Raanan Gillon

Philosophical medical ethics

immature physically, emotionally, and intellectually and quite incapable of the firm bonding that an enduring marriage requires. So encouraging teenagers in early sexual activity is very liable to mean for a lot of them misery and broken marriages and unhappy offspring, not to say blighted career prospects. If you divorce sex completely from marriage and procreation and caring you will avoid some of those drawbacks-and substitute others for them. For example, Dr Ashton and apparently the American report on which his article is based are notably silent on the relation between teenage sex on the one hand and sexually transmitted diseases and a later high incidence of cervical cancer in young women on the other. He presumably stays silent on these topics because they do not suit his case.

Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism.

Medical ethics and law for doctors of tomorrow: the 1998 Consensus Statement updated

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council (GMC) requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved.

Medical ethics and law as a core subject in medical education: A core curriculum offers flexibility in how it is taught—but not that it is taught

In Tomorrows Doctors Britains General Medical Council initiated a radical and needed reform of medical education. One of the less noticed, yet revolutionary, aspects of this reform is that medical ethics and law have become a core component of the curriculum. Thus all medical students, states the council, must acquire knowledge and understanding of ethical and legal issues relevant to the practice of medicine and be able “to understand and analyse ethical problems so as to enable patients, their families, society, and the doctor to have proper regard to such problems in reaching decisions.”1 Seeking to pool their expertise, most of the academics currently teaching medical ethics and law in UK medical schools—mostly cliniciansphilosophers, lawyers, and theologians—hammered out a consensus statement about what should constitute the core academic content necessary to produce “doctors who will engage in good ethically and legally informed practice.” They also agreed some minimal organisational requirements for the subject to be taught successfully. The consensus statement sees the teaching of medical ethics and law as contributing to the overall objective of medical education—“the creation of good doctors who will enhance and promote the health and medical welfare of the people they serve in ways which fairly and …

The principle of double effect and medical ethics.

In one of a series of articles on philosophical medical ethics, Gillon examines the Roman Catholic doctrine of double effect as it applies to discussions of the moral difference between acts and omissions in patient care. The doctrine holds that, in the context of actions that have both good and bad effects, an action that has a bad effect is morally permissible if (a) the action itself is good, (b) its perpetrators intention is solely to produce the good effect, (c) the good effect is not achieved through the bad, and (d) there is sufficient reason to permit the bad effect. Gillon concludes that, while the doctrine of double effect is unlikely to be accepted fully by non-absolutists, some of its claims are useful in deciding which clinical interventions are morally justified.

Justice and allocation of medical resources.

In one of a series of short articles on philosophical medical ethics, Gillon examines the principle of justice as it applies to adjudicating competing claims for the distribution of scarce medical resources. He describes Aristotles theory of justice--with its demands of formal equity, impartiality, and fairness--and then considers various substantive criteria that have been proposed to justify choosing among competing candidates for scarce resources. In the absence of an acceptable way to give consistent moral priority to any of the criteria, he concludes, practical systems should be set up to resolve conflicts by taking into account the fundamental moral values of respect for autonomy, beneficence, and nonmaleficence while incorporating Aristotles formal principle of justice.

Consequences for research if use of anonymised patient data breaches confidentiality

EDITOR—During this century well conducted clinical and epidemiological research has formed the basis of remarkable advances in medical knowledge. The benefits provided to countless patients by these advances have greatly outweighed the possible risks entailed in clinical studies. The success of these endeavours has been well safeguarded by established laws, directives, regulations, and guidelines. Research using patient records has provided important information on factors predisposing to disease and successful outcomes. A recent legal case—Source Informatics (now owned by IMS Health) v Department of Health, 28 May 1999—now threatens much healthcare research by suggesting that the use of patient data that have been subjected to procedures ensuring the anonymity of …

Sanctity of life law has gone too far

Recent court ruling distorts healthcare provision and values and should be challenged

Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics

This paper argues that the four prima facie principles—beneficence, non-maleficence, respect for autonomy and justice—afford a good and widely acceptable basis for ‘doing good medical ethics’. It confronts objections that the approach is simplistic, incompatible with a virtue-based approach to medicine, that it requires respect for autonomy always to have priority when the principles clash at the expense of clinical obligations to benefit patients and global justice. It agrees that the approach does not provide universalisable methods either for resolving such moral dilemmas arising from conflict between the principles or their derivatives, or universalisable methods for resolving disagreements about the scope of these principles—long acknowledged lacunae but arguably to be found, in practice, with all other approaches to medical ethics. The value of the approach, when properly understood, is to provide a universalisable though prima facie set of moral commitments which all doctors can accept, a basic moral language and a basic moral analytic framework. These can underpin an intercultural ‘moral mission statement’ for the goals and practice of medicine.

Justice and medical ethics.

Justice, in the sense of fair adjudication between conflicting claims, is held to be relevant to a wide range of issues in medical ethics. Several differing concepts of justice are briefly described, including Aristotles formal principle of justice, libertarian theories, utilitarian theories, Marxist theories, the theory of John Rawls, and the view--held, for example, by W.D. Ross--that justice is essentially a matter of reward for individual merit.