1 May 2009
In this blog entry, I argue the notion that the method by which medical students are trained screens out those who are most concerned with the value of life and alleviation of suffering. Namely, by forcing medical students to experiment on animals (euphemistically referred to as “sacrificing” them), the medical establishment itself selectively screens out the very same potential physicians who are most concerned with life.
I know this self-selection happened in my own case. I was wildly enthusiastic about biology. Beginning in 6th grade, I happily rode two hours on a public city bus several days per week to study biological science at the Science Center of Pinellas County, a nonprofit devoted to children’s science education. Originally started by a scientist who taught local children out of his garage, the programs I fell in love with were in animal science taught by Dr. Ramstein. I took his course in microbiology and couldn’t wait to take the next course that he taught. Only six youngsters would be allowed in the course, and it required several prerequisites. while I was on the waiting list for his class, I took other classes on entymology, herpetology, and marine biology. Finally, I was one of the lucky children who drew the straw to take that class. Funny, I don’t even remember the name of the class now, because I never took it. That’s because, during an open house for parents, I heard Dr. Ramstein telling visitors about some of the experiments we would be doing. I couldn’t quite believe my ears. It was things I couldn’t do.
The class required that mice be “sacrificed”. I vividly remember my shock at the thought of killing animals. The extent of my horror and disbelief was such that, once I got home I decided that I must have been mistaken. Surely this was a class about LIFE. Surely each child in the class would not be required to experiment on animals and then kill them. So, at the next opportunity, I talked with Dr. Ramstein about it. Gingerly, of course, because he was almost like God in terms of my child-like estimation of his stature. His reply? He reassured me that the animals were treated humanely at all times. It was quite necessary, he insisted, and besides, it was "just" mice.
Well, mice are living creatures, too. With great sadness and disappointment, I decided that "sacrifice" of animals was not within my values. For the record, my decision was not for lack of passion or talent. Though I never took another biology course, six years later as a senior in high school I placed in the 99th percentile on the Florida state biology exam. I also exempted a year of college biology, never having taken a single biology class in high school. I don’t say that for the purpose of bragging, but rather to make the point that a qualified student was weeded out on account of adherence to a standard of ethics that placed a higher value on life than that adhered to by the professional teaching the class.
If the path toward medical education were to be visualized as a sifter, there are many things that sift young students out of the path. Some get sifted out because they don’t have the grades or talent for it. Some get sifted out because they have other interests or passions. Some, like me, get sifted out by the requirement that they lose their squeamishness about killing animals. Who is left; who is the square peg who finds that medical education is the square hole that fits them?
Well, first of all, they are smart. Students who get into medical school can memorize and parrot back formulas, chemical compositions, and diagnoses. Second, they don’t mind spending time in a lab and doing precise work. Third, they have stamina and social tolerance for the long hours required. Fourth, they have monetary resources to attend school for many years. Fifth, many of them are also highly motivated by the promise of rich monetary reward that awaits a successful physician. And Sixth, yep, they can tolerate doing awful things to innocent animals.
A girlfriend of mine who used to work in the animal lab at a medical school told me why Golden Retrievers are one of the dog breeds preferred for medical school experimentation. The medical students are required to do various surgeries on the animals. These surgeries become progressively more involved, such as amputation of the animal’s leg, and then end with something like open heart surgery so that the medical student can see the beating heart. And then the animal’s heart is stopped and it is euthanized. The reason Golden Retrievers are preferred is because of their sweet temperament — they keep wagging their tails and loving on their owners even as they are having their legs cut off.
It’s possible to argue dozens of reasons why vivisection is a necessary requirement of medical education. Indeed, just recently I read a column by a physician who argued that dissection of a human cadaver was a necessary means of preparing future physicians for the emotional challenges of cutting on (and doing medical procedures to) a living human being. A doctor can’t afford to be squeamish about jamming a knife into a person’s body, if that’s what it takes to cut out a tumor.
But cutting on a cadaver is different in both kind and degree from inflicting pain on, and then killing, a non-consenting, sentient, being. I’m continually amazed at the artificial rationalizations people will create to justify decisions they have already made. The notion that babies — or fish — don’t feel pain is one of these outlandish notions. Of course they feel pain. Even amoebas react to painful stimuli, that’s one of the central functions of the central nervous system.
This is only the beginning of where those arguments could go. The most important fact to consider is that by sifting out young people and eliminating from medical education those who cannot stomach animal experiments, Medicine as a profession eliminates the very people it ought to be seeking out: those persons who place such a high value on life that they refuse to degrade it.
When I was ten years old and lacked perspective, I made the mistake of thinking that my qualms, and my resulting inability to engage in higher medical education on account of it, was just personal to me. However, since that time I’ve become aware of this happening in a more systematic way. Through the years, I’ve become aware of many other people who were also thwarted from medical education because of their value of life.
