Values, Ethics and Health Care

Duncan, P. Values, Ethics and Health Care . London : Sage . 2010 . Ix+157pp. $37.95 (E-book) ISBN 978-1-84920434-7 £60.00 (hbk) ISBN 978-1-41292351-4 . £19.99 (pbk ) ISBN 978-1-41292352-1 . Values, Ethics and Health Care is billed as something of a ‘textbook’ or guide to the topic aimed at undergraduate students in the healthcare and allied healthcare professions. Some of the comments included on the publisher’s website suggest that it will also be of interest to the postgraduate and/or practitioner. While I have no reason to disagree with these suggestions, the book repeatedly raises a single question: how do we teach values to students of the healthcare professions? This question or varieties of it are scattered throughout the recent history of medical education, usually appearing under the rubric of teaching the art, in contrast to the science, of medicine. What originated (in their modern form at least) as questions regarding the teaching of a good bedside manner developed into a more specific concern with the teaching of communication skills and then into one of medical ethics and law. Modern research into medical education began in the postwar era and has increased dramatically in volume, purpose and nature between the 1980s and the present day. Running alongside ‘curricula’ developments has been a trend towards a generalised ‘reflective’ pedagogical approach. Research into medical education is a diverse endeavour not only in that its authors may be clinical or, increasingly, non-clinical medical educators but also in that they may be operating as medical outsiders and may be working from any number of disciplinary perspectives such as education, sociology, anthropology, history; applied ‘empirical’ ethics; and psychology, not to mention the various subfields of these disciplines and the increasing practice of interdisciplinarity. Duncan’s book is an interesting representation of some of these general trends in modern medical education. The book and its chapters are explicitly structured around reflection with regular ‘question boxes’ prompting readers to examine their own thoughts, feelings and (potential) practices. There is a chapter devoted to historical perspectives and, following two chapters on ‘standard’ perspectives on medical ethical thinking, one which takes in professional codes and how they might be understood to relate to the character or virtuous individual practitioners. The developments in medical education over the past 20 years have exposed the inadequacy of teaching medical ethics from a perspective of applied ethics which is necessarily basic. Whilst philosophy has been central and essential to the development of modern professional, medical and healthcare ethics we have realised that treating medical students as if they were philosophy students is an error. Initial responses to this realisation, in the UK at least, were along the lines of vertical and horizontal integration of ethics education, and a great deal has been learned by medical educators and medical ethicists from these experiences. However there is now a number of developing approaches to ethical and moral education in medical and healthcare which aim at further engagement. The as yet predominantly US phenomenon of ‘professionalism’ is one such strand as is a turn to the medical humanities, particularly history, literature and drama, in undergraduate medical education. Duncan’s book adopts a third approach of having a central focus on the place of values in healthcare. Talk of values is often amorphous and uncertain. The relative neglect of virtue theory and neo-Aristotelianism in medical ethics and medical education is testament to both this and to the medical profession’s preference for philosophical ethical objectivity embodied in rules, principles or utilitarian calculations. The impact of reflective education and practice has been to undermine medical certainty and to promote self awareness. In the sphere of medical ethics the medical profession is beginning to acknowledge that it necessarily has an evaluative aspect, like Bosk’s analysis of non-directive genetic counselling, reflective education is giving lie to the fact of a morally neutral medical profession or healthcare practice. Duncan’s book is a direct attempt at encouraging such engagement on the part of professionals in training, practising professionals and the professions as institutions. On the whole Values, Ethics and Healthcare successfully facilitates and prompts reflection in a number of relevant areas. It cannot, of course, circumvent the inherent uncertainty of what it might mean for a profession or professionals to adopt x, y or z as a central value for their practice. This latter point reveals perhaps the difficulty in making a textbook seemingly designed to prompt individual reflection. Values must be seen as social or cultural phenomena; an aspect of the medical field. Whilst some professionals reading this book may take their reflections to work and discuss their thoughts with colleagues, for others the reflective activity prompted by the book may merely serve to reinforce their existing perspectives. This, of course, may not be a bad thing but it is a limitation for the individual reader. The book is very much structured around what should, ideally, be group or classroom based discussions or exercises in reflection. This indicates the use that some of the readership of Sociology of Health and Illness may find for this book which, strangely, is not openly promoted by the publisher. For those of us who take classes or convene courses on ethics for medical students, postgraduate students or under the rubric of continuing professional development, Values, Ethics and Healthcare offers some interesting examples which might be appropriated as readings or discussion points by those seeking to refine or develop their courses

Curriculum · Health care · Medical education · Medical ethics · Medical humanities · Pedagogy · Political science · Rubric · Sociology · Ethics in medical practice · Law · Medicine · Psychology

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