Course helps medical students deal with ethical issues in class

An Emory medical school course is helping students learn to deal with the types of ethical dilemmas faced each day by practicing physicians.

The third-year course, called "Clinical Ethics," is a collaborative project of the medical school and the Ethics Center. It introduces students to resources the average doctor might not be familiar with, such as ways to access the legal system for assistance in ethical dilemmas.

Legal guidance might be helpful if there is division within a family about whether or not to continue life support, as demonstrated by a recent case encountered by an Emory physician. A patient dying of painful metastatic breast cancer, although she was delirious and confused, asked to have all drugs, chemotherapy and life support withheld--yet the patient's family wanted to take all possible measures to prolong her life.

"If we can imprint the skills for ethical decision making on students at a formative stage of their professional development, we believe it will have a lifelong impact," said course co-director and Emory psychiatrist Alan Stoudemire. "This may be one of the most helpful things we can impart to medical students."

Many of the cases students deal with involve the compassionate care of terminally ill patients. In pediatrics, for example, a case might deal with the dilemma of continuing life support in a premature infant with brain damage. In internal medicine, it might deal with whether or not to continue nutrition in a patient with Alzheimer's disease who is in a vegetative state. In surgery and anesthesia, the debate might involve whether or not to continue respirator support in a patient with severe head trauma who will not recover cognitively. In obstetrics and gynecology, students might discuss issues of surrogate parenting, ethical issues of selective termination of pregnancy in multiple births, or prescribing contraceptives for underage teenagers.

"Not only will we be graduating medical students who are well informed about medical ethics, but we also will be increasing faculty members' levels of knowledge and sensitivity in ethical matters," Stoudemire said.

Under the guidance of Stoudemire and course directors Kathy Kinlaw, associate director of the Ethics Center, and Mary Lynn Dell, assistant professor of psychiatry, students study medical ethics cases relating to the specialties through which they rotate during their third year.

"This is not an equation, but simply a framework around which to organize their thinking," Kinlaw said.

--Holly Korschun

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