1. Introducing Medical Ethics and Law Dr Michael Dunn, Prof Maureen Kelley and Prof Michael Parker

2. Why is medical ethics and law taught? In 1993, in ‘Tomorrow’s Doctors’ the General Medical Council placed a new formal obligation on medical schools for ethics to be taught and assessed as part of the core curriculum for medical students.

3. Why is medical ethics and law taught? Modern health care practice aims to be evidence-based and patient-centred Both imply that doctors should be able and willing to justify (to give reasons for) why they choose one course of action over another These moves have their origins in criticisms of paternalism and tradition in medical practice: – the doctor knows, and should do, what is best for the patient – “we’ve always done it this way here”

4. Why is medical ethics and law taught? Medicine involves scientific/technical judgements But... it also involves making value judgements, e.g. – About how a patient’s ‘best interests’ should be understood – About whether patients’ requests (e.g. for terminating a pregnancy) should always be respected Evidence-based, patient-centred practice means being able and willing to recognise, make and justify the value judgements that you make This course will help you become doctors who can do this

5. Why is medical ethics and law taught now? Progression into the clinical years represents an important shift in your professional training and the ways in which you are taught The values and duties of the profession become applicable to you in a way they were not previously You actions as a medical student can have an impact on patients and their care You can be held to account (in court, or by the GMC) if you do not act in line with these values and duties

6. Our aims Our sessions have two broad aims: 1.To enable you to understand: a)The ethical values that are recognised as being associated with the role of the doctor [e.g. ‘respect the patient’s autonomy’ ; ‘act in the patient’s best interests’] b)How these values are written into professional regulations and guidance, and into English legal duties c)How these values, regulations, guidance and laws should be interpreted and applied to particular clinical situations

7. Our aims 2.To enable you to think through and address two kinds of challenges: a)The ethical challenge: determining what you ought to do when professional values conflict in practice o “Should you provide medical treatment to a patient, when i) the treatment has a very good chance of saving the patient’s life and ii) the patient is refusing the treatment without giving any reason?” b)The professionalism challenge: negotiating the boundaries between professional values and your own personal values, sense of duty, and relationships o “Should you be allowed to opt-out of being involved in an end of life treatment decision because of your religious views?”

8. How we meet these aims We take a very practical, case- and problem-based approach There is a strong focus on interaction and small group discussions in all of our sessions. Please don’t be afraid to contribute! All of our discussions focus on improving your knowledge of the relevant values, laws and guidance – as well as your skills in ethical analysis and argumentation

9. Contents of the ethics and law course Year Four (core teaching) – Confidentiality and Introduction to English law/negligence – Consent to treatment – End of Life decision-making – Ethics and the clinical use of genetics/genomics – The ethics and governance of medical research Year Four (options) – Four-week special study module (Feb/March 2016)

10. Contents of the ethics and law course Year Five (core teaching) – Public Health: priority-setting and resource allocation – Reproductive ethics: abortion and assisted reproduction – The care and treatment of children – Psychiatry: treatment without consent – Andrew Markus Essay Prize in Medical Ethics Year Six (core teaching) – Ethics and infectious diseases (student-led session) Year Six (options) – Year Six SSM (some students choose an ethics topic)

11. Contents of the ethics and law course *Please note* The ethics and law course is one of the components of the GMC’s core requirements for medical education We will take an attendance register at each session. If you need to be absent from one or more sessions, please get in contact with us (preferably in advance) to arrange for you to attend at another one. Your adequate attendance is now a formal requirement for progression to the next year

12. How is the course assessed? In two ways: 4 th year: an ethics and law OSCE, introduced in 2012-13 6 th year: final examinations How will the OSCE work? A 5-minute structured conversation between student and examiner Focused on a short clinical case description that engages with one of more of the topics covered in the year You will be expected to: – recognise the practical ethical issues raised by the case – understand and apply the relevant guidelines and legal concepts/frameworks to the case – reason about relevant ethical values to make a decision about what ought to be done in the case in a practical clinical context – identify, and be able to defend against, counterarguments to your recommendation

13. Who is the course taught by? The majority of the teaching on the medical ethics and law course is provided by: Prof Michael Parker Professor of Bioethics Dr Michael Dunn Lecturer in Health and Social Care Ethics Prof Maureen Kelley Associate Professor of Bioethics

15. www.ethox.ox.ac.uk

16. Ethics and Assisted Dying On September 11 th 2015 an Assisted Dying Bill will be debated in parliament. It would allow doctors to prescribe a lethal dose to terminally ill patients judged to have six months or less to live and who request it The Bill could potentially give MPs the first vote on this issue since 1997

17. In August 2015, Bob Cole who was suffering from aggressive lung cancer travelled to Dignitas to end his own life, 18 months after his wife had done the same thing. Mr Cole criticised the UK law arguing that he ‘should have been able to do this at home’.

18. Analysing the Cole case Individually… 1.What ethical issue(s) is raised by this kind of case? 2.Any idea what the law in England permits in this kind of situation? In pairs... 3.What do you think should be done in this kind of case? 4.How might someone who disagreed with you argue against your position, and how would you respond?

19. Acting as a professional apprentice As mentioned, professional standards apply to you from day one as a trainee doctor In particular, you need to be aware from today of your professional requirements in relation to confidentiality and consent We will discuss these issues at length later in the year, but in the meantime...

20. Being a medical student on the wards Ensure patients are aware that you are students and not doctors. Wear clear badges prominently. Introduce yourselves as a student Gain permission from a doctor or nurse before approaching a patient in order to carry out, participate in, or observe, a medical examination Remember that patients have a legal right to refuse to allow medical students (and indeed all health professionals) to carry out any medical procedure Any procedures you are asked to perform, or assist with, for educational purposes must have been agreed to by patients

21. Medical students and confidentiality Exactly the same standards as expected of fully-qualified doctors Treat all clinical information in strict confidence to be discussed only with patient’s clinical team Do not discuss patient issues in a public place (e.g. lift; canteen; bus) Do not talk about patients you have observed (e.g. over dinner to your friends; on Facebook) Read GMC Duties of a Doctor [www.gmc-uk.org]

22. We look forward to working with you! Any questions about the course, please contact michael.dunn@ethox.ox.ac.ukmichael.dunn@ethox.ox.ac.uk at any time