Friday, October 31, 2008

High School Students and the Vocation of Medicine

Yesterday evening I had the pleasure of meeting with students at a distinguished independent school who were taking an elective in medical ethics. The class was reading "Setting Limits Fairly," the book Norman Daniels and I wrote about the ethics of resource allocation and rationing, and the instructor invited me to a special evening session.

Although my main topic was the ethics of resource allocation, I was especially moved by our discussion of the distinction between medicine as a "job" and as a "calling," a topic I touched on in a posting - "Searching for a Secular Health Care Ethic" - a year ago.

I gave the students a vignette from my practice. A man in his 40s with chronic schizophrenia who I had seen monthly for many years when we monitored the regular white count that has to be done for people taking clozapine asked me to remember him in my prayers. My patient was Catholic. I told the students that I am (a) Jewish, (b) something of a "theological slacker" and (c) do not practice petitionary prayer. I asked them how they thought I should respond to his question.

I was blown away by the thoughtfulness of their responses. Given that teenagers often want to tell it like it is whatever the consequences, I was surprised when every student expressing an opinion thought I should tell the patient I would indeed remember him in my prayers.

One young woman was moved to tears by the story. From my tone she correctly discerned that I was very fond of my patient, respected his courage in the face of significant disabilities, and admired his integrity. Her tears were for his struggle and bravery. Another student could have been channeling my own thoughts from the time of the exchange with my patient. Here's what she said:
"You should tell him you will remember him in your prayers. When he uses the term 'prayer' I think he means 'I want you to care about me deeply and hope for the best for me.' I don't think he means 'I want you to kneel down, put your hands together, and ask God to take away his symptoms.' Given what I think he meant, you would be telling him the truth if you said 'yes.'"
The students clearly found medical ethics a gripping topic. The instructor is planning to expand the scope of ethics education. I suggested that if this expansion is successful the school could offer curricular modules and faculty development to other schools.

Given the low level of political dialogue about health care issues, wider education about health care ethics could contribute to a more health literate public. Our system's key need is more educative political leadership than the U.S. has seen to date (always excluding former Oregon Governor John Kitzhaber), but every bit of broader understanding of resource allocation ethics and social justice issues will help. The thoughtfulness of the students I met with yesterday left me optimistic about the potential for meaningful education at the high school level.

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