Letters
This program looks like a design not to influence competency but to mandate a prescribed moral belief about homosexuality. Human sexuality is inherently a moral discussion. Will this proposal give full expression to differing views and model the tolerance it purports to teach? Without penalty? Moral convictions at odds with this curriculum could be risky for student or faculty. A closet might be a safe place.
Then again, maybe the authors have in mind the original idea of the university -- unimpeded inquiry, free expression of ideas, search for truth -- and I just missed it. We have here a curriculum enthusiastically promoted but without evidence. AIDS aside, questions of prevalence, genesis, dynamics, associated morbidities and medical justice relating to homosexuality are largely unstudied but are typically decided in the well-rehearsed court of febrile opinion.
This proposal appears to offer no departure. Surely medical research is not satisfied by reference to a few surveys of the gay population. The sad irony is that because the answers are "known" before the questions are posed and because acceptance of homosexual behaviour is sacrosanct, it is unlikely that tough issues will be faced, that rigorous research will be conducted and, ultimately, that anything will be learned.
Finally, and most offensively, is what the authors propose the good physician to be. Rather than simply showing compassion, integrity and respect for all, it is conformity that matters. Acquiescence to a particular moral view becomes the proper aspiration of all physicians. Dr. Michael Myers urges people in medicine who belong to quite conservative religions that consider homosexuality a sin to refer their gay patients to other physicians (CMAJ 1996;155:765-70). In this brave new curriculum, when we cannot change people's beliefs, they keep them to themselves, and we mandate referral. Whether this advice applies to other types of behaviour that people find sinful, such as adultery, child abuse and lying, is not stated. Perhaps we need a list of referrable sins and colleagues who agree with them. Drs. Robinson and Cohen opine that physicians with good understanding cannot provide optimal care to gay patients if they do not support their orientation. This belies an indifference to our calling to serve the patient's best interests first.
This curriculum is not about understanding, ethics or the good of the patient -- the noble traditional pursuits of medicine -- but about something foreign and foreboding. The curriculum-reform troops are at the school gates, but educators would do well to pause before admitting them with this self-interested agenda, threat to freedom of conscience and impoverished idea of what a good physician is.
Bruce W. Jespersen, MD
Calgary, Alta.