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J R Soc Med. 2005 September; 98(9): 435–436.
PMCID: PMC1199651

Taking an ‘ethics history’

In 2001 my colleagues and I published an article in the Journal of Medical Ethics entitled ‘The value of taking an “ethics history”.’1 In this article we coined the term an ‘ethics history’, to describe a series of questions that could be used as an addendum to medical history taking in a clinical context. These questions were:

  1. Do you know much about your illness?
  2. Would you like further information?
  3. If a member of your family approached us to find out what was wrong with you would you like us to tell them?
  4. Do you think we should ask you first?
  5. If something serious was wrong with you, would you want us to tell you (or someone else) or would you prefer not to know?
  6. If you needed risky treatment would you want to decide for yourself? If not who should decide?
  7. Very occasionally patients have what is called a cardiac arrest... Usually doctors decide what to do, but some patients prefer to decide for themselves. Would you like to make this decision? Would you like us or a family member to decide?
  8. Some people have advance directives or living wills. Have you heard of this?
  9. If so are there any such directives that you would want us to know about?

We took this history from 56 competent patients, and showed that taking an ‘ethics history’ is a simple and not particularly time-consuming way of obtaining useful information about patients' preferences. That was why we did not need to question its value in the title.

The June JRSM included an article by Das and Mulley entitled ‘The value of an ethics history?’2 in which these authors suggest that an ‘ethics history’ could be taken in an outpatient setting. They propose/offer seven key questions which incorporate (with minor modification) all of the questions from our original article, yet no acknowledgment of the source is given. They also fail to acknowledge the source of their idea—an ‘ethics history’—although the title of their article is virtually peeled off ours.

I would appreciate an explanation for these irregularities.


1. Sayers GM, Barratt D, Gothard C, Onnie C, Perera S, Schulman D. The value of taking an ‘ethics history’. J Med Ethics 2001;27: 114-17 [PMC free article] [PubMed]
2. Das AK, Mulley GP. The value of an ethics history? J R Soc Med 2005;98: 262-6 [PMC free article] [PubMed]
2005 September; 98(9): 435–436.

Authors' reply

Our review was inspired in large measure by the original work of Dr Sayers and her colleagues, to which we did refer. Somehow, in the course of repeated redrafting, we lost the passage that made clear our aim—to echo their recommendations and offer further points for consideration. We apologize unreservedly for this error.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press