Friday, April 01, 2005

U.K. Should Have Clinical Ethicists in Hospitals As Well

An article appears in today’s British Medical Journal (BMJ) arguing for the presence of clinical ethicists in U.K. hospitals in order to provide more ethical guidance to doctors. The article points out several interesting items:

1) Although doctors receive ethical training during the course of their education, that training is cursory and insufficient in providing them with a good foundation that may be used in assessing ethical dilemmas faced on a day-to-day basis. Further, there’s little time for doctors to receive more training while in school given the already long and exhausting education period.

2) Although hospitals have Ethics Committees (EC), not all doctors feel comfortable enough or have time enough to approach these ECs. The article emphasizes that most novice doctors feel uncomfortable seeking out guidance as it reveals their ignorance.

3) Most hospitals in the U.S. have full/part-time clinical ethicists in order to bridge the gap noted above, and to provide training and guidance to doctors and others on the front lines of health care.

4) Based on these points, the article argues that U.K. hospitals should employ clinical ethicists.

Some thoughts on these:

In respect to point #1, I wonder if there are other venues that provide a crutch for ethical training while the doctors serve out their residency? That is, ought we not look at the larger picture, outside of formal training? So, although doctors don’t receive formal ethics training of the detail noted by the author, I’m sure they interact with more experienced doctors who provide them with guidance. Of course, I wouldn’t be surprised if these discussions occur only when presented with an ethical quandary…and thus, at times too late.

I do, however, understand that there is no feasible way to increase the amount of ethical training doctors receive during their education. I wonder though, whether that training could be improved upon. Perhaps made to be more interactive by presenting students with situations that commonly occur in practice and have them decide in some dialectical method.


Blogger The Food-Guy said...

Wow...I hope you're wrong that there isn't a way to increase the amount of ethical training med students/residents receive. Of course, that may just be due to the fact that I'm working on my doctorate in education focussing on ethics education in medical school. I do think that what you allude to at the end of your post is the way to go. Getting more class time for overt, ethics-only education is virtually impossible. I think the way to go is to weave ethical considerations throughout the medical school curriculum.

I think that the key is to teach med students to approach ethics in the same way that they approach medicine...a plan of care approach. Anticipate issues, develop ways to address them and keep an eye on what the possible effects of a treatment could be. This sort of approach wouldn't really require more class time for teaching ethics to the exclusion of other things it would highlight the fact that ethical considerations and issues are a part of pretty much every medical decision made.

April 03, 2005 3:23 PM  
Blogger Bioethics Dude said...

Chris, you're totally on. Nothing will be accomplished in a vacuum. Thanks for reading and posting! Keep comin' back. --BD.

April 04, 2005 11:04 PM  

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