Ethics: entitlement may benefit disadvantaged patients and students alike
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《英国医生杂志》
EDITOR—Jagsi and Lehmann extrapolate three major areas of research ethics to medical education but could have added entitlement, using the ideas of Rawls, to benefit disadvantaged people.1 2
All fourth year medical students at this medical school see a patient with intellectual disability, and they not infrequently question the validity of that patient's consent to be interviewed. A person with mild or moderate intellectual impairment can usually give informed consent to student contact, but this does take extra time and effort. People with severe intellectual disability usually cannot.
We therefore notify in advance the patient's carers, community team, and general practitioner of the proposed student's visit, any of whom can prevent the visit if they consider it may be harmful. We also point out that we offer to the patient with intellectual disability an extra benefit in the form of a supervised, student led, physical health check that he or she otherwise might not have had, and a biopsychosocial assessment that is often unblinkered and innovative. Such benefits to potentially disadvantaged people may well be happening in other areas of medical education but may not have been recorded.
Malcolm McCoubrie, senior lecturer in disability
St George's Hospital Medical School, London SW17 0RE mccoubri@sghms.ac.uk
Competing interests: None declared.
References
Jagsi R, Lehmann LS. The ethics of medical education. BMJ 2004;329: 332-4. (7 August.)
Rawls J. A theory of justice. Cambridge, MA: Harvard University Press, 1971.
All fourth year medical students at this medical school see a patient with intellectual disability, and they not infrequently question the validity of that patient's consent to be interviewed. A person with mild or moderate intellectual impairment can usually give informed consent to student contact, but this does take extra time and effort. People with severe intellectual disability usually cannot.
We therefore notify in advance the patient's carers, community team, and general practitioner of the proposed student's visit, any of whom can prevent the visit if they consider it may be harmful. We also point out that we offer to the patient with intellectual disability an extra benefit in the form of a supervised, student led, physical health check that he or she otherwise might not have had, and a biopsychosocial assessment that is often unblinkered and innovative. Such benefits to potentially disadvantaged people may well be happening in other areas of medical education but may not have been recorded.
Malcolm McCoubrie, senior lecturer in disability
St George's Hospital Medical School, London SW17 0RE mccoubri@sghms.ac.uk
Competing interests: None declared.
References
Jagsi R, Lehmann LS. The ethics of medical education. BMJ 2004;329: 332-4. (7 August.)
Rawls J. A theory of justice. Cambridge, MA: Harvard University Press, 1971.