Strange Bedfellows: How Medical Jurisprudence Has Influenced Medical Ethics and Medical Practice

Citation

Smith, I. (2003), "Strange Bedfellows: How Medical Jurisprudence Has Influenced Medical Ethics and Medical Practice", Journal of Health Organization and Management, Vol. 17 No. 6, pp. 473-473. https://doi.org/10.1108/14777260310506632

The easiest and initial comment about this book would be that it is American. Because this is American the casual reader might be tempted to leave it on the shelf. American medical practice is bedevilled with the risk and occurrence of litigation. European and English medical practitioners may therefore feel that this book is of limited value. However, I disagree.

As a teacher of health care ethics and a paediatrician, but not a philosopher nor a lawyer, I agree with Ben Rich's opening arguments that much of the discussion about medical ethics has been forced on us as clinicians by the activity of the courts. Hardly a week goes by in England without some legal judgment over a contentious medical ethics issue. Philosophers might like to think that they have changed medical practice but I suggest that change has been forced on us by not only the law, but also media pressure. There may be good philosophical arguments why we should behave in a better way towards our patients and the general public but I suspect that the pace of change has been forced on us. Discussing hard cases and general theory or principles with junior medical colleagues confirms that there remains an implementation gap between the classroom and the bedside.

This book attempts to illustrate how in the USA, medical practice has been influenced by the law. English readers should now contemplate the future of practice if and when a English Supreme Court is established. Unfortunately, since there is not a written English Constitution, I suspect that it will be less potent as a driver for change than in the USA.

The book has its short statutory discussion about moral theory and derived principles. It does go on to discuss more clinical matters which often form the basis of hard choices, for example, abortion, living wills and informed consent. The writing style, like most good American academic texts, is clear, unambiguous and easy to follow.

It is a great shame for UK medical practitioners that we do not have a similar book for English, Scottish and European law.

This is a book that I will recommend to more enthusiastic students.