Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Ethics is given excess emphasis over law in the proposed curriculum
- Wai-Ching Leung (1 June 1998)
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EMedLaw training should include knowing when to call for help
- Raj Mohindra (8 June 1998)
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An meaningful omission
- Gonzalo Herranz (15 June 1998)
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Untitled
- Aadil A Khan (7 August 1998)
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Wai-Ching Leung, Senior Registrar in Public Health Medicine Sunderland Health Authority, Durham Road, Sunderland SR3 4AF
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In the consensus statement on the core undergraduate curriculum for medical ethics and law reported by Doyal and Gillon (1), the consensus group recommends that there should be at least “one full time senior academic in ethics and law with relevant professional and academic expertise”. In order to lead the teaching of the subject effectively, a spread of knowledge in the principles of law, philosophy, and theology is necessary. Whilst law and ethics may address the same questions, their approaches are entirely different. Legal reasoning is largely based on statutes and case laws, whilst ethical reasoning is based on philosophical and theological principles. It is essential that students have a basic understanding of both approaches. Currently, most “senior academics in ethics and law” have an exclusively legal or philosophical / theological background. This would lead to severe distortion in the presentation of the subject. Hence, it is important to define what is “relevant professional and academic expertise”. I would suggest that two part-time academic staff - one with legal background and another in either philosophical or theological background - would be more appropriate. It is also important that the academic staff have sufficient clinical experience themselves, so that they can apply their theoretical knowledge to clinical situations and inspire confidence from their students and other tutors . There are legal topics relevant and important to the undergraduates and the newly qualified doctors which have been omitted. These include general principles and procedures of medical negligence, ways of minimising the risks of litigation claims, NHS complaints procedures and how to handle them, the employment relationship between employers and hospital doctors. Doctors may potentially face these issues from the first day of their first house jobs, and yet they often receive no teaching on these issues. On the other hand, whilst the topic of “the new genetics” are interesting and thought-provoking, it is unlikely to be of direct relevance to the doctors in their first few years of practice. An quick analysis of the composition of the consensus group reveals that members with a background in philosophy or theology outnumbered those with a legal background by about 10 to 1. This may account for a predominant emphasis of ethics over law in the proposed undergraduate core curriculum, and that the subject is named “medical ethics and law” rather than “medical law and ethics”. (391 words) Reference 1) Doyal L, Gillon R. Medical ethics and law as a core subject in medical education. BMJ 1998; 316: 1623-4. |
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Raj Mohindra, SpR General (Intermal) Medicine Milton Keynes General Hospital
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In medical practice the importance of: a.knowing there is a problem; b.knowing it lies beyond your skill to deal with it and; c.knowing how to get help are clearly established. Such skills should not be neglected in training for medical law and ethics. Therefore, I would suggest that the objective of training in medical law and ethics for medical students should include the following: 1. the ability to identify the existence of moral, ethical or legal issues in any given medical situation the trainees are likely to encounter 2. to develop a base of core skills and knowledge that could be used to address those issues 3. the ability to recognise when those issues arising in 1. above fall beyond the ability of the student (and ultimate medical practitioner) to resolve alone and; 4. should the issues in 1. above lie outside the skills base of the student, what avenues to pursue. |
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Gonzalo Herranz, Professor of Mecical Ethics Medical Scool, University of Navarre, Spain
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EDITOR. As an academic with some experience in the teaching of medical ethics to undergraduates and young doctors, I cannot but congratulate those responsible for creating the core consensus statement on medical ethics and law teaching. Only after reading the statement in full text it is possible to appreciate the richness and insight of their contribution, both in relation to the contents of the proposed syllabus and to the context of teachers and teaching1. Although the list of topics is designed for the UK only, its validity is much wider. Despite local statutory peculiarities, the list could be used everywhere as an outline for drafting the subject matter of a general course of medical ethics. That potential universality allows me to offer a criticism: the disproportionately meagre attention awarded in the list of topics to the relations between doctors and to the corporate aspects of the medical practice. Only Topic X (Vulnerabilities created by the duties of doctors and medical students) makes a passing reference to the good inter- and intra- professional communication and teamwork. That is too little. Especially, that is in strong contrast with the emphasis given to the matter in, for example, the BMA’s Medical Ethics Today2. My main point is not so much to propound the inclusion in the core curriculum of the ethics of professional relations, as to suggest that the medical corporation as such be presented to the students as the ethical community inside which they are to live. It is a pity that for so long medical schools and national medical associations have practised a mutual ignorance, and, occasionally, mutual contempt, with the consequence that frequently young doctors enter the practice of medicine with a pessimistic or skeptical outlook towards the ethics of the profession. Medical students, it has been said, are partially committed iatroblasts. Medical schools have the responsibility of providing them with the ethical receptors and expressors which prepare them to enter the medical body with due knowledge of the ethical self of the profession. References 1. Consensus statement by teachers of medical ethics and law in UK medical schools. Teaching medical ethics and law within medical education: a model for the UK core curriculum. J Med Ethics 1998;24:188-192. 2. BMA’s Ethics, Science and Information Division. Medical ethics today: its practice and philosophy. London: BMJ Publishing Group;1993. Gonzalo Herranz Department of Bioethics University of Navarre Apartado 177. 31080 Pamplona, Spain Email: gherranz@unav.es |
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Aadil A Khan, Medical Student (B.Sc. year) King's College, London
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As part of the new currriculum introduced at King's College the year my class matriculated, we were taught medical ethics as a core part of the curriculum. The course spanned the two pre-clinical years, dealing with the issues of autonomy and patient confidentiality in the first year. The second year raised the topics of genetic screening and "when life begins to matter morally". I am certain I am not alone when I say that the ethics course was one of the most interesting courses we took. It allowed for critical discussion of these controversial issues and brought to light the different viewpoints that can exist, even in a room of 60 medical students. I believe that the ethics course should indeed be made part of the core curriculum in medical schools, because medicine is not all about science. As a result of the course I think I would be more confident in dealing with any such ethical issue should it arise. The prospect of being "thrown into the deep end" after finishing medical school is daunting enough for most students, and courses such as ethics/law will be vital in helping junior doctors to survive in the medical jungle. In addition it helps students grow as people to faec up to these kinds of issues and discover for themselves what their own opinions and thoughts on the matter are. |
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