Medical ethics education.

There has never been much doubt that medical ethics in Dunstan's sense of 'the obligations of a moral nature which govern the practice of medicine' (1) has been an important part of medical education for at least two and a half thousand years. But in a second sense of medical ethics-philosophical or critical medical ethics (2)-the subject is very much a newcomer to medical curricula, with the pacesetters having been mostly in the USA over the last twenty years or so. During that period this new-fangled philosophical or critical study of medical ethics has been viewed with considerable suspicion by the medical profession, more so in Europe than America. Increasingly, however, its importance has been recognised, albeit sometimes reluctantly, and now in Britain the barriers are being cautiously dismantled. In 1984 the General Medical Council held a conference on medical ethics teaching (without however distinguishing explicitly between the two types of teaching) (3). In 1986 the British Medical Association (BMA) called for all medical schools to provide identifiable, substantial and 'non-dogmatic' teaching in the medical curriculum 'devoted to the ethical and legal aspects of medical practice', with the context making it fairly clear that the BMA meant critical medical ethics (4). Earlier this year an Institute of Medical Ethics Working Party Report-the Pond Report-recommended the active development of medical ethics teaching in Great Britain, stating that the longstanding medical norm of teaching and promoting professional standards should be supplemented by medical ethics teaching in the second sense of 'rational argument about ethical questions' and 'the study of ethical or moral problems' arising in the practice of medicine (5). The Pond Report was based on the deliberations of a multidisciplinary working party of 19 members of whom 10 were doctors (including two medical school deans, a past President of the Royal College of Physicians and the erstwhile Chief Scientist to the Department of Health and Social Security), two nurses, four clerics, one a lawyer, one a philosopher and one the deputy health service commissioner. The group deliberately did not propose a model curriculum, arguing that local conditions and curricula varied greatly and that experiment and innovation were needed, with reassessment of developments after a further five years. However, the report recommended among other things that throughout medical training 'time should be set aside within existing teaching for ethical reflection'; that such teaching should normally begin from clinical examples, and should be …