Medical ethics, teaching and the new genetics.

We usually discuss how to use medicine to teach ethics, but since I started teaching molecular genetics to medical students over thirty years ago, I have been surprised at how little we use their keen interest in ethical issues as a motivator towards a better general understanding of how to provide excellent science-based medicine. I have been reluctant to offer my views on this, because I am neither a clinician nor an ethicist, but as the years go by I have become less worried that I might make mistakes (we all make mistakes) and more concerned to discuss what I think might lead to better practice. In my experience, medical students (at least in Scotland, England and Australia) are unlike most other students in that virtually every one of them enters university an idealist, with the intention of behaving in an overtly ethical fashion. Indeed, as our editor said in his recent inaugural professorial address, "Medicine is a fundamentally moral pursuit". In this sense, it differs from science, or law, or fine arts no one would say, for instance, of my own discipline that "Chemistry is a fundamentally moral pursuit". In my experience, students enter the medical course hungry for ethical meat. We give them (in most cases) anatomy, physiology and biochemistry. In each department in which I have taught (Glasgow, St Mary's, London and Melbourne Universities, with occasional forays to the US and France) I have tried to move the teaching of human genetics to the beginning of the first term of the first year. I have also started the course with patients who have inherited disorders (and not with DNA nor with yellow and green peas). For medical students, ethical issues are best illustrated by people and their problems as they interact with health care professionals. Genetics is, at the moment, the perfect subject for teaching ethics to medical undergraduates. Perhaps I can give a few examples of the way the issues come up. We discuss, for the most part, ethics and genetics equally. Genetics is the study of families. Who owns genetic data: the person tested, his or her parents, his or her children? What of employers, insurers, the community? We can now do the tests easily (in a matter of minutes, at little cost)