American Journal of Law & Medicine

The Jay Healy technique: teaching law and ethics to medical and dental students.(Symposium Dedicated to Joseph "Jay" Healey)


Health law and medical ethics are both integral parts of undergraduate medical curricula. The literature has addressed the importance of teaching law(1) and ethics(2) separately in medical school settings, yet there have been few descriptions of teaching law and ethics together in the same curriculum. A combined program in law and ethics required for first-year medical and dental students was developed and implemented by Professor Joseph (Jay) M. Healey, Jr.,(3) at the University of Connecticut Schools of Medicine and Dental Medicine from 1975 until his death in 1993. This Article describes the thirty-hour, interactive, case-based course he created.(4) The course, Legal and Ethical Aspects of Medicine and Dental Medicine (LEA), has continued after Jay's death, and is one of his many legacies to us. LEA consists of fifty-six actual and hypothetical cases written by Jay from which basic legal and ethical principles are extracted by participants and reinforced by instructors. The course provides medical and dental students with an understanding of the legal and ethical underpinnings of the decisions they make as professional health care providers and individuals, and enables them to gain experience in applying the basic principles of law and ethics to practical problems in health care.(5)

The first section of this paper describes courses in law and ethics in medical schools in the United States and Canada. Law and ethics are each defined, and the interrelationship of the two in the context of health is described. The second section discusses the LEA course itself, including benefits, objectives, description and content, class structure, assignments, and examinations. In section III Baby Boy Doe v. Mother Doe(6) is used to demonstrate how Jay used cases to examine legal and ethical issues in health care. Finally, section IV discusses implementing such a program and makes recommendations for adapting this and similar courses to the conditions that will exist as we move toward the year 2000.


Of 108 United States medical schools reporting data, nine, or eight percent, teach Law and Medicine as a required course.(7) Sixty schools, or fifty-six percent, report that health law is taught as part of an existing, required course.(8) An analysis of 129 United States medical schools' self-reported lists of electives reveals that seventy-one, or fifty-six percent, offer health law as an elective.(9)

Most aspects of health law are suffused with ethical considerations.(10) Medical ethics is set aside as a separate educational category in the curriculum directory of the Association of American Medical Colleges. Forty-three of the 108 reporting U.S. medical schools, or forty percent, offer medical ethics as a separate required course;(11) sixty-six schools, or sixty percent, offer medical ethics as part of a required course;(12) and 113, or eighty-eight percent, of the 129 U.S. medical schools provide courses in medical ethics as an elective.(13)

While both health law and medical ethics are vital parts of the medical school curriculum, it is useful to distinguish between the two as they are applied to medical education and, ultimately, practice. Ethics is the study of behavior and moral obligation in the context of established ethical principles.(14) There are at least three related applications of the term "medical ethics."(15) First, medical ethics refers to professional codes and oaths such as those of Hippocrates, the American Medical Association, and the American Dental Association. Second, medical ethics is used in the evaluation of moral issues in medicine and dental medicine and is concerned with what a physician or dentist ought to do in the provider-patient relationship. Third, medical ethics is applied in the institutional setting. The institution in which the health professional will practice, whether hospital, nursing home, or other health facility, may also have an established institutional code of ethics.

Health law is the law related to the delivery of health care; it defines the rights and responsibilities of the individuals involved. Many aspects of health care in general, once considered to be solely matters of ethics, are now the subject of legislation, litigation, and regulation. For example, informed consent is now a legally recognized principle of the provision of medical care in the United States and is no longer simply an ethical obligation.(16) A system of third-party private payers, as well as Medicare and Medicaid, has propagated more regulation of the delivery of medical care. Whether the result of case law or statutory regulation, legal issues in medicine increasingly affect physicians and medical practice.(17) Thus, it is imperative that physicians be educated during their training about what the law requires of them and their profession.

Legal analysis is a valuable tool for patient advocacy.(18) The study of basic legal principles encourages caring for all segments of the population, particularly disadvantaged groups. Instruction in medical law and its rationale is essential for the practice of medicine.(19) Physicians need to be familiar with reports they may be legally obligated to file, types of testimony they may need to give, or potential suits in which they may be involved. Courses in medical school should utilize a formalized decision-making model that takes into account the interests of all affected parties.(20) Such instruction can go a long way toward fulfilling the recommendation of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to educate students to value the patient as a full participant in medical decision-making.(21)

Although the legal and ethical aspects of medicine can be taught separately, they become enmeshed in the fabric of each case. Much of the subject matter of law as applied to medicine raises ethical dilemmas, and many of the ethical questions raised in medical cases contain legal elements.(22) In medicine, the basic legal and ethical principles of justice, autonomy, and beneficence are applied to areas of complex decision-making, including life and death decisions.(23)

Incorporating ethical principles into legal interpretation encourages respect for patient dignity and autonomy. In an era of increasing technology and attention to biomedical issues, ethical principles blended with basic health law should serve future physicians as resources for decision-making.(24) The trend towards health care reform increases the need for education of physicians about both ethics and the law. To balance the physician's duty to advocate for individual patients against increasing pressure to serve health care initiatives, physicians need clear guidelines for ethical analysis of the issues.(25)

There is an inherent relationship between medicine and ethical decision-making. It is therefore advantageous to integrate the teaching of law in medicine with medical ethics. The areas where law and ethics overlap should be a focus of educational programs in medical schools. Indeed, in health care, legal and ethical issues that arise throughout the entire life span need constant analysis. Such topics as confidentiality, informed consent, truth telling, malpractice, abortion, contraception, and issues at the end of life are infused with both legal and ethical concerns and are crucial to a law and ethics curriculum. In addition, since the law defines almost everything a doctor does in practicing medicine, it seems essential that practitioners understand the law's framework for decision-making.



In addition to LEA, which is the cornerstone of the law and ethics program at the University of Connecticut Health Center, there are other courses offered in law or ethics, all of which were developed and implemented by Jay Healey. A six-hour segment of a core course on social and behavioral sciences taken during the first year explores the interrelationship of the law and medicine. In addition, three of the six clinical clerkships (primary care, obstetrics and gynecology, and surgery) have required sections that examine legal and ethical issues arising during the students' clinical experiences.(26) A seminar, "Analyzing Legal and Ethical Issues in Medicine," is also included in the curriculum as a fourth-year elective. Furthermore, the program provides an extensive curriculum for residency training that addresses specific interests of residents in law and ethics. Finally, five law courses are offered in the Masters of Public Health program. These may be taken advantage of by medical students, residents, faculty, practicing physicians, and staff.


Legal and Ethical Aspects of Medicine and Dental Medicine, offered in the first year of medical and dental school training, is important for several reasons. First, the practice of medicine and dental medicine, as well as the pursuit of scientific research, are imbued with ethical and legal dimensions.(27) Second, society, which supports the training of health professionals and gives them their mandate, expects them to understand and respect the ethical and legal dimensions of their work.(28) Third, practitioners and researchers who understand the ethical and legal dimensions and have developed a framework for decision-making are better able to avoid errors that might result in breaches of their ethical and legal obligations.(29) Fourth, such individuals and researchers are also better prepared to participate actively in the formulation of health care policy. …

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