Ethics in medical education, practice, and research: An insight

Abstract

A combination of moral principles and values that are applied to take judgements in medical education, practice, and research are termed as medical ethics. There have been other many traditional medical ethics guidelines brought about by Muslim Ishaq ibn Ali al-ruhawi wrote “the Conduct of physicians”, Jewish and Catholic scholastic thinkers over time. Ethics in modern medicine started way back in 18 th century when Thomas Percival, a physician based in England, wrote a book on medical ethics and coined the terminology of medical ethics and medical jurisprudence. The medical profession should be viewed differently and a rethought on the ethical practices is the need of hour to make it an exciting and fulfilling profession. A rethink on the status of modern medicine will certainly pave the way for obtaining specific answers for many dilemmas in modern medicine including the best ethical codes and practices.

Keywords: Ethics and medical teacher, ethics in clinical trials, medical ethics

How to cite this article:
Ramana K V, Kandi S, Boinpally PR. Ethics in medical education, practice, and research: An insight. Ann Trop Med Public Health 2013;6:599-602

 

How to cite this URL:
Ramana K V, Kandi S, Boinpally PR. Ethics in medical education, practice, and research: An insight. Ann Trop Med Public Health [serial online] 2013 [cited 2021 Mar 5];6:599-602. Available from: https://www.atmph.org/text.asp?2013/6/6/599/140200

 

Introduction

A combination of moral principles and values that are applied to take judgements in medical education, practice, and research are termed as medical ethics. History enlightens us that guidelines on the duty, conduct, and moral responsibility of a medical practitioner has been thoroughly evaluated and the first code of medical ethics called as “Formula Comitis Archiatrorum” was published during the reign of the Ostrogothic King Theodoric the Great way back in the 5 th century. Medical ethics have also been historically preached by western people in the form of Hippocratic Oath and through Christian teachings. There have been other many traditional medical ethics guidelines brought about by Muslim Ishaq Ibn Ali Al-Ruhawi wrote “the Conduct of a physicians”, Jewish and Catholic scholastic thinkers over time.

Ethics in modern medicine started way back in 18 th century when Thomas Percival, a physician based in England, wrote a book on medical ethics and coined the terminology of medical ethics and medical jurisprudence. American Medical Association also came up with code of ethics in medical practice which was largely based on Thomas Percival book. [1] From being more eccentric and noncompetitive, the medical ethics went through dramatic shift due to more liberal thinking and considering procedural justice, evolved in to what is termed as bioethics.

Conduct of a Medical Practitioner

In the text book “Principles of biomedical ethics,” authored by Tom Beauchamp and James Childress, have highlighted the importance of four basic moral principles in medical practice including, respect for patients autonomy, acting in the best interest of patient, nonmalfeasance do no harm, and justice fairness and equality in treatment. Other values that are expected from medical personnel are respecting the dignity of a patient and truthfulness, honesty in informed consent. [2] Moral values though are essential for well-being of patients, there are numerous occasion that lead to crisis due to decisions of patients that may limit healthcare necessary for patients benefit. Reduction of ethical conflicts can be achieved by better communication between the health care provider and the patient groups. Physician prescription influenced with the benefits that are on offer from various drug manufacturers may be another cause for ethical conflict, where the patient may not afford the cost of treatment. There have been studies that have also implicated physicians’ unwarranted relationship with patients or their relative which may be responsible for ethical crisis. Medical practitioners should believe that the service to patients is a service to GOD, who has considered them as next to Him. Prescription under the drug manufacturer’s influence, where patients are forced to take high cost drugs/devices is another area of concern being properly addressed in India under the medical council of India guidelines on industry-physician relationship. [3] An ethical code of conduct concerning the relationship between the industry and the medical professionals is necessary to ensure transparency, better promotional modes, and good relationship practices.

