Teaching of Medical Ethics Regarding Children, Death and Dying, and Research at the Uniformed Services University of the Health Sciences (USUHS) During Its First Fifty Years.

Abstract

Introduction: The first class at USUHS took its initial course in medical ethics in 1977. I directed this course until recently when COVID first emerged. In this piece, I review what these students were taught during the first 3 of 8 class sessions involving children, end-of-life care, and research (the last 5 of these 8 sessions are discussed in a companion article). This review provides readers with information regarding some of the faculty brought in to provide these lectures, and key points they emphasized. It also summarizes the more subtle points regarding ethics that it was hoped students would gain and use throughout their medical careers and lifetimes.

Methods: This review focuses particularly on core military medial ethical issues that were posed by others writing on this subject and accordingly introduced to students in this course. It also highlights core concepts that students were introduced to prior to their entering the clinical wards. In all these classes, the initial presentations were designed primarily to prime or involve these students personally and emotionally in these issues so that they would want to address them in their discussion groups.

Results: Students achieved a grounding in leading and representative ethical conflicts arising in major medical fields. These included their considering military physician different roles, limitations genetics might pose in certain roles, pregnant person/fetal conflicts, students facing the need to confront their teachers, and students' struggles to achieve the highest moral standards they could.

Conclusion: Medical ethics is now taught in all medical schools but at USUHS this education must include traditional core medical topics and military medical issues as well. A challenge posed throughout the course was whether to emphasize what ethical and professional behaviors would be expected of students in their later military careers or to challenge them to engage in original analysis of ethical questions that had no self-evident answers. The decision was made in most cases to encourage students to discuss and debate controversial issues in their discussion groups, especially since they would learn what was expected of them in their military roles from multiple other sources. The priming for these discussions in the presentations seemingly succeeded in engaging the students and in provoking relevant debate throughout all of these cases. This learning is highly important in that in the future in both medicine and the military new unanticipated ethical issues will continue to arise. Since there will be no self-evident best ethical answers to these issues, those tasked with and thus seeking to resolve them will have to depend on having the optimal ethical skills for approaching and resolving these issues. This course sought to initiate this process, engaging these students and moving them hopefully to want to increase their skills in analyzing ethical dilemmas as they continue to progress throughout their military careers.