Edited by Thomasine K Kushner and
David C Thomasma

Cambridge University Press,
£18.95, pp 265
ISBN 0 521 66452 7
Rating: ***

In 1993 the General Medical Council published Tomorrow's Doctors which changed the face of medical education in Britain. The report, which was responsible for the introduction special study modules, also dictated that the teaching of medical ethics and law should become a core part of the undergraduate curriculum. It advises that students should acquire knowledge and understanding of the ethical and legal issues relevant to the practice of medicine in order to enable them to consider such problems appropriately when reaching decisions.

It is clear to all of us that there is a need to tackle such issues and provide students with a means of addressing concerns. However, as most of you will know, ethics teaching in this country focuses on more traditional dilemmas. End of life issues, consent to treatment, and the Mental Health Act are all valid concerns but of little use to the student who is asked to perform a rectal examination on an unconcious patient or instructed to undertake a new procedure unsupervised. Very little seems to be being done to address the things which are of a far more immediate concern to medical students.

Ward Ethics is seeking to fill this yawning gap. The editors are aiming “to break the silence that surrounds the daily dilemmas faced by trainees as they try to balance learning medicine, performing procedures and interacting with patients and col­ leagues.” Through a series of over 80 real life cases followed by comments from a panel of international experts from varied fields, the readers are intended to reach a position where they are empowered to draw their own conclusions. Although the cases are isolated incidents, the book addresses a huge range of topics which will be familiar to most clinical students, from performing procedures to the place of humour on the ward round to whistle blowing on colleagues. The commentaries are clear and present a variety of opinions. However, in many cases simple, textbook solutions are not necessarily the answer. With the introduction of continuous assessment at the end of every attachment how many students are going to feel able to stand up to their seniors, to report unethical behaviour, or refuse to carry out a procedure? While Ward Ethics is a step in the right direction for changing the student's lot, I think you will agree that there is still a long way to go.