Journal of Bioethical Inquiry

, Volume 15, Issue 1, pp 101–109 | Cite as

Law as Clinical Evidence: A New ConstitutiveModel of Medical Education and Decision-Making

  • Malcolm Parker
  • Lindy Willmott
  • Ben White
  • Gail Williams
  • Colleen Cartwright
Original Research

Abstract

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model is supported on the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion.

Keywords

Applied ethics Attitudes toward death Clinical ethics End-of-life Medical law Professional ethics 

Notes

Acknowledgements

We are very grateful to the two anonymous reviewers of the paper, whose comments and suggestions have clarified and strengthened the arguments it puts forward.

References

  1. Australian Medical Council. 2012. Standards for assessment and accreditation of primary medical programs by the Australian Medical Council. http://www.amc.org.au/images/Accreditation/FINAL-Standards-and-Graduate-Outcome-Statements-20-December-2012.pdf. Accessed November 21, 2016.
  2. A Working Group, on behalf of the Association of Teachers of Ethics and Law in Australian and New Zealand Medical Schools (ATEAM). 2001. An ethics core curriculum for Australasian medical schools. Medical Journal of Australia 175(4): 205–210.Google Scholar
  3. Callahan, D. 1993. The troubled dream of life. New York: Simon and Schuster.Google Scholar
  4. Campbell, A. 2012. Teaching law in medical schools: First, reflect. Journal of Law, Medicine and Ethics 40(2): 301–310.Google Scholar
  5. Doran, E., K. Fleming, C. Jordens, C. Stewart, J. Letts, and I. Kerridge. 2015. Part of the fabric and mostly right: An ethnography of ethics in clinical practice. Medical Journal of Australia 202(11): 587–590.Google Scholar
  6. Dowie, A. 2011. Making sense of ethics and law in the medical curriculum. Medical Teacher 33(5): 384–387.Google Scholar
  7. Foster, C., and J. Miola. 2015. Who’s in charge? The relationship between medical law, medical ethics, and medical morality. Medical Law Review 23(4): 505–530.Google Scholar
  8. Fox, E., R.M. Arnold, and B. Brody. 1995. Medical ethics education: Past, present, and future. Academic Medicine 70(9): 761–769.Google Scholar
  9. Fulford, K.W.M. 1989. Moral theory and medical practice. Cambridge: Cambridge University Press.Google Scholar
  10. General Medical Council. 2015. Outcomes for graduates. http://www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asp. Accessed November 21, 2016.
  11. Goldenberg, M. 2005. Evidence-based ethics? On evidence-based practice and the “empirical turn” from normative bioethics. BMC Medical Ethics 6: 11.Google Scholar
  12. Illich, I. 1976. Limits to medicine. Medical nemesis: The expropriation of health. Harmondsworth, Middlesex: Penguin.Google Scholar
  13. Illich, I., I.K. Zola, J McKnight, J. Caplan, and H. Shaiken. 1977. Disabling professions. London: Marion Boyars.Google Scholar
  14. Jonsen, A. 1998. The Birth of bioethics. New York: Oxford University Press.Google Scholar
  15. ____. 2000. A short history of medical ethics. New York: Oxford University Press.Google Scholar
  16. Kennedy, I. 1981. The unmasking of medicine. London: Allen and Unwin.Google Scholar
  17. Miles, S.H., L.W. Lane, J. Bickel, R.M. Walker, and C.K. Cassel. 1989. Medical ethics education: Coming of age. Academic Medicine 64(12): 705–714.Google Scholar
  18. Moore, G.E. 1959. Principia ethica. Cambridge: Cambridge University Press.Google Scholar
  19. Mormann, T. 2007. Carnap’s logical empiricism, values, and American pragmatism. Journal of General Philosophy of Science 38(1): 127–146.Google Scholar
  20. National Center for Medical Legal Partnership. 2017. The need for medical legal partnership. http://medical-legalpartnership.org/need/. Accessed February 25, 2017.
  21. Nickens, H.W. 1984. The scientific status of psychiatry within medicine. Journal of the National Medical Association 76(7): 699–703.Google Scholar
  22. Parker, M. 2009. Two concepts of empirical ethics. Bioethics 23(4): 202–213.Google Scholar
  23. Parker, M., L. Willmott, B. White, G. Williams, and C. Cartwright. 2015. Medical education and the law: Withholding/withdrawing treatment from adults without capacity. Internal Medicine Journal 45(6): 634–640.Google Scholar
  24. Porter, R. 1997. The greatest benefit to mankind. A medical history of humanity from antiquity to the present. London: Harper Collins.Google Scholar
  25. Preston-Shoot, M., and J. McKimm. 2010. Prepared for practice? Law teaching and assessment in UK medical schools. Journal of Medical Ethics 36(11): 694–699.Google Scholar
  26. ____. 2011. Towards effective outcomes in teaching, learning and assessment of law in medical education. Medical Education 45(4): 339–346.Google Scholar
  27. Putnam, H. 2002. The collapse of the fact/value distinction and other essays. Cambridge MA: Harvard University Press.Google Scholar
  28. Royal College of Physicians and Surgeons of Canada. 2005. CanMEDS 2005 Framework. http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/framework/the_7_canmeds_roles_e.pdf. Accessed November 21, 2016.
  29. Searle, J.R. 1995. The construction of social reality. London: Penguin.Google Scholar
  30. Shelton, W. 2013. A new look at medicine and the mind-body problem: Can Dewey’s pragmatism help medicine connect with its mission? Perspectives in Biology and Medicine 56(3): 422–441.Google Scholar
  31. Stirrat, G.M., C. Johnston, R. Gillon, and K. Boyd (on behalf of the Medical Education Working Group of the Institute of Medical Ethics and associated signatories). 2010. Medical ethics and law for doctors of tomorrow: The 1998 Consensus Statement updated. Journal of Medical Ethics 36(1): 55–60.Google Scholar
  32. White, B., L. Willmott, C. Cartwright, M.H. Parker, and G. Williams 2014. Doctors’ knowledge of the law on withholding and withdrawing life-sustaining medical treatment. Medical Journal of Australia 201(4): 229–232.Google Scholar
  33. White, B., L. Willmott, G. Williams, C. Cartwright, and M. Parker. 2016. The role of law in decisions to withhold and withdraw life-sustaining treatment from adults who lack capacity: A cross-sectional study. Journal of Medical Ethics 43(5): 327–333.Google Scholar
  34. Willmott, L., B. White, C. Cartwright, M.Parker, G.M. Williams, and P. Neller. 2016a. Doctors’ perspectives on law and life-sustaining treatment: Survey design and recruitment strategies for a challenging cohort. Progress in Palliative Care 24(4): 213–220.Google Scholar
  35. Willmott, L., B. White, M. Parker, C. Cartwright, and G. Williams. 2016b. Is there a role for law in medical practice when withholding and withdrawing life-sustaining medical treatment? Empirical findings on attitudes of doctors. Journal of Law and Medicine 24: 342–355.Google Scholar

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2018

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of QueenslandBrisbaneAustralia
  2. 2.Law SchoolQueensland University of TechnologyBrisbaneAustralia
  3. 3.School of Population HealthUniversity of QueenslandBrisbaneAustralia
  4. 4.Southern Cross UniversityLismoreAustralia

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