Medicine, Health Care and Philosophy 2: 239–254, 1999. © 1999 Kluwer Academic Publishers. Printed in the Netherlands. Teaching medical ethics: A review of the literature from North American medical schools with emphasis on education D.W. Musick Department of Physical Medicine and Rehabilitation, College of Medicine, University of Kentucky, Lexington, KY 40536-0284, USA Abstract. Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow. A literature review focused on medical ethics education among North American medical schools reveals that instruction in ethics is considered to be vitally important for medical students. Agreement by medical educators on a possible “core curriculum” in ethics should be explored. To develop such a curriculum, “deliberative cur- riculum inquiry” by means of a targeted Delphi technique may be a useful methodology. However, the literature reveals that medical curricular change is notoriously slow. General implications for medical ethics education as a discipline are discussed. Key words: medical ethics, curriculum development, medical education Introduction Within the past thirty years, the subject of ethics has become an established part of the curriculum at most medical schools in North America. Interest in the legal and ethical aspects of medicine has increased due to technological advances made in such areas as genetics, human reproduction, organ donation and life-sustaining treatment methods (Miles et al., 1989; Steinberg, 1995). Other topics which have deepened the interest of the medical profession in ethics are the medical malpractice crisis, changes in health care reimbursement policies, and the emergence of a “patient as consumer” model and its resulting effect(s) on the physician-patient relationship (Hafferty and Franks, 1994). The goal of medical ethics education has been described as endowing physicians with “practical wis- dom”, or an ability to realize the importance of values in the management of patient care (Loewy, 1986). The editor of a leading journal in academic medi- cine today agrees: “all of us need help confronting the limits of medical control and the tangled choices presented by medical successes . . . we need wisdom, not knowledge alone, and wisdom is the realm of ethics” (Caelleigh, 1989). An impressive array of med- ical educators, politicians, and social scientists have increasingly called for U.S. medical schools to give more attention to instruction in diverse topics such as ethics, law, philosophy, human behavioral sciences, and humanities (Ryan, 1994; Bok, 1984; Hatfield, 1994; Petersdorf, 1989; Petersdorf and Turner, 1995). In light of these pleas for ethics education to be emphasized, medical schools world-wide have taken up this challenge. All Canadian medical schools now provide ethics instruction as part of their training of physicians (Baylis, 1991). The World Health Organ- ization has issued specific calls for renewed emphasis on ethics instruction (Walton, 1993). More recently, Steinberg has stated that “the teaching of biomedical ethics is currently recognized by almost all medical schools in western countries as a specific branch within the study of medicine” (1995). These developments indicate that progress is being made. Yet, equally obvious is the fact that much remains to be done. A 1994 national survey of U.S. medical school graduates reveals that some 60% felt that time devoted during their training to ethics and legal medicine was inad- equate (“Teaching Family Violence: Mixed Reviews”, 1995). It is doubtless still true in many medical schools that ethics instruction is perceived as “soft, non-verifiable, and . . . separate from the technical con- siderations of medicine” (Loewy, 1986). Examples of specific educational programs in med- ical ethics are plentiful. It must be realized, however, that “the success of any format will be contingent . . . on the nature, history, and interests of the institution into which it is introduced” (Jonsen, 1989). In most