OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology (...) were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. (shrink)

Until 2008, if doctors followed the General Medical Council's (GMC's) guidance on providing information prior to obtaining a patient's consent to treatment, they would be going beyond what was technically required by the law. It was hoped that the common law would catch up with this guidance and encourage respect for patients' autonomy by facilitating informed decision-making. Regrettably, this has not occurred. For once, the law's inability to keep up with changing medical practice and standards is not the problem. The (...) authors argue that while the common law has moved forward and started to recognise the importance of patient autonomy and informed decision-making, the GMC has taken a step back in their 2008 guidance on consent. Indeed, doctors are now required to tell their patients less than they were in 1998 when the last guidance was produced. This is an unfortunate development and the authors urge the GMC to revisit their guidance. (shrink)

This paper addresses the work of the Council of Europe in the fight against corruption. It presents briefly the Council of Europe’s organisation, activities and priorities and goes on to introduce its work in the fight against corruption. Activities in this field are carried out by the Multidisciplinary Group on Corruption (GMC) which is made up of governmental representatives of the forty Member States of the Organisation and in accordance with a Plan of Action against Corruption. Following work by the (...) GMC, the Committee of Ministers, the decision-making body of the Council of Europe, adopted in 1997 ‘The 20 Guiding principles for the Fight against Corruption’ and in 1998 ‘The Agreement establishing the Group of States against Corruption-GRECO’ which will be called upon to monitor States’ compliance with their international commitments in the fight against corruption. Three international legal instruments are currently under preparation by the GMC, namely: a convention on corruption (dealing with the criminal aspects of the problem), a convention on civil remedies resulting from corruption and a European model code of conduct for Public Officials. Work on these instruments is well advanced and it is expected that they will be adopted before the end of 1998. (shrink)

The General Medical Council (GMC) instructs doctors to act ‘reasonably’ in obtaining consent from patients. However, the GMC does not explain what it means to be reasonable: it is left to doctors to figure out the substance of this instruction. The GMC relies on the Supreme Court’s judgment in Montgomery v Lanarkshire Health Board; and it can be assumed that the judges’ idea of reasonability is adopted. The aim of this paper is to flesh out this idea of reasonability. This (...) idea is commonly personified as the audience that has to be satisfied by the doctor’s justification for offering, or withholding, certain treatments and related information. In case law, this audience shifted from a reasonable doctor to a ‘reasonable person in the patient’s position’; and Montgomery expands the audience to include ‘particular’ patients, too. Senior judges have clarified that the reasonable person is a normative ideal, and not a sociological construct; but they do not set out the characteristics of this ideal. John Rawls has conceived the reasonable person-ideal as one that pursues fair terms of co-operation with other members of society. An alternative ideal can be inferred from the feminist ethic of care. However, the reasonable patient from Montgomery does not align with either theoretical ideal; but, instead, is an entirely rational being. Such a conception conflicts with both real-life constraints on rationality and the doctor’s duty to care for the patient, and it challenges the practice of medicine. (shrink)

Leslie Burke challenged the GMC guidelines on withholding and withdrawing artificial nutrition and hydration because he wanted to ensure that food and fluids were not withdrawn from him at a time when he might still be cognisant. This article reviews the case and the judgments at first instance and in the Court of Appeal. In the interests of patient autonomy it argues that the patient is best placed to decide what is in her or his best interests and that the (...) first instance decision was an appropriate response to Mr Burke's challenge. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

The General Medical Council’s Outcome for Graduates, published in 2018,1 is the latest guidance for medical schools on the GMC’s expectations of the undergraduate medical curriculum. One of its three top level outcomes—Professional Values and Behaviours—refers to medical ethics and law, professionalism and patient safety competencies. Furthermore, the recent proliferation of patient safety inquiries in the UK2–4 has elevated the emphasis on ethical medical practice5 and critical medical ethics and law competencies for future doctors. In response to these developments and (...) to ensure an up to date offering, the Institute of Medical Ethics Education Committee has updated the consensus statement on the core curriculum for medical ethics and law for doctors of tomorrow.6 This refined curriculum is the result of a national consultation process. We asked for the views of all lead teachers of medical ethics and law in all UK medical schools, the UK’s chief medical officers, the GMC, and delegates at our annual education conference in 2017 who …. (shrink)

