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Medicine is concerned with human affairs that are of special moral and existential importance in the lives of individuals, and in what the French sociologist Emile Durkheim termed the “vie serious” (“serious life”) of a society, states Prof. Ashoka, in the fifth part of his erudite paper, exclusively for Different Truths.
It makes sense to structure the teaching of the knowledge and skills, the attitudes and values integral to these dimensions of physicianhood around an ethics core. For, in common with other professions, medicine is concerned with human affairs that are of special moral and existential importance in the lives of individuals, and in what the French sociologist Emile Durkheim termed the “vie serious” (“serious life”) of a society. In the case of medicine, this entails nothing less than a palpable and intimate relationship to the human body and psyche; to “some of the most basic and transcendent aspects of the human condition” – birth, growth and development, sexuality, ageing, mortality and death; and to the comedy and tragedy, joys and sorrows, suffering and solace, and the irreducible enigmas and mysteries of the human “story.”
In this sense being a physician is not just an occupation. It is – or at least it ought to be – a “calling” as well.
In the words of physician scientist and humanist Leon Kass, what this requires “is a matter not only of mind and hand, but also of the heart, not only of intellect and skill, but also of character…. It is rooted in our moral nature.” Physicians are ideally expected to grapple with problems entrusted to them by patients in a way that serves not only those persons’ individual needs and welfare, but also (to quote theologian James M. Gustafson) “the larger ends and purposes of human good.” In this sense being a physician is not just an occupation. It is – or at least it ought to be – a “calling” as well.
However appropriate it may be for the nonbiomedical education of medical students to be built around the ethical center of the physician’s role and the moral foundations of the profession of medicine, a larger-than-bioethics conception of ethics is needed to foster the social, emotional, and moral competence and growth of doctors-in-training and their capacity to implement and “uphold their most noble values” in the various arenas of their professional lives. As I envisage it, this would entail inserting the sort of bioethics-driven approach that currently prevails in some medical schools in a psychological and social framework of analysis grounded in cases germane to “the morality of ordinary [medical] practice,” which also opens onto a wide historical, cultural, and societal perspective. Such a framework would neither evade the spiritual questions evoked by illness and suffering, nor minimise the role that no rational factors play in our individual and collective existence. Social and cultural differences would be fully acknowledged, not subordinated either to the recognition of common, human attributes, or to the articulation of universal principles. The bearing of the diverse personalities and social backgrounds of patients on their health, on their experiences with illness and the health-care system, on the relationships they do and do not form with physicians, and on their reactions to the processes of diagnosis, therapy, prognosis, and to the culture of medicine, would be stressed.
Methodical attention would be paid to the largely latent process of professional socialisation through which medical students pass…
Methodical attention would be paid to the largely latent process of professional socialisation through which medical students pass – that is, to the learning of certain attitudes, sentiments, and behaviours that they undergo in synchrony with their acquisition of knowledge and skills-and to the intellectual, interpersonal, and situational sources and shapers of these dimensions of becoming a doctor. Contemporaneous events and developments taking place on the broader social scene that directly or indirectly affect the health-care sector of society would also be considered.
It requires the establishment of a knowledgeable, integrated, and synergistic relationship between medicine, ethics, and social science
Translating this purview into a concrete curriculum is not a simple undertaking. It requires the establishment of a knowledgeable, integrated, and synergistic relationship between medicine, ethics, and social science, accompanied by a considered, data-based analysis of when and where in the trajectory of medical education and medical students’ stage of development the teaching that it entails ought ideally to occur, in what form, and by whom. Too much of this teaching has been squeezed into the first two years of medical school where, in compressed bursts of time, it is carried out by a procession of instructors assigned to give no more than one or two lectures apiece. Too little of it has been located in the third and fourth years of medical school – when students are learning to think and work as physicians, and the instruction could thus emanate directly from the clinical experiences they are having.
In addition, it would be advisable for medical educators to consider whether some of the foundational teaching of these aspects of health, illness, and medicine ought to be done before students enter medical school, while they are still in their college years, in an intellectual setting and on a schedule conducive to being contemplative about these matters. Based on my own long history of teaching pre-med undergraduates, I believe not only that this is an optimal time for such learning to begin, but also that medical educators would transmit a strong message about the importance they attach to it if they made some relevant under graduate course work a requirement for admission to medical school.
(To be continued)
©Prof. Ashoka Jahnavi Prasad
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