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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Ethics or common sense?
- Kayvan Shokrollahi (16 July 2004)
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Ethics into practice
- Peter J Waugh (16 July 2004)
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Re: Ethics or common sense?
- sheila otto (16 July 2004)
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Tuskegee was bad enough
- Hilary Curtis (18 July 2004)
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Correction to editorial
- Michael J Parker (19 July 2004)
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Common Sense Uncommon
- James L Reynolds (20 July 2004)
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Kayvan Shokrollahi, Trust Surgeon Dept Plastic Surgery, Radcliffe Infirmary, Oxford, OX2 6HE
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I agree with many of the points raised by Parker. However, how far does one go? The position of "core" subjects in medical curricula is increasingly tenuous with the push to incorprate more and more peripheral (but nevertheless important) subjects. I am not aware of any evidence that formal training in medical ethics makes people any more ethical. Furthermore, despite having an interest in medical ethics, being an expert member of a regional ethics committee, with formal medicolegal training and even having read Aristotle's "Ethics" cover to cover, I find ethical issues and decisions just as difficult as always. In most situations where ethical considerations arise "on the shop floor", common sense and a sense of ease or unease (morality?) will guide most in the right direction. I suggest that common sense is difficult to teach, and that perhaps formal ethics training, despite playing a valuable role, may therefore not be as effective as we might think. It may be more productive to involve "ethicists" more in day-to-day medicine, so that there is always someone on a bleep, such as a clinician with a special interest, who can give advice on ethical issues. Such input could then be integrated into every-day practice, and be discussed along with other issues such as morbidity and mortality, or audit, during monthly departmental meetings. Competing interests: I am an expert member of the Oxfordshire Research Ethics Committee (A) and am a final year medical law student at the University of Northumbria |
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Peter J Waugh, Medical Inspector HSE
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I am troubled by the moral equivalence implied in this article where it refers to "several high profile scandals that have occurred in medicine". Citing an instance where prisoners were deliberately infected with syphilis along with the Alder Hey matter raises a very important point about the way in which moral and ethical issues are portrayed. I agree that the Alder Hey matter was wrong, that it shouldn’t have happened and numerous relatives were profoundly upset. However, I cannot accept that there is such a close moral and ethical comparison with the deliberate infection of live human beings in the way suggested such that these two matters can be included in the same sentence. The reader is invited (wrongly I believe) to make the connection and I believe that the effect of this comparison is to add further weight in the mind of the reader to the moral opprobrium that has attached to the Alder Hey issue. This is, in other words, a journalistic device or trick that has the effect of adding to the misery felt by the relatives. Misery that has been in some measure been created by expectations derived from ill informed and exaggerated comment by politicians and the media competing for attention. The effect of this has been to stifle research in a very important field of medicine to the ultimate detriment of those and others whose emotions have been so cruelly exploited. Competing interests: None declared |
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sheila otto, ethicist Albany Medical Ctr. NY, 12208
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Most persons I work with think of themselves as ethical. Many decisions indeed involve common sense. However, to ask if ethics training makes persons ethical or if lack of training leaves one less ethical is to miss the point. Given the ongoing rapid technologic changes in today's medicine many questions have arisen to which ethical persons have very different responses. The ethics training piece is key for two reasons: 1)awareness and 2)process. Our medical college supports mandatory ethics training over the four years. When we meet with students in their clinical years, they are asked to bring issues forward for discussion. Many of the problems identified are not addressed by the care team but are troubling for the students. In looking at a troubling case, a comprehensive approach of information gathering, identifying dilemmas, exploring competing ethical principles and resolution is a challenging, key exercise not undertaken by most senior clinicians. To simply rely on common sense implies that there is one solution to a problem, the one that we come up with based on our upbringing, training and experience. To utilize a learned process, leaves room for the ability to individualize solutions and to recognize and respect differences. One size often does not fit all. Competing interests: None declared |
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Hilary Curtis, Freelance Home, London NW6 7HF
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Atrocious as it was, as I understand it the Tuskegee experiment did not involve infecting anyone with syphilis. Rather a group of poor and poorly-educated African-Americans (not prisoners) who had syphilis were left untreated and I think in some cases denied treatment for other intercurrent infections as well. Tuskegee has cast a long shadow. Even today, conspiracy theories about the origins of HIV/AIDS may be best understood in terms of a legacy of mistrust about the motives of government health officials. Hence it is important not to spread further misinformation about this dark episode in the history of the US public health service. Competing interests: None declared |
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Michael J Parker, reader in medical ethics University of Oxford, OX3 7LF
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I would like to thank the previous respondent to this editorial for identifying a factual mistake in the text. The Tuskegee study did not involve people being deliberately infected with syphillis. It was an observational study of 600 men, some of whom had syphillis. The study is often cited as an important example of unethical research practice because despite the discovery of an intervention for syphillis in the 1950s (penicillin)the men in this study were not offered this treatment until the study came to an end in 1972. This was something I failed to pick up at proof stage and I am grateful to the author for pointing this out. In response to an earlier rapid response. I mentioned both Alder Hey and Tuskegee in the editorial not because they are comparable in seriousness but because they are both examples of 'scandals' in medicine that have led to a debate about ethics and ethical practice. I share the author's concerns about the subsequent reaction to the revelations about practice at Alder Hey but this was not the focus of my editorial. Competing interests: I am the author of the editorial |
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James L Reynolds, Professor Family Medicine University of Manitoba Winnipeg Canada R2H 2A6
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I agree with the author that there is a need for more continuing professional development in ethics for physicians. Appeals to common sense are fine but common sense in less common than generally assumed. In educating physicians we need to resist the modern medical tendency to oversimplify issues and to rush to judgment. This combined with the M, Diety syndrome can lead to some very bad judgements. Yes, there may be no one right answers but there are many wrong ones. Ethical decision making takes time. Involving other professionals especially our nursing colleagues along with patients and families in decision making is another important step. Competing interests: None declared |
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