Teaching medical ethics in different cultures
- Ole Doering, Ph.D. .
Bochum University, Germany
1 Drawing the outlines
With respect to culture, ethics and the goals of teaching, it is vital, in medical ethics as in other related endeavours, to make sure we understand from the beginning:
WHO is the teacher and who the student,
WHAT is the meaning and purpose of the respective studies and exercises,
HOW will the actors be enabled to relate to the purpose in their full capacity as human beings, intellectually and morally, in terms of proper methods?
Such inquiries are not trivial, but constitute the beginning of ethical teaching and learning. The subjects of learning (and teaching) change regularly, e.g. with each new class there are different individual personalities to be respected; the very process of learning is meant to change the subjects involved. The methodology should adapt to such dynamics. The meaning of medical ethics is continuously re-interpreted and further refined. The skills required in the medical professions need to be adapted according to the development in medical sciences, technology, the related laws and codes.
The teacher thus shall be prepared to react flexibly and adjust his plans according to the actual circumstances. He should demonstrate and teach how to make difficult decision, often under the pressure of limited time and urgent needs of students. Hence, teaching medical ethics to some extent requires skills of a mentor, a social-, psycho-, physiological analyst, and a Socratean midwife. In many ways, a teacher in medical ethics resembles the doctor in relation with the patient, especially regarding situations of delicate communication, in discussions of intricate problems and conflicts of loyalty (e.g. medical paternalism versus accepting a patient’s “wrong” decisions). This structural similarity can be used as an asset in teaching.
2 Medical ethics and the perspective of cultivation
Teaching and learning ethics can be described as an integrated process of cultivation. This process involves the students, the teachers and the teaching environment. It aims to enhance the reflective, strategic and habitual performance of would-be medical professionals, with special respect for the patients’ prevention from harm and the well-being of patients, doctors and nurses, and society. By considering the teaching environment, culture is invoked in the sense of relevant external factors. To involve students and teachers is an appeal to culture as (collective) representations of assessments of a ‘good life’ or reflected moral experience. The entire endeavour, ideally, relates to the overall regulative idea of a singular (though counter-factual or non-empirical) CULTURE, as described by Eagleton (Eagleton 2000).
This approach begins with moral learning from the grassroots, that is, from the individual agent as the originator, transformer and equal partner in the process of learning. Students are appreciated for their individual intellectual skills and moral capability and encouraged to cultivate them. This notion stands in contrast to approaches of ‘moral preaching’, indoctrination or learning by mimicking, whereas it acknowledges the (limited) merit of teaching models. Teaching and education, in the comprehensive sense of the German term “Bildung” (as distinct from the technical or specialist “Ausbildung”) embraces persons and personalities in their aspiration to a ‘good life‘ that rather not alienates but fosters the professional view. It is intimately connected with the corresponding notion of “Wissenschaft”, as an integrating human quest for science and understanding. It engages teachers and students, with their intellectual, social, emotional and creative capacities.
. pp. 551-557 in Macer, DRJ., ed., "Challenges for Bioethics from Asia" (Eubios Ethics Institute, 2004).