ETHICS EDUCATION AND FILMS
The scope of ethics education guidelines has expanded over the years. These are based on the requirement that learners at all levels receive preparatory education for commitment to professionalism in patient care.1 Medical educators agree that teaching medical ethics can affect the professional development of future physicians. The vexing question is, ‘What are the best teaching and learning practices for professionalism and ethics?’ The authors of the Romanell Report on ethics education state that there is no single best pedagogical approach for teaching professionalism and suggest that teaching methods need to be flexible and varied.2 To simulate reality, the learning experience must be natural, multisensory, and one in which the learners can see themselves playing a role.3 Watching films allows us to make the transition between abstract ideas and concrete experience; it also opens the door for discussion on these topics.
OUR CHOICE OF FILM
The Last King of Scotland (directed by Kevin Macdonald and released in 2006) is one of the films used to teach professionalism in the Department of Family Medicine at the American University of Beirut. It depicts the adventures of Nicholas Garrigan (played by James McAvoy), a Sottish physician arriving in Uganda at the time Idi Amin Dada Oumee became president following a coup in 1971. A coincidental meeting with Idi Amin results in Garrigan becoming the new president’s personal physician. This exposes Garrigan to the brutal realities of the corruption, repression, and violence of Idi Amin’s regime.
This film and its themes resonate with our residents’ local realities. Lebanon ranked 154th in place out of 180 in the Corruption Perceptions Index of 2021.4 Corruption in Lebanese ruling class is associated with the economic crisis that hit Lebanon at the end of October 2019, with inflation reaching 240% in January of 2022.5
REFLECTIONS
After watching the film, our residents discussed their options if they were in the shoes of Garrigan. They reflected on the reasons that may have made him accept a position in conflict with the ethical principles of a physician. Points often raised include the young doctor’s ego and the difficulty of saying no to a dictator. They find Garrigan to be immature and impulsive. This is evident in his ignorance of the real situation in Uganda and his love affairs with two married women; particularly the one with Kay, the wife of his patient and boss, Idi Amin. This is generally considered as highly unprofessional and breaking all ethical rules. Residents were asked if they would ever agree to have an official position in the government despite knowing how corrupt the system can be. Some said yes as this would allow them to be ‘on the inside’ and work on changing things. Garrigan was initially lured into the circle of corruption with the gift of a suit and ultimately accepts a Mercedes and a luxury house. Physicians should be aware of the ethics of gifts and patronage — especially the difference between a gift of gratitude and a bribe. The American Medical Association’s Code of Medical Ethics states that physicians should decline gifts that are inappropriate or come with strings attached.6 The moment Garrigan accepted the gifts in the film, a shift in power between the two characters was obvious and a point of no return reached. Our residents also highlighted the contrast between Garrigan’s enthusiasm when he first arrives in Uganda and his gradual detachment from his primary mission of helping impoverished people. They wondered if this is due to the clash between his White, Western approach and the local medical traditions in Uganda. Others stated that he may have been overwhelmed by the humanitarian crisis he encountered and for which he was not prepared.7
In conclusion, watching and studying films allow healthcare professionals to immerse themselves in ‘near-true’ experiences that challenge their values and principles. It is a relatively safe way to explore different situations, sometimes at the extreme end, and to deepen reflections on ethical issues.
- © British Journal of General Practice 2022
