Importantly, the sense in which this AMEE Guide discusses ‘ethics’ is not interchangeable with any of the domains in Box 8. The last two in the list are significant as they introduce the added dimension of accountability towards an external authority, such as licensing or monitory boards for standards in research, or regulatory bodies governing professional practice in healthcare. Different professions have, in key respects, their own distinctive ethics, and this takes us finally to the notion of professional ethics in medicine. While there will be continuities with biomedical ethics and with healthcare ethics of other professions, the focus of professional ethics in medicine is clinical medical ethics relating to the care and treatment of patients, including the frameworks of legal jurisdiction and regulatory governance.


Professional ethics in medicine, then, is not a normative theoretical or ‘applied’ ethical discourse, as its starting point is engagement in a practice. However, there is a saying that while, in theory, there is no separation between theory and practice, in practice there is! Consequently, it is fundamental to the perspective of this AMEE Guide that the ethico-legal learning of our students comprises performance and affect as well as cognition. This is an understanding of ethics as practical reason, or phronesis (Dowie, 2000). In the Eudemian Ethics, Aristotle indicates the practical quality of reasoning in phronesis (Woods, 1992):


“What we wish is to be courageous, not to know what courage is; to be just, not to know what justice is; in the same way as (we wish) to be healthy rather than to know what being healthy is, and to be in a good state, rather than to know what it is to be in a good state”.


The primary goal of our curriculum in ethics and law is not for students to know in the abstract what ethical practice is, but to be ethical in their practice. Derived from ‘ethos’ as ‘character’, the idea of ethics entails the habits or characteristic practice of a person. Referring to the Nicomachean Ethics, Downie (2006) explains that, “the point of ethics is not knowing but doing”.


At the same time as being oriented towards practice, the ‘reason’ in practical reason shares an equal weight, and there will be choices to make in the curriculum on the way learning in ethical theory is brought to reasoning in terms of awareness and analysis. For example, what level of theoretical detail is appropriate? Also, through which lens is it to be refracted: philosophical (a critical emphasis), clinical (a specialty emphasis), professional (a regulatory emphasis), or a combination of these? Recalling the three broad approaches to ethics curricula mapped out in Box 5 (theoretical, pragmatic, and embedded), the strategy chosen will have a major bearing on students’ learning of ethical theory.


Keeping ethics and law together


Another early choice in your course planning is likely to be on how medical law is engaged in the curriculum. In an already overcrowded programme, you may be asking, ‘Why place an even greater load on the limited time available with the addition of medical law?’


The cognate relationship of law and ethics is one part of the rationale. Justice as a value is a cornerstone of ethics, and law as a system oversees the codification and administration of standards of justice.


12 Guide 53: Ethics and Law in the Medical Curriculum


‘Why place an even greater load on the limited time available with the addition of medical law?’


The primary goal of our curriculum in ethics and law is not for students to know in the abstract what ethical practice is, but to be ethical in their practice.


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