Medical training prides itself on being an art, never simply a black-and-white field where answers to increasingly complex health questions are merely algorithmically derived. It follows then that the only way for medical knowledge to transcend this rigid, computational process is through the accumulation of clinical experience, which over enough time should inform our intuition to the point where we become masters of navigating a sea of grays. This archetype is classically understood to be the epitome of an astute clinician.
However, we should ask ourselves whether this alone is the end goal. More specifically, where do the interests of an astute clinician end and a humanist practitioner begin?
Thus far, the focus of medical training is largely focused on the former, gearing curricula towards the hard sciences (and understandably so) since lab values, physical exams and pathological findings act as the fundamental divide between life and death.
However our culture of learning regards classes that deal with equally complex issues like ‘medical ethics’ as an unnecessary obstacle to what is already a demanding schedule. As they stand, ethics courses by design and allotted value do little in the way of establishing a platform for students to defend their proposed ethical beliefs, cultivating a philosophical base that can be utilized to answer clinical questions, or discussing how our central beliefs can routinely impact other actors in a health care setting. Perhaps the role of ethics and morality in health care are vastly underestimated.
Consider that the cultural narrative concerning the health care profession has historically been understood in moral terms. The common phrase “doing God’s work” is evidence for how highly the public regards the profession of medicine. This axiom is so reflexively accepted as truth that society sees those who operate within the field as almost inherently ethical. It can be argued that we as future practitioners begin to internalize society’s understanding of our work and, in turn, assume the ethical objective that is essential to medical practice has largely already been achieved. That is to say, by virtue of becoming health care practitioners, we have already become ethical people. If this is the case, then this may explain why we regard ethics courses the way we do.
While my medical education is far from complete, it has already afforded me enough of an experience to humbly realize this is a fundamentally problematic understanding of our work. For one, obviously medicine is composed of a heterogeneous population, all driven by a myriad of motivations, which may or may not be moral in nature. Judging someone’s intention however is not my concern. Rather, I would like to direct my attention to how we as future practitioners gauge our own work and how this culture of self-examination (or lack thereof) colors both our training and, more importantly, our treatment of future patients. The one component of our education that could potentially provide this very opportunity is medical ethics.
Case in point, our class recently watched Dax’s Story: A Severely Burned Man’s Thirty-Year Odyssey. The protagonist Dax, through a set of unfortunate circumstances, suffers severe burns all over his body, yet refuses care. However, he is still treated and by the end, reiterates to the well-intentioned doctors that they never should have treated him on the grounds he refused care to begin with. What really served as the eye opener was the reaction of the physicians around him, especially the surgeon who treated many of Dax’s burn wounds. He essentially tells the viewers at the film’s conclusion that refusing care to Dax was not the type of medicine he was taught.
This struck me as particularly compelling because it tacitly asks the questions at the heart of the film: what are the goals of medicine and who do they serve? It takes an extremely competent physician to actually restore health in the presence of a pathological process. However, I would like to believe there is more to medicine than acting as an engineer of medical knowledge.
What separates a competent clinician from a humanist practitioner is someone who can take inventory of the interests of all actors in a disease setting, including the doctor’s own, and allot each the rightful sense of value and autonomy. In this case, placing the interests of Dax paramount to the physician’s perceived sense of rightful responsibility could perhaps have been the guiding protocol for the most humanistic mode of action, even if not the most traditional one.
To solely heal the patient by modern medical standards is a narrow vision of what we as future practitioners can do. Rather, I believe the onus is on us to collect the necessary information that allows us to execute their will, desire and expectations of what they believe can lead to a better life for themselves and those around them. Can we as future practitioners fight the urge to impose our understanding of health onto patients, irrespective of what we may consider propriety? Can we, in essence, truly serve the patient?
Now while my beliefs on the degree of patient autonomy may be flawed (at the very least, I’d be remiss if I didn’t acknowledge the very obvious fact that following the patient’s orders without any conscious thought can become a problem in and of itself for several reasons), it does however open a much needed dialog that only a course like ‘Medical Ethics’ could facilitate and nourish. For instance, how far do we go till we abandon precepts of patient autonomy? In what specific clinical situations is this indicated? When do these patients regain autonomy and on whose authority? If anything, any disagreement on these fundamental matters validate why ethics should have a greater role in our curricula as the complexity involved in such a conversation makes ethics not unlike medicine with respect to its layered nuances in decision making.
If we see ethics simply as a set of unified understandings and deducted cultural beliefs that inform protocols, it can undoubtedly be a tangible asset in the clinical setting. However this reiterates the same algorithmic thinking we hope to break out of throughout our training. If medicine teaches us what to do in a clinical setting, medical ethics can teach us why we do. To forego the latter in the name of ‘focusing’ on objective medicine makes our education feel incomplete as we prime ourselves to become so enamored with the physical body we essentially deny it of its soul—its essential humanism. Severing this tie between student and subject so callously denies this unique relationship the one commonality that is shared between the two from the onset. Therefore we must be careful as a group to not let this transient fixation manifest into what can become a very pathological way to not only deal with patients, but people as a whole. Seen through this lens, medicine become a microcosm of life: a never ending moral journey, that can at times be overwhelming but given the right outlook can also serve as a buoyant reminder that there is always a way to do more.
Contributing Writer Emeritus
Rocky Vista University College of Osteopathic Medicine
I am a Class of 2016 medical student at the Rocky Vista University College of Osteopathic Medicine interested in ethics, politics and medical anthropology.