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Ethics in Health Education

There is an old political joke about proposing a constitutional amendment requiring anyone who won an election to serve a prison term before taking office…in order to save time!

Considering the increasing number of reports on unethical conduct in health care, some might argue that providers and researchers might do the same. In a recent study of medical schools conducted by Papadakis, et al., it was found that physicians who were disciplined by state medical licensing boards were up to eight times as likely to have displayed unprofessional behavior in medical school.1 The authors of this study suggest that schools need to emphasize both patient care and professionalism across the entire curriculum in order to improve professional behavior and reduce disciplinary action.

As a college professor in the health sciences, I sometimes wonder who amongst the fold will one day get in trouble for compromising principles of nonmaleficence or beneficence. Will it be the student with a lame excuse for turning his work in late? Will it be the one who turned in the same paper he submitted last year for another class? Will the students in the bottom half of the class have a greater temptation to stray than those in the top half? Or, are those top students too shrewd to be caught?

How much of their unethical behavior can be blamed on me, their mentor, for failing to teach them the value of a virtuous life? Everyone knows that cheating or hurting others is wrong. Why even bother formalizing an education in health care ethics? Shouldn’t it be enough that we have laws that forbid irresponsible behavior?

Although laws may deter some unethical actions, not all unethical behavior is illegal. Whereas legal dilemmas seldom exist (if the light is red, I break the law by failing to stop), ethical dilemmas occur when there is no obvious right or wrong behavior. That doesn’t mean there is no right or wrong answer, just that the issues concerned require further examination.

I am glad to see research supporting the value of ethics as a core competency in health education and believe it should be a central theme in every course. Professionalism is a learned human behavior, but it is not guaranteed by a wall covered with diplomas. We cannot assume ethical behavior is "inherent” or that students will learn it later on the job. Considering the increasing diversity of health care students, it is not realistic to presume that they are able to guess what kind of behavior is expected of them.

In fact, one of the reasons allied health and nursing students are attending class is to learn how to become a professional in the health community. While colleges are not often considered the "real world,” they are the real world of academia and have the responsibility to prepare students for the real world of healthcare. This includes helping students understand which behaviors are acceptable and which behaviors are not.

Email your responses to me at holub@nsu.nova.edu.

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