Foreword to the book by Professor Godfrey Laferla, Dean, Faculty of Medicine and Surgery, University of Malta

The Faculty of Medicine and Surgery has given increasing importance to Ethics, Law, Communication and the human side of medical practice. Doctors today are not expected to be competent physicians only; it is well known that the quality of the doctor-patient relationship affect the morale and outcome of illness. Moving to a more and more technology-oriented medical practice, it is easy to be happily amazed, losing sight of what really counts – the person. As the author Prof. Pierre Mallia points out, one cannot study medicine, let alone surgery, without patients.

The clinical encounter is as important as the symptoms and signs elicited – that is why many patients already feel good once the doctor has seen them. In fact, good communication and correct ethical practice are a human endeavour and not simply rules to go by. In the book Bioethics and Clinical Ethics, from theory to practice the author points out that whilst biomedical ethics is the foundation of clinical ethical practice, it remains theoretical and moreover cannot be applied without the contextual nature of the patient, and indeed the doctor-patient relationship. As pointed out in the text, pharmacology is also mostly theoretical and based on scientific research, but it is the doctor who has to decide, based on the clinical picture when and how to use the drug. The relationship between bioethics and clinical ethics is defined in the same way. While bioethics is done by social science, philosophy and to an extent theology, these professionals can only give theoretical knowledge. On the clinical side it is the doctor who takes ethical and legal responsibility when and where to apply this theory.

The book is invaluable for students wishing to supplement lectures. It goes through most of the issues concerning ethics, and ethical codes, but throughout there are examples to illustrate how clinical ethics is applied to a case. It is not enough to be pro-choice or pro-life, for example; one has to know how to tackle a patient requesting an abortion, treating her like any other patient – the doctor may be the first person she is speaking with – and ask relevant questions. A chapter on communication skills helps to show how questions of an ethical nature can use the tools of history, examination and management in questions of an ethical nature.

While communication and ethics go together, the broader picture of how we can identify problems and dedicate meaning to our lives by leading change is interesting in its own right and comes through the author’s experience in the end-of-life Erasmus+ Project, EndCare, hosted by the Bioethics Research Programme of the Faculty of Ethics and Surgery.

There are two levels of clinical ethics – that which each doctor uses in his or her daily practice, using even the history-taking as a skill to build rapport; then the more specialist practice of a clinical ethicist, called in to help with dilemmas in health care. The latter need not be a doctor, but certainly has to work with patients themselves and not from an armchair. But this book is mostly about the former and will hopefully help the reader in understanding better the nature of ethics in healthcare. It is hoped that this book serves doctors and people in any way involved in healthcare, including patient groups, carers and patients themselves, to better understand the practice, besides the theoretical nature of clinical ethics.

Copies available from www.kitegroup.com.mt and leading bookstores