Medical students are taking medical ethics further and wider, and they are learning by doing
The biomedical ethics that Sokol discusses are critical to enabling medical students to develop professional, caring and appropriate responses to the medical dilemmas that they are bound to face in clinical practice, and it is important and worthy that we continue to question how effective medical education is and how to improve it. However, it is important to note that Sokol’s discussion takes a narrow view of the content and potential impact of ethics training at medical schools. While ethics has traditionally focused on issues of human autonomy and the wellbeing and rights of individuals, challenges currently facing health and health services have forced issues of population health, global health and the environment into the ethics spotlight.
Global health poses many ethical challenges, including related to the distribution of health resources (workers, medicines, organs for donation) internationally. New sustainable healthcare education learning objectives referenced by in the UK’s ‘Outcomes for Graduates’ ask students to recognise the ethical tension between treating a patient (allocating resources to their care) and impacts of resource use on the environment and public health locally and globally. In the UK, threats to the provision of a publically-funded health service and increased moves to restrict access by requiring proof of identity, may increasingly raise ethical issues about health equity and the right to health which clinicians may need to address. The Global Consensus on Social Accountability highlighted that medical schools have a role in preparing students to face current and future health threats; and that medical schools and medical students need not only talk about, but can also enact partnerships and initiatives to promote health by addressing social and environmental issues. Medical students not only need to understand and discuss ethics, but they can explore ethics by acting on their values and expanding their own views and perceptions.
Just as it is difficult to assess whether teaching about ethics may result in a medical student spending longer with a dying patient, it is difficult to identify any causation between teaching about environmental ethics or social justice and medical students’ advocacy to promote healthy environments or human rights. Anecdotally, however, there is evidence to suggest that students do respond to the opportunity, for example, to explore the intergenerational equity impacts of our current rate of fossil fuel consumption in health services or their own values in relation to ethical procurement by healthcare providers. At the Sustainable Healthcare Education network, educators have found that reflective logs and student evaluation often highlights that students are newly engaged by education about the ethics of sustainable healthcare and plan to take action in their personal or professional lives. Meanwhile, advocacy about global and environmental ethics by medical students appears to be alive and kicking, for example through the Healthy Planet campaign, which is calling on health organisations to divest from fossil fuels and the International Federation of Medical Students’ Associations which is currently campaigning about refugees’ rights to access healthcare.
Competing interests: I am a member of the Sustainable Healthcare Education network and contributed to the process of developing priority sustainable healthcare learning objectives, including those on environmental sustainability. I did not receive any payment for my involvement or to cover my expenses for this work.