Changes in undergraduate attitudes toward medical ethics.

To detect any change in medical students'' attitudes toward medical ethics, students from the same class were given a questionnaire on their first day of medical school and again near the end of their fourth year of study. The results showed a strong shift away from the students'' initial expectations that they would rely on specialists or scholarly sources in the future; the need for a medical ethics course in the curriculum, while still felt, was less important to them by the fourth year. The reasons for these changes were not apparent, for the students'' levels of knowledge and perceptions of the role of ethics in medicine in the first and fourth years did not differ. It is recommended that medical school faculty actively reinforce the initially positive attitudes of students during clinical supervision.     

Patients' responsibilities in medical ethics

Patients have not been entirely ignored in medical ethics. There has been a shift from the general presumption that 'doctor knows best' to a heightened respect for patient autonomy. Medical ethics remains one–sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one–sided account of duties in medical ethics. Duties fall mainly on doctors and only exceptionally on patients. Medical ethics may exempt patients from obligations because they are the weaker or more vulnerable party in the doctor–patient relationship. We argue that vulnerability does not exclude obligation. We also look at others ways in which patient responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair captivity of doctors as helpers.