The increasing use of digital image recording devices, whether they are digital cameras or mobile phone cameras, has democratised clinical photography in the UK. However, when non-professional clinical photographers take photographs of patients the issues of consent and confidentiality are either ignored or given scant attention.Whatever the status of the clinician, the taking of clinical photographs must be practised within the context of a professional etiquette. Best practice recognises the need for informed consent and the constraints associated with confidentiality. Against (...) the background of the poverty of the current discourse of these issues, as presented during the Valentine GMC Fitness to Practice1 hearing, the paper considers the need for orthopraxy in the use of clinical photography. (shrink)

Since Flexner's (1910) report over a century ago, we have observed the growth of medical education as a specialty (Donini-Lenhoff and Hedrick 2000). Of late, we have seen a strong move towards outcome-based education driven by educationalists and national bodies alike (GMC 1993; Harden, Crosby, and Davis 1999; Spady 1988). As medical educators, our understanding has grown considerably. However, there is an area that remains relatively unexplored. All surgeons within teaching hospitals share in the collective responsibility for training more junior (...) doctors (GMC 1995; Leung 2002). As with many facets of postgraduate teaching, this is multi-factorial. Trainee surgeons find themselves fighting a war on many fronts. .. (shrink)

This article surveys and analyses the reflections on medical ethics teaching by colleagues teaching in United Kingdom (UK) medical schools in the early 2020s. Participants were recruited mainly by using the worldwide web to identify 64 people from 41 UK medical schools who were thought to contribute to teaching medical ethics based on their internet profiles. Twenty-three people responded. The survey data reveals that many staff are happy with the provision of medical ethics teaching, but also that some are concerned (...) about the quality of provision due to concerns with staff expertise and teaching time. In spite of the fact that the General Medical Council (GMC) and other organisations are perceived to have contributed to raising the profile of medical ethics, there is significant concern with how it is embedded within local UK medical curricula. Some participants contributed hardly or not at all to research in medical ethics, where one attributed this decline in research to the pandemic. Future work will need to address what can be done to improve the provision of medical ethics teaching to address some of these findings and to survey and analyse how perceptions might have changed in light of recent challenges and developments. (shrink)

As the General Medical Council (GMC) is currently in the process of reviewing its ethical guidance on confidentiality, it is a prescient time to consider the legal and ethical issues inherent in it. This paper examines the question of anonymized data, and highlights the fact that the legal position regarding whether it should be classed as confidential is unclear, with the possibility of a change in the law being very real. Indeed, the article argues that the notion that anonymized data (...) is not confidential can be challenged on both legal and ethical grounds, and thus that the GMC should take this into account in its new guidance. Although identifying the fact that this might have implications for epidemiological research, the article highlights an alternative approach that would allow the conduct of such research while not infringing patients' legally protected human rights. (shrink)

Introduction -- Interlude #1: Consider the oxen -- The agrarian ideals of Cerridwen farm -- Vine sanctuary responds -- Interlude #2: Moral syllogism 101 -- Green Mountain College students mount a defense -- Professors and administrators make their case -- Voices of dissent shatter the cocoon at GMC -- Interlude #3: President Fonteyn provides a reprieve -- A wise intervention, a suspicious death -- Conclusion -- About the author -- About the publisher.

ABSTRACT The UK Supreme Court ruling of Montgomery v Lanarkshire clarified that in obtaining informed consent to treatment, practitioners are under a duty to inform patients of material risks. Traditionally such risk has pertained to the clinical risks inherent to treatment. In examining empirical and judicial evidence, this paper makes the case for disclosure of potent financial interests; with potency relating to those interests likely to have greatest influence over practice. The paper explores how financial interests may detrimentally influence practice (...) patterns and how non-disclosure of such interests may be linked to the erosion of patient trust and subsequent disinclination to consent to treatment. Judicial notions of material risk are explored, and the conclusion reached that they offer a broader interpretation of disclosable risk compared to current UK GMC guidance. It is anticipated that empirical evidence could be used by the courts in determining questions of both materiality and causation in cases of negligent non-disclosure of potent financial interests. The paper concludes that there is sufficient reason to surmise that a test case could successfully apply the principles identified therein to establish the materiality of conflict of interest in informed consent to medical treatment. (shrink)

