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Good medical ethics can be practised in a variety of ways, and case discussion is one of those: but do we get the best out of these conversations? Busy clinicians will usually stop to focus on a case: it is part of the culture and is one of the ways medicine has progressed. But cases seem less commonly published now than when the JME started. I should like to examine case discussion in the early years of the JME , to see what it contributed that was different, and then think about the future. Where has case discussion got to now? Where might it go?
To make my case about cases, I need to begin near the beginning: that is, for my generation of early enthusiasts, 40 years ago.
Medical ethics discussion in the early '70s
I can still hear his intake of breath behind my left shoulder as I pinned up a notice: the first medical ethics debate to be held in the doctors' mess. The neurologist's sardonic smile under half moons and curly grey hair were all of a piece. "Higgs, when I hear the word 'ethics' I reach for my golf clubs." He turned on his heel and was gone, leaving the corridor as empty as my chances of getting a reference.
Of course there were many seniors then in Britain who could see the gaping holes in medical education as well or better than us newcomers, and great leadership and encouragement was given by them to us across schools and disciplines: but as students many of us wanted to be directly involved in discussing the issues we came across, more constructively than we could round the student bar. Within the medical ethics groups then forming, opportunities were increasing. 1 Papers were circulated, and out of these arose a collection series named 'Documentation in Medical Ethics'. Though the ideas were sharp, the ethics were usually not, and so at last in 1975 a journal was founded. At a time when there was no medical ethics shelf in the university bookshop, and very little indeed on ethics at all, the JME 's first editor, Alastair Campbell, had already broken the ice with a book of his own. 2 We were not short...