Tuesday, April 28, 2009

Exprimenting on Humans

The article from the Lebanese Newspaper, Al Hayat, (Friday 24, 2009, issue no. 16821) refers to numerous experiments done on humans in prison camps. These experiments are being carried out in occupied Palestine, Iraq and other countries without patient consent. The Nuremberg War Crimes Trial and the infamous Tuskegee Experiments (among others) led to a serious reexamination of ethical standards in research and to the agreement that potential human subjects needed to be protected from being exploited as 'guinea pigs' in scientific research.
The stories revealed in the article are a clear violation of many treaties and codes of research ethics. Yet, they continue to take place and nothing is being done to stop them.

As Dante once said, “The hottest places in hell are reserved for those who in times of great moral crises maintain their neutrality”.

Click on Picture to read text in Arabic.

Tuesday, April 7, 2009

The Hidden Curriclum in Medical School

Physicians treat patients and medicine is a moral enterprise. We all agree to that. Well, I hope we do. In teaching hospitals, doctors teach medical students to become future physicians. Yet, teaching is not all there is to it. From what I can tell, it is basically a “do as I do, not as I say” thing. So, not matter how hard the medical programme tries to teach students to be ethical, to do the right thing, unless the hidden curriculum speaks the same language, it is a losing battle.

Many student of medicine complain that some of their teachers go into the classroom, tell them how important it is to stand up, greet the patient, comfort the patient, treat the patient as a person not a disease and, once on the floors, they see a different scenario, often by the same tutor! They are told to respect autonomy and when in the clinic, they see live scenarios where the right to decide is dismissed. They are taught to be humble and when they shadow physicians, they sense humility has no place in the equation and that their curriculum is a sham.

What do we tell these physicians-to-be? Or better, what should we do, lest we regret?

يوافق الجميع على أن مهنة الطبيب تتمحور حول معالجة المرضى وعلى أن الطب مهنة أخلاقية.

في المستشفيات الجامعيّة، يتعلم تلامذة الطب كيف يعاملون المرضى كما يتعلمّون أسس أخلاقيات الطب التي هي أساس المهنة، ولكن واقع الأمر هو أن أفعال الأساتذة وتصرفاتهم هي التي تترك أثرا على التلاميذ وليس أقوالهم. لذلك، فإن ما هو معروف "بالمنهج الخفي" هو أهم بكثير من المنهج الرسمي المقرر. كم من تلميذ جلس في الصف وتسمّر يستمع إلى المحاضر يتكلم نظريا عن التواضع وعن احترام المريض واحترام حرية قراره بينما يجد هذا التلميذ نفسه أمام ذاك المحاضر الطبيب عينه في أروقة المستشفى وهو يتصرف بعكس ما كان يحاضر. هكذا وبلحظات معدودة يلغى المنهج الرسمي ولا يبقى في ذاكرة التلميذ – طبيب المستقبل – سوى ما رآه من تصرفات الطبيب المتمرس الذي كان له المثال الأعلى.

ماذا نقول لهؤلاء التلامذة أو ماذا نفعل حيالهم كي لا نندم؟
Image above: Hugh Laurie "Everybody lies" - House MD