Arriving in a foreign place, astonished with the glamorous sparkle of the city, all set and ready for a change in life, excited for what this new adventure has to offer—this is what the students on exchanges experience at the beginning of their exchanges. With this, it is very often the students are blinded with the wide opportunities presented to them, and they forget the simplest and the most basic thing—in order to enter a war zone and get out later alive and well, one must be equipped with adequate attributes and preparation. This, dear SCOPEOPLE and people of exchanges, is exactly why we need to address the issue of ethics in exchanges.
Abby has just freshly graduated from her preclinical years and decided to fill the holiday between her preclinical and clinical years by going for exchange. Arriving at her country of choice, she was super excited for her clerkship. On the first few days, she had already gotten the chance to observe several surgeries. On the third day, the chief doctor asked her to assist him in a complicated surgery, a matter of life-and-death. Excited with the opportunity, she agreed. Long story short, the operation went well, fortunately, and the patient lived. But if the story didn’t go that way and the patient died, whose fault wa it? The overall unwise decision and quite unethical one is at fault. The question is, which part exactly that made the decision unethical and unwise?
Ethics is an ideal concept. It talks about the good and the bad, in context of moral duty and obligation. As doctors, our world of profession is tightly linked with the issues of morality, duties, and obligation. Our profession itself is created with an ethical vision: to bring good to human welfare. Therefore, it is extremely important for people who work in the field to hold tight to the principles of ethics: the familiar principles of autonomy, nonmaleficence, justice, and beneficence.
In exchanges, the implementation of ethics in the professional work of our health duties might just be quite blurry. The differences in culture, regulations, and the overall situation leave the lines of what is ethical and what is not, blurry. These blurred lines are tinted with the grey area of unknown things: unknown regulations of host country to the students, unknown level of competence and knowledge of students to the hosting tutors and doctors, and a bunch of other unknown things. It could be quite difficult to do what is ‘right’ when the regulations that help defining what is ‘right’ is different to what you know. You tutor might just mistakenly push you to do what you are not yet ‘rightfully’ allowed to do because he didn’t know of your competence and knowledge.
The story above points out three things: the importance of ethics, the implementation of ethical principles in the context of exchange, and the consequence of ethical misconduct. Ethics is extremely important as the guidelines for us doctors to work. It sets the baselines, what we should and should not do. Holding on to and basing our work with those principles helps us see clearly what to do in our line of duty. Abby should have been fully aware of her competence: a freshly graduated student of preclinical competence, having only observed and has not even assisted on any surgeries yet, is clearly not competent in assisting a complicated one. Holding on to the ethical principle of nonmaleficence, she should have not agreed to the offer. She should have not risked the patient’s safety for her chance of self-development.
Yes, she should push her limits and yes, this exchange is to encourage and facilitate student’s development. However, the life of the patient being at stake should not be the price to pay for it. The line between an act of learning and an act of risking patient’s safety is merely set by the ethical principle. Asking herself, “Is this harming the patient?” might just result in a different decision. The phrase “Do not do things you wouldn’t do to your grandmother” is the simplest form of self-reminder students in exchange should keep in mind. Wanting to experience the thrill of new things and ignoring the steps needed to reach that point is unwise. Take learning step by step, and the phrase could just set the limit of how far the leap you could take before it falls under the category ‘harming the patient’.
True, ethical implementation is quite subjective, and to set a safety net, other than keeping the principles in mind, is to learn the regulations. Regulations are made to objectify the subjective in ethics, and they might help clear things up when your view of the lines get quite blurry. In the context of exchange, it is extremely important for students to minimize the grey area of unknown and it could be achieved by learning both international regulations that sets the universal standards of ethical medical conduct and the local regulations of their hosting country.
The context of exchange may just present you the phenomenon of a brand-new population of humans, and people could tend to forget that beyond the differences seen by the eyes, they are still humans. They are not lab rats, and their lives and safety are not the price to pay for our exchange to be priceless. I will end this short article with a quote from our very own Hippocratic Oath, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being.” Doctors are humanitarians, meaning we strive for human welfare. Keeping in mind that the patient is human, and that we are treating humans, take ethical decisions, gain knowledge and experience ethically, and our exchange will not be any less valuable.