Beatrice Khater is clinical instructor in family medicine, American University of Beirut
Bassem Saab is professor of clinical family medicine and program director, American University of Beirut
Ethics education at the movies
he 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 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, multi-sensory, and one in which the learners can see themselves playing a role.3 Playing movies allows making this transition between abstract ideas and concrete experience; it also opens the door for discussion on these topics.
Our choice of movie
To simulate reality, the learning experience must be natural, multi-sensory, and one in which the learners can see themselves playing a role.
“The last King of Scotland” (directed by Kevin Macdonald) is one of the movies we use to teach professionalism in the Department of Family Medicine at the American University of Beirut. The movie depicts the adventures of Dr Nicholas Garrigan, a Sottish physician who arrives to Uganda at the time Idi Amin Dada became president following a coup in 1971. A coincidence meeting with Idi Amin results in Garrigan becoming new president’s personal physician. This exposes Garrigan to the brutal realities of the corruption, repression and violence of Amin’s regime.
This film and its themes resonate our residents’ local realities. Lebanon ranked in 154th place over 180 in the Corruption Perceptions Index of 2021. 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 2022.4
Reflections on The Last King of Scotland
After watching the movie, our residents discuss their options if they were in the shoes of Dr Garrigan. They reflect on the reasons that made Garrigan accept a position that was in conflict with the ethical principles of a physician. Points often raised include the ego of a young doctor and the difficulty of saying no to a dictator. They find Garrigan 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 a breakage of all ethical rules.
It is a relatively safe way to explore different situations, sometimes extremes and to deepen reflections on ethical issues.
We have asked residents if they would agree to have an official position in the government despite knowing how corrupt the system can be. Some indicate yes as this would allow them to be “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 AMA Code of Medical Ethics states that physicians should decline gifts that are innapproriate.5 The moment Garrigan accepts the gifts in the movie, a shift in power between the two characters was obvious and a point of no return was reached.
Our residents also highlight the contrast between the enthusiasm of Garrigan when he first arrives in Uganda and his gradual detachment from his primary mission of helping underprivileged people. They wonder if this is due to the clash between his Western approach and the local traditions in medicine. Others state that he might be overwhelmed by the humanitarian crisis he encountered and for which he was not prepared.6
Movies allow health care 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 extremes and to deepen reflections on ethical issues.
- Rabow MW, Remen RN, Parmelee DX, Inui TS. Professional formation: Extending medicine’s lineage of service into the next century. Acad Med. 2010; 85:310–317.
- Carrese J , Malek J, Watson K, Lehmann L, Green M, McCullough L, Geller G, Braddock C, Doukas D. The essential role of medical ethics education in achieving professionalism: the Romanell Report Acad Med. 2015; 90(6):744-52.
- O’Leary R, Jurkiewicz C, Giacalone R. Through the lens clearly: using films to demonstrate ethical decision-making in the public service. Journal of Public Affairs Education. 2000; 6(4): 257-265.
- Colt H, Quadrelli S, Lester F. The picture of health: medical ethics and the movies. Oxford Scholarship Online. May 2015.