Medical Teacher

A medical teacher must be chosen carefully as his approach toward practice, activities, and ethics will be deciding factors on the moral values of future doctors. The medical profession should be viewed differently and a rethought on the ethical practices is the need of hour to make it an exciting and fulfilling profession. A rethink on the status of modern medicine will certainly pave the way for obtaining specific answers for many dilemmas in modern medicine including the best ethical codes and practices. Medical ethics education can be useful in creating virtuous doctors who are well-versed in solving ethical dilemmas in clinical practice. Medical education should concentrate on empirical studies that examine student outcome, evaluate teaching methods in medical ethics, and effectiveness of various medical teaching methods. [4] There have been few studies that have argued the inclusion of ethical consideration topics in undergraduate medical education curriculum. [5] Few studies have highlighted the importance of accrediting medical teachers with medical ethics course or having this subject integrated during graduation. [6] Medical educators have a great responsibility on them of both responsible and answerable to the society to produce quality medical professionals and also be a role model for the same cause to their students. Privatization and capitalism may be responsible for the degrading medical ethical values which are actually responsible for the breaches in basic principles of medical practice and resulting in ethical fallacies.

Ethics in Medical Education and Research

From our experience, it becomes clear that we have ignored the importance of ethics teaching in undergraduate medical curriculum. It becomes an epitome of subject to prepare medical practitioners in their moral responsibilities and legal issues related to patient care. [6] A comprehensive evaluation of undergraduate curriculum in regards to ethical and legal medical practices is the need of the hour. Ethics of medical research on human subjects has been a matter of much analysis. Though medical practice and medical research both involve patients and both are necessarily benefiting the patient as well as the public, without ethical guidelines the benefit to either remains elusive. Exposure of patients to training undergraduates and postgraduates is mostly not after informed consent of the patients and it remains as an obligation with respect to patients, who can be either benefited or sometimes may undergo unnecessary agony mentally, physically, and financially. [7] Ethical theory, analysis, argument, attitude, medical humanities, critical, and normative medical ethics should be the matter of subject in ethical codes for a proper and expected medical professional behaviour. A balance in class room (lectures based medical teaching and practice-based (hospital and patient exposure/clinics medical education can result in the production of better medical practitioner. [8] General medical practice can benefit a lot from the standard classification of infectious diseases which provide guidelines on specific symptoms of a disease/infection and later toward diagnostic methods to be used for confirmation and finally the treatment modalities to be subjected on the patients. In principle, medical education needs to include more emphasis on the significance of ethics teaching/preaching at graduate medical schools. It would be beneficial to have full time academic faculty to take care of ethics teaching. Studies have also found significant benefits from small group ethics teachings than didactic lecture deliveries which has its own disadvantages in requiring more skilled and trained staff. Systematic procedures resulting from fundamentals of ethics can benefit the patient as well as medical practitioner, educator, and researcher.

A recent study on the effect of integrated medical ethics curriculum on 1 st -year students from Singapore revealed a positive response from the subject group and that the ethics teaching and assessment in medical education resulted in significantly greater receptiveness toward ethical codes of profession and had better critical thinking and clinical ethical competency. [9]

A study from London which reviewed the teaching hospitals has come out with recommendations of including medical ethics teaching from the time medical students start visiting clinics (2 nd year) and till the completion of clinical course. Study has also recommended course content that included general principles of ethics, a topic on developmental problems (genetics, abortion, and explanation of life), resource allocation, clinical research and community issues care of elderly, mentally handicapped, and prevention and cure, and regular evaluation of ethical standards using assessment forms. [10]

The status of medical ethics is at its low in the poor and developing countries where the government hardly takes care of population health. [8],[11] Corporatization of medical education, medical practice, and drug manufacturing has already made its negative impact, where poor patients are made to undergo seemingly life-threatening medical procedures (newer drug, newer invasive prosthetic devise, transplant and plastic surgeries) for the sake of monetary benefits. Medicine, ethics, and law should have their practical place in undergraduate medical curriculum for preparing medical practitioners to act ethically and legally. Physician-patient relationship will be symbiotic only when ethical and legal concerns are properly addressed. Confidentiality (human immunodeficiency virus status), informed consent (procedural consent), patient autonomy in decision making (refuse treatment), role of patient’s family, justice in cases of organ donation, patient abandonment, malpractice, and patient care during emergencies are the core issues involving ethical and legal decisions by medical practitioners. The bioethical guidelines benefit medical practitioners to defend their treatment and patient management decision on the grounds of moral, ethical, and legal practices. [12]

