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The Academy

CFA/ Registration: Postgraduate Bioethics, 2016

30 Jun, 16 | by Iain Brassington

“Oi, Iain,” says David.  “Could you put a shout out for the Postgraduate Ethics Conference?”

Indeed I could.  The theme is “Bioethics in Theory: Bioethics in Practice”.  Details – including the call for abstracts (the deadline for which is the 8th July) and the registration form – are here.

There’s Argument, and there’s Disputation.

7 Jun, 16 | by Iain Brassington

Very well, then: let’s allow that the quality of argument in bioethics – and clinical ethics in particular – is not of high quality.  What should be done about it?

That’s a hard question, though it’s predictable and wholly justifiable that it should be asked.  And, to be honest, I don’t know offhand.  I might have a few germs of ideas, but nothing that I’d be prepared to mention in public.  That doesn’t mean that I can’t look at other ideas, and test them out.  One such idea is mooted in this paper by Merrick et al: in essence, they propose a sort of debating competition.  They begin by explaining – with some plausibility – some of the factors that make it a bit hard to get full-blooded engagement with ethics in the medical curriculum:

As educators, we have observed additional challenges medical students face in their ethics education, which echo others’ experiences. First, because of the prodigious amount of information medical students are presented with during their first two years of training, they typically adopt a strategy of selectively reading assignments, attending large lectures, and participating in small group discussions.  In this context, ethics appears to be deprioritized, because, from the students’ perspective, it is both more demanding and less rewarding than other subjects.  Unlike other subjects, ethics requires students to reflect on their personal moral sensibilities in addition to understanding theory and becoming familiar with key topics and cases.  Yet, also unlike other courses, poor marks in ethics rarely cause academic failure, given the way performance in medical school curricula is typically evaluated.  Thus, ethics is both more demanding—because of the burdens of self-reflection—and less rewarding—because excellence in ethics does not contribute significantly to grades or test scores.

Second, medical students face challenges in how they individually conceptualize the value of ethics in the medical context.  Although many indicate that morality is important to them, they also suggest that it is a subject matter that relates to their personal, as opposed to professional, actions.  Instead, students often conflate the domains of institutional policy and health law (especially risk management and malpractice litigation) with medical ethics.  Although these domains are obviously also of essential concern for future physicians, they remain distinguishable from ethical issues likely to emerge in practice.  Consequently, rigorous and effective ethics education within the medical school context faces the challenge of distinguishing ethics from other aspects of professionalism.

Too often, ethics gets run alongside communication skills training (well, it’s all about getting informed consent, isn’t it?  Eh?  Eh?); and I’ve lost count of the number of times I’ve been asked to prepare multiple choice questions for ethics assessment.  (Standard answer: nope.  It’s got to be an essay of some sort, or it’s not worth doing.)

So what to do?  The paper, as I’ve already said, suggests a quasi-competitive debating competition, in which teams of students are given a problem, and a limited time to make a case in response to that problem.  An opposing team then has a limited amount of time to place a counterargument.  Then they swap roles, so the counterarguing team gets to make the argument, and the previous arguers now become counter-arguers.  Judges can ask questions, and assign a score.  “The basic aim of the MEB curriculum,” the authors say,

is to help students learn how to produce and present an argument for an ethical position in response to a realistic clinical situation.

Hmmmmm.

Every now and again I get asked to help judge debating competitions – sometimes for academic institutions, sometimes for non-University bodies, sometimes for others (*cough* Instituteofideas *cough*).  I used to be happy to help out.  But I’m not so sure now. more…

Writers Whose Expertise is Deplorably Low

4 Jun, 16 | by Iain Brassington

Something popped up on my twitter feed the other day: this document from Oxford’s philosophy department.  (I’m not sure quite what it is.  Brochure?  In-house magazine?  Dunno.  It doesn’t really matter, though.)  In it, there’s a striking passage from Jeff McMahan’s piece on practical ethics:

Even though what is variously referred to as ‘practical ethics’ or ‘applied ethics’ is now universally recognized as a legitimate area of philosophy, it is still regarded by some philosophers as a ghetto within the broader 
area of moral philosophy.  This view is in one way warranted, as there is much work in such sub-domains of practical ethics as bioethics and business ethics that is done by writers whose expertise is in medicine, health policy, business, or some area other than moral philosophy, and whose standards of rigour in moral argument
are deplorably low.  These writers also tend
 to have only a superficial understanding of normative ethics.  Yet reasoning in practical ethics cannot be competently done without sustained engagement with theoretical issues
in normative ethics.  Indeed, Derek Parfit believes that normative and practical ethics are so closely interconnected that it is potentially misleading even to distinguish between them.  In his view, the only significant distinction is between ethics and metaethics, and even that distinction is not sharp.  [emphasis mine]

It’s a common complaint among medical ethicists who come from a philosophical background that non-philosophers are (a) not as good at philosophy, (b) doing medical ethics wrong, (c) taking over.  All right: there’s an element of hyperbole in my description of that complaint, but the general picture is probably recognisable.  And I don’t doubt that there’ll be philosophers grumbling along those lines at the IAB in Edinburgh in a couple of weeks.  There’s a good chance that I’ll be among them.

There’s a lot going on in McMahan’s piece, and his basic claim is, I suppose, open to a claim that, being a philosopher, he would say that, wouldn’t he?  But even if that claim is warranted, it doesn’t follow that it’s false.  And it probably isn’t false.  There is some very low-quality argument throughout bioethics (and, from what I remember from my time teaching it, business ethics) – more particularly, in the medical ethics branch of bioethics, and more particularly still, in the clinical ethics sub-branch.  Obviously, I’m not going to pick out any examples here, but many of us could point to papers that have been simply not very good, because the standard of philosophy was low, without too much difficulty.  Often, these are papers we’ve peer-reviewed, and that haven’t seen the light of day.  But sometimes they do get published, and sometimes they get given at conferences.  I’ve known people who make a point of trying to find the worst papers on offer at a given conference, just for the devilry.

It doesn’t take too much work to come up with the common problems: a tendency to leap to normative conclusions based on the findings of surveys, or empirical or sociological work; value-laden language allowing conclusions to be smuggled into the premises of arguments; appeals to vague and – at best – contentious terms like dignity or professionalism; appeals to nostrums about informed consent; cultural difference used as an ill-fitting mask for special pleading; moral theories being chosen according to whether they generate the desired conclusion; and so on.  Within our field, my guess is that appeals to professional or legal guidelines as the solutions to moral problems is a common fallacy.  Not so long ago, Julian noted that

[t]he moralists appear to be winning.  They slavishly appeal to codes, such as the Declaration of Helsinki.  Such documents are useful and represent the distillation of the views of reasonable people.  Still, they do not represent the final word and in many cases are philosophically naïve.

Bluntly: yes, the WMA or the BMA or the law or whatever might say that you ought to do x; and that gives a reason to to x inasmuch as that one has a reason to obey the law and so on.  But it’s unlikely that it’s a sufficient reason; it remains open to us always to ask what those institutions should say.  Suppose they changed their minds and insisted tomorrow that we should do the opposite of x: would we just shrug and get on with the business of undoing what we did today?

And yet…  The complaint about poor argument is not straightforward, for a couple of reasons. more…

Stop What You’re Doing: This is Important.

14 Oct, 15 | by Iain Brassington

I’d not realised it, but the latest iteration of the erstwhile Medical Innovation Bill – colloquially known as the Saatchi Bill – is up for debate in the Commons on Friday.  This is it in its latest form: to all intents and purposes, though, it’s the same thing about which I’ve blogged before.

In a nutshell, the Bill does nothing except remove protections from patients who would (under the current law) be able to sue for negligence in the event that their doctor’s “innovative” treatment is ill-founded.

Much more articulate summaries of what’s wrong with the Bill can be found here and here, with academic commentary here (mirrored here on SSRN for those without insitutional access).  There have been amendments to the Bill that make the version to be discussed on Friday slightly different from that analysed – but they are only cosmetic; the important parts remain.

Ranged against the Bill are the Medical professional bodies, the personal injuries profession, patient bodies, and research charities.  In favour of the Bill are the Daily Telegraph, a few people in the Lords who should know better (Lord Woolf, Lady Butler-Sloss: this means you), and Commons MPs who – understandably – don’t want to be seen as the one who voted against the cure for cancer.

