Experience of Teaching Ethics to Medical Technology Students

Introduction

Compliance with ethical practices is necessity for all health care workers being physicians, surgeons, technologists, nurses or other staff working in direct relation to patient care. Teaching ethics to all these groups according to their capacity of handling with patient is need of time. This commentary is based upon author’s personal experience of teaching ethics to medical technology students at undergraduate levels; this program was started in 2008 and running for last 12 years with one semester every year. Being associated with an institution which is not only providing free of cost renal care services to whole spectrum of urological and nephrological ailments, but also serving as degree awarding institution for nursing graduates at self-run school of nursing, at school of medical technology bachelor degree in 6 different specialties including hemodialysis, intensive care, operation theater assistants, clinical laboratory sciences, radiology and nuclear medicine. This institution also awarding post graduate degrees in nephrology, urology, intensive care/respiratory medicine and radiology to medical graduates, and PhD in basic medical sciences. (www.siut.org) Author has published initial experience of teaching ethics to medical technology students those days this school was affiliated with large University in town, later when institution assigned degree awarding status teaching subjects and curricula has been expanded much [1]. Students entering to school (going to any of the sub- specialty) have passed their F.Sc (fellow of science) from pre-medical group thus has background knowledge of biology, physics, chemistry, religions and social studies. Ethics has not yet included in formal curricula of schools and colleges in country. As these technology students during their training period and after completing their Commentary graduation have to deal with patients or patients body fluids directly, it is important for them to have a sound knowledge of morals about issues related to patient care within not only their religious and cultural context, but additionally get ideas about other societies and religions. For these B.S students ethics was given a whole semester and author designed curriculum for the semester. Titles included in curriculum were General Introduction to ethics and Ethics through ages, connecting ethics with different religions, The Principles of Medical Ethics, Connecting literature and art with ethics, different codes of medical ethics, Genetic Engineering and Ethical issues, Ethical consideration in pharmaceutical and medical services marketing, Informed consent, Privacy and Confidentiality, Ethical issues related to Abortion and Contraception, Organ transplantation Issues, Understanding ethical dilemmas, End of life issues, Patient’s rights and physicians obligations and Socio- economic issues of medical profession.

The session on ethics through ages included introduction to ancient philosophers including Socrates, Aristotle and Plato, to travel towards Hedonism, to theories of teleology, deontology, institutionalism and ethics of care [2]. Students were introduced that how ancient philosophers have placed moral values in their teaching and how with the time different theories were shaped. Introduction to different religions and addressing different issues by religious authorities in different parts of world sensitizes students to have broader view of looking at approaches to problem. The book from Beauchamp and Childress was referred for teaching principles of ethics [3]. Similarly during session of humanities where ethics taught through literature and art, pieces of writing from prose and poetry from writers of national and international fame was selected. These

writing were penned down after getting inspired from different issues observed in surroundings and while expressing creator’s feelings on one hand, same time addressing to reader or audience on certain moral values [4, 5, 6].

Among different codes of ethics students were taught about codes designed by different specialties like doctors, nurses, pharmacists etc. All have common considerations for honesty, integrity, freedom, loyalty, hard work, truthfulness, respect for patient, consideration of family and societal values, religious beliefs and consideration for patient’s rights and health care provider’s duty. Development in science and technology while meant for mankind benefit carries lots of reservations and issues. Genetic engineering has brought revolution in treatment of certain diseases and by bringing genetically modified food and animals for human consumption has shown promises for cutting down shortcoming with increasing population under same available resources. Golden rice has promised for enhanced nutrition, fast growing salmon and huge fowlers meeting requirement for white meat. An ethicist would see consequences and motivation behind any technology and students need to be sensitized towards such approaches.

Beginning of life and end of life issues are vast subjects of concern and interest, artificial methods of conception and abortion address the former and mechanical ventilation, allocation of resources in brain dead or patients with metastatic cancers where aggressive treatment may remain futile to address the later. What are patient’s rights and what are health care provider’s duty while considering social and religious beliefs under such circumstances is subject to be taught to these technology students. Knowing about validity and components of informed consent is as necessary as any other thing in health care because ranging from simple drawing of a blood sample to undergoing any major surgical procedure to simple ultrasonography to radio therapy all based on patients agreement for procedure. The students also need sensitization about scenarios where two possible actions for any clinical situation, both with equally favorable and unfavorable alternatives. They should learn to appreciate ethical dilemmas and come up with reasonable solution for problem or at least reflect what action they would prefer to take. As such dilemmas cannot always be avoided.

Medical profession need to address many social issues parallel to treatment of physical ailments. Some societies have gender differences among social status and it affects provision of health facilities along with education, job opportunity and socialization in society. Knowledge of such issues is a must before planning any strategy to handle them [7]. Organ transplantation has been recognized as one of most promising clinical practice for treatment of end organ failure during past 5-6 decades with tremendous progress in terms of technologies and immunosuppression made during past few years. In a way it provides gift of life to those who are suffering from end organ failure. There are many issues related to organ transplantation varying from social, cultural, legal, ethical and religious. Students during this course of ethics were introduced about all the issues.

As happens with any subject that students knowledge being assessed through evaluation made by different methods, here we do a midterm assessment by giving multiple choice question; students have to select single best answer and essay type or scenario based questions where a typical scenario is given, usually from day to day problems and students are asked to identify the ethical issues. Similar evaluation is done at end of semester and sometimes they are given assignments to write up any given title.