Improving awareness of ethical issues.

Medical ethics embraces two broad issues. 1 First, the level of professional competence to deliver the best possible medical care. Second, ethical and moral concerns that are raised in the course of the investigation and management of medical disorders. Recent decades have seen an increase in the time given to instruction in medical ethics in the standard medical curriculum. In 1950 the General Medical Council (GMC) recommended that medical ethics be taught to all medical students.2 In 1986 the British Medical Association called for all medical schools to provide curriculum teaching time for ethical and legal aspects of medical practice.3 In 1987 the Pond report gave detailed information on the current state of medical ethics teaching in British medical schools and made recommendations how this instruction might best be given1; not as a subject with a set syllabus added to an already overburdened curriculum but by integration with all aspects of medical practice. In particular, local initiatives were to be encouraged-built on existing arrangements in individual medical schools. In this paper we describe an education programme to help clinical students develop an awareness of common ethical issues and an appreciation of the frequency of ethical dilemmas in day-today paediatric practice. Teaching methods Students in the University of Wales College of Medicine in Cardiff currently study paediatrics and child health in eight week rotating block attachments, each containing about 30 students, in the second and third clinical years; this teaching takes place in the main teaching hospitals in Cardiff and in district general hospitals throughout Wales. There is no formal course on medical ethics in Cardiff but some lectures are given towards the end of the final year on medicolegal aspects of care. At the beginning of the paediatric attachment an introductory one hour lecture is given by the senior hospital chaplain (RL-R) who has specialist knowledge and experience in medical and health ethics. The aim is to introduce a number of key issues in ethical decision making in paediatrics and to give students a framework around which ethical matters may be considered. The following aspects are emphasised: (1) MORAL VALUES AND MORAL REASONING Many students come to moral decision making equipped only with influences from their personal background. We present moral values as the tools of moral reflection rather than prescriptive values. It is possible to show that good ethical review and the process of moral decision making is dependent …