A book for nurses, doctors and all who provide end of life care, this essential volume guides readers through the ethical complexities of such care, including current policy initiatives, and encourages debate and discussion on their controversial aspects. dived into two parts, it introduces and explains clinical decision making-processes about which there is broad consensus, in line with guidance documents issued by WHO, BMA, GMC, and similar bodies. The changing political and social context where 'patient choice' has become a central (...) idea, and the broadened scope of potients' best interests, have added to the complexity of decision-making in end of life care. The authors discuss issues widely encountered by GPs, nurses, and hospital clinicians. These include patient choice, consent, life-prolonging treatment, and symptom relief including sedation. Part rwo explores the more controversial current end of life care initiatives, such as advance care planning preferred place of care and death, euthanais and assited suicide, extended ideas of 'best interests', and the view that there are therapeutic duties to the relatives of Throughout their discussion the authors draw attention to loose ends and contradictions in some of the proposals. Examining the current policy of comsumerist choice, they reject its place in the health service, proposing a a realistic, fair, humane and widely adoptable system of end of life care. As knowledge of ethical theories is required in training courses, and the vocabulary of ethical theory is widespread in current discussions a substantial appendix on ethical theories and terms is available online. Written by the same authors as The Philosophy of Palliative Care: Critique and Reconstruction, which won the Medical Journalists' Association Specialits Book Award 2007, this new book for non-specialists is essential reading for all health care professionals involved in providing end of life care. (shrink)

Introduction The General Medical Council stipulates that doctors must be competent professionals, not merely scholars and practitioners. Medical school curricula should enable students to develop professional values and competencies. Additionally, medical schools are moving towards integrated undergraduate curricula, Cardiff's C21 being one such example. Methods We carried out an audit to determine the extent to which C21 delivers GMC professionalism competencies, and a student questionnaire to explore student perspective on ethics and professionalism. Results and discussion C21 delivers explicit or implicit (...) teaching for all major GMC competencies, though some missed opportunities remain. The questionnaire responses showed that most students value ethics and professionalism teaching, and that it is most well received when delivered in a variety of ways and contexts throughout the curriculum. We also note that some respondents confuse ethics and professionalism with the policing of student behaviour. Conclusions C21 and curricula like it offer many opportunities for nurturing ethically and professionally competent physicians. Students appear to value this, though there remains confusion between medical school discipline and ethics and professionalism which needs further explication. (shrink)

Current General Medical Council guidelines state that any doctor who does not wish to carry out a non-therapeutic circumcision (NTC) on a boy must invoke conscientious objection. This paper argues that this is illogical, as it is clear that an ethical doctor will object to conducting a clinically unnecessary operation on a child who cannot consent simply because of the parents’ religious beliefs. Comparison of the GMC guidelines with the more sensible British Medical Association guidance reveals that both are biased (...) in favour of NTC and subvert standard consent procedures. It is further argued that any doctor who does participate in non-therapeutic circumcision of a minor may be guilty of negligence and in breach of the Human Rights Act. In fact, the GMC guidance implies that doctors must claim conscientious objection if they do not wish to be negligent. Both sets of guidelines should be changed to ensure an objective consent process and avoid confusion over the ethics of NTC. (shrink)

The British Medical Association (BMA) has called upon the General Medical Council (GMC) to instruct all medical schools to provide identifiable and substantial courses on medical ethics in their undergraduate curricula. The author reviews a postgraduate scheme of study in the ethics of health-care and suggests that it could provide some useful guidelines for teaching the subject at the undergraduate level.

