Medical students who completed a course in medical ethics attached greater importance to patients' capacity to make informed choices, displayed a deeper understanding of the issues raised by physician-assisted suicide, and showed a greater concern over economic and liability issues, according to researchers at Emory University.
"Many of the students demonstrated that they were able to critically and analytically consider the benefits of actions that they had not considered prior to taking the course," says lead author Risa P. Hayes, Ph.D., Grady Health System, Atlanta, Georgia. "The course gave students both a structured approach to the medical case presented to them and a vocabulary to voice their particular concerns."
Third-year medical students participated in case-oriented seminars designed to help improve their ability to make ethically informed decisions, particularly in the areas of quality of life and end-of-life care. The course taught students to systematically examine the treatment options in each case; the patient's preferences and decision-making ability; the quality of the patient's life; and the legal, social and economic context of the case. The study appears in the current General Hospital Psychiatry.
Before and after the course, 104 third-year medical students read a case study of a 64-year-old woman with breast cancer that had spread to her brain and other parts of her body. The students described their reasons for recommending a specific course of treatment for the woman, who appeared hopeless and at times confused and had refused a new course of chemotherapy that could extend her life by three months.
"Although the students identified a similar number of ethical issues raised by the case both before and after completing the course, the line of reasoning they used to make ethically based decisions differed greatly," said Hayes.
Both before and after the course, for example, all of the students questioned the woman's ability to make an informed choice. But after the course, a much higher percentage thought there needed to be a formal evaluation or a court determination of the woman's competence (58 percent vs. 42 percent).
"The students' change in reasoning was most apparent when considering physician-assisted suicide," said Hayes. Before the course, nearly all of the students who addressed this issue based their decision on personal beliefs or the conviction that physician-assisted suicide is in direct conflict with a physician's duty to do no harm. After the course, however, many argued that physician-assisted suicide might be consistent with the role to do no harm because it ends the patient's suffering.
"The complexities of ethical dilemmas require physicians to demonstrate skills beyond the retention of factual knowledge, changes in attitude, or the identification of ethical issues," said Hayes. "The ability to analyze and synthesize information and then evaluate ethical issues from a variety of perspectives is essential."
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Don R. Lipsitt, MD, at 617-499-5008.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org , 202-387-2829.
Journal
General Hospital Psychiatry