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TEACHING ETHICS IN THE ERA OF AIDS

AIDS has focused attention on deficiencies in medical education and in particular the teaching of ethics in medicine. The relative impotence of doctors to treat HIV/AIDS has served to remind them and other health workers that the ethics of care and prevention is ultimately about power‐sharing with people. A holistic approach to ethics in medicine requires proper attention to be given to developing both professional competence and interpersonal competencies. These need to be developed at the Micro (Clinical), Macho (Interprofessional), Meso (Service Management) and Macro (Health Policy) levels. Like medicine, ethics is a practical discipline, requiring knowledge of general principles and skills in problem‐solving. Both need to be learned in actual clinical settings, in interprofessional team‐work, applied management of health services, and through participation in the development of ethical health policy (albeit for the local health centre, clinic or hospital). In ethics, as with general medical education, AIDS has shown that there needs to be more scope for person‐centred and experiential learning, to build the kind of competencies that enable young doctors to deal with sensitive issues around sexuality, substance abuse, death and bereavement (particularly affecting people of their own age group). Instead of reinforcing the tendency towards the privatization of ethics, medical schools should follow the example of some leading business corporations in conducting institutional ethical reviews of systems and procedures, in developing corporate ethical policies, which will nourish the development of ethical competence in all staff and place ethics teaching in the context of total quality management.