What is the core content, then, of everyday ethics in medicine? The spectrum of what this might contain is listed in Box 12. Other articulations of content are included in the discussion by Miles et al. (1989) and in the comprehensive summary by Goldie (2000). The World Medical Association medical ethics manual organises its topics under the headings of principal features of medical ethics, physicians and patients, physicians and society, physicians and colleagues, and medical research.
BOX 12 UK revised consensus on core learning for medical ethics and law
Key areas (a) Foundations of medical ethics and law (b) Professionalism: good medical practice (c) Patients: their values, narratives, rights and responsibilities (d) Informed decision-making and valid consent/refusal (e) Capacity and incapacity (f) Confidentiality (g) Justice and public health (h) Children and young people (i) Mental health (j) Beginning of life (k) Towards the end of life (l) Medical research and audit
Theory-based
In the core curriculum, a theoretical strand can probably attempt not much more than a relatively superficial glance at models of law or philosophical theories (Lawlor, 2007), and students who are keen to study these in greater depth may do this in optional components of the course. In clinical practice, ethico-legal decisions are theory-based in the sense of being informed by the principles and obligations deriving from ethics and law symmetrically (Box 9). Student learning in ethico-legal reasoning, particularly when presented with unfamiliar situations, involves the coupling of awareness education and analysis education (Box 3). Sources relevant to theory-based approaches in this sense include the UNESCO bioethics core curriculum (Box 13), indexed to Articles of the UNESCO Universal Declaration on Bioethics and Human Rights (2005), and in healthcare contexts the quintessential distillation by Beauchamp & Childress (2009) in the four principles of respect for autonomy, justice, beneficence, and non-maleficence.
In the process of weighing these principles, however, there are necessary limits to their scope within the constraints of clinical practice (Gillon, 1994). As concepts they are also not adopted uniformly across the world. Among European countries, for example, variation surrounding the idea of autonomy makes a significant difference to how the ethics of patient consent is approached (Parker & Dickenson, 2001). Häyry (2003) discusses Continental European perspectives of precaution, solidarity, and dignity in health care ethics, and proposes these might be conceptualised more adequately in terms of prudence, communality, and a deep sense of values.
(Adapted from Stirrat et al. 2010)
Guide 53: Ethics and Law in the Medical Curriculum
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