Medical ethics teaching programs at the University of California, San Francisco, and the University of Washington.

The author describes the comparative dearth of scholarship and literature on medical ethics in 1972 when he began designing an elective lecture-discussion course at the School of Medicine, University of California, San Francisco (UCSF). He traces the development of ethics teaching at that school and of his conviction that medical cases must be the focus of ethics education, not merely as illustrations but as the matrix of the ethical problems encountered and their resolution. Eventually, a required fourth-year course was developed that focused upon four essential aspects of medical cases: medical indications, patient preferences, quality of life, and external socioeconomic factors. This course and its evaluation--including inherent quandaries of evaluating ethics teaching--are described; he attributes the success of the course to the appropriateness of the four-part format for analysis and the support and participation of leading members of the medical faculty. Throughout this description of the UCSF program are short descriptions of the additions to the bioethics literature that were made during the mid- and late 1970s. The author then describes the present ethics teaching program at the University of Washington School of Medicine, where he has taught since 1987, and the intriguing and perhaps innovative possibilities for expanding and redefining that program.