I never really understood the purpose of humanities courses in my first year medical curriculum. I was mostly interested in the science part, the disease pathophysiology and treatment options since this is what drew me to medicine. So I would dread Monday afternoon’s as this was the medical humanity slot. “So in conclusion, always remember to approach each patient as if he or she was your relative”. These were the words of my medical ethics lecturer as he concluded a debate session on that day’s topic. It was a long day of lectures and I was already tired but weirdly enough my wondering mind managed to grasp that concluding statement as I was planning what I would have for dinner.

　　Two years later I started my clerkship and I was thrilled to finally interact with patients and be a ‘real’ doctor. Before then we had a white coat ceremony where we recited the Hippocrates oath in front of our teachers and peers. I couldn’t contain my excitement, wearing that white coat was a dream come true and still is. Did I really take time to understand the oath? What it meant? Well to be honest, I was just looking forward to taking pictures after the ceremony and celebrate my white coat.

　　Fast forward we started our clerkship and after finding my feet and adapting to the change from classroom to hospital, I discovered that I enjoyed being at the outpatient department. This is where patients’ would walk in with their chief complaint. My partner Sharon and I would always make our own differential diagnosis when the patient came in. We would beam with excitement when the attending doctors’ diagnosis would match ours. One particular day as per norm we were excited to identify fetal anomalies at the Obstetrics ultrasound clinic. My excitement was cut short when I realized that at the other end of the desk was a young couple who just received news that their unborn child had congenital defects. My heart sank when I saw how they clung to each other upon receiving the news.

　　The way Dr. Hung our clinical teacher handled this blew my mind, he listened, explained and was sympathetic to the couple. He gave them their options which included termination and thoroughly elucidated the implications of each option. The couple walked out encouraged, their eyes that a few moments ago were filled with despair showed a glimpse of hope. We then had a brief lesson later and the clinical teacher expounded on the importance of informed decision making and how medical ethical principles apply in this case.

　　That encounter was my first real life experience on how medical ethics can be integrated in clinical practice to provide a holistic approach to patient care. Sharon and I were so fixated on the diseases and treatment options while neglecting the humanities aspect, especially the principles of ethics. Thinking about this reminds of one episode in the medical show Grey’s Anatomy, where the interns knew all about the medical images, laboratory results and diagnosis of a patient but no one knew the name of the patient. This is common among medical students including myself however it is worth noting that people are just not their medical conditions but are people with feelings, thoughts and names.

　　As always after the clinic session Sharon and I debated on what the couple should opt for, which decision was more feasible, of which obviously was blinded by our partialities. That day I went back to read my medical ethics notes from first year, trying to make sense of the ethical principles and connect the dots from theory to clinical practice.

　　Medical ethics is founded on four principles as we know them and recite them without even blinking. But the question is, how do we apply them? Is there any formula to it? Juggling these big words and their definitions: beneficence, nonmaleficence, autonomy and justice can seem easy. We would read and regurgitate them for an exam or quiz but then the purpose is to apply these principles in everyday practice. Going through my notes again it became clearer that these words come alive when applied to real life situations and real patients. Jonsen, Siegler, & Winslade (2010) emphasize that clinical ethics is a practical approach which goes beyond the identification of the problem and data gathering but used as a guide in decision making.

　　According to Lo, (2009) an approach to ethical dilemmas can follow through a series of questions such as; (1) what is the dilemma? (2) what are the medical facts? (3) what are the concerns, values and preferences of the clinician? (4) what are the concerns, values and preferences of the patient? (5) what are the ethical issues? (6) what ethical guidelines are at stake? (7) what practical considerations need to be addressed? This approach can aid clinicians in broadening their scope in dealing with perplexing cases. On the encounter we had with the couple faced with an important decision to keep the pregnancy or terminate this pattern of thought can be applied as well.

　　Dealing with ethical dilemmas can be controversial, there are other conflicting aspects to consider as well. The principle of respect for autonomy was the first that came to my mind when dealing with the case of the couple. This principle emphasizes one to view individuals with moral values and dignity. Each person has their own beliefs, cultures, values which they uphold so highly thus the need to be respected. There are so many conflicting issues in the application of this principle in this case.

　　According to (Chima & Mamdoo, 2015) ethical dilemmas such as women's autonomy rights may conflict with fetus' right to personhood, and doctor's moral obligations to society. Furthermore in liberal jurisdictions, previable fetuses may not have legal rights of personhood therefore appropriate decision would be to respect pregnant women's decisions regarding termination. So in essence there several factors to consider thus a multidisciplinary approach is important. As a person coming from a strong religious background and from a country where termination is prohibited I tended to let my own beliefs cloud my thinking in terms of what would be the best next step for the couple.

　　I have since learnt that medical ethics is very broad and there are so many conflicting scenarios hence it is best tackled by case based learning. As a student it is important to be familiar with the principles and know when to use them. I have encountered other interesting cases during my rotations and tried to connect the principles to everyday practice.

　　Looking back to that Monday afternoon when I heard the words to approach patients as if they were your relative, these words hold true. Medical humanities including ethics although not attractive to many medical students as first, is key in connecting the medical and human aspect in medicine. The study and application of these principles is imperative in developing interpersonal skills and empathy hence providing holistic care in clinical practice. When encountering patient’s I ask myself the question, if this patient was my mother or father would I still approach them the way I would? This guides me to provide quality medical care while ensuring that the principles of ethics are not violated. This has since grounded me to make the four principles of medical ethics come alive and apply them whenever possible.

*References

1. Chima, S., & Mamdoo, F. (2015). Ethical and legal dilemmas around termination of pregnancy for severe fetal anomalies: A review of two African neonates presenting with ventriculomegaly and holoprosencephaly. Nigerian Journal of Clinical Practice, 18(7), 31. doi:10.4103/1119-3077.170820

2. Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Introduction. In Clinical ethics: A practical approach to ethical decisions in clinical medicine (pp. 3-4). New York: McGraw-Hill Medical.

3. Lo, B. (2009). Chapter 1. In Resolving ethical dilemmas: A guide for clinicians (4th ed., p. 7). Philadelphia, Pennsylvania: Wolters Kluwer Lippincott Willimas &Wilkins.