Rahul Abhyankar, '11
Medical Student at Indiana University
1) What are you doing now?
I am a third-year medical student at Indiana University School of Medicine in Indianapolis, IN.
2) How do issues of ethics and values enter into your professional role?
As you can imagine ethical issues and value judgments are married to healthcare. Autonomy, justice, beneficence, and nonmaleficence - the so-called four pillars of medical ethics - have become a classic part of the medical education. Power of attorney, the Tarasoff decision, and exceptions to confidentiality accompany the "zebras" (clinically rare illnesses) that make up board exam fodder. Just this week I attended a lecture which featured Quinlan, Cruzan, and Schiavo. The speaker requested, as a class exercise, that we write our own, personal advanced directives in the hope that we become proactive with our patients at end of life. What, perhaps, I found most interesting about the field is the relationships. Not only doctor to patient or nurse to patient but student to resident to attending. There is a unique hierarchy in medicine steeped in tradition - just picture that scene in film of a senior physician followed by droves of underlings each one more tired than the next. The morally corrupt superior presents an interesting predicament for young students like myself. You won't find many junior medical students willing to stand up for what they think is right.
3) What societal ethics issues are most important for us to address and why?
It bothers me that much of "ethics" in medicine really is just law. What does the law say? That's what concerns most healthcare workers, but that question is short-sighted. Healthcare workers rarely ask, "Is this law justified?" Medicine has an interesting history - one which includes a time when contraception was illegal but eugenics were not. Values in medicine ebb and flow with culture. My sister likes to say everything is sociology, and maybe she has a point. What grips CNN, MSNBC, and Fox News these days? Obamacare. Healthcare, in general, really. It seems to me Americans want it both ways: they want the best healthcare system in the world but they don't want to pay for it. They want the best procedures at the lowest cost. They want the diagnosis tomorrow but the bill to be lost in transit. Healthcare reform is one, big, confusing web of ethical issues, but I find what happens before the patient reaches the hospital more important. Prevention - the realm of the public health worker - not the doctor ought to be the most pressing ethical issue in medicine. I fear it is often too late for the patient when he or she sees the doctor. Good eating habits, frequent exercise, and early cancer screenings are the types of things that will keep healthcare costs low - not some bill that passes in Congress. It makes sense really - stay out of the hospital so you don't have to pay for it. With scrutiny on prevention innocuous questions become ethical ones like the commonly asked, "Why are healthy foods expensive but junk foods not?" What allows fast food chains more exposure than healthy alternatives? Are the menus of some chains simply immoral? Are companies that promote gluttony just as morally reprehensible as the cigarette companies of the 1960's that hid the malignancies of their product from the public? Of course the malignancies of overeating and poor nutrition are well known to the public so it is also important to ask what is preventing individuals from leading healthier lives - big can of worms I know. The societal change is much tougher to deal with than the healthcare reform. Nobody wants to open that first can.