Weeding Out Medical Student Ethical Misfits: Who is Responsible to Do That?

I was stimulated by the theworld.com’s link to the UK Guardian’s article about testing medical students for how well they have learned ethics and if they failed the test they should be dropped from medical school and not given the M.D. degree. I put the issue up to the ethicists on a bioethics listserv and interestingly two points of view were presented in response.

One view was the argument that the degree of medicine was nothing more than representing a technical achievement and medical schools should not be responsible for weeding out “ethical misfits or even miscreants”:

“ I propose that this task should be left to
licensing boards (just as lawyers have to pass character tests in
addition to the bar). If someone of dubious ethical constitution wants
to go out and *learn* about medicine, I don't see any reason why anyone
should object. Now, if he wants to *practice* medicine, then there is a
problem. More generally, I view a medical degree as a ‘certification of
technical merit’ (to use a phrase the DoD has been using) and object to
their being any moral prerequisites for the degree (note that the
requirement for courses in medical and legal ethics are requirements for
study, not for character).”

The other view:

“I believe that professional schools such as medical and nursing schools
have a strong, pro-active duty to "weed out ethical miscreants". There
are several reasons for this:

1) It is unreasonable to expect that this could be done at licensing. As
teachers we are in the best position (perhaps the ONLY position) to
observe behaviors that are inappropriate. There is absolutely *no*
mechanism by which a sociopath could be identified at the point of
licensing but many points during their education process.

2) The public funds a significant portion of professional education and
clearly expects that we will produce not just competent clinicians but
also decent ones. There is a very clear public expectation that a student
who exhibits truly egregious behavior will be 'culled' from the ranks.
Examples of behavior that ought to result in dismissal include patterns of
behavior (not necessarily single instances) of lying, covering up errors,
harsh treatment of patients, inappropriate interactions with colleagues
(such as yelling, demeaning comments), etc.

3) We have a duty to begin mentoring students in the fiduciary nature of
the health care relationship, and to live by our own teachings.
Professions are self-regulating. We are granted the right to practice our
professions with the agreement that *we* will insure that our clinicians
are competent. To ignore egregious behavior in students is to ignore our
professional duty to police ourselves.”

I would very much like to read comments from my visitors (including medical students) to this blog as to what they consider are the responsibilities of medical schools to society with regard to the ethical behavior and ethical knowledge of the student who may be receiving the degree of Doctor of Medicine. ..Maurice.