of medical students faced with the current changes to licensure. As a fellow medical student I wholeheartedly agree with many of the concerns he has raised. Not only is there no proven need for another examination, but it is also difficult to understand why the MCC has prematurely embraced the notion of administering an examination (at a cost of $1000 to each poor medical student) that achieves nothing for students: it does not lead to licensure or even to a guarantee of portability. The College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada should be left to determine whether their applicants fulfil the necessary criteria (which can be modified in conjunction with the MCC and other relevant bodies) and demonstrate the appropriate skills and attitudes to become licensed physicians. I am even more frustrated that, as a medical student, there is so little that I seem to be able to say or do when the powers that be decide my fate. I have written two letters to the MCC outlining my concerns about the part II examination, but to date I have received only one (totally unsatisfactory) response that did not address any of my concerns. I sympathize with and appreciate the efforts of the CFMS, but I wonder if the time has come for medical students across the country to unite in solidarity and refuse to write the MCC part II examination. Is this now our only effective voice? Shabbir M.H. Alibhai Richmond Hill, Ont.
Physicians of Canada when the part II examination was first proposed. Maudsley's account of the sequence of events is accurate. His arguments for moving the part II examination back to the end of undergraduate training are logical and thoughtful, and they should be supported. Reg L. Perkin, MD Executive director College of Family Physicians of Canada Mississauga, Ont.
Ethics and the physician W ith regard to the correspondence on this topic in the Sept. 1, 1992, issue of CMAJ (147: 575-581), by Dr. Eike-Henner Kluge and others, I have these comments. Bid adieu to the days when physicians Were believed to have knowledge and skills With conundrums of choices and duties and rights As opposed to their scalpels and pills.
Say farewell to that part of caring That allowed us to guide and assist. Untutored, inadequate, now we are saved By the "Expert Witness Ethicist."
Rejoice, for it offers solutions To the questions of good versus ill. Open minds may be closed as the answers come down From the perch on the ethical hill. How unique to be blessed with such wisdom To know just how others should think, And insist they adopt that perspective As they skate on the ethical rink.
I wish to support the position taken by Dr. Robert F. Maudsley To a few this might seem to be in his editorial "Timing of the arrogant, Medical Council of Canada clin- But, of course, then who are they ical examination" (Can Med Assoc to judge, J 1992; 147: 995-997). His views Unrecognized as they are by Canadian courts? are congruent with the position taken by the College of Family But ";law is not ethics." Oh, fudge! 1746
CAN MED ASSOCJ 1992; 147 (12)
Perspectives might vary with cultures and time, As will people and medical platitudes. Will ethicists change as the paradigms shift Or be frozen in time by their
attitudes? Philip F. Hall, MD, BScMed, FRCSC Professor and head Department of Obstetrics, Gynaecology and Reproductive Sciences St-Boniface General Hospital Winnipeg, Man.
[Dr. Kluge responds:] Happy day! Here is a physician Who seems to have seen the light, Who has recognized that mere tradition May mislead as to wrong and to right, Who has seen - alas it is painful, But the truth must out, t'would appear That the ethics of good old Percival No longer have society's ear, Who has seen - though he's loath to admit it That the courts have broken the mould. There's a new approach to ethical practice: The paternalism of old Must give way to new manners of treating.
"Informed consent" and "objective standard of disclosure" Have become de rigueur in the land. Of course there are those i'the profession Who rebel and who rant and rave, Even try their hand at doggerel, But nothing their practice can save From the lawsuits that seem to follow Their patterns of practice so bold, When they ignore Malette v. Shulman Or Mclnerny v. Macdonald. I'm told That the tide of their fear is rising: Hippocrates is no longer a shield. Doctors actually have to learn ethics! They no longer control the field Of patient decision-making! "Best interests" is no longer enough, Unless the patient defines it. The life of a doctor's become tough. The old and well-worn approaches"'Tis in your best interest, my dear," Or "Doctor knows best, Mrs. Murphy, So do it! Go on! Never fear!LE 15