BMA calls for urgent review of ethics teaching to improve patient care
Press release 2 December 2003
In the aftermath of recent national medical scandals the BMA is calling on the Government to fund an urgent review of ethics training.
The call for a review coincides with the launch of the publication “Medical Ethics Today – the BMA’s handbook of ethics and law”.
The BMA believes doctors need better ethics training to provide good patient care and help them deal with the increasingly complex ethical and legal dilemmas they have to face everyday. These range from common questions about the rights of unmarried fathers to make decisions about their children’s medical care to complex issues about when life-prolonging treatment can be withdrawn from very sick patients.
Dr Michael Wilks, Chairman of the BMA Medical Ethics Committee, said today: “There is no doubt that the public’s confidence in doctors took a severe knocking after the Alder Hey and Bristol Royal Infirmary hospital scandals and we need to restore this.
“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. The BMA receives thousands of enquiries every year from doctors needing assistance with ethical issues. In just one week at the end of November our online ethical guidance was accessed by more than 1,400 visitors.”
Although medical ethics is now an accepted part of undergraduate courses, experts strongly suspect that the quality and quantity of teaching varies considerably. This certainly was the finding of the first comprehensive review of UK ethics teaching*, published by the Institute of Medical Ethics in 1987.
The 1987 review strongly recommended that another evaluation should take place within five years but that has never happened. Since 1987 not only have there been key changes in case and statute law (the Tony Bland case**; Data Protection Act 1998; Human Rights Act 1998) but major scandals have shaken public confidence in the medical profession.
The BMA would like a new and thorough review to establish how effectively medical ethics and basic law are being taught and identify how the system can be improved.
Professor 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. Since there has been virtually no comparative evaluation of the different teaching models used across the UK, we still do not know what works best. Just as medicine should be evidence-based, so should our education programmes be based on what actually works.”
“Medical Ethics Today” is a comprehensive collection of doctors’ ethical questions to the BMA and is a good indication of the range of topics doctors currently feel uncertain about. It is aimed at medical students as well as practising doctors.
The new edition not only covers perennial ethical questions such as whether terminally ill patients can demand help to end their lives (or ask for an overseas referral for legal euthanasia), but also addresses relatively new areas of ethical debate such as ethics and public health medicine (do target payments for immunisation influence a doctor’s impartiality?), healthcare dilemmas in custodial settings and wider medical policy issues such as whether sperm donors should be guaranteed anonymity.
Dr Vivienne Nathanson, the BMA’s Head of Science and Ethics, commented: “The size of this book and the subjects covered demonstrate the expansion of medical ethics. Medical technologies are growing at such fast speed and what was once thought impossible is becoming reality.”
She added: “Doctors can be involved with decisions concerning withdrawing and withholding treatment, approaching bereaved families about organ donation and assisted reproduction. We only need think of media headlines in the last couples of years, ‘Dianne Pretty’, ‘Ms B’, ‘the Hashmi and Whitaker babies’ to realise how medical ethics play an integral part in being a doctor. Indeed there has never been such an important role for medical ethics to help guide doctors in their everyday decisions.”
Ends
Notes to editors:
* The Pond Report on the Teaching of Medical Ethics, published in 1987 by the Institute of Medical Ethics.
** Tony Bland was in a persistent vegetative state following the Hillsborough Football Stadium disaster. In 1992 the court held that artificial nutrition and hydration was a form of medical treatment which could be withdrawn because providing it was not in Tony Bland’s best interests. This case, for the first time, clarified a doctor’s legal right to withhold and withdraw treatment from a patient.
Chapter 18 of ‘Medical Ethics Today’ covers issues surrounding education and training.