Gloriously, Christ Heaton-Harris, who introduced the Bill, did so only after winning the ballot for Private Members’ Bills.  In a nutshell, he was allotted Parliamentary time, and then began the process of wondering what to do with it – which suggests that even the Bill’s sponsor doesn’t have a burning commitment to the cause – or, at least, didn’t when he took it on.

Still, the Bill has the support of Government; as it stands, there’s a good chance that it’ll pass.

SO: Take a few minutes to look up your MP’s email address – you can do that by following this link – and drop him/ her a line to encourage them to vote against the Bill.

Do it.

How do Medical Students Learn Ethics?

3 Aug, 15 | by Iain Brassington

Guest Post by Carolyn Johnston

How interested are medical students in learning ethics and law? I have met students who have a genuine interest in the issues, who are engaged in teaching sessions and may go on to intercalate in ethics and law. On the other hand some consider that ethics is “just common sense”. They want to know only the legal parameters within which they will go on to practice and do not want to be troubled with a discussion of ethical issues for which there may not be a “correct” answer.

Ethics and law is a core part of the undergraduate medical curriculum and so in order to engage students successfully I need to know whether my teaching materials are relevant, useful and interesting. In 2010 I ran a student selected component in which MBBS Year 2 students created materials for medical ethics and law topics for pre-clinical students which they considered were engaging and relevant, so that students might go further than learning merely to pass exams. One student, Marcus Sorensen, who had managed a design consultancy focusing on web design and development before starting his medical studies, came up with the idea of a website as a platform for ethics materials for King’s students and he created the website http://get-ethical.co.uk.

It was through our ongoing discussions that we identified a lack of information about students’ experiences of learning medical ethics and law, especially outside the classroom environment. more…

Making the Jump to a Medico-Legal Career

15 Jul, 15 | by BMJ

Guest Post by Daniel Sokol

On a number of occasions, I have been asked by early career ethicists about the move from ethics to law, or the wisdom of seeking a legal qualification to supplement their ethical knowledge. In the UK, this can be achieved remarkably quickly. This blog post is an answer to those questions, based only on my own experiences.

In 2008, I was a lecturer in medical ethics and law at St George’s, University of London. I had no legal training, and felt uncomfortable teaching law to medical students. Some of the graduate students were former lawyers and it must have been obvious to them that the limits of my legal knowledge extended no further than the PowerPoint slide.

That year, an old school friend, a solicitor, encouraged me to become a lawyer. “I can imagine calling you ‘My learned friend‘ in court”, he said. And so the seed was planted, and with each soul-sapping marking session, and each article published and quite unread, the seed grew until, in 2009, I resigned from my lectureship to study on the law conversion course, now called the Graduate Diploma in Law (GDL). more…

On Being a Hypocrite

1 Jul, 15 | by Iain Brassington

A piece appeared in The Atlantic a few days ago that aims to prick the perceived bubble of professional ethicists.  In fact, the headline is pretty hostile: THE HYPOCRISY OF PROFESSIONAL ETHICISTS.  Blimey.  The sub-headline doesn’t pull its punches either: “Even people who decide what’s right and wrong for a living don’t always behave well.”

I know that headlines are frequently not written by the person whose article they head, and so these won’t tell us much about the article – but, even so, I’m beginning to twitch.  Do I decide what’s right and wrong for a living?  I don’t think I do.  I possibly thought that that’s what an ethicist does when I was a fresher, or at school – but I’m not certain I did even then.  And even if I did, I discovered pretty quickly that it’s quite a bit more complicated than that.  For sure, I think about what’s right and wrong, and about what “right” and “wrong” mean; and I might even aspire to make the occasional discovery about right and wrong (or at least about how best to think about right and wrong).*  But as for deciding what is right and wrong?  Naaaah.

Anyway: to the substance of the piece, which – to be fair – is more moderate in tone, pointing out that “those who ponder big questions for a living don’t necessarily behave better, or think more clearly, than regular people do”.  That’s probably accurate enough, at least a good amount of the time.  I’d like to think that I’m thinking better about a particular problem than most people when I’m working on it; but I’m also thinking better about in that context than I would be at other times.  (Ask me about – say –  genetic privacy while I’m drafting a section of a paper on genetic privacy, and I’m your man.  Ask me while I’m making pastry… not so much.)  If we allow that I’m better at dealing with (a) specific moral question(s) while “on duty”, that won’t mean I’m not susceptible to the same intellectual shortcuts and fallacies as everyone else at least most of the rest of the time.  I’m probably almost as susceptible to them even when I am on duty.  I’d assume that the same applies to others in the profession, too.

