Complex Medical Ethical Problems

Abstract

Jana Wandrowski et al. published an informative article on physicians’ knowledge and awareness of medical ethics. On the basis of our experience in patient care as well as continuing medical education in medical ethics, we think that some additional comments are warranted. Better ethics in clinical practice requires more training in medical ethics. Even though one might intuitively agree that this hypothesis expressed by the authors is correct, the presented empirical data are too weak to support such a far-reaching statement. Others have rightly pointed out that the method used by the authors, of questions with predefined responses on a scale, does not do justice to the complexity of medical ethical problems (1). The superficial case description given in the questionnaire can test merely knowledge of the terminology of medical ethics, but does not promote deeper understanding of ethical positions. In contrast to the authors’ assertions, non-insertion of a percutaneous endoscopic gastrostomy (PEG) tube does not automatically equate to passive assistance in dying since patients can also be fed intravenously. The term “passive assistance in dying” is actually outdated. The article lacks a clear definition for the term “medical ethical knowledge”. The authors’ tacit understanding is led by the topic and focuses exclusively on autonomy. The subject of medical ethics entails more than just autonomy. Physicians’ ethical positions partly change as their professional experience grows. This finding is made clear in the study. Since we recognized this fact at an earlier stage, we initiated a special seminar course that is available to physicians (2). We agree with the authors in that an increased need for training exists at all levels of medical education in questions and problems in the area of medical ethics and law. The subject matter should be taught with the target audience in mind so that they can be applied in clinical practice.