Lessons from a Bygone Medical Ethics Program  

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ANONYMOUS

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Cambridge Quarterly of Healthcare Ethics (keterangan: ada di Proquest) vol. 12 no. 01 (2003), page 102.

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Perpustakaan FK Nomor Panggil: C01.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Ethicists in American medical schools feel increasingly discouraged these days. In the 1960s, 1970s, and 1980s, society's enthusiasm for teaching about medical ethics flourished as new medical technologies posed new ethical perplexities. Americans eagerly sought ethics advice and looked to medical schools to provide it. As the sites where many of the new technologies were developed and future physicians were trained, medical schools were the logical place for medical ethicists to work and teach. A few schools recognized society's need and instituted explicit medical ethics teaching-allocating funds, hiring ethi¬cists, creating departments, and trumpeting their accomplishments. But most schools responded to the need with indifference or even hostility. They dis¬trusted outside "experts" and feared a zealous reform movement aimed at the character or practices of modem medicine.1 Yet even those schools were forced to create ethics programs to meet powerful accreditation requirements adopted around 1990. Complying reluctantly, these schools allocated few personnel and minimal budgets. The resulting programs struggled. The severe budget cuts beginning at all American medical schools in the mid 1990s threatened the very survival of these struggling programs. Many schools instituted resource-based budgeting, by which every program must pay its way. Predictably, medical ethics programs had difficulty complying. Although they undoubtedly prevented expensive lawsuits against medical schools and teaching hospitals, these programs rarely received direct payment for their services, such as clinical ethics consultations or institutional review board participation. As a result, medical schools have steadily cut ethics budgets while trying to maintain full ethics programs. Many schools now hire inexpe¬rienced junior faculty at low pay, impose burdensome teaching loads, recruit ill-prepared nonethicists to help teach, and depend on research grants to defray ethics teaching costs. No wonder ethicists feel discouraged. Like most others, my medical school has always reacted to medical ethics teaching with indifference at best. When I negotiated my job years ago, I did not perceive that attitude. School officials agreed to allow me to create an unofficial ethics program on my own time with the unspoken proviso (which I did not realize until long afterward) that the program would cost the school nothing. When I arrived, I eagerly set about planning a first-rate ethics program. I envisioned rigorous, cutting-edge research, exciting teaching on headline

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