Empirical medical ethics.

Three papers published in this issue describe empirical studies of one kind or another.' A look through recent volumes of the journal reveals several further examples. And yet there has been little explicit acknowledgement of this developing field of empirical medical ethics. I hear people talking of it, but the textbooks and the standard writings see medical ethics as almost exclusively a branch of philosophy. Is this empirical work unfortunate, taking medical ethics away from its true intellectual base in philosophy and leading to mediocre studies of little interest or significance? Is it a worthwhile activity, but not medical ethics? Or is it a healthy development in the maturing subject of medical ethics? I take the latter view. It is not that there is no more philosophical work that needs doing-quite the contrary-but empirical work will be an integral part of the development of the subject, perhaps in the same way that physics develops through a healthy relationship between theory and experiment. Almost fifteen years ago Raanan Gillon wrote Philosophical Medical Ethics.' The title was chosen, I suspect, to contradict the idea, then prevalent amongst clinicians, that ethics was simply a matter of common sense and experience. Gillon wanted to emphasise the importance of a proper philosophical approach-a set of academic skills with a secure intellectual base-which needed to be brought to bear on the increasingly complex and sophisticated field of medical ethics. What is needed is a sister volume: Empirical Medical Ethics. Why is the field of empirical ethics developing? I think there are several reasons why this field is developing now. Some developments in the methods of philosophical medical ethics are sympathetic to empirical issues. Narrative ethics, for example, emphasises the importance of the empirical details of the case or situation under discussion. The material for ethical analysis tends to be the details of real situations. Over the last thirty years a great deal has been done to clarify the contribution of philosophy to medical practice. This conceptual work has helped to delineate what are the relevant empirical issues. For example, the concept of advance directives raises important empirical questions to do with how such directives are best formulated, what their impact is, etc, etc. The multidisciplinary nature of medical ethics has meant that many of those working in the field have their principal academic background in the empirical sciences rather than in philosophy. Researchers interested in medical …