Prideaux (2003) emphasises that it is especially important in medical education that learning outcomes transcend “a narrow range of student skills and knowledge that can be readily expressed in behavioural terms” so as to include “higher order thinking, problem solving, and processes for acquiring values”. Before we can do so, this means first clarifying our position on questions of, ‘What do we mean by ‘ethics’?’ and, ‘How do ethics and law fit together?’
The nature of ethics as practical reason When we use the word ‘ethics’, what do we have in mind, and is it the same as what our colleagues and students have in mind? We often intend very different things by this single word with many shades of meaning! Box 8 offers a summary of various types of ‘ethics’.
BOX 8
Different domains called ‘ethics’ Metaethics
Normative ethics Morals
‘Applied’ ethics ‘Practical’ ethics Bioethics
Biomedical ethics Research ethics Healthcare ethics
Critical philosophical ethics
Analysis of theoretical relevances in ethical situations Personal, cultural, or faith-based behavioural codes Determinative reasoning correlated with normative ethics Similar to ‘applied’ ethics
Normative and ‘applied’ ethics in biological and life sciences Similar to bioethics, with a focus in scientific medicine ‘Applied’ ethics and governance in research
‘Applied’ ethics and governance in health professions
When we use the word ‘ethics’, what do we have in mind, and is it the same as what our colleagues and students have in mind?
Sometimes ‘ethics’ is synonymous with metaethics, critical thinking relating to ethical concepts and theories in the abstract (Darwall, 2003). An example of a metaethical question might be, ‘What is the place of altruism in patient care?’ Alternatively, sometimes ‘ethics’ means normative ethics, which is analysis of theoretical dimensions appropriate to ethical situations (Darwall, 2003), and is closer than metaethics is to the world of policy and protocols. An example of a question in normative ethics might be, ‘What are the obligations, imperatives, duties, values, and guiding models of ordinate action that are relevant to establishing criteria for decisions on cardio- pulmonary resuscitation?’ In conjunction with normative ethics, ‘applied’ or ‘practical’ ethics brings a determinative mode of reasoning to these ethical situations (Darwall, 2003). An example of a question in ‘applied’ or ‘practical’ ethics might be, ‘Should couples receiving fertility treatment have the option of choosing the sex of their child?’.
For many, there is a moral context to medicine that correlates personal ethical standards with an accepted world-view. In order to distinguish between morals and ethics, the term ‘ethical’ is used throughout these pages and has a broader spectrum in which our own personal ethical commitments may be one of a number of discourses, particularly the legal and professional (see Box 10 in the next chapter).
For many, there is a moral context to medicine that correlates personal ethical standards with an accepted world-view.
Guide 53: Ethics and Law in the Medical Curriculum
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