The Virtue of Medical Ethics Education
The teaching of medical ethics in UK Medical Schools has come a long way over the last 40 years, though there remains wide variation in the quantity and content of material delivered across medical schools. Attempts to improve and standardize medical ethics teaching has come from the Institute of Medical Ethics in the form of a Consensus Statement, which details a core content of learning consistent with GMC guidance on undergraduate education. All graduating medical students must be aware of and understand the main ethical and legal issues they will face in clinical practice. However, as recent events at the Mid Staffordshire NHS Trust and Vale of Leven Hospital illustrate, medical ethics education still has a long way to go and medical educators must strive to understand what underpins moral decision making in reality. A recent appointment to develop medical ethics education locally has led me to question what an effective medical ethics education should deliver to our students. This requires rethinking what “medical ethics” means to students and, in doing so, move away from the notion of ethics as a separate discipline characterized by “dilemmas”. Whilst such cases are useful for illuminating the role of ethical theories or principles, good ethics teaching must deal with everyday ethics and all the factors that affect decision-making in reality. To do so we must find a role for a
virtue-based ethics theory and the space for moral learning.
2. Stirrat GM, Johnston C, Gillon R, Boyd K. Teaching and learning ethics: medical ethics and law for doctors of tomorrow: the 1998 Consensus Statement updated. J Med Ethics. 2010:36(1):55-60. DOI: 10.1136/jme.2009.034660.
3. General Medical Council. Medical Students: Professional Values and Fitness to Practice. London, UK: General Medical Council; 2009.
4. General Medical Council. Tomorrow's Doctors: Outcomes and Standards for Undergraduate Medical Education. London, UK: General Medical Council; 2009.
5. Johnston C, Haughton P. Medical students’ perception of their ethics teaching. J Med Ethics. 2007;33:418-2. DOI: 10.1136/jme.2006.018010.
6. Canham R, Kelly S, Lang C, Sherman S. Ethics Teaching at the University of Edinburgh. Wordpress site produced for Medical Student Special Study Module. March 2015. http://studentblogs.med.ed.ac.uk/2015-ssc2b-a1/ (accessed 10 July 2015).
7. Gillon R. Four scenarios. J Med Ethics. 2003;29(5):267-8. DOI: 10.1136/jme.29.5.267.
8. Campbell AV. The virtues (and vices) of the four principles. J Med Ethics. 2003;29(5):292-6. DOI: 10.1136/jme.29.5.292.
9. Bowman D. What is it to do good medical ethics? Minding the gap(s). J Med Ethics. 2015;41(1):60-3. DOI: 10.1136/medethics-2014-102299.
10. Leget C, Olthuis G. Compassion as a basis for ethics in medical education. J Med Ethics. 2007;33(10):617-20. DOI:10.1136/jme.2006.017772.
11. Sokol DK. Doing Clinical Ethics. A Hands-on Guide for Clinicians and Others. London, UK: Springer; 2012.
12. Farsides B. What is good medical ethics? A very personal response to a difficult question. J Med Ethics. 2015;41(1):52-5. DOI: 10.1136/medethics-2014-102298.
13. Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861-71.
14. de Zulueta PC. Suffering, compassion and ‘doing good medical ethics’. J Med Ethics. 2015;41(1):87-90. DOI: 10.1136/medethics-2014-102355.
15. Pellegrino ED. Teaching medical ethics: some persistent questions and some responses. Acad Med. 1989;64(12):701-3.
16. Beauchamp T, Childress J. Principles of Biomedical Ethics. 1st edition. Oxford, UK: Oxford University Press; 1979.
17. Gillon R. Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. J Med Ethics. 2015;41(1):111-16. DOI: 10.1136/medethics-2014-102282.
18. Beauchamp T. Methods and principles in biomedical ethics. J Med Ethics. 2003;29(5):269-74. DOI: 10.1136/jme.29.5.269.
19. Kong, WM. What is good medical ethics? A clinician’s perspective. J Med Ethics. 2015;41(1):79-82. DOI: 10.1136/medethics-2014-102302.
20. Solbakk JH. What is it to do good medical ethics? On the concepts of ‘good’ and ‘goodness’ in medical ethics. J Med Ethics. 2015;41(1):12-6. DOI: 10.1136/medethics-2014-102310.
21. Hicks LK, Lin Y, Robertson DW, Robinson DL, Woodrow SI. Understanding the clinical dilemmas that shape medical students’ ethical development: questionnaire survey and focus group study. BMJ. 2001;322(7288):709-13. DOI: 10.1136/bmj.322.7288.709.
22. Page K. The four principles: can they be measured and do they predict ethical decision making? BMC Med Ethics. 2012;13:10-5. DOI: 10.1186/1472-6939-13-10.
23. Parker L, Watts L Scicluna H. Clinical ethics ward rounds: building on the core curriculum. J Med Ethics. 2012;38:501-5. DOI: 10.1136/medethics-2011-100468.
24. Kleinman A. The art of medicine. Caregiving as a moral experience. Lancet. 2012;380(9853):1550-1. DOI: 10.1016/S0140-6736(12)61870-4.
25. Gardiner P. A virtue ethics approach to moral dilemmas in medicine. J Med Ethics. 2003;29(5):297-302. DOI: 10.1136/jme.29.5.297.
26. Hope T, Savulescu J, Hendrick J. Medical Ethics and Law. The Core Curriculum. 2nd edition. Oxford, UK: Churchill Livingstone; 2008.
27. General Medical Council. Good Medical Practice. London, UK: General Medical Council; 2013.
28. Hursthouse R. On Virtue Ethics. Oxford, UK: Oxford University Press; 2001.
29. Pellegrino ED, Thomasma DC. A Philosophical Basis of Medical Practice, A Philosophical Reconstruction of Medical Morality. Oxford, UK: Oxford University Press; 1981.
30. Smith R. All doctors are problem doctors. BMJ. 1997;314(7084):841-2. DOI: 10.1136/bmj.314.7084.841.
31. Glover J. Humanity – A Moral History of the Twentieth Century. New Haven, CT, USA: Yale University Press, 2000.
32. Coulehan J. Today’s professionalism: engaging the mind but not the heart. Acad Med. 2005;80(10):892-8.
33. Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London, UK: The Stationery Office; 2013.
34. Bloch S. Medical students and clinical ethics. Med J of Australia. 2003;178:166-9.
This is an Open Access journal. All material is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) licence, unless otherwise stated.
Please read our Open Access, Copyright and Permissions policies for more information.