Although some doctors celebrated when the Court of Appeal overturned Hadiza Bawa-Garba’s erasure from the medical register, it is argued here that in many ways the ruling is by no means good news for the medical profession. Doctors’ interests are served by transparent professional tribunals but the Court of Appeal’s approach to the GMC Sanctions Guidance risks increasing opacity in decision-making. Close attention to systemic factors in the criminal trial protects doctors yet the Court of Appeal states that the structural (...) circumstances surrounding Bawa-Garba’s failings were only of peripheral relevance to her conviction. Public confidence in the profession is undermined when convicted doctors return to work because the public de facto do not understand the nuance of gross negligence manslaughter law. Rather than changing the law to make the regulator more lenient towards doctors, it would be better to ensure that doctors are only convicted of gross negligence manslaughter when their conduct is so serious that they ought to be struck off. (shrink)

UK general practitioners (GPs) are self-employed entrepreneurs running small businesses with commercial considerations. In this situation there is no clear distinction between information, self-promotion and advertising. In response to the growing public demand for more information about medical services, the medical profession should voluntarily accept the notion of soft self-promotion in the form of 'notices' or 'announcements' placed in newspapers. Newspapers are the most effective way of giving easy access to information. The resistance to newspapers may be more concerned with (...) preserving certain medical traditions than consideration of the public interest. The General Medical Council's (GMC's) arguments against soft self-promotion are seen as misguided paternalism, inconsistent and irrational. (shrink)

This personal view draws attention to the lack of regard, given by the BMA in its new guidance, to the symptomatic benefit of clinically assisted nutrition and hydration in patients who are not imminently dying. This article aims to identify how ignoring symptomatic benefit is a serious oversight and cause for concern given that this document, endorsed by the General Medical Council and courts, is created with the purpose of providing a framework for best interests decision-making. The new BMA guidance (...) on CANH, which is endorsed by the GMC,1 follows up on the Supreme Court case of An NHS Trust v Y,2 that any removal of CANH from a patient in prolonged disorder of consciousness no longer requires the approval of the court unless there is disagreement or the decision is finely balanced. The decision in …. (shrink)

Following Alder Hey and the earlier and much more extreme practices at Nuremberg, legislation has been developed governing the practice of medical ethics and research involving human participants more generally. In the medical context, relevant legislation includes GMC guidance, which states that disclosure of identifiable patient information without consent, for research purposes, is not acceptable unless it is justified in the public interest. There is a presumption, in other words, in favour of the view that patient consent ought to be (...) obtained before any piece of research is conducted. The Data Protection Act, furthermore, requires informed consent to be given before any use of identifiable personal data is made for any purpose. Moreover, ensuring that the informed consent of participants is gained is common practice on most research ethics committees. I argue, in this paper, that applying the principle of ‘informed consent’ too mechanistically in the research ethics context risks undermining the very principle it is designed to support – the principle of autonomy. This issue has been much discussed in medical ethics but not so much, so far, in the research ethics context. It will be argued that a more discerning and a less rigid and mechanistic approach, applied by research ethics committees, may help ensure that ethical issues are properly considered. (shrink)

In late 2005, the General Medical Council carried out several consultations. In the review of procedures for sick doctors were proposals to strengthen powers to monitor doctors and plans to introduce unannounced drug testing of doctors whose behaviour raised concerns.1 The GMC consultation on the strategic options for undergraduate medical education considered how education is changing in the light of social and clinical demands. It focused, in part, on developing guidance on medical students’ health and conduct and a proposed national (...) registration system for medical students.2 The most significant consultation in terms of medical ethics was the GMC’s review of Good Medical Practice – its main ethical guidance for doctors.3 The GMC’s aim was to re-define practical and attainable modern standards. A proposed draft emphasised partnership in the doctor-patient relationship, human rights, and doctors’ obligations and responsibilities towards children—all of which are issues increasingly significant in medicine. The consultation also opened up discussion on how far the GMC should be concerned about doctors’ behaviour in their private lives. Should it be concerned, for example, about clinically successful consultants being obsessed with hardcore pornography or having affairs with very young women?4 Questions were also posed about how far doctors can exercise a conscientious objection. Should they be able to refuse to refer pregnant women for abortions because they themselves consider it wrong?5 Other potentially contentious issues questioned the extent to which doctors have rights to protect themselves against risks from patients. British Medical Association policy, dating from the era when HIV first began to be diagnosed, stated that it is unethical to withhold treatment solely because a patient’s condition poses risks to doctors’ health. At the time it was adopted, this policy was intended to be anti-discriminatory as HIV patients were already stigmatised. Doctors …. (shrink)

Abraham Flexner delivered his eponymous report 100 years ago. The Report had an immediate and profound impact on medical education in North America that resonated for several decades afterwards. Its impact was less immediate in the United Kingdom, but over time the major principles have been assimilated (GMC 1993). However, which—if any—of these principles are still relevant today? No doubt there will be debate about this, but in my view, Flexner's principle of academic and scientific excellence as one of the (...) most fundamental underpinnings of medical education is even more relevant today than it was in 1910. To illustrate this, I shall highlight two aspects of current medical education in the United Kingdom: the .. (shrink)

The role of the General Medical Council has changed over the last few years and this paper shows how the GMC now gives advice on good practice, as well as a warning against bad practice.

Many members of the public think of the General Medical Council (GMC) as the body which tries doctors: the doctors' law courts, as it were. And, except in the more sober of newspapers and news reports, the 'offences ' which receive the most publicity are those concerning alleged improper relations between doctors and patients. Professor Sir Denis Hill, in the following paper, which he read in the spring of this year to the annual conference of the London Medical Group devoted (...) to a discussion of human sexuality, chose to examine the whole function of the General Medical Council as a frame of moral reference for doctors. Judging allegations of professional misconduct by doctors is the function of the Council's Disciplinary Committee. Judging sexual misconduct forms only a small part of their work. The GMC's responsibility covers the whole notion of morals and morality as it concerns doctors in their professional work. Sir Denis Hill stresses the modern thinking that morality must be learned and that attitudes are always shifting as society alters its norms of what is moral conduct. That is not to say that all that was previously considered not to be moral has now become acceptable but rather that other concepts have entered the field of moral debate. Therefore the GMC must constantly review the frame of reference it offers to doctors and the public may be surprised to learn that that process is never static. Sir Denis Hill in this paper is speaking personally and not as a member of the General Medical Council or of any of that body's special committees. (shrink)

This article considers the nature of Mr Burke's concerns in bringing his action and the practical implications of similar situations. When artificial nutrition and hydration is provided, practical issues arise regarding future, potentially long-term care. This in turn raises concerns about place of care, provision of carers and funding, which may not easily be resolved. The GMC guidance exists to provide direction and help for practitioners when difficult decisions have to be made about future treatment with the intention that the (...) patients' wishes and benefit of any potential treatment will be central to the discussions. Nevertheless, the reality of having these conversations, raising emotive issues with the patient and/or carers, and the implications of the final decision, may be very different in practice. (shrink)

Informed consent is one of the perennial problems of medical ethics. It raises interesting philosophical questions, but also questions about regulation and implementation. The paper by Fovargue and Miola in this issue look at the recent guidance to doctors on informed consent from the UK's General Medical Council. They reach the rather depressing conclusion that whereas the law in the UK has moved forward in the recognition of patient autonomy, the GMC has moved backwards in some areas since the previous (...) guidance was issued in 1998. A paper by Potts et al also look at consent, but in this case consent to organ donation. They criticise a paper by Ben Saunders published in the JME in 2010. Saunders combined David Estlund's concept of ‘normative consent’ with Peter Singer's ‘greater moral evil’ principle and argued on this basis that actual consent to organ donation after death is not necessary, only absence of a clear refusal. Potts and …. (shrink)

An implicit rationale for ethics in medical schools is that there is a perceived need to teach students how not to think and how not to act, if they are to avoid a lawsuit or being struck off by the GMC. However, the imperative to keep within the law and professional guidance focuses attention on risks to patients that can land a doctor in trouble, rather than what it means to treat a patient humanely or well. In this paper I (...) explore the gap between learning how not to think and act as a doctor, and learning to be reflective and responsive to patients as fellow human beings. This gap is exposed by the difference between a GMC web resource for doctors, and a detailed ethical discussion by Gawande in his book Complications. The latter raises fundamental questions of meaning, and exemplifies an approach to ethical thinking as the appropriate management of doubt that, according to the argument of this paper, is of utmost importance for doctors. (shrink)