Assessment of medical ethics of fourth-year medical students

From 2005 to 2008, the authors assessed the medical ethics of 779 medical students in the Department of Obstetrics and Gynecology at the Faculty of Medicine, Chulalongkorn University by using the Chula Method. This was conducted through a written examination asking the students to express their opinions about ethical issues. Their answers were rated as either Satisfactory (S) or Unsatisfactory (U). It was found that 750 students (96.3%) earned S while 29 students (3.7%) earned U. The results from this study can not be compared with the results from studies published in medical journals. Thus, knowledge about medical ethics is not complete even though it is intensively taught in medical schools and has been practiced for a long time. The authors would like to propose a new assessment of the medical ethics so that it can be systematically applied.

Ethics and the comprehensive application of epistemology in medical practice

Our simple definition of ethics is good thought, speak and action. Epistemology means the hypothesis of facts about thought, speech and action. Medical practice is all means of medicine. Medicine classifies people into normal and abnormal. The abnormal are the sick. They loose some organs or those normal looking organs are dysfunctional. They are social problems, some can be treated, and some do not get the appropriate care. The problems of society of normal people are overeating and obesity, abortion, drug abuse, promiscuity, torture, terrorism, disobeying rules and order, corruption, brain-washing and unethical advertisements, etc. On the other hand, the social problems of the abnormal are down, deafness, blindness, dumb, hypertension, hypercholesterolemia, diabetes mellitus and cancer, etc. An example of the social-doctor problem is the mal distribution of doctors in rural areas. It was reported by the ministry of public health that the ratio of doctor to population to be 1:800 in Bangkok and 1:5, 700 in some rural areas in the north eastern part of Thailand. The doctors, themselves, are at a high grade of worker and intelligent quotient. They know all the problem and, at the same time, create problems, both, faster than the general population can do. It affects good and bad in the society. In the past, present and the foreseeable future the medical students get their studies in the western style. Their medical schools are situated in big cities. These schools are old and famous. They learn their medical procedure in a big hospital of more than 400 beds in the inpatient department wards. Their instructors and professors are highly qualified, are middle class people and well accepted in the society. Their families are lovely and warm. Their children study in the first class schools in town. The medical students feel very happy and appreciate seeing their professors in television routinely at prime time. In conclusion, their professors are an example of role model for them to follow. Everyone looks for security in her/his profession. Facts need no proof and reference. People with justice in mind should believe and understand the above mentioned. This leads to the problem of mal distribution of doctors in rural areas, why do doctors live in big cities or wish to be in the private sector? In fact, not many a number of doctors serve in the rural area. About 4-5 of them, their name will be announced yearly as the best rural doctor award. After the big ceremony, lasted not longer than a month, it is hard to remember their name. They are proud to be praised, it pushes them into stress intentionally with all the best of their intelligence and the total of their body strength to work harder in rural. Unfortunately their earning, the security of their profession, the increased chance of being sued, to get caught in the medical litigation, the expenses of their family social status and the study of their children cannot be compared to of those doctors in big city and/or in the private sector. Mal distribution of doctors in remote rural areas has been a persisting unresolved problem in many parts of the world, why not apply the principles of ethics and epistemology? They have been left, untouched forever.

Medical ethics for senior medical doctors (episode I)

A good leader will never ever forget themselves, or abuse the power or authority, and also not trust only the inner circle voice, nevertheless they have to listen and consider the voice of disagreement from others. Otherwise, they will transform themselves to be a "dictator" unconsciously which is very dangerous and harmful to the democratic ruling system as well as themselves and their family members, as you can see from the past history of foreign countries and even Thailand itself. Thai culture is surrounded and consistes of kindness, mercy and good wishes to each other. The patient is so grateful and appreciates the value of the medical doctor for saving their life. Even although the Western culture is penetrating globally as a business-oriented culture in which medico-legal cases such as patient's rights, the value of the patient's benefit protection and certainly it requires the legal act to get involved eventually. The compromised culture which has been embedded in Thai society for a prolonged period can be changed firmly and gradually because of the usual and regular condition and definitely the good and valued medical doctors is still around. The opportunity of medical doctors to act as a pioneer of the trend and conflicted societies, is responsible to them and it's a great opportunity for Thai medical doctors to reach out to these goals and excellence. The above statements can be found in various media. Is it true that the medical doctors will absolutely be hundred percent good guys and have good luck from time to time? But for sure, even our medical colleagues are very much dedicated and concentrated in their job, as the family members of our medical profession, they have been left out, they have no time to share with or even be responsible to them. Many of our friends in the same profession might feel so sorry or appreciate the term "short-belt situation" or "unexpected" event which might attack us from the society violently and unmercifully.

Searching for medical ethics in Dharma conversation

Our medical ethics team has a great opportunity to consider the terminology of"Moral Rights", "Good guys", "Understanding the real world" and the issues about "live salvation". What has been mentioned about these terms in Buddhism? In Buddhism, it has been cited that moral duty is the cause that leads to the moral rights as result. When we act the right as well as decent things, we are entitled to get the fair deals in return. We used to forget to consider that, isn't our moral duty or not?, to just either pay respect to the other people's rights or simply protect the other people's rights. Regarding to the Buddhism religion, there are a certain criteria to be "Good guys" i.e. firstly, not to make any sin at all such as not to exploit the others physically, verbally and mentally. Secondly, to make merits, such as helping out; showing the mercy and kindness to the underprivileged; donating money, land and properties, or even sharing the justified idea is also included. We also forgot to ask about tempting the others with a certain of hindrance i.e. assets, land and properties. Have you already made the sin with these temptations or dominating the idea of people? How the people will understand the fine line between the sin and meritorious deed? Buddhism kindly advises us to understand and consider the real world in two steps as well as in parallel way. Looking around us as surrounding of illusion. These illusion or fantasies will not be sustainable, only temporarily indeed. For example, human being has to go through aging process, illness and eventually death. What we need to consider in parallel is the matter about "Within us". What is the secret issue about "Within us"? Brain, spirit, heart or extremities, wherever we point at, will be just only human biological tissues or various elements. Last, but not least, practicing salvation when you still alive is perplexing. Live salvation is already existed within us, nowadays. No need to wait for the next life. Salvation can exist when we still alive. Salvation is to purify our spirit which require proper training to keep it clean in sustainable way.

Expatriate clinics and medical evacuation companies are a growth industry worldwide

Globalization and the growth of tourism, which now includes "adventure" visits to very remote regions, has created new employment but also new problems. For example, elderly tourists break their hips where there is no competent orthopedic surgeon, a traveler gets bitten by a cobra in rural Cambodia where there is not even an "Ambu" bag to keep him oxygenated, and a tour guide develops high-altitude cerebral edema on a remote Nepalese mountain. What would we do without organizations that are capable of removing such victims rapidly and safely to a place able to provide appropriate medical care? Fortunately, several well-staffed and well-equipped air ambulance companies stand ready almost worldwide to help 24 hours a day. Medical assistance firms, which sell their own travel insurance and/or act as agents of large insurance companies, are also at hand and have offices in major cities worldwide. They have 24-hour telephone numbers and are prepared to advise a sick or injured traveler where he or she should go to obtain competent medical care. Most of these firms have regional medical advisors in strategic locations who maintain a network of contacts. They can ensure that an ill traveler is receiving appropriate care and will act as quality controllers. They are also able to advise whether medical evacuation to a higher level of care is needed and where the traveler should be evacuated to.

Informed consent

Information to make patients fully aware of all the details of treatments is an important part of the medical practice before obtaining patient's signature in the consent form. Explanation may be detailed enough to make patients understand the process of treatment. However, sometime it may not be inclusive enough to cover all major statements that give pros and cons of the treatment. Perhaps detailed explanation may reveal too much information that may discourage patients to receive treatments and cause fear, anxiety, and hopelessness. If health care personnels do not mention all the risks involved in medical treatments, they may be subjected to an accusation of concealing the truth that should be made known to patients. This is one of many ways of looking at the problems. There is no easy answer to the problem of what 'appropriate' explanation should be. Most of our patients are from all walks of life which are not medical profession, and they do not have knowledge to understand technical terms. How should we approach patients in order to be safe from an accusation of that we are not over supporting, not giving the patients false hope? Therefore, we would like to present a guideline for informing and explaining to the patients under the following headings (15): 1. Diseases or major symptoms which are diagnosed. 2. The necessity to receive treatments for the benefits of patients or fetus. 3. If possible, determine the duration of treatments. 4. Methods of treatment, evaluation, and schedule for next appointment. 5. Inform about necessary investigations. 6. Inform about complications of risks, and cost of investigations 7. Usefulness and results of investigations. 8. If options of treatments are available, they should be explained in details, the pros and cons, the risks, and the costs, etc. 9. Maintaining medical confidentiality and the use of patient chart by medical personnel and other related health care providers, for instance, hospital staffs from all levels, medical students, technical medical students, and social workers, etc.

New-world and transcultural impact on Thai medical practices and professional behaviour

Thailand, which is barely recovering from the 1997 economic collapse, has passed a new constitution, has a new government and all of this will have a profound effect on the way doctors practice and interact with their patients. Some of the factors that have been responsible for this are 1) Passage of a patient's rights bill 2) Legal definition of what is a proper consent form 3) The public's demand for openness, better communication and transparency in medicine These concepts, which now have a legal as well as moral basis, will impact directly on doctors and nurses as their practices will be subject to increasingly intense scrutiny and criticism. Doctors and nurses in past generations were among the most respected members of Thai society. They were trusted almost without exception and their judgment was not questioned. Only rare cases of malfeasance and malpractice came to public notice though, no doubt, they existed but to a much lesser degree. A physicians' life was much simpler for our teachers, fathers and grandfathers. Life was inexpensive, families were less demanding and the doctor did not have to surround himself with expensive foreign-made apparatus which can bankrupt the doctor as well as the patients who have to pay the bills. Medical decisions were made mostly on the basis of observation, past experience at the bedside and not in the laboratory or imaging rooms. Honest errors in diagnosis were common, treatment was limited and simple and this was all tolerated or expected by the public. Few if any disappointments on the part of patients ended up before a judge.

Humanistic learning in medical curriculum

This paper argues for more attention and exposure to humanistic learning in the Thai medical curriculum. Humanistic learning traditionally consists of literature, history and philosophy, and is advantageous for medical education in that it tends to foster sensitivities to feelings, awareness of social traditions, and creating of skills in deliberating complex, ethical issues. These dispositions are necessary for a doctor in the world where there is an ever increasing public demand for communication, accountability and transparency on the part of doctors. It is proposed that the Thai medical curriculum should include more humanistic learning, and that medical students should be given opportunities to interact more with students from other disciplines throughout their studies and later professional life.