Medical Ethics and the Moral Practice of Medicine

The current level of bioethics education at most medical schools is severely lacking. Due to the exponential increases in our understanding of biology, physiology, and pathology, the time devoted to the medical humanities in medical school continues to be cut in order to accommodate the "essential" information that graduating medical students are expected to acquire in their four years of training. Relegating bioethics to a "filler" subject is not without its risks. The medical profession has prided itself on its vast fund of knowledge, its technical proficiency, and its ability to cure disease. However, history has also shown us that medicine can be used to discriminate, to harm, and to kill. The Holocaust, which began with racial hygiene theories and culminated in medicalized genocide, is testament to the evil that can arise when ethics are neglected in the name of science.

Graduate studies in bioethics are an ideal way to inoculate physicians against forgetting their primary moral commitment to the welfare of their patients and humanity. It will also prepare them for the complex and emotionally-charged ethical dilemmas that surround such issues as abortion, euthanasia and physician-assisted suicide, limits on patient autonomy, medical research, the Human Genome Project, the new reproductive technologies, the right to healthcare, and the allocation of scarce medical resources. My education has provided me with the specialized knowledge and expertise necessary to critically approach an ethical dilemma, analyze the relevant moral issues, and work toward an acceptable resolution. These are skills that will be invaluable to me in my future practice as a psychiatrist, where I will be confronted with unique ethical challenges and controversies particular to that profession, including the role of physicians as agents of the state, capacity and competency, confidentiality, involuntary commitment, and forced treatment.

The strong emphasis on human rights at Boston University's School of Public Health was ideally suited to me as a psychiatrist. Persons with mental illness have a long history of being disenfranchised and marginalized. They need physicians who can understand the nature of their -illness, who are sensitive to their needs and difficulties, and who can advocate strongly and effectively for their rights.

Studying and conducting research in the area of health law has also been an indispensable part of my medical humanities education. I now have a much better understanding of how medicine influences and is influenced by various legal, moral, and public policy factors. Scrutinizing landmark cases in health law, including Roe v. Wade, Tarasoff v. Regents, Cruzan v. Director, Vacco v. Quill, and Washington v. Glucksberg, has given me the confidence to evaluate how legal decisions will likely affect physicians, their patients, and society.

During the course of my studies at the Boston University School of Public Health I have had the privilege of working closely with some of the most respected teachers and thinkers in the field of medical ethics and health law. My research projects have included:

• Examining the ethics of using prenatal diagnosis and preimplantation genetic diagnosis in preventing mental disorders, and proposing ethical guidelines to assist physicians in applying these technologies.
• Evaluating the effectiveness of current international human rights instruments for protection of persons with mental illness, and proposing methods for improving standards.
• Reviewing the Massachusetts Department of Mental Health's (DMH) use of referents "consumer," "client," and "patient," and proposing a plan to return the DMH to a patient-centered model of care.
• Evaluating the federal legislation governing dietary supplements (Dietary Supplement Health and Education Act), and proposing amendments to protect consumers from harmful herbal supplements.
• Studying the ethical difficulties created by the physicianÐpharmaceutical company relationship, and drafting guidelines to limit conflicts of interests.
• Comparing the racial hygiene and sterilization programs in the United States and Germany, based on a review of the contents of The American Journal of Psychiatry between 1930 and 1948.

This year, in addition to training in consultation-liaison psychiatry, I am a Fellow in Medical Ethics at Harvard Medical School...