See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/40023944

MERCI: a useful systematic aide

memoir to help clinicians teach ethics
ARTICLE in MEDICAL EDUCATION DECEMBER 2009
Impact Factor: 3.2 DOI: 10.1111/j.1365-2923.2009.03539.x Source: PubMed

READS

520

3 AUTHORS, INCLUDING:
Zabidi Azhar Mohd Hussin

Teguh Haryo Sasongko

Universiti Sains Malaysia

Universiti Sains Malaysia

36 PUBLICATIONS 147 CITATIONS

39 PUBLICATIONS 149 CITATIONS

SEE PROFILE

SEE PROFILE

Available from: Zabidi Azhar Mohd Hussin

Retrieved on: 05 April 2016

letter to the editor

MERCI: a useful systematic aide memoir to help
clinicians teach ethics
Zabidi AMH Zabidi-Hussin,1 Teguh H Sasongko2 & Mohd D Kamaliah3
Editor Medical educationists
worldwide have long recognised the
importance of ethics in the training
of medical doctors.1,2 Various approaches and guidelines have been
proposed and formalised either
globally,3 or regionally in Canada,4
Europe5,6 and Australasia.7 The true
effectiveness of these approaches
has not been exhaustively evaluated.
The teaching of a long list of ethical
subjects considered to be core
knowledge to clinicians in a busy
clinical setting is often prohibitive.
Lack of time in the curriculum and
faculty schedules, and limited availability of qualified teachers, were
cited most frequently as obstacles to
ethics education.8
Outsourcing the teaching of ethics
to non-clinical experts, however,
risks distancing clinicians further
from the subject. An easier method
of implementation is thus required.
We would like to propose a systematic thinking approach that can
serve as an aide memoir on the
subject of ethics for clinicians in
their daily routine clinical service.
1
Department of Paediatrics, School of Medical
Sciences, University of Science Malaysia
(Universiti Sains Malaysia), Kelantan, Malaysia
2
Human Genome Centre, School of Medical
Sciences, University of Science Malaysia
(Universiti Sains Malaysia), Kelantan, Malaysia
3
Department of Medicine, School of Medical
Sciences, University of Science Malaysia
(Universiti Sains Malaysia), Kelantan, Malaysia

Correspondence: Zabidi AMH Zabidi-Hussin,

Department of Paediatrics, School of
Medical Sciences, Universiti Sains Malaysia,
USM Health Campus, 16150 Kubang Kerian,
Kelantan, Malaysia. Tel: 00 60 9 767 6523;
Fax: 00 60 9 764 7642;
E-mail: zabidi@kb.usm.my
doi: 10.1111/j.1365-2923.2009.03539.x

1218

The acronym MERCI gives a quick

guide to the core contents of ethics
and can be a useful tool during
ward rounds.
M (MEDICAL) ensures that all
acute and non-acute medical
problems relevant to the patient
have been properly dealt with.
E (EMPATHY) represents an
awareness of the patients
emotions and the ability to express
that awareness to the patient.9 R
(RIGHTS) reminds the doctor to
establish whether sufficient respect
for the patients rights has been
shown. These include rights to
knowledge, treatment options,
autonomy of decision-making and
confidentiality. C (COMMUNICATION) ensures that all matters
pertaining to effective communication have been satisfactorily dealt
with. Lastly, I (INSIGHT) serves to
remind the doctor to check
whether the patient has a comprehensive degree of insight into his
or her illness and whether the
attending team has a holistic
appreciation of the patient,
including his or her social and
cultural considerations.
Such a thinking frame would
enable clinicians to quickly consider the various ethical issues with
their students and medical officers
before moving on to see other
patients in a busy ward round. We
have found from our brief experience that this approach helps to
increase awareness of medical
ethics in a clinical setting. Further
evaluation of its effectiveness is
currently planned.

REFERENCES
1 Selvakumar D, Joseph LBM. The
importance of including bio-medical ethics in the curriculum of
health education institutes.
Educ Health (Abingdon) 2004;
17:936.
2 Doyal L, Gillon R. Medical ethics
and law as a core subject in
medical education. BMJ
1998;316:16234.
3 Willams JR. Medical Ethics Manual,
2nd edn. Ferney-Voltaire Cedex:
Ethics Unit of the World Medical
Association 2009;7134.
4 Ethics Committee of the College of
Family Physicians of Canada. Family
Medicine Bioethics Curriculum; Clinical
Cases and Reference. Mississauga, ON:
College of Family Physicians of
Canada 2005.
5 Comite Permanent des Medecins
Europeens [Standing Committee of
European Doctors]. Teaching of
Medical Ethics in Basic and Continuing
Medical Education. Brussels: CPME
1992;267.
6 Comite Permanent des Medecins
Europeens [Standing Committee of
European Doctors]. Medical Ethics
Core Curriculum on Consent,
Confidentiality and Human
Rights. Brussels: CPME 2008;
742.
7 Braunack-Mayer AJ, Gillam LH,
Vance EF et al. An ethics core
curriculum for Australasian
medical schools. Med J Aust
2001;175:20510.
8 Lehmann LS, Kasoff WS, Koch P,
Federman DD. A survey of medical
ethics education at US and Canadian medical schools. Acad Med
2004;79:6829.
9 Stepien KA, Baernstein A. Educating
for empathy: a review. J Gen Intern
Med 2006;21:52430.

Blackwell Publishing Ltd 2009. MEDICAL EDUCATION 2009; 43: 1218