Marika Davies: Virtual ethics—could 3D avatars help prepare doctors to deal with ethical dilemmas?

marika_daviesThe news that virtual reality is making a comeback is likely to meet with a mixed reception in the world of medical education. Concerns were recently raised that simulation should be used less in medical education, and that medical schools “have vastly overused and abused the technologies of the unreal.” But the use of immersive virtual reality (IVR) to enable students to experience “live” ethical dilemmas may prove difficult to resist for those involved in their teaching.

IVR technology allows people to completely immerse themselves in a virtual world. At University College London, Sylvie Delacroix and her colleagues are exploring the use of 3D avatars in IVR to replicate consultations in general practice. To enter the virtual consulting room GPs don a portable, head-mounted virtual reality system, called an Oculus Rift. As part of the Rift, a built-in head-tracking device enables the scene in front of them to update according to the movements of their head. 3D avatars or ‘patients’ then respond to questioning by the GPs, allowing a clinical history to be taken, which completes the illusion of the consultation.

The project relies on the fact that people tend to respond realistically to situations portrayed within an IVR system. But how is this, if everyone knows that virtual reality is not real? At a recent inter-disciplinary workshop held to discuss the project, Professor Mel Slater explained why. First of all is the illusion that IVR gives of being in a virtual place; second is the illusion that the events occurring within that place are real. “Participants don’t actually believe they are in that place, or that what is happening is real, but a part of the brain does not know about virtual reality,” he said. “By the time the participant has ‘reasoned’ this it is too late, they have already responded realistically.”

In this way IVR allows people to experience new or challenging situations, which for professionals presents an invaluable opportunity for learning and reflection. It can help them to make decisions if they are ever involved in a similar situation in the real world, and will be of particular help to those learning how to deal with ethical dilemmas. Delacroix points out that, when teaching ethics to professionals, there may be “a huge discrepancy between their answers in class and what they end up doing in reality.” Understanding the reasons for this is a key objective of the project. Her long term plan is to study whether repeated exposure to particular scenarios impacts on the way doctors make ethical decisions.

It seems difficult to imagine that technology could ever be a substitute for the human interaction that forms such a key part of any ethical dilemma. But given the huge potential of IVR as a learning tool, it is also difficult to imagine a future in which it does not play a part in helping doctors to be better prepared to make difficult ethical decisions.

Marika Davies is a freelance journalist and medicolegal adviser.

Competing interests: “I have read and understood BMJ policy on declaration of interests and declare the following interests: I am employed as a medicolegal adviser by the Medical Protection Society.”