Read in one way the title of this chapter is a plea. Not more medical ethics! This plea may have a reactionary voice. Not everyone is an enthusiast for the new growth industry which is medical ethics. Yet it may also have a progressive voice. Even among those who are supportive of medical ethics there is a suspicion that, growth industry or not, at the end of the day it will add rather little to the actual practice of medicine.

In this chapter I want to explore the possible contribution to medical ethics of linguistic or conceptual analysis, in particular as this has been concerned with the distinction between fact and value. Some may consider this a philosophically old-fashioned approach. Others may believe that it is too theoretical to be practically useful. However I hope to show that followed through with sufficient determination it can help to bring medical ethics closer to the contingencies of everyday clinical work.

Conceptual difficulties in medicine

The belief that medical ethics has relatively little practical relevance is a facet of what has become known as the medical model. This model is called ‘medical’ because it is the model (or picture) of medicine that is adopted more or less consciously by most doctors. It amounts to the idea that medicine is essentially a science, and hence that the problems with which doctors are concerned in their everyday clinical work are, at heart, empirical.