For example, I once knew a promising premed student who got further than I did in her quest toward a medical education. She had nearly a 4.0 GPA in her college premed courses; and she obtained a prestigious internship / fellowship to work for a neuroscientist. Part of the plum was that the student’s name would be included in a research publication.
Part of this students’ job was to prep animals for surgery. The surgery was not supposed to proceed until the animals were fully anesthetized. Well, you can guess right here what happened. The surgeries would proceed before the animals were anesthetized. When the student objected, the neuroscientist supervising the research grew irate. The student then had to make the choice whether to take her concerns to the university ethics committee, which could cause severe stigma and backlash, or whether to do nothing. The student could not bring herself to do either. She didn’t just quit her internship. She thought this was the tip of the iceberg; she decided to quit premed altogether. I’ve since heard of more, similar kinds of decisions.
How many students have pulled themselves out of the premed or medical school track on account of ethical qualms about medical education? If I, in my personal experience, have known two or three, how many more must there be?
As a result of this self selection which eliminates an entire class of moral people from the list of potential physicians, the entire “pool” of future physicians is skewed toward those who are less concerned with ethics, who are less concerned about life and the very values that a medical education is supposed to protect. As a result, our physicians are those who don’t mind tolerating “animal sacrifice” and pain.
If our educational system is designed to screen out students like my friend, who had qualms about doing surgery on conscious rats, then we shouldn’t be surprised when our physicans are more like that neuroscientist who got so angry at my friend — willing to overlook ethical qualms, willing marginalize those who disagree, willing to overlook suffering and pain in the interest of "science". If we teach students to be callous and to rationalize away suffering, why would it surprise us when our physicians are callous to pain and rationalize away suffering? It is our medical education system that selects for training only those who don’t have qualms about it.
Alright, I’m certain that a physician reading this is up in arms at this point. YOU care about ethics, you care about suffering, that’s the reason YOU went to medical school. Yes, I don’t dispute that. I’m speaking in terms of the outside edges of the bell curve. It’s not YOU that I’m worried about. The fact that YOU are reading this article at all is an indication that you indeed have concern for ethics and that, in your case at least, I am preaching to the choir.
But what can we do about that small minority of students who could care less? And, more importantly, how can we move the bell to capture more of the students who are most concerned about life, even those students who are loathe to engage in animal experimentation?
Talking about ethics is a good first start. Too many physicians have spent all their time in a biology lab. Because they have never systematically studied philosophical ethics, they fail to appreciate the fact that ethics and morality is not just a matter of opening one’s mouth to voice the opinion du jour. They fail to understand that there are various analytical frameworks which can be used to discuss ethics and to inform the process of making ethical decisions.
When I was in graduate school studying medical ethics, I telephoned a few of my local hospitals and a few large medical practices, to survey them about the resources they devoted to ethics. My initial thought was to write a paper about ethics procedures at the hospitals.
All of them had ethics committees, because they were required to do so as part of their federally mandated certification requirements. However, none of them had a system in place to ensure that the members of the committee had any training in ethics, and none of them had devoted significant, institutionalized resources (such as library budget or training) to development of expertise in the ethical decision making process. At the time, I thought that there was inadequate source material from which to write a paper. On the other hand, perhaps the fact that ethics was just getting lip service within the medical establishment is the material itself, needed to jumpstart a discussion about the role that ethics plays (or ought to play) in medical decision making. Is it really enough to give a nurse a beeper and tell her that she now has ethics duty? And what about the role of patient advocate? Is a patient advocate merely someone who can write down a complaint voiced by a patient, or is it someone who has the authority and backing to go head to head with a blustering, loud, and red faced surgeon who resents being told what to do?
But this is almost beside the point. At the present time, medical education itself sifts out as chaff all potential physician candidates who have moral qualms about medical education. While it would be outrageous to call all physicians a-moral (because most of them are moral people) I would urge that medical education, as it’s currently practiced, sifts away those who are most concerned about life and pain and other, more ephemeral, values which ought to be sanctified by the medical profession.
No amount of “training” in ethics can impart a basic, foundational, fundamental respect for life. Until medical education is fundamentally altered by finding ways to include those who are most concerned with the sanctity of all life, it will always be skewed away from sanctity of life and toward the less ethical among us. I am not saying that the middle portion of the bell curve of physicians is unethical or amoral. What I am saying is that the profession ought to rise to the challenge of finding ways to include the most morally sensitive members of society in medical education and, in so doing, shift the paradigm of medical education toward even greater respect for the value of life and alleviation of suffering.
"First, do no harm," is more than an ideal, it is a moral imperative.