Teaching ethics to medical students.

While few would deny that some attention must be given to ethical issues as part of a medical student's education it has never been clear how this might be best achieved. And at the present time those who are battling with this problem have a further dilemma. On the one hand, the numbers of ethical issues that face the medical profession are increasing at a frightening rate, ranging as they do from genetic engineering to the provision of increasingly expensive resources in the marketplace economy of the National Health Service. On the other, medical schools are being encouraged by the General Medical Council (GMC) to decongest the curriculum and to try to reduce rather than increase the amount of taught material. How are we best to prepare young people for battling with problems ranging from QALYs (Quality Adjusted Life Years), and DALYs (Disability Adjusted Life Years), through the complexities of child abuse, to the rights and wrongs of altering the genetic make-up of future generations? Whatever we do it is extremely important that medical ethics is not taught as a dry, academic subject that is perceived to be remote from day-today practice. It is a topic for which the lecture theatre (and examination hall) has a very limited role. Somewhere early in the medical course, probably in the pre-clinical years, it may be useful to give students some inkling of the background to the way in which a framework for analysing ethical problems can be established. At least they should have a nodding acquaintance with the concepts of duty-and right-based approaches, the principle of utilitarianism and some related basic concepts. But beyond this the only way to make ethics into a 'living' subject is to teach it as a 'real life', case-based discipline. If the important ethical issues of our times are best aired and taught in the context of individual cases and specialties, how can such an interactive programme be organised? Ideally such discussions should stem directly from the problems of patients or from clinical situations that have been encountered by students along the way during their clinical training. Questions of confidentiality, maintenance of patients on life-support machines, the use of scarce resources, and other difficult issues of this kind, are much better taught in small groups within individual clinical departments or practices and based on actual cases. This approach can be augmented by the organisation of seminars at …