personally to contribute teaching sessions based on ethico-legal cases specific to the blocks in question, depending on the constraints of your own time and the offer of space in the block programme. Linked to these constraints is the question of whether sessions are in the form of lectures or small groups, which involves a trade-off between efficient consumption of your resource and educational effectiveness. Distributing to theme leaders an accessible summary of key learning in ethics and law is useful, but it would be optimistic to suppose an attractively produced document is in itself likely to make a significant impact on the learning experiences of the students!
Another possibility is to develop a set of core ethico-legal patient case presentations to be incorporated formally into the medical school curriculum. According to the course outcomes you have specified (see Chapter 2) and the core topics you have selected (Chapter 3), it will be possible, ideally with the input of colleagues across the specialties, to construct a series of clinical cases around these. The work-up for each of the presentations can include details not only of essential knowledge but also of relevant ethico-legal analysis. How many of these cases would be adequate? To generate too many is likely to be unhelpful for the other theme leaders, so a cross-section rather than building up blanket coverage might be preferable, and perhaps the order of around twenty cases may be pragmatic.
Miles et al. (1989) warn against over-stylised hypothetical cases, or stripping the nuances from real cases, or selecting bizarre cases with “less relevance to daily work”. Instead, routine cases from ordinary clinical situations may be selected to illuminate different facets of capacity, consent, confidentiality, disclosure, duty of care, and so on, and organised around the four principles of respect for autonomy, justice, beneficence, and non-maleficence (see Beauchamp & Childress (2009) for a discussion of ten case presentations). From the dynamic sources of medical ethics depicted in Box 10, the cases might interact with key statutes relating to areas such as incapacity, mental health, parental responsibility, child protection, discrimination, and information; or other possible foci could be guidelines issued by the medical council, colleges, and learned societies. Another benefit from incorporating core cases as a formal part of the medical school curriculum is the opportunity to provide tutor development based on the ethico-legal work-up. Moreover, the core cases help maintain the explicit profile of law and ethics with colleagues and students.
Person
For patients, the healthcare they receive is profoundly personal. For our students, to be able to relate to the personal experience of patients requires something of an analogical imagination. Scott (1997) cites modern writers who engage with the earlier philosophical classics relating to ethical imagination, and comments that “one cannot sympathise or empathise with a patient if one cannot imaginatively enter into the world of the particular patient with whom one is in contact”.
Arts and humanities in medical education are powerful resources for engaging ethico-legal imagination, aesthetically and critically, through literary and visual forms typically involving narrative (the cinematic included),
Routine cases from ordinary clinical situations may be selected to illuminate different facets of capacity, consent, confidentiality, disclosure, duty of care, and so on, and organised around the four principles of respect for autonomy, justice, beneficence, and non-maleficence.
One cannot sympathise or empathise with a patient if one cannot imaginatively enter into the world of the particular patient with whom one is in contact.
Guide 53: Ethics and Law in the Medical Curriculum
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