Dr Boehm is a professor in the Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee.
The results of a 2015 survey of residency directors on medical ethics in ob/gyn residency programs may be news to some in our specialty but they are not a surprise to me. Published in the American Journal of Obstetrics and Gynecology the data reveal that medical ethics is a part of the core curriculum in 50% of ob/gyn residency programs but is taught in an unstructured manner, with 57% of programs dedicating 5 or fewer hours per year to the subject.1 In addition, 73% of the survey respondents stated that they would like “more” to “a lot more” ethics education for their program and 85% indicated that they believed medical ethics education should be required.
Interestingly, 67% reported that a lack of faculty expertise in medical ethics was a significant barrier to their attempts to provide a more comprehensive educational process. I have a proposal for a solution to these problems: Teaching about the “house of ethics” in ob/gyn, as we do at Vanderbilt University.
When I served as Chair of the Vanderbilt Medical Center Ethics Committee from 1990 to 2004, I came to understand that ethics is the study of standards of conduct and moral judgment as well as a code of behavior. I also came to realize that the question of what is “right” is at the center of most of our ethical discussions and debate. I came to believe that the issues surrounding medical ethics were pervasive and ubiquitous throughout the day-to-day practice of medicine.
Medical ethics issues involve much more than whether it is appropriate to perform an abortion or to allow a patient to refuse treatment. It also involves each and every patient encounter, whether in an outpatient setting or within the confines of a hospital.
Pillars of the ‘house’
Because of this, I began to teach our ob/gyn residents that in our profession, we practice in what I call a “house of ethics” and each time we undertake a patient encounter, we enter this domicile. I tell them that the foundation of this house comprises 4 principles of medical ethics first introduced by Hippocrates: beneficence, non-maleficence, autonomy, and justice. I explain that the walls of the house are made of the many virtues of medical professionalism and the roof comprises the informed consent process. This metaphor frames understanding and stimulates an encompassing concept of medical ethics.
We teach our residents that beneficence is the duty to do good on behalf of the patient; non-maleficence is the duty to refrain from harming the patient; autonomy is the respect for self-determination for patient and physician; and justice is the patient’s right to be treated fairly and to receive a fair distribution of the burdens and benefits of healthcare. They are taught further that the walls of professionalism are defined as the principles of how we conduct ourselves while serving our patients and include such virtues as confidentiality, truthfulness, compassion, sympathy, promptness, reliability, a nonjudgmental attitude, absence of conflicts of interest, lifelong learning, integrity, honesty, humility, and collegiality.