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Ethics

In a recent student survey, "altruism” was ranked 24th out of 25 professional qualities required by health professionals (trailed only by "charity”) (Hafferty, 2004). In fact, the current debate in my online healthcare ethics course has divided the class into two groups: those that believe health professionals have the right to deny care based on personal beliefs and those that believe health professionals are bound to duty and the respect for patient autonomy - in a word, altruism. The majority of my students were in the former group, so I decided to "do like them” and see what Google and Wikipedia had to say about "altruism.”

Indeed, if my research on "altruism” were based on a Google search, I would come to the conclusion that the word has nothing to do with health professionals and everything to do with patients, that is, "organ transplantation and the altruism of donors.” In fact, Martin B. Van Der Weyden, editor for The Medical Journal of Australia, likens altruism and medicine to "oil and water” (Van Der Weyden, 2006).

On to Wikipedia (which I would ban in my classes, if it were not for the fact that I use it myself to spice up ethical discourse with sensational links to articles on Michael Swango, body snatching, and other topics not published in peer reviewed journals). "Altruism,” according to Wikipedia, applies to ethics, evolutionary biology, psychology, religion, love and even politics; but, there are no references to healthcare or medicine. The site does credit Auguste Comte with coining the term. Comte (1852) wrote, [the] social point of view cannot tolerate the notion of rights, for such notion rests on individualism. We are born under a load of obligations of every kind, to our predecessors, to our successors, to our contemporaries. After our birth these obligations increase or accumulate, for it is some time before we can return any service.... This ["to live for others"], the definitive formula of human morality, gives a direct sanction exclusively to our instincts of benevolence, the common source of happiness and duty.

If I were to limit my understanding of "altruism” to the above two online resources, I would probably count myself in the same group of undergraduate healthcare ethics students who view altruism as a philosophical ideal, irrelevant to medial professionalism. But, I do not limit my understanding, nor should we expect our students to limit their understanding of altruism to religious or philosophical piety.

The American Board of Internal Medicine’s Project Professionalism (2001) lists four pillars of professionalism: excellence, humanism, accountability, and altruism. The Association of American Medical Colleges’ Learning Objectives for Medical Student Education (1998) lists teaching altruism as the first objective in a medical student’s education. This report, which serves as a guideline for medical schools across the country, stresses that before graduation a student will demonstrate "A commitment to advocate at all times the interest of one’s patients over one’s own interests” (p. 5).

When I was a student, I remember a patient who had so much poking and twisting of his sprained ankle that he sent the hoard of podiatry students out of the exam room. A classmate of mine turned to me and said, loud enough for the patient to hear, "Who does he think he is?” The patient, man…he’s the patient.

References

American Association of Medical Colleges. (1998). Medical school objectives project. Retrieved December 10, 2006, from www.aamc.org/meded/msop/start.htm

American Board of Internal Medicine. (2001). Project professionalism [Electronic version]. Philadelphia: ABIM.

Comte, A. (1852). Catechism of Positivism. Retrieved March 15, 2007, from http://en.wikipedia.org/wiki/Altruism

Hafferty, F.W. (2002). What medical students know about professionalism. Mt Sinai Journal of Medicine, 69, 385 - 397.

Van Der Weyden, M.B. (2006). Can altruism survive? The Medical Journal of Australia, 184(4), 145.

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