Medical Students, Medical Ethics, and Health Reform

It's almost two weeks since I did my last blog post. Even when I was in India for a month last year I wrote more than that.

My teaching in the Harvard Medical School medical ethics course is the cause. It's not the time the teaching takes. I'm always busy. Rather, it's that the intellectual and emotional engagement the teaching brings taps the same energy sources that go into the blog.

The course is taught in seminar. My 12 students write 500 word essays each week and get them to me electronically before the seminar. I read the essays on my laptop and respond within the text. The 2/11 topic was informed consent. 2/18 was confidentiality and truth telling. Today was deciding for others.

After WW II Jean Paul-Sartre, Albert Camus, and the other French existentialists encouraged us to be "engagée." The students are decidedly engagée with the topics of the course, and more broadly, with health and health care. That contrasts with what's been most disheartening about the health reform process - the degree to which petty politics and venality have swamped meaningful public engagement with some of the central ethical issues of our era.

I love joining the students as they engage with the ethics of health and health care. There's so much thought, passion, humor, and good will. They evince everything that should characterize health reform but is so pathetically absent.

A month ago I ended a pessimistic post about the prospects for federal reform by invoking the "think globally, act locally mantra." Perhaps the Democrats will be able to squeak a bill past the Republican just-say-no machine. I hope so. But for now it's at the level of states and enterprising employers where the creative action will happen.

And, at the same time, working with future health professionals so that our professions can do a better job of leadership in the future than we've done to date.