0
Correspondence |

Clinicians’ Competency in BioethicsResponse FREE TO VIEW

Alberto Giannini, MD
Author and Funding Information

Affiliations: Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy,  Johns Hopkins University, Baltimore, MD

Correspondence to: Alberto Giannini, MD, Pediatric Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientitico Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via della Commenda, 9, 20122 Milano, Italy; e-mail: a.giannini@policlinico.mi.it



Chest. 2007;131(5):1612-1613. doi:10.1378/chest.07-0205
Text Size: A A A
Published online

Carrese and Sugarman in their interesting article in a recent issue of CHEST (December 2006)1 concluded that “competency in bioethics is required to competently practice medicine,” but they also highlighted deficiencies in knowledge among clinicians and trainees in this respect.

The data and perspective they present are almost exclusively confined to the cultural context of North America. How is this issue addressed in Europe? For example, the European Society of Intensive Care Medicine has included knowledge of and skills in ethical aspects of intensive care medicine in the core curriculum for training.2 However, the practice is not yet in line with these recommendations in all countries.

For instance, two facts may shed light on the current situation in Italy. First, findings not included in an Italian survey published in 20033on ICU physicians’ attitudes regarding end-of-life decisions showed that 88% of physicians expressed interest in the ethical aspects of intensive care medicine, but only 12% had received any specific education in bioethics (and only 7% were interested in receiving any in the future), 7% regularly read articles or texts on bioethical subjects (while 60% did so only occasionally), and 17% attended conferences or debates on the subject (and only 13% were interested in doing so in future). Second, in the new curriculum for intensive care specialists in training that was specified in a 2005 reform,4 ethical issues have only an extremely marginal role.

In Italy too, therefore, physicians’ competency in bioethics cannot be taken for granted, as the level of education and updating of the knowledge of intensivists about ethical concerns still seems a long way from both the standards commonly proposed2,5 and from the idea of bioethics as an essential component of good clinical practice.1 Much remains to be done regarding education about ethics, and the new training curriculum for ICU physicians1 regrettably seems to have wasted the opportunity to fill this gap.

The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

The authors have no conflict of interest to disclose.

Carrese, JA, Sugarman, J (2006) The inescapable relevance of bioethics for the practicing clinician.Chest130,1864-1872. [PubMed] [CrossRef]
 
European Society of Intensive Care Medicine.. Guidelines for training in intensive care medicine.Intensive Care Med1994;20,80-81. [PubMed]
 
Giannini, A, Pessina, A, Tacchi, EM End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting.Intensive Care Med2003;29,1902-1910. [PubMed]
 
Ministero dell’Istruzione, dell’Università e della Ricerca. Riassetto scuole di specializzazione di area sanitaria; decreto ministeriale 1 Agosto 2005, Gazzetta Ufficiale 5 Novembre 2005, No. 258, supplemento ordinario No. 176; 5–8.
 
Singer, PA, Pellegrino, ED, Siegler, M Clinical ethics revisited.BMC Med Ethics2001;2,E1. [PubMed]
 
To the Editor:

We thank Dr. Giannini for making the point that education in bioethics as it relates to clinical practice is an issue of international importance. In his letter, Giannini points out the discrepancy between what the European Society of Intensive Care Medicine calls for in terms of bioethics training, and what, in fact, is happening in Italy with respect to a new curriculum for trainees specializing in intensive care. Interestingly, he also points out that while the great majority of Italian ICU physicians surveyed (88%) