Medical Matters: There has been some discussion in the media about restricting the access of people with disabilities to medical education. So far the Equality Authority, the Irish Council for Civil Liberties and the chairman of the Council of Deans of medical schools have contributed to the debate.
Universities here are currently drawing up protocols to govern the admission of students to medical schools. Among their concerns is the possibility of a student with a transmissible disease infecting a patient during hospital training. Medical school deans are also debating whether there is a level of disability beyond which a student would be unable to carry out necessary clinical tasks.
It is an area full of ethical and legal conundrums and one that can generate deeply emotional responses. Firstly, it could be said that a medical degree is an educational matter and that the issue of professional practice only arises during the intern year when the recent graduate's performance is assessed prior to the granting of full registration by the Medical Council. An increasing percentage of medical graduates never practise medicine; why assume that all students are heading for a career at the clinical coalface? But perhaps the most powerful argument against restriction is the right of the disabled person to equal educational opportunity. At a time when great strides are being made in opening up the full gamut of CAO course options to everyone, it seems strange that medicine should want to head in the opposite direction. Indeed, it is difficult to see an argument at a purely educational level for restricting entry to medicine.
However, at a practical level, there could be areas of difficulty. A blind doctor is unlikely to succeed in a career in cardiology, although this presupposes that a Braille-like system will never be developed for the reading of scans and X-rays. A doctor (or student) with a highly transmissible form of hepatitis E could be a danger on the wards and in the operating theatre. And what about the student who appears in an ante-natal clinic with the typical rash of German measles? It can be argued that the training hospital has a duty of care to expectant mothers to ensure that all students are rubella immune and could not be the cause of severe congenital abnormalities in an unborn child.
Although it is the deans of medical schools who are making the running on this issue at present, it is by no means confined to doctors-in-training. The same dilemmas exist for those responsible for training physiotherapists, occupational therapists and speech therapists. Schools of radiography and psychology must also consider their positions.
So much for the theory. When faced with ethical dilemmas I have always found practical experience a useful guide. Here are my personal experiences of disability in healthcare workers.
A colleague with a physical disability is one of the finest general practitioners in the country. He is someone who has chosen to work in a deprived area; his was one of the first practices to respond in a humane way to the special needs of asylum seekers and immigrant workers. I first met him when, as a medical student, he joined the surgical team for which I was the intern. One of my tasks was to teach him how to take blood. With a marked hand deformity this was not easy. Yet, over time, and with innovation, he mastered the act. Rather than be put off, I found that patients took pleasure in his learning. He responded with a gentleness that many able-bodied students could only aspire to.
Many of the manual practices of medicine required some adaptation in order for him to master them. Yet this is precisely what he did; he passed all his exams and now cares for his own unique community.
I am aware of another doctor with a hearing impairment. How does he hear his patients' heart and breath sounds? With the help of technology and the compensation of other sharpened senses.
There are paramedics who are visually impaired. One of my acquaintance managed a department and has treated thousands of patients during her career. An observer would not be struck by her disability - but rather by her immense ability to do a fine, professional job.
Medicine is a degree within which the graduate has a very wide range of career options, from laboratory medicine to hospital administration and from cardiac surgery to specialised areas of psychiatry. In any case, I am not aware of it having been officially designated as a vocational degree. Some graduates use the qualification to develop other careers outside medicine.
While the motivation for regulation by medical school deans is honourable, they must proceed with the lightest of legislative touches. Rather than seek exclusion from entry to medical school, an inclusive approach which considers each case on its merits must be the way forward. If ever there was a case for the medical maxim primum non nocere (at first do no harm), this is it.
• In last week's column on salt and its effects on the body it was stated that salt is sodium. This should have read, salt is sodium chloride.
You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries