Australian Bioethics Conference, Sydney, 5-9 July 2000

Choosing or excluding? The use of an "ethics test" to select students for medical school entry.

I Kerridge, M Bore, D Munro, M Lowe, D Powis

In recent years there has emerged a general consensus that ethics should be included in the education of doctors. The rationale for teaching ethics has been that (i) ethics is integral to health care, (ii) changes in society and technology have raised concerns about the adequacy of professional codes or individual "conscience", and (iii) cultural and moral pluralism creates a need for students to recognize and manage ethical issues in a context in which their own personal and professional values may not be shared by patients, family, colleagues, their work institution or society.

If being "ethical" is regarded as a desirable professional characteristic, then the question for educators is whether ethics (however it is defined) can be taught. If not then the emphasis should be on attempting to measure students "ethics" as part of the admissions process, if it can then emphasis should be placed on curriculum development.

Past research suggests that content knowledge and moral reasoning skills may be developed by formal education and by professional experience. Given that selection is unavoidable and is ultimately a moral decision, then the most justifiable basis for selection would be to exclude only those who lack the capacity for moral development, who are unlikely to develop moral tolerance or moral autonomy or who exhibit extremes of behaviour.

This paper describes the philosophical and educational principles underlying the development of a valid measure of "ethics" for selecting potential doctors.