menuPaper: What does ethics mean to medical students: fiction and reality?
04 November, 2003
My name is Stefan Gutwinski. I am going to talk about the meaning of ethics to medical students. To what extent is it fiction and to what extend reality?
Firstly, I am going to talk about my connection to the field of ethics, which might explain why I am here.
Afterwards I will try to look at ethics from a multiple choice point of view.
Then I will describe the meaning of ethics, by describing its meaning to three different kind of medical students.
I am connected to this workshop by a research exchange, I joined last summer, entitled “Medical ethics and literature” at Erasmus M.C in Rotterdam. It was organized by the office of Professor Inez Beaufort.
There, I read several novels and wrote an essay about “Doctor-patient Relationship in Six German Novels, under Consideration of its Narrative Use.” This was the title of my essay.
I tried to analyze the relationship of doctors and patients in “Magic Mountain”, by Thomas Mann, in Franz Kafka´s “Country doctor”, I am going to mention this novel later again, and also in “Woyzeck” by Georg Büchner and three other German novels.
On this basis I was invited to this workshop. I am glad to be here.
What does ethics mean to medical students?
In 58 days I will have my Physicum, which is an examination for all medical students after two years. This test consist of 320 multiple choice questions. Influenced by my preparation for this examination I had the idea to look at ethics from a multiple choice point of view.
How could an ethical question occur in such a multiple choice test? For example: How could a specific question about euthanasia look like?
Could multiple choice questions cover ethical dilemmas?
To my point of view, it does not seem to be possible, off course. Because medical ethics deal with problems, where one can not tell, what is right and what is wrong, we can not tell in a multiple choice test: answer A is right and the others wrong.
To my point of view, the medical staff, doctors and medical students should be aware of the fact that there is not a right way and they should be prepared to find one way, which seems to be best.
Thus, dealing with medical ethics from a multiple choice point of view might not be helpful. In fact, ethics is not part of the examination in summer.
Then, what does ethics mean to medical students?
I would like to tackle this question by describing the forms of ethical approaches I could find in my three friends. I would like to introduce my three friends Bernd, Florian and Andreas.
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Bernd is 24. Before he started his studies he had been working in a hospital for one and a half years. Still, he works once or twice a week on an intensive care unit. There, all patients are in a very unstable state and need intensive care.
Bernd’s ethics are closely connected to the real problems on his ward.
Questions bothering him could be like this:
How am I going to treat these patients, who are just living as long as they are connected with high-tech machines?
What kinds of life do these patients live just consisting of sleepless nights and a variety of body checks?
As Bernd, many medical students have half-time jobs in hospital. They are connected to ethics by their doings, for example the way they treat their patients.
Such problems are mostly solved or answered by the rituals of the ward, the guide of elder nurses, which know what to do and the need to be professional. It means there is a “course of doings” even in extreme situations.
The words and advice while having a coffee with other nurses might be the best way of dealing with these kinds of problems.
This kind of ethics is not fictional, but very real to medical students.
Probably, this kind of issues and the way of dealing with it is the way most ethical questions might occur in clinical every day life.
Thus, from the example of Bernd who works on an intensive care unit, ethics means to medical students to solve concrete or real problems.
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What does ethics mean to my friend Florian?
For my research exchange in Rotterdam I read the novel “Country doctor” ( Der Landarzt) by Franz Kafka.
It is a story about a country doctor who is on a night-time summon. He visits a young patient, but fails to find the wound. The doctor seems to be unable to find any illnesses, because he is tired, preoccupied with personal distraction and grievance against the family of the patient and has also several personal problems in his mind, for example the loss of his maid.
He gets humiliated by the family of the patient and has to leave undressed.
In the stile of Kafka it is a schizophrenic description of this doctor, where imagination and reality gets mixed up.
In Rotterdam, I was looking at the doctor-patient relationship of the protagonists. But while reading the story I had my friend Florian in mind. The doctor symbolizes in some way a personality in struggle, but still keen to do his work.
My friend Florian is a fellow from south Germany, who spends any free time in nature climbing or travelling. He struggles to study indoor.
Both Florian, who prepares days and nights for his courses and the doctor of the novel, are under pressure and are both trying to do their work, even though they are tired, not interested and struggling with personal problems.
There are numerous situations in the medical education, where one has to keep on working, even though one has an aversion to the situation. Take the example of the anatomy-course, where a dead body has to be opened and the medical student is examined on the skills of dissecting the dead body.
In another situation, there is just a long course day without any patients or dead bodies, but the student himselfe is in difficulty, because of problems with the boy- or girlfriend or with the amount of work one has to do.
I guess, in the first week of the anatomy course many students had aversions to the dead body and the fact there will be examinations about it. At that time the issue was real and not fictional.
On the other hand it did not seem to be an ethical question in all cases, rather an aversion, which disappeared after a while.
But the problem of aversion and struggle has an ethical component, because there are patients the doctor has to deal with. The quality of work, decisions and the way one is dealing with the patients is closely connected to the doctor’s state of mind.
Florian said, ethics mean to him to continue studying in times of struggle, as one has to deal with patients in the future, even though one has grievance against them or is in personal difficulty, as in the story of Kafka.
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Finally, I would like to describe the meaning of ethics to Andreas.
The third friend, Andreas is 22 and does very well with his studies.
Probably, based on his reading and several trips to Asia he is very much aware of the gap between the different health standards in most countries. His ethics are closely connected to moral or political issues like the existence of the third world and poverty:
How am I going to treat ill patients in Germany while illness in Africa could mean dying?
Is it real help to cure coughing and give people a day off work, compared to Malaria illnesses?
Shall I strive for working in a German hospital, where I spend more time with paperwork and disputes with others, than with the patients?
These three questions are just an outline of many problems and issues; I guess many students sometimes have.
But I am not satisfied by calling it fictional or real.
On the one hand reading about such problems is fiction, and the thoughts one has about it are rather philosophical and hypothetical.
On the other hand, these problems are real and important and there are ways to help, for example working in third world countries.
In some case such issues might even occur in Western European clinical daily life: for example, compare the status of poor patients to private patients.
Andreas is influenced by his impressions and got aware of some moral aspects by his reading and travelling; to my point of view a very interesting aspect in terms of the impact of fiction.
Andreas ethics might be both fictional and real; but they are surely not as specific as the problems Bernd is struggling with in his intensive care unit.
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In my speech I tried to give insight into the meaning of ethical questions to medical students, by presenting three examples taken from my close surrounding.
There is Bernd, who tries to handle the difficulties on his ward, where he deals with the dilemmas he is confronted with.
There is Florian, who is not getting mad, as Kafka´s doctor, but trying his best in times of struggle.
While Andreas deals with ethics from a moral and philosophical point of view. Supported by his impressions, newspapers, books and his time in India he calls the Western European health system into question.
To my point of view the three friends do very much represent attitudes, thoughts and dilemmas of several medical students.
The ethical problems and questions of Bernd, Florian and Andreas are closely connected to reality, but are influenced by fiction and a variety of experiences.
Thank you very much.
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