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Globalisation and Contemporary Medical Ethics (ICM7108)

Module lead:  Dr Miran Epstein

The past four decades or so have seen the decline of local systems of medical ethics and their ongoing supersession by a single global new one, also known as ‘biomedical ethics’. The doctrine of informed consent, respect for the patient’s autonomy, the discourse on allocation of scarce resources, national and international oversight committees, and the academic-clinical discipline of bioethics - all are now accepted worldwide, reflecting a process of globalisation/harmonisation of medical ethics. This new globalised core ethic is supposed to regulate the relations both among health care providers—the state, the medical industry, health care and academic institutions, staff, and scientists—as well as between them and other stakeholders, notably the patient, the human researchee, and the public.

The module will take the student on a journey through seven major areas of contemporary medical ethics:
• consent and consensus
• medical confidentiality
• the discourse on distributive justice
• human and animal research ethics
• end-of-life ethics
• transplant ethics
• reproductive ethicsThe introductory presentation of each of these topics will be followed by a critical discussion on their possible history and on the theoretical and practical implications of the competing conclusions.

This module aims to:
• Construct general definitions of ethics and medical ethics and compare them with existing definitions.
• Construct a general historical theory of ethics.
• Show that medical ethics is actually being globalised, and to introduce its major elements.
• Show the critical advantage of a historical reflection on contemporary medical ethics over the traditional philosophical reflection.
• Present the major competing historical narratives concerning the emergence and evolution of the ethical transformation in medicine and assess the explanatory value of each.

This module differs from conventional modules on medical ethics in that it does not treat its object philosophically, but rather historically. Indeed, it attempts to define the ethical transformation in terms of both form and content, identify its social beneficiaries and victims, and provide competing historical explanations for its emergence and evolution.
The conclusions of the discussion will have no necessary philosophical, ie, justificatory, implications; however, they may cast a new counterintuitive light on the entire enterprise, and prompt us to reconsider our ethical and philosophical choices.

• Develop an understanding of the nature of contemporary medical ethics and its major features
• Develop an understanding of the competing historical theories concerning the emergence and evolution of the new ethics
• Develop an understanding of the theoretical and practical implications of the historical narratives
• Develop an understanding of the advantage of history over philosophy as a critical tool in studying, assessing, and doing medical ethics.
• Describe the relations between philosophy and medical ethics
• Explain the difference between philosophical and historical discourses
• Outline the conditions for a plausible historical theory of medical ethics

Key texts
• Jackson E. Medical Law: Texts, Cases and Materials. OUP 2006.
• Brazier M. Medicine, Patients and the Law. 5th ed. Penguin 2011.
• Jonsen A. The Birth of Bioethics. OUP 2003.
• Jonsen A. A Short History of Medical Ethics. OUP 2008.
• Stevens T. Bioethics in America: Origins and Cultural Politics. Johns Hopkins Press 2003.
• Epstein M. How will the economic downturn affect academic bioethics? Bioethics 2010; 24(5): 226–233.
• Hope T, Savulescu J, Hendrick R. Medical Ethics: The Core Curriculum 2nd ed. Churchill Livingstone 2008.

3,000 word essay style assignment (100%)

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