Call for urgent review of UK ethics training

December 5, 2003

An urgent review of the ethical training received by British medical students is needed to identify those schools that are failing to take the subject seriously.

The British Medical Association has called on the government to fund a nationwide study to establish how ethics and law are taught in different institutions.

The BMA, which launched a new edition of its handbook on ethics and law on Tuesday, believes good ethics training is vital to enable doctors to properly care for their patients and deal with the increasingly complex ethical and legal dilemmas that they will encounter in their work.

These range from an understanding of the rights of unmarried fathers to the withdrawal of life-prolonging treatment from very sick patients.

While medical ethics is an accepted element of all undergraduate courses, experts suspect that the quality and quantity of teaching varies considerably.

This was confirmed in a survey carried out in 1987. But despite changes in the law and a decline in public trust since then, no further review has followed.

Raanan Gillon, deputy chairman of the BMA medical ethics committee, said:

"We know that some medical schools have excellent programmes but others seem to be lagging far behind. This puts doctors and patients at risk of bad decision-making and legal action."

Comparing the different ways in which ethics are taught in medical schools will enable the best approaches to be applied elsewhere. "Just as medicine should be evidence-based, so should our education programmes be based on what actually works," Professor Gillon said.

Michael Wilks, chairman of the BMA medical ethics committee, said there was a need to restore public confidence in doctors after the scandals at Alder Hey Hospital and at the Bristol Royal Infirmary, where the bodies of thousands of children were kept without consent.

"Modern doctors are increasingly expected to have analytical skills and an understanding of the law, but we know from the calls we receive that they often feel unprepared for such roles," he said.

At Bristol University Medical School, Alastair Campbell, professor of ethics in medicine, is head of a six-strong Centre for Ethics and Medicine that teaches and engages in research.

He ensures that there is a strong element of ethics in each of the five years of medical tuition, which starts as the undergraduates prepare to dissect their first cadavers, when issues such as respect and consent are discussed.

Students are also offered the opportunity to earn a BSc in medical ethics if they dedicate an extra year to its study.

"Among the undergraduates there is more worry than there used to be about litigation, while they are very interested in new developments such as the implications of genetics for privacy," Professor Campbell said.

"We are fortunate at Bristol but there are other places where ethics is rather low down the agenda, where it is not sufficiently integrated into the curriculum and where it isn't examined," he added.

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