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seek contraception, or does a minor
have the right to privacy?
A very common problem is the doc-
tor's role with a patient who refuses to
be treated. How far can the physician
go in trying to convince the patient to
accept medical help?
"I can't help thinking that someone
who has spent some time thinking about
not only these individual topics, but
about a general theory of ethics and
morals would have an easier time
making such a decision on the spur of
the moment," said Gwynedd Warren,
a student coordinator of a local ethics
conference.
T HE QUESTION IS, where does the
tedoctor pick up that exposure?
Professors and students across the
country are now trying to figure out
whether most of the knowledge comes
with a "learn by doing" approach, or
whether medical schools are obligated
to try to instill an ethical sensibility in
their students by requiring them to take
special courses.
Most medical schools offer several
electives designed either to give a
general base in the philosophies behind
medical ethics, or to consider specific
moral issues.
But a growing number of schools not
only offer such couses but require that
their students take them. Michigan
State University, Harvard, University
of Wisconsin, and Penn State Univer-
sity, to name a few, all have either a
specific ethics requirement or a more
general humanities requirement which
focuses heavily on the ethics of
medicine.
But Pernick doesn't buy most of these
arguments. "With a serious ad-
ministration, room can be found," he
says. "(Penn State) decided every
student would take two full courses.
Somehow, it got done."
Under the current program, he says,
competitive forces work against the
elective course in the medical school.
"Students without strong feelings find
the cost is too high for taking an ethics
course. The only way to go is to set
aside required time.
"If something is required, it is there
not to force studentsd to take it, but to
allow them not to be penalized for elec-
ting a course. A requirement is there to
protect them from competitive forces."
Philosophy Prof. Richard Noble, who
teaches the required ethics course in
the Inteflex program., blames the
problem on "the structure of medical
education itself." He says the selection
process, with its heavy emphasis on
grades, "doesn't necessarily mean you
select the students most sensitive to
ethical concerns.
"We have to ask, just how much.
science is necessary as an un-
dergraduate?' " Noble says. "Maybe
the medical school should take some
risks in selecting people with different
backgrounds." He says he'd also like to
see ethics :incorporated in the
curriculum to a greater degree for the
students once they get into medical
school.
"(The bi-annual medical conference
held here) is great, but voluntary. If
there is a requirement it shows where
your priorities are. It says this is im-
portant.' It gives added emphasis,"
Noble says.
I DEALLY, ACCORDING to Pernick,
teaching medical ethics takes place
in two phases. The first teaches the
academic side of ethics during the first
two years of medical school. During the
second half of medical school-the
clerkship and clinical years-students
should see how the academic side has a
practical application.
-Pernick says the problem at the
University is that "students are the

major force for support in ethics. At
other institutions, such as Penn State, it
is the opposite. The support comes from
the top down."-
Here, a group of students has
organized a medical ethics conference
every term for the last five years. The
Conference on Ethics, Humanism, and
Medicine is the result of the efforts of
several Inteflex students with en-
couragement from their Inteflex ad-
visers and philosophy Prof. Carl Cohen.
Once a term since the winter of 1978,
the conference has brought together
several hundred students, faculty
members, and other interested people.
It was founded "to promote a rational
and interdisciplinary approach to
medical ethics," says Doreen Ganos, a
sixth-year Inteflex student and one of
the original CEHM members. "We
bring together interested people to talk
and get a framework for approaching
problems."
.Cohen, who has actively participated
in the conferences, says that studying
ethics yields two main benefits. First,
"students will gain a sensitivity to cer-
tain questions like abortion. Many
people on both sides of the argument
don't understand their opposition," he
says. "Second, they stand to get the
ability -to deal with these moral
questions using a different technique of
reasoning than they get in the technical
sphere ... Often students don't realize
there is a need for such instruction."
Many people feel that, along with the
medical school's elective course and
the brown bags, the conference is the
best place to teach ethics.
"CEHM is a better context for
teaching ethics," says Dr. Jane
Schultz, the medical school's dean for
student affairs. "Students do it them-
selves and it is a one-time elective time
commitment-there is no paper or
exam to worry about."
But Prof. Ronald Bishop, who teaches
the elective ethics course in the medical
school, says not enough is being done to
point out to the medical student that
"any act the, physician performs is in-
volved with a judgment, though much
of those are automatic.
"Students need an introduction, a
foundation, as an undergraduate or as a

I

Prof. Martin Pernick: Working for more education

results of a three-year study being con-
ducted by the Association of American
Medical Colleges. The study is designed
"to assess the present approaches to
the general professional education of
the physician and college preparation

[ school should take

'Maybe the medical
some risks in selecl
f erent backgrounds.'

ting people with dif-
--Prof. Richard Noble

during their
medical school
The study isa
year, and in tr
regional hearii
the country
munication c
members of tf
interested part
The Universi
of 87 medical
studies in cony
study, Taren sc
"The AAMC
input," he saic
at Harvard hal
mendations, si
trance tests sii
requirement.'
Taren said
results of the
medical school
chance "wen
science require
emphasize the
the duplicity"
undergraduate
school years.
"There is
faculty concern
that that move
1980s concerni
ces be balance(
Taren says. "T
ce high tech wit
David Spa)
writer.


first- or second-year medical student,"
he says. "Many students don't see ap-
plications of these questions until their
clinical activity-then they don't have
time to discuss the situation."
Bishop says he'd "rather have the
students want the ethics training than
force them to take it by making it a
necessity," but "at times I think it
should be mandatory."
P ERNICK THINKS that a lot of
what will or will not happen at the
University depends largely on who wil
replace former medical school Dean
John Gronvall. The dean is, after all,
the top of the, hierarchy in the medical
school.
Another big influence may be the

for medicine," according to the charges
of the various committees set up for the
project. Those committees also are
aiming "to stimulate broad discussions
among the medical school and college
faculties . .. about their philosophies
and approaches to medical education."
The study is divided into three com-
mittees. The first is designed to con-
sider what basic knowledge all medical
students need as a foundation for their
chosen field of specialization. The
second committee is designed to
examine what basic skills students
need to acquire to gain the basic
knowledge. The final committee, which
Gronvall is chairing, is designed to
describe personal qualities, value, and
attitude traits students should develop




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