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Ward ethics. Dilemmas for Medical Students and Doctors in Training
  1. R N J Graham
  1. rnjgraham{at}doctors.org.uk

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Edited by T K Kushner, D C Thomasma. Cambridge University Press, 2001, £18.95, pp 265. ISBN 0-521-66452-7

Kushner and Thomasma have assembled a distinguished group of contributors who are almost all practising clinicians with an interest in medical ethics. The book is well laid out and is divided into two main parts: part one “On caring for patients” and part two “On becoming a `team player’: searching for esprit de corps and conflicts of socialization”. This is a convenient way to think about medical ethics. Part one covers the ethical dilemmas of doctors caring for patients and the many practical problems that arise; this area of medical ethics is what most doctors would consider to be “true” medical ethics. Many doctors would not consider part two to be medical ethics at all, because once a person has fully undergone the process of becoming a medical professional they can lose sight of the ethics involved in professional interactions. This is not to say this area of medical ethics is not important, indeed, it is extremely important but is not often considered by doctors in their everyday practice. The medical student, however, is in a better position to evaluate the ethical problems arising in training and staff interaction because they have not yet fully undergone medical socialisation.

Each of the two main parts is further subdivided into sections. The first section of part one is performing procedures. This covers informed consent; the person performing the procedures when inexperienced; blaming the patient for your own shortcomings; doctor-patient confidentiality; the newly dead and their rights, and peer and senior support in caring for patients. The format within each subsection is identical throughout the book. One to five clinical cases are briefly described that will be instantly identifiable to any medical student or doctor. Two commentaries then follow, written by different contributors. These commentaries are in general well thought out, logically argued, and pitched so that someone with little or no prior exposure to medical ethics will be able to understand them. They tend to contradict one another in parts, which is one of the books strongest attributes in that it shows medical ethics to be a subject where debate is encouraged rather than a discipline where a prescriptive set of rules holds sway. Concluding each section is a set of thought-provoking discussion questions. The two further sections of part one are: (a) problems in truth-telling, which covers issues such as admitting mistakes to patients and omitting to tell patients salient facts and (b) setting boundaries, which explores doctor-patient professional boundaries, treating patients you don’t like, and the limits of a doctors compassion.

The second section of the book covers all aspects of professional behaviour, including: abuse (psychological, physical, and sexual); professional communication (jargon and humour); questioning authority and the status quo; whistle blowing; alcohol and drug abuse; mistreating patients; covering up, and misrepresenting research. These issues are rarely covered in medical education and it is to be hoped that through this book their profile will be raised in mainstream medical education. The second section is as equally well written as the first and the authors communicate their ideas well.

I think this book would make an excellent basis for a course in medical ethics for medical students. The course could be taught as a continuous module or a number of planned sessions throughout an academic year. Ward Ethics is also very suitable for trainee doctors, if not all doctors, and I would recommend it to anyone with the slightest interest in medical ethics.

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