Abstract
The development of medical ethics in the UK has been closely tied to its development as an aspect of medical education. Whilst the development of bioethics in America was marked by the activities of medical outsiders and a concern with broader bioethical questions in the UK it has been marked by ‘insiders’ or, more accurately, by ‘insider–outsiders’ and by a predominant concern for the professional issues of medical ethics. Some of this can be seen in the work of Maurice Pappworth, an early medical ethical whistleblower often considered the UK’s Henry Beecher. As well as raising concerns about unethical practices in biomedical research Pappworth also raised concerns about certain pedagogic practices, notably the internal examination of sedated women without obtaining their consent. However the link between medical ethics and medical education is most clear in the advent of the London Medical Group (LMG), the export of this model to other medical schools in Great Britain and its role in the creation of the Institution of Medical Ethics (IME).
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Notes
- 1.
The relevant passages of the Mepham Report were cited in the Annual report of the LMG 1965 and 1967/8. See: Reynolds and Tansey (2007, pp. 7–8 and 76–77).
- 2.
Shotter indicates that the primary reason the other medical groups were convened by clerical, rather than medical, professionals was the pragmatic fact that his ‘bush telegraph’ was comprised of fellow ministers involved in pastoral care of (medical) students (Reynolds and Tansey 2007, p. 10).
- 3.
Shotter suggests that the discussions of the LMG were open to the public and whilst this may have been the case the fact was that they were advertised on the notice boards of the London hospitals meant that, in effect, discussions remained in camera.
- 4.
It is interesting to note that Wilson suggests this period of the 1980s should not be mythologically construed as the historical origin of UK bio- and medical ethics but, rather, its high-water mark, presumably in terms of impact on government policy and the structural aspects of the medical profession and, we might add, medical ethics education (2011a).
- 5.
Dr Gillon took over from the founding editor, Dr Alastair V. Campbell who published the first UK book on medical ethics in 1972. Campbell and Gillon were jointly awarded the Henry Knowles Beecher prize for contributions to ethics and the life sciences by the Hastings Centre. See: http://www.thehastingscenter.org/About/Default.aspx?id=2972 [Accessed June 2011].
- 6.
Tomorrow’s Doctors is a document first published by the GMC in 1993 and revised in 2003 and 2009. It sets the agenda for undergraduate medical education in the UK and has proved to be an extremely influential document. It is discussed further below.
- 7.
The early professional biography of Maurice Pappworth stands as a testament to the anti-Semitism of British society of the time (Booth 1994). The anti-Catholic nature of a certain strata of English society is well established.
- 8.
This concern for ongoing learning is evident in Flexner’s early twentieth century survey of medical schools (Calman 2007, p. 230).
- 9.
Leinster (2011) offers a useful survey of the contemporary influences on Tomorrow’s Doctors.
- 10.
For brief biographical details, and others who were involved in the development of UK medical ethics, see Reynolds and Tansey (2007, pp. 169–192).
- 11.
The SSME was originally set up as a postgraduate study group by ‘alumni’ of the LMG as it initially proceeded by attempting to circumvent the hierarchical structure of medicine to its own advantage. Fully established medical professional (predominately consultants) and undergraduate students were deliberately brought together as it was felt that, as with all initiates, medical students were accorded a certain freedom to question established medical practices and professionals in a manner that was not open to junior doctors (Whong-Barr 2003, pp. 76–77).
- 12.
See, for example how Hafferty and Franks (Hafferty and Franks 1994) contend that formal ethics education was imagined to be something of a ‘magic bullet’ capable of immunising medical students against their exposure to the more negative aspects of medical practice.
- 13.
Since writing this chapter Reubi (2013) has produced a complimentary perspective which considers the activities of many of those discussed here in terms of a bioethical 'thought-collective.
- 14.
This is not to say that undergraduate medicine should not address what I have called ‘medical politics’ (Emmerich 2011b). But I would say that this is not the same a simply reintroducing ethico-political questions to the medical ethics classroom and I would also argue that whilst it is important for the medical profession to engage with political and ethico-political discourses this does not require all medical professionals to be educated to do so. Rather it demands a certain structure to the profession and its institutions to facilitate such engagement and there being opportunity for specialist training, in the form of intercalation and masters level degrees, and, further, giving those with humanities degrees access to the graduate entry medical degree.
- 15.
It is worth noting that SSCs in medical ethics are pre-dated by intercalation degrees as well as postgraduate certificates/Master level courses in ethics aimed at healthcare professionals. These higher-level qualifications continue to be an important aspect of the field of medical ethics and medical ethics education but are beyond the scope of my discussion.
- 16.
Mainstream analytic bioethics is, of course, predominantly concerned with patients and diseases. One has to turn to phenomenological, feminist and narrative bioethics to rediscover a concern for individuals and their illnesses.
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Emmerich, N. (2013). Medical Ethics as an Aspect of Medical Education: A UK Perspective. In: Medical Ethics Education: An Interdisciplinary and Social Theoretical Perspective. SpringerBriefs in Ethics. Springer, Heidelberg. https://doi.org/10.1007/978-3-319-00485-3_3
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