The article does make great play of the apparent inconsistencies between what ethicists say and what they/ we do.  So there’s the finding about how many more say that eating meat is morally problematic than actually avoid it, and the chestnut about how ethics books are the ones most frequently stolen from libraries.**  At least there are decent sources cited – peer-reviewed papers like this one that are philosophically informed, to boot.

So: ethicists aren’t reliably better behaved than others.  I don’t think that should surprise us, though.  But, there’s a couple of questions into which we might still want to dig more deeply. more…

Questions to which the Answer is Yes

28 Nov, 14 | by Iain Brassington

Over at Practical Ethics, Charles Camosy asks a question: Can bioethics be done without theology?

Yep.  It can.

Well, that was quick and simple.

But – oh, all right: I probably ought to say a bit more.  Now, Camosy’s post is quite long, and that means that if I want to scrutinise it in any detail, I’d have to generate something at least as long.  I’m not sure if I – or any reader – has the patience for that, so what follows is probably not going to be without the odd gap.  All the same, this post has turned out to be something of a monster in its own right – so it might be worth going to make a cup of tea first if you intend to read it.

The tl;dr version is that I think that Camosy’s argument is fallacious in several places.  And though I’m arguing from a position of godlessness, I think that the problems ought to be apparent to those who do have faith as well.  With that caveat issued, here we go… more…

Consigned to the Index

28 May, 14 | by Iain Brassington

There’re probably times when all of us have had a solution, and just had to find a problem for it.  It’s an easy trap; and it’s one into which I suspect Gretchen Goldman may have fallen in an article in Index on Censorship about scientific freedom and how it’s under threat from disputes about Federal funding in the US.  No: I’m not going to be arguing against scientific freedom here.  Only against a certain use of the appeal to scientific freedom in response to a particular problem. First up, let’s note the points on which Goldman may well be correct.  She notes that the disputes in the US about federal funding that have led to big cuts and a short-but-total government shutdown are very bad for science.  She points out that political machinations even meant that researchers working in government-funded areas couldn’t access their emails.  This had direct and indirect consequences, all of which were pretty undesirable.  For example,

[m]any government scientists were not allowed to access email, much less their laboratories. One scientist noted that his “direct supervisor … confiscated all laptop computers on the day of the shutdown”.

Without access to work email accounts, federal scientists were also prevented from carrying out professional activities that went beyond their government job duties. Several scientists pointed out that their inability to access emails significantly slowed down the peer-review process and, therefore, journal publication.

In the wider sense, to have science and funding bodies that are vulnerable to political shenanigans isn’t good for science, and is probably not good for humanity.  You don’t have to think that research is obligatory to think that it’s often quite a good thing for science to happen all the same.  And shutdowns are particularly bad for students and junior researchers, whose future career might depend on the one project they’re doing at the moment; if a vital field trip or bit of analysis or experiment is liable to get pulled at almost any moment, they don’t have a reputation yet to tide them over.

So far, so good.  However, things are iffier elsewhere. more…

Resurrectionism at Easter

23 Apr, 14 | by Iain Brassington

There’s a provocative piece in a recent New Scientist about what happens to unclaimed bodies after death – about, specifically, the practice of coopting them for research purposes.

Gareth Jones, who wrote it, points out that the practice has been going on for centuries – but that a consequence of the way it’s done is that it tends to be the poor and disenfranchised whose corpses are used:

[T]he probably unintended and unforeseen result [of most policies] was to make poverty the sole criterion for dissection. [… U]nclaimed bodies are still used in countries including South Africa, Nigeria, Bangladesh, Brazil and India. While their use is far less in North America, they continue to constitute the source of cadavers in around 20 per cent of medical schools in the US and Canada. In some states in the US, unclaimed bodies are passed to state anatomy boards.

For Jones, the practice of cooption ought to be stopped.  His main bone of contention is the lack of consent – it’s a problem that’s made more acute by the fact that the bodies of the disenfranchised are more likely to be unclaimed, but I take it that the basic concern would be there for all.

One question that we might want to ask right from the off is why informed consent is important. more…

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