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Ethics and medical school
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We cheered on a death... written on Saturday October 22, 2011
First, a bit of a disclaimer.
My original idea for this post was to have a much longer, more thoroughly developed idea to put across. That stil may happen, so I am going to treat this much as a first draft. When time permits, I shall add pertinent references and such to support my proposition, but those will be lacking, at a minimum for tonight. I definitely will not be using any sources without referencing the original documents at this point, I will simply be presenting original material and that which I have already consumed but should be common knowledge.
And we begin the post.
Today, we supported a death. It was more than merely allowing it to occur in our cheered presence, we brought on the death of the individual and expressed exuberance when it finally occured. There was a slight rodent infestation of my dorm room since the moment my roommates and I moved in. A small fissure exists between the tile and our exterior door. This, otherwise miniscule opening, is sufficient for a small rodent, in our case, lizard, ants, what have you to enter our dorm without being invited in. I am certain this was how our mouse arrived, I looked through much of the rest of the dorm and could find no other spot suitable for entry.
One of my roommates was particularly concerned about the situation and he purchased lethal traps to solve the problem, as he saw it. The other roommate seemed slightly disturbed by the infestation but not enough to take definitive action against it. This initial distinction is more important than it may initially seem. And individual may easily have a problem with something and yet do nothing at all to solve the situation. It takes amply more energy, coordination of thought processes and time to go about proposing an enacting a potential solution. In our everyday lives, we may complain about our bosses, but how many of us go through with discussing the situation with him or her, or his or her supervisor, in order that the situation be resolved? I am guessing that the number is small, probably less than 20%. If it were even to reach that high, I would be amazed. As Americans, it seems that we have increasingly become apathetic, unable to logically and usefully assert ourselves. Instead we go to one extreme or the other, we use a solution that is far beyond what he the situation calls for or we do nothing and complain, hoping the situation will resolve on its own. Without doing much further research, I can only speculate as to why this is and that speculation is far beyond the scope of this discussion.
Conversations were had in common areas of the dorm where the problem was spelled out, implications of the problem (such as the mouse eating food not left for it) and in lethal and non-lethal solutions. I remained quiet for the bulk of the conversations as I was interested in how the proceedings would occur. The leading non-lethal solution was to catch the mouse and release it into the wild. The leading lethal solution was the ancient "mousetrap" that everybody should be aware of at this point where the large bar is held precariously by a small lever against a strong spring. When the touches the lever, due to the lure of food, the spring is set into action, hurling one end of the bar towards the rodent striking the head, body or even tail in a grotesque exhibition of he who has the weapons wins the war.
It was decided, mostly by the roommate who despised the mouse the most, that the lethal option was the one we were going to be using. One day, traps were purchased, baited and laid out for our adversary. One morning, there was a loud snap! There was no doubt the mouse had died that morning. When I got up for the morning, I saw the dead mouse approximately 4 cm from the trap, with a significant amount of blood on the tile taking into consideration the size of the rodent. Having never killed a mouse previously, it seemed like alot of blood, but it surely could have been an average amount when looking at the entire population of mice on our small island. When the roommate who purchased the traps saw the scene, he exclaimed with happiness at our good fortune. When we had visitors later in the afternoon, they were all treated to a tour of the morbid site.
We are all medical students. We have all, my roommates and I, received at least bachelor of science degrees from reputable, accredited universities, both in the United States and in Canada. When I was an undergraduate and a graduate student, ethics courses were required to graduate. As an undergraduate, one had to take some philosophy course out of a list and as a graduate student, it was specifically with regard to ethical research methods and such.
This situation is particularly ethically sticky to me. We killed a mouse for no reason at all. The mouse had little to no likelihood of transmitting disease to us, was not bothering any other flora or fauna and could easily be removed with non-lethal methods. On the other hand, how much is a mouse's life worth? Surely not as much as another human. But, no other humans were at risk. How shall we quantify the worth of this rodent? What if it were a cat or a dog? There are many feral cats and dogs around this island. Should we euthanize those animals, too? What would these future physicians think of putting a cat or a dog to sleep because it has become a nuisance? Even those conducting research must go through institutional review boards when conducting animal research ensure that their treatment of the animals, including mice and rats, is ethical. I believe that we are not properly preparing these future physicians.
I am not aware what other schools require, but the ethics requirements at our medical school are rather light. We have been treated to a single lecture that was not tested on during our current curriculum. I posit that a greater number of ethics courses should be required for medical students. These students are but a few years away from making life or death decisions, holding people's lives in their hands, and we teach them little to nothing about how to make appropriate, ethical decisions when dealing with these complex issues. What about the recent rash of pharmacists who refused to administer contraceptive prescriptions to their customers (a reference or two is forthcoming for this)? What does a young physician do when his patient has just killed a mother and child in cold blood? Obviously, his or her decision must to treat the patient to the best of his or her ability, but we are giving the young, already confused, physician nothing to support the charge that treating this patient is the right thing to do. After treating the patient, where does the physician go to analyze the situation he or she was shoved face first into? He or she could go to his or her religious leader, seeking answers from holy scripture, but for those without religion or those who do not want to get all of their answers from the Bible, Qu'ran, or other scripture as their religion prescribes, where do these physicians go?
Most situations encountered on a daily basis by physicians are not as dramatic as the one we presented here, but there is always the chance that a physician will have to treat a patient whom he or she finds objectionable or even reprehensible. If we provide a better ethical standing for future physicians, this should, for the most part, become a problem of the past. We will give these new physicians the ability to critically analyze ethical and philosophical situations so that they are not automatons to their previous learning.
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