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PubMed1985

Teaching medical ethics in other countries.

In the past 20 years, around the world, there has been an explosion in the teaching of medical ethics. As the dust begins to settle, it would appear that such teaching is likely to have its most effective impact not during the undergraduate period but at the immediate postgraduate level and in continuing education. Whilst important contributions can be made by teachers of religion, philosophy and law, probably the essential wisdom, capable of standing a doctor in good stead throughout the developments of a lifetime's career, must largely come from those who have studied both medicine and ethics. It would be appropriate if the study of medical ethics were to lead to better international understanding among doctors.

Bulgaria↗
PubMed1985

A model for teaching medical ethics.

The approach to teaching employed in the Dictionary of Medical Ethics (1) provides a model which might be adopted in other media. Most of the 150 authors were medical, but many represented other disciplines, and they wrote for similar professionals and for the general public. Medical ethics is derived from medical science and practice, moral philosophy, sociology, theology, the law and other disciplines, all of which make essential, distinctive and complementary contributions to knowledge and to teaching. Medical practitioners must play the primary role, because they are responsible for clinical ethical decisions, but they need the co-operation and guidance of others. All who are concerned should work towards the development of a general moral consensus among the profession and public, which keeps abreast of scientific and technical advances and to which all are committed.

Dictionaries as Topic↗
PubMed1985

Self help in medical ethics.

The paper traces the development of programmes of lectures and symposia in most British medical schools, which have developed into a postgraduate programme of research and publication. It is asserted that a morally neutral approach is a necessary prerequisite for wide multidisciplinary involvement, as is a high level of student participation in identifying topics for discussion. Alternative possibilities for formal teaching are discussed and pitfalls highlighted.

Education, Medical↗
PubMed1985

Objections to hospital philosophers.

Like morally sensitive hospital staff, philosophers resist routine simplification of morally complex cases. Like hospital clergy, they favour reflective and principled decision-making. Like hospital lawyers, they refine and extend the language we use to formulate and defend our complex decisions. But hospital philosophers are not redundant: they have a wider range of principles and categories and a sharper eye for self-serving presuppositions and implicit contradictions within our practices. As semi-outsiders, they are often best able to take an 'external point of view,' unburdened by routine, details, and departmental loyalties. Their clarifications can temporarily disrupt routine, but can eventually improve staff morale, hence team practice and patient welfare.

Codes of Ethics↗
PubMed1986

'Medical ethics'--an alternative approach.

Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium.

Ethical Theory↗
PubMed1987

Health care ethics: a pattern for learning.

The British Medical Association (BMA) has called upon the General Medical Council (GMC) to instruct all medical schools to provide identifiable and substantial courses on medical ethics in their undergraduate curricula. The author reviews a postgraduate scheme of study in the ethics of health-care and suggests that it could provide some useful guidelines for teaching the subject at the undergraduate level.

Curriculum↗
PubMed1987

Combining law with medical ethics.

A postgraduate Diploma in Medical Ethics and Law was started in October 1984 by the Centre of Medical Law and Ethics at King's College. It is a part-time one year course designed so as to enable students to continue with full-time employment if they wish. It is multidiscipinary and is open to all who have a first degree in a relevant discipline, for example law, philosophy, theology, medicine and nursing studies. It is unique in combining medical law and medical ethics and has attracted students of high calibre from a variety of backgrounds during its first three years. Building on the experience of the diploma the course is being upgraded to an MA in 1987-88. It will be available either full-time for one year or part-time for two years.

Curriculum↗
PubMed1987

Teaching medical ethics symposium. Medical ethics in Manchester.

Manchester's multi-disciplinary approach to medical ethics combines established methods and new initiatives. There is a longstanding Medical Group and also, plans are evolving for the inclusion of medical ethics teaching in the undergraduate curriculum, the start of an MA in Health Care Ethics in October 1987 and the establishment of the Centre for Social Ethics and Policy to act as a focus within the university for research and study in a wider context.

Curriculum↗
PubMed1987

Practical problems in the teaching of ethics to medical students.

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may be as important as that of the students.

Curriculum↗
PubMed1989

The Appleton Consensus: suggested international guidelines for decisions to forego medical treatment.

Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'.

Beneficence↗
PubMed1989

Giving answers or raising questions?: the problematic role of institutional ethics committees.

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver.

Cultural Diversity↗
PubMed1989

Advanced medical ethics symposia for fifth-year students.

Case-based, multidisciplinary seminars provided a vehicle for clinicians, philosophers and students to debate current problems in medical ethics in a manner which ensured maximum learning and interest for all participants. Prior training in philosophical medical ethics was an essential prerequisite, giving students the knowledge and skills to take part in the discussions at an appropriate level of sophistication.

Bioethical Issues↗
PubMed1990

Choosing between cancer patients.

The leading ethical problem in medical practice for the coming decade is likely to be how to select patients for priority. Criteria for such decision-making in the case of cancer patients are discussed. Clinicians, ethicists and others need to agree guidelines on giving priority to one patient over another when resources are limited, and such criteria need to be approved by society at large. The public must accept that in a non-explicit rationing system, each individual competes with every other. In the case of even more difficult ethical choices, a multidisciplinary national committee is required to advise on decision-making, and its views need to be debated by the general public.

Advisory Committees↗
PubMed1990

The Council of Europe's first Symposium on Bioethics: Strasbourg, Dec 5-7 1989.

This symposium discussed bioethics teaching, research and documentation and also research ethics committees. An international convention for the protection of the integrity of the human body was called for, as was a new European Committee on Ethics. 'The genetic impact' was a major preoccupation of the symposium.

Advisory Committees↗
PubMed1991

Literature and medicine.

There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.

Attitude to Health↗