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Establishing Medical Ethics

Re: “Medical Ethics Louisiana-Style,” Health column by Brobson Lutz M.D. August 2014 issue.

As director of the Foundations of Medicine course for Tulane University School of Medicine, I take exception to Dr. Brobson Lutz’s column “Medical Ethics Louisiana-Style” (August 2014), which did not present a full and accurate portrait of the ethics training programs at Tulane.

We believe that a strong foundation in ethics is essential for medical students to become compassionate physicians. Tulane benefits considerably from an endowed chair in ethics, and we offer many opportunities within our curriculum for students to learn medical ethics.

Within the first two years of pre-clinical coursework, students get 24 hours devoted to ethics. The vast majority – 19 hours – is exactly the discussion-based discourse Lutz prescribes in his column. In that first year, we cover principles of medical professional ethics, research ethics, issues of patient consent, genetics, healthcare equity, medical error disclosure and end of life care, among others. In the second year, the course focuses on cultural and ethical issues and covers topics such as LGBT health, implicit biases and their effect on the delivery of care.

While many institutions have ethics curricula that discuss issues in an abstract fashion, our students participate in simulated patient scenarios that allow them to confront real-time situations in a safe environment to develop the skills needed to be ethical, humanistic physicians. These practice simulations cover providing informed consent prior to a procedure, disclosing a medical error, investigating a patient’s wishes on death and dying and probing the biopsychosocial issues affecting marginalized populations.

Our training doesn’t end after the second year of medical school. We host visiting and endowed lectureships on aspects of medical ethics, and this fall, will launch a new ethics seminar series for third- and fourth-year medical students. Tulane is also unique in that we require student representatives to serve on our academic medical center’s ethics committee, which meets monthly to any address issues that arise in patient care.

Ethics programing is consistently one of the highest-rated components of our curriculum. This is due to the dedication of our faculty in engaging our students, the diversity of the students themselves, and by our commitment to actively include medical ethics training in our patient care.

Chayan Chakraborti, MD, FACP, FHM
Associate Professor of Clinical Medicine
Director, Foundations in Medicine Course
Director, Student Career Services
Tulane University School of Medicine

Dear Editor,
I read with interest Dr. Brobson Lutz’s article entitled “Medical Ethics Louisiana-Style” in the August 2014 issue of the New Orleans Magazine, and I wish to contribute some additional information.

In 1970 my husband, Prim B. Smith Jr., BBA, JD, M.Div., was invited by Dr. James A. Knight to assist him with his medical ethics course at Tulane Medical School. Tulane also provided him with an office for counseling on Fridays. At the time he was Episcopal chaplain to Tulane University and pastor of the Chapel of the Holy Spirit across from the Newcomb campus.

In 1972 when Dr. Knight left Tulane to become the first Dean of the newly formed Texas A&M University College of Medicine, Smith invited Dr. Charles B. Moore, an Ochsner cardiologist and Episcopal priest, to assist him in teaching the Tulane medical ethics course. In ’83 Smith spent four months as a full-time Visiting Scholar at the Kennedy Institute for the Study of Bioethics at Georgetown University. In ’84 he obtained permission from his bishop to seek a two-year grant to begin a full-time ministry at the Tulane Medical School. Trinity Church in New Orleans provided him with a grant. In ’85 he became a full-time chaplain at the Downtown campus and received an appointment to the Tulane School of Public Health (HSM) to teach ethics.

When Father Smith retired to spend his time funding the Episcopal Ministry to the Medical School, the Rev. Robin Whitlock took over his duties as chaplain. He was succeeded by the Rev. Dr. Donald Owens, who as your article points out not only taught medical ethics and was a counselor, but also assumed other duties at the medical school and became the holder of the James A. Knight M.D. Chair of Humanities and Ethics in Medicine. I hope that when Father Don retires in 2015, someone will continue his excellent work.

The Reverend Prim Smith Essay Award was established in 2013 to be used to support an annual award to recognize senior medical students who author an essay of note on the topic of medical ethics. It is presented during the Ivy Day ceremonies associated with the Tulane University School of Medicine’s graduation celebration.

Charlene M. Smith
New Orleans

Ed. Reply:
We acknowledge the pioneering role that Tulane Medical School has performed in advancing medical ethics. The thrust of the article was to hope that such efforts are not diminished. We are encouraged by the responses.

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