Case studies and medical education.

In this issue of the journal Christopher Coope presents three sorts of worries about the use of case studies in medical ethics teaching. The first is that heavy reliance on case studies 'tends to exaggerate the degree to which morality is controversial'; the second is that 'it is often quite unclear what problems count as moral problems'; the third is that there are 'limits as to what we may regard as open to discussion'-both because some questions 'do not arise' (a similar point was more briefly made by Minerva of the British Medical Journal (1)); and because some questions 'ought not to arise'. Each of these worries deserves careful reflection, especially by those of us who are heavy users of case studies in teaching medical ethics to health care students and professionals. Use of controversial cases undoubtedly needs to be supplemented by analysis of uncontroversial cases, and the use of cases needs to be supplemented by some degree of theoretical analysis-a sort of to and fro process between cases and theory that seeks 'reflective equilibrium' or 'coherence' (2). And undoubtedly too there is a substantive philosophical issue about 'what problems count as moral problems', though it is unclear why this is supposed to be a particular problem in relation to teaching by case studies as distinct from any other sort of ethics teaching. Suffice it to assert that for everyday ethics teaching a straightforward response is provided by Professor Raphael's account of ethics as 'philosophical inquiry about norms or values, about ideas of right and wrong, good and bad, what should and what should not be done' (with philosophical inquiry being 'the critical evaluation of assumptions and argument', including the clarification of relevant concepts) (3). Students and practitioners who argue that these accounts are inadequate should be encouraged to pursue further philosophical studies! The third of Mr Coope's worries is that some sorts of cases should not be discussed, either because the moral problem depicted simply does not arise or because the moral problem depicted ought not to arise. Medical students and doctors tend to agree entirely that there is no point in discussing issues that do not in practice arise. But while it is therefore wise not to overdo discussion of such cases it would also be foolish to rule them out altogether, for two reasons. First it is clearly worth anticipating cases that might arise, so that we …