Physician trainees including the medical students, residents, and fellows must understand that trust and respect are essential for a better doctor-patient relationship. Patients should not be taken for granted and an informed verbal consent is required before every physical examination, suturing, drawing blood, and other invasive procedures. Balancing between training medical personnel and patient’s autonomy can result in better output in terms of medical teaching, research, and practice. Practice of having institution review boards (IRBs) for addressing ethical concerns in research involving human subjects certainly reduce conflicts of interests arising from financial relationship between review board members (IRB) and the sponsors/pharmaceutical companies. [11],[13]

Ethics in Clinical Trials

With respect to drugs manufacturing status in India, the Drugs Controller General of India approval is not difficult and the government’s priority appears encouraging clinical research in India to produce good-quality data using good clinical practice standards. It must be said that the ethical guidelines of Indian Council of Medical Research and World Medical Association Declaration of Helsinki for ethical principles for medical research involving human subjects are least followed and there is inadequate monitoring where many queries are left unaddressed. [14],[15] India has come a long way ahead in the clinical trial and drug manufacturing industry, where the government has enabled the growth with decisions’ including waiver of service tax and that has encouraged foreign investments in the clinical trial and drug manufacturing industry. The problem here is that the agony that a patient/study subject undergoes if the said trial results in a permanent injury or even death in some cases. Ethical considerations in these studies include how the subjects are recruited, whether the patients concerns are addressed in case of serious adverse events, and the quality of care they receive during the trial. [16] We should accept that physicians/researchers are forced to recruit study subjects for which they are monetarily rewarded, breaching the ethical code. There are many reports that patients do not get justice in many ways when there is an injury. Things can be improved if ethics committee in coordination with government and the Association of Clinical Research Organizations, Associated Chambers Of Commerce and Industry of India, and Central Drugs Standard Control Organization address the concerns of the study subjects.

Conclusion

Ethics in medical practice, education, and research should stress on self-regulation of medical profession, become proactive in improving the social image of a doctor/medical researcher to make people understand that this profession is not for trade/money but for the benefit of the patients and public at large. Government should encourage ethical practitioners and punish unethical practices by private practitioners and clinical research companies. Medical schools must be encouraged to include ethics in the course curriculum and medical education training be provided to all medical teachers. We should not forget that a small seed grows to a very large tree if properly watered and taken care of. Therefore by addressing ethical concerns in medical education, we can produce a better practitioner and good medical researchers.

References

 

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10. Burling SJ, Lumley JS, McCarthy LS, Mytton JA, Nolan JA, Sissou P, et al. Review of the teaching of medical ethics in London medical schools. J Med Ethics 1990;16:206-9.
11. Jafarey AM, Iqbal SP, Hassan M. Ethical review in Pakistan: The credibility gap. J Pak Med Assoc 2012;62:1354-7.
12. Puliyel J. Compensation for victims of clinical trials: A discussion on how current rules and guidelines are hurting India. J Clin Diagn Res 2012;6:1367-8.
13. Bajpai V, Saraya A. Industry-sponsored clinical research. Natl Med J India 2011;24:300-2.
14. Nadig P, Joshi M, Uthappa A. Competence of ethics committees in patient protection in clinical research. Indian J Med Ethics 2011;8:151-4.
15. Banerjee A. Industry and the medical profession: Sleeping with the enemy. Med J DY Patil Univ 2013;6:1-2.
16. Brody H. The ethics of drug development and promotion: The need for wider view. Med Care 2012;50:910-2.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.140200

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