Ms. Becker is a third-year medical student and Dr. Cochran is associate professor of medicine and community and family medicine, both at Dartmouth Medical School, Hanover, New Hampshire.
Few would argue that elective abortion is the most ethically and politically charged medical procedure in the United States. While the technical aspects of the surgical procedure and the pharmacology of medical abortion are typically addressed in both the preclinical and the clinical years of medical education, the ethics of abortion are often overlooked.1 This may reflect an uncertainty among medical ethics teachers about how to approach such a controversial topic.2
Concerned about the lack of discussion of the ethical issues surrounding abortion in the curriculum, in 1999-2001 a group of first- and second-year students at Dartmouth Medical School with different perspectives on abortion organized a facilitated discussion on the subject. The success of the forum among the student body led to its incorporation the following year into the preclinical ethics curriculum, where it again provoked thoughtful and respectful discussion among students.
In this forum, faculty and students participated in a 90-minute facilitated discussion about the ethics of abortion, tackling such questions as “What is the responsibility of the physician to the pregnant woman and the fetus?” “Who is the patient?” and “How do we respond when our patients request a service that conflicts with our ethical viewpoint?” Afterwards, students expressed their gratitude for having been encouraged to consider an issue to which they had not previously given much thought. They found themselves challenged and surprised by their classmates' perspectives and also felt inspired by the thoughtfulness and civility with which the subject was discussed. Many echoed one student's comments that she had never participated in a more peaceful discussion of this volatile issue.
As first- and second-year medical students prepare for the clinical years and beyond, the importance of ethics in the everyday practice of medicine is easily overlooked. However, issues such as elective abortion arise in many clinicians' practices, and students must be prepared to face ethical conundrums as well as diagnostic quandaries. Providing a structured environment where students can begin to grapple with ethically difficult subjects encourages them to thoughtfully articulate their personal opinions while learning to respectfully acknowledge differing points of view. Including the discussion in the curriculum also communicates to students that such issues deserve recognition and careful consideration. We hope that our positive experience may stimulate other medical educators to consider implementing similar classroom discussions at their institutions.
1. Perkins HS, Geppert CMA, Hazuda HP. Challenges in teaching ethics in medical schools. Am J Med Sci. 2000;319:273–8.
2. Woo J. Results of survey of abortion in ethics curriculum at 26 U.S. and Canadian medical schools, March 2000 [unpublished report].