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Ethics
Peter Holub,
DPM., MS.
Nova Southeastern University
United States |
One For All,
and All For Altruism!
In a recent student survey, “altruism” was ranked 24th out of 25
professional qualities required by health professionals (trailed only by
“charity”) (Hafferty, 2004). In fact, the current debate in my online
healthcare ethics course has divided the class into two groups: those that
believe health professionals have the right to deny care based on personal
beliefs and those that believe health professionals are bound to duty and
the respect for patient autonomy - in a word, altruism. The majority of my
students were in the former group, so I decided to “do like them” and see
what Google and Wikipedia had to say about “altruism.”
Indeed, if my research on “altruism” were based on a Google search, I would
come to the conclusion that the word has nothing to do with health
professionals and everything to do with patients, that is, “organ
transplantation and the altruism of donors.” In fact, Martin B. Van Der
Weyden, editor for The Medical Journal of Australia, likens altruism and
medicine to “oil and water” (Van Der Weyden, 2006).
On to Wikipedia (which I would ban in my classes, if it were not for the
fact that I use it myself to spice up ethical discourse with sensational
links to articles on Michael Swango, body snatching, and other topics not
published in peer reviewed journals). “Altruism,” according to Wikipedia,
applies to ethics, evolutionary biology, psychology, religion, love and even
politics; but, there are no references to healthcare or medicine. The site
does credit Auguste Comte with coining the term. Comte (1852) wrote,
[the] social point of view cannot tolerate the notion of rights, for such
notion rests on individualism. We are born under a load of obligations of
every kind, to our predecessors, to our successors, to our contemporaries.
After our birth these obligations increase or accumulate, for it is some
time before we can return any service.... This ["to live for others"], the
definitive formula of human morality, gives a direct sanction exclusively to
our instincts of benevolence, the common source of happiness and duty.
If I were to limit my understanding of “altruism” to the above two online
resources, I would probably count myself in the same group of undergraduate
healthcare ethics students who view altruism as a philosophical ideal,
irrelevant to medial professionalism. But, I do not limit my understanding,
nor should we expect our students to limit their understanding of altruism
to religious or philosophical piety.
The American Board of Internal Medicine’s Project Professionalism (2001)
lists four pillars of professionalism: excellence, humanism, accountability,
and altruism. The Association of American Medical Colleges’ Learning
Objectives for Medical Student Education (1998) lists teaching altruism as
the first objective in a medical student’s education. This report, which
serves as a guideline for medical schools across the country, stresses that
before graduation a student will demonstrate “A commitment to advocate at
all times the interest of one’s patients over one’s own interests” (p. 5).
When I was a student, I remember a patient who had so much poking and
twisting of his sprained ankle that he sent the hoard of podiatry students
out of the exam room. A classmate of mine turned to me and said, loud enough
for the patient to hear, “Who does he think he is?” The patient, man…he’s
the patient.
References
American Association of Medical Colleges. (1998). Medical school objectives
project. Retrieved December 10, 2006, from
www.aamc.org/meded/msop/start.htm
American Board of Internal Medicine. (2001). Project professionalism
[Electronic version]. Philadelphia: ABIM.
Comte, A. (1852). Catechism of Positivism. Retrieved March 15, 2007, from
http://en.wikipedia.org/wiki/Altruism
Hafferty, F.W. (2002). What medical students know about professionalism. Mt
Sinai Journal of Medicine, 69, 385 - 397.
Van Der Weyden, M.B. (2006). Can altruism survive? The Medical Journal of
Australia, 184(4), 145.
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