Negotiating the Moral Education of Medical Students in the Age of Multiculturalism

Formal teaching of ethics in medical courses has failed, providing little more than a vehicle for recapitulating conventional theories and reinforcing social prejudices. Courses are most typically based on out-dated and partial hyper-rationalistic theories that bear little relevance to the tasks of decision making in actual clinical life and on outmoded educational theories. A more adequate approach must recognise two paradoxes. First, the educational process in medicine has to be both limiting and enabling: it must control behaviours, characters and interpersonal styles, and it must achieve exactly the opposite, by establishing the possibility of responding to novel situations and inventing original solutions to ethical uncertainties. Second, despite the extreme complexity of ethical encounters and cultures, communication among contending discourses is always possible; indeed, the more profound the gulf is, the richer and more fecund the play of differences that constitute the dialogue can become. The multiple, diverse tasks of ethics are linked to contrasting technologies and pedagogies. In recognition of this, this article highlights the need for educational approaches in medicine that do not only reproduce the moral assumptions and prejudices of the mainstream culture but also are faithful to the actual practices of clinical decision making, thereby contributing to the cultivation of multidimensional competencies covering many levels of personal and social experience.