The ethics of intimate examinations—teaching tomorrow's doctorsCommentary: Respecting the patient's integrity is the keyCommentary: Teaching pelvic examination—putting the patient first
Editor - Coldicott et al suggest that students should take
responsibility for performing intimate examinations on patients without
adequate consent, rather than attempting to shift responsibility to
supervising staff by implying coercion.1 However, in the face of such
authority, is it really possible for undergraduates to challenge and
disobey?
Stanley Milgram began a series of controversial obedience experiments
in the 1960s, which took the following pattern. Two men attend the
prestigious Yale University to participate in an experiment on punishment
and learning. An uncompromising experimenter in a white coat (the
authority figure) tells them that one will take the role of the learner
and the other the teacher. The teacher must train word pairs to the
learner and punish the learner's mistakes by administering electric
shocks. Unbeknown to the teacher, the learner is actually the
experimenter's confederate.2,3
Before the experiment begins, the teacher receives a mild shock and
then watches the learner being strapped into a chair and an electrode
attached to his wrist. The experimenter then takes the teacher into
another room housing the Shock Generator, which generates shocks ranging
from 15 (labelled slight shock) to 450 volts (labelled XXX). The teacher
administers shocks in 15-volt increments each time the learner makes a
mistake. At 75 volts the learner begins to moan, at 180 volts he cries
that he cannot stand the pain, at 270 volts he screams in agony and after
330 volts he falls silent. Throughout the experiment, the experimenter
encourages the teacher to administer shocks using verbal prods such as
"please continue".2,3
In his initial experiment with a random and heterogeneous sample of
40 men, 25 (63%) went clear to 450 volts.4 Interestingly, when Milgram
replaced the white-coated experimenter with a clerk, participants'
obedience reduced from 63% to 20% and when the experiment took place in a
modest commercial building, obedience reduced to 48%.2,3
What these classic experiments tell us is that in the face of
legitimate individual and institutional authority, many individuals engage
in behaviours that cause others harm because they are told to do so.
Whilst I would agree with Coldicott et al. that students should take
responsibility for their own actions, we should not be surprised when they
do not.1 Indeed, as medical educators, it is our responsibility to
provide students with learning environments in which they feel empowered
to challenge authority. Maybe we still have some way to go in achieving
this?
Charlotte Rees, lecturer in clinical education
Institute of Clinical Education, Peninsula Medical School, University of
Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU
Rapid Response:
The influence of obedience to authority
Editor - Coldicott et al suggest that students should take
responsibility for performing intimate examinations on patients without
adequate consent, rather than attempting to shift responsibility to
supervising staff by implying coercion.1 However, in the face of such
authority, is it really possible for undergraduates to challenge and
disobey?
Stanley Milgram began a series of controversial obedience experiments
in the 1960s, which took the following pattern. Two men attend the
prestigious Yale University to participate in an experiment on punishment
and learning. An uncompromising experimenter in a white coat (the
authority figure) tells them that one will take the role of the learner
and the other the teacher. The teacher must train word pairs to the
learner and punish the learner's mistakes by administering electric
shocks. Unbeknown to the teacher, the learner is actually the
experimenter's confederate.2,3
Before the experiment begins, the teacher receives a mild shock and
then watches the learner being strapped into a chair and an electrode
attached to his wrist. The experimenter then takes the teacher into
another room housing the Shock Generator, which generates shocks ranging
from 15 (labelled slight shock) to 450 volts (labelled XXX). The teacher
administers shocks in 15-volt increments each time the learner makes a
mistake. At 75 volts the learner begins to moan, at 180 volts he cries
that he cannot stand the pain, at 270 volts he screams in agony and after
330 volts he falls silent. Throughout the experiment, the experimenter
encourages the teacher to administer shocks using verbal prods such as
"please continue".2,3
In his initial experiment with a random and heterogeneous sample of
40 men, 25 (63%) went clear to 450 volts.4 Interestingly, when Milgram
replaced the white-coated experimenter with a clerk, participants'
obedience reduced from 63% to 20% and when the experiment took place in a
modest commercial building, obedience reduced to 48%.2,3
What these classic experiments tell us is that in the face of
legitimate individual and institutional authority, many individuals engage
in behaviours that cause others harm because they are told to do so.
Whilst I would agree with Coldicott et al. that students should take
responsibility for their own actions, we should not be surprised when they
do not.1 Indeed, as medical educators, it is our responsibility to
provide students with learning environments in which they feel empowered
to challenge authority. Maybe we still have some way to go in achieving
this?
Charlotte Rees, lecturer in clinical education
Institute of Clinical Education, Peninsula Medical School, University of
Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU
charlotte.rees@pms.ac.uk
Competing interests: None declared.
References
1. Coldicott Y, Pope C, Roberts C. The ethics of intimate examinations -
teaching tomorrow's doctors. BMJ 2003;326:97-101.
2. Myers DG. Social psychology, 6th edition. Boston: McGraw-Hill, 1999.
3. Aronson E. The social animal, 8th edition. New York: Worth
Publishers, 1999.
4. Milgram S. Some conditions of obedience and disobedience to authority.
Human Relations 1965;18:57-76.
Competing interests:
None declared
Competing interests: No competing interests