers play a guiding role in the teaching of ethics, and development of a cohort of competent ethics teachers is essential. In Beijing Medical University both physicians and teachers of philosophy serve as ethics faculty. Our training program for the former emphasizes principles and knowledge and theory of ethics, while the program for the latter focuses on necessary medical knowledge and general understanding of clinical practice. …