The fourth year of medical school offers students unprecedented opportunities for travel and choice. Of course, their travel is largely to interview for residency programs and their choices are among carefully reviewed electives. Still, students are generally pleased at being so close to completing their doctorate in medicine and in having some opportunities to study subjects of special interest to them. Many of them pick humanities electives. In contrast to students in the first three years of medical school, fourthyear students have ample opportunities to take elective course material. Over the first three years students have about 60 required contact hours with the Department of Medical Humanities faculty, but no opportunities for elective course work.

In contrast, students in the fourth year have only about six required contact hours with the humanities faculty, but they have ample opportunities to take our elective courses.

The Department of Medical Humanities faculty offers a variety of month-long, half-time elective courses for fourth-year medical students. Between a third and half of each graduating class takes two humanities electives. Most of the electives are offered in April, when graduation fever runs high and plans for the school play are ripening. These are primarily reading and discussion courses and most include student presentations. Their names and goals are listed below.

1. Self-designed electives. Goal: To give students the opportunity to pursue a subject in the medical humanities not addressed elsewhere or to study a topic that is addressed in more depth. Students working with a faculty member may select and design a topic and determine an appropriate method of study.

2. History of Medicine. Goal: To provide students with a historical perspective on medical practice and the profession of medicine. Special emphasis is placed upon teaching students how to find material on specific medical historical topics, and upon nineteenth and twentieth century American medicine.

3. Literature and Medicine. Goal: To learn from and enjoy literature. The works of physician authors receive special attention including A. Chekhov, A.C. Doyle, W. Osler, W.C. Williams, F. Sams, E. Canin, P. Klass, and J. Stone. In this class, students examine how illness and medical settings have been used to represent important themes and concepts about the human condition.

4. Death and Dying: Philosophical and Moral Issues. Goal: To study the meaning and moral values associated with death and the care of dying people. Students are encouraged to draw upon different fields of study as they consider the concept of death, criteria for determining death, attitudes to death and dying, moral issues regarding terminal care, the use of advance directives, DNR orders, pain management, hospice care and requests for assistance in dying.

5. Introduction to Law and Medicine. Goal: To introduce students to the legal duties of physicians, the American legal system and legal concepts concerning health care. The focus of this course is medical liability law and includes topics on the care of children, end-of-life decision-making, maternalfetal issues, professional licensure, credentials and peer review.

6. Women’s Studies. Goal: To consider women’s contributions to and the assumptions being made about men and women in our society. Key historical works by Wollstonecraft, Wolf, de Beauvoir and others are juxtaposed against contemporary writers to study issues about prejudice, discrimination and social expectations regarding gender. Gender and race biases in medicine are discussed along with strategies for flourishing in the workplace.

7. War and Medicine. Goal: To explore the history of doctors and medicine during past wars and to study the roles and responsibilities of doctors and medicine during wartime. Students reflect on the moral dimensions and consequences of conventional and nuclear war and on potential roles for doctors in preventing war.

8. Issues in Clinical Ethics. Goal: To enable students to draw on their own clinical experiences as they reflect upon the moral issues commonly encountered in medical practice and explore strategies for resolving these moral problems.

9. Animals, Medicine and Ethics. Goal: To explore the factual, conceptual and moral issues of our relationship with animals, with special reference to the use of and care for animals. Students consider the nature of human-animal relationships in different historical and social contexts, moral duties to animals, ways of knowing the mental capacities of animals, and the ethics of and regulations regarding biomedical research on animals.

10. Ethical and Social Issues in Human Genetics. Goal: To understand a variety of ethical and social issues relating to clinical genetics, including those relating to counseling, diagnosis, testing, and discrimination. In addition, students examine genetic models of disease and health, and moral and social issues regarding genetic research and germ-line gene therapy.

11. Foundations of Medicine. Goal: To examine fundamental philosophical, methodological and conceptual issues in medicine. Students consider the goals of medicine, the art and science of medicine, decision-making in medicine, clinical judgment, evidence-based medicine, reductionism, explanation, the concepts of health and disease, and the role of tradition and authority in medicine.

Medical Humanities faculty also offer a required, daylong program for fourthyear students. Since this is part of “Dean’s Month,” our Dean, Dr. James Hallock, takes a special interest in these programs. In the past we have had conferences on Informed Consent, Physician-Assisted Suicide, and Religion and Medicine. This spring, our program was on Professionalism. At this conference, we discussed the problems and consequences of using market forces to determine access to and rationing of health care, as well as the impact of for-profit managed care organizations on medical practice, and the education of medical students and residents. We also considered professionalism in relation to complementary and alternative medicine, boundary issues, physician unionization, and impaired physicians.

Our elective programs and the oneday conference for the entire fourth-year class offer the faculty of the Department of Medical Humanities an opportunity to evaluate the students’ progress following four years of humanities teaching. We are invariably pleased at how successfully students integrate their clinical experiences and training with the foundational material and insights provided by the Department’s ongoing programs, and how they have developed into mature professionals. After teaching students in different contexts throughout their four years in medical school, it is rewarding to see how well they grapple with moral and social problems, and what this will mean for them in their residencies and as practicing physicians.

Landman to Become Director of Ethics Institute

We in the Bioethics Center and Department of Medical Humanities bid a fond farewell this summer to our colleague, Dr. Willem Landman. After five years with us, Willem is returning to his native South Africa in August to become founding Director of the Ethics Institute of South Africa. We are most grateful for the many valuable contributions Willem has made to the Center and the Department during his tenure at East Carolina, and we wish him well in the exciting new effort he will be undertaking. We also welcome the addition of a new colleague this year. Dr. Joel Shuman comes to the School of Medicine from the Duke University Divinity School to serve as Visiting Assistant Professor of Medical Humanities this fall. We look forward to working with and learning from Joel. Those who are interested in corresponding with Dr. Landman may contact him at:

    Willem A. Landman, D. Phil
    Director, Ethics Institute of South Africa (EthicSA)
    P.O. Box 2427, Brooklyn Square,
    0070 Pretoria, South Africa
    Tel (from US): 011-27-12-342-2799
    Fax: 011-27-12-342-2790
    Email: willem@ethicsa.com