1. Our ethics course is not a philosophy seminar relying on indefinable terms like good, right, or moral.
Traditionally, medical ethics has been taught as a philosophy course.
Generally, it teaches that clinicians be “good” not “bad;” “right” not “wrong;” “just”
not “unjust;” “moral” not “immoral;” etc. However, terms like these in fact describe
absolute value judgments that can neither be defined nor applied to actual
conduct because they vary with the frame of reference of the observer.

Attitudes, culture, ethnicity, religion, socio-economic status, mental health,
personal experience, and numerous other factors determine how any value
judgment will be perceived or interpreted. As a result, such value judgments are
useless for the purpose of guiding behavior. “Good” or “right” behavior depends
on what an individual interprets as “good” or “right.” Using words like these to
describe the goals of ethical conduct is misleading and futile. Most clinicians
already believe that what they do is “good,” and will not improve their conduct as
a result of an ineffective ethics course.

The businessman may believe it ethical to maximize the value of his goods
when negotiating a price. The buyer may believe it ethical to minimize the value
of the goods. Who is “right?” both are right from their own frames of reference,
and each is wrong from the other’s frame of reference. Clinicians frequently have
difficulty accepting the idea that two opposite views can both be correct.

2. We provide clear and practical guidance to help busy clinicians distinguish ethical from unethical behavior.
Teaching medical ethics from a philosophy perspective does not adequately
address the common ethics violations of clinicians, and will not lead to
improvement. For effective teaching, medical ethics courses must identify the
fundamental concepts that result in the broad range of ethics violations
commonly found throughout clinical practice. The courses must then identify the
most common ethics violations and show how they are inconsistent with the
fundamental concepts. This is the teaching style on which the Western Institute
of Legal Medicine’s ethics course is based. Awareness of these common ethics
violations is one reason why lecturers who have medical practice experience are
best qualified to teach medical ethics. Medical practice experience is also
necessary to understand the practical needs of clinicians, to not demand
impractical changes in behavior, and for the lecturers to preserve their credibility
with clinicians.

2. 3. We give usable answers instead of just asking questions that leave clinicians uncertain about what is or is not ethical.
Traditional ethics teaching asks many questions, but often leaves the
answers to the clinician. This creates a vague and inconsistent understanding of
what ethical conduct requires. Such a technique may be appropriate for a
didactic philosophy course relying on the Socratic method, but is inappropriate
for the education of busy practicing clinicians. They need to learn what types of
conduct need to improve, and how to improve them for their own benefit and the
benefit of their patients.

4. We address a full range of actual ethical issues often encountered by clinicians, and not just the most controversial ones.
Traditional ethics teaching often fails to directly examine many of the most
common ethical errors arising from clinical practice situations. Just a few
examples are:

  • Avoiding conflict by acceding to medically inappropriate patient or family demands.
  • Emotionally acting out to the detriment of the patient or others.
  • Exaggerating the medical benefits or understating the risks of a recommended intervention at a time when the clinician’s greater experience performing that intervention would provide career advantages.
  • Exercising power in hospital medical staff peer review proceedings despite conflicts of interest.
  • Failing to learn the law directly applicable to the clinician’s medical practice.
  • Failing to recognize and control the clinician’s bias against certain patients.
  • Forming an opinion, then persisting with it after additional findings show it to be unsupportable.
  • Habitually documenting inadequate or inaccurate medical records.
  • Inadequate or delayed communication with other members of the health care team, including failing to provide copies of patient records in a timely manner.

5. We teach clinicians how to distinguish ethics from law, and we provide a systematic and accurate understanding of the legal principles that are often confused with ethics.
Traditional ethics teaching is often composed primarily of controversial and “glamorous” topics because they have potentially serious legal implications. Examples found in ethics textbooks are:

  • Abandonment.
  • Access by patients to medical information.
  • Boundary violations.
  • Confidentiality.
  • Deceiving a patient to the patient’s detriment.
  • Decision-making capacity.
  • Disclosure of errors to patients/families.
  • Euthanasia and physician-assisted suicide.
  • Gifts given to clinicians by other clinicians.
  • Health care rationing decisions.
  • Impaired clinicians.
  • Informed consent.
  • No-code decisions.
  • Tarasoff warnings.

6. Our course combines ethics, law and medicine in a way that can be taught only by lecturers who are fully trained and extensively experienced in both law and medicine.
ALL of the above topics primarily involve LEGAL requirements of medical
practice. The legal basics of every topic must be clearly distinguished from
ethical aspects, if any, and should be systematically explored by an ethics
lecturer who possesses and can apply the full scope of a formal legal education
and practical legal experience. The lecturer should also accurately discuss the
potential legal consequences to a clinician of unethical behavior. This too is
complex and requires a legal education. If you want tax advice, you get it from a
CPA, not a philosophy professor!

Courses that alternate lawyer lecturers with clinician lecturers do not properly
teach medical ethics concepts to clinicians. Neither type of lecturer can
effectively and correctly combine a broad understanding of both law and
medicine. Such understanding and its application to clinical practice are part of
the unique body of knowledge possessed by the fully trained legal medicine
specialists who teach for the Western Institute of Legal Medicine.

Practical Medical Ethics and Professionalism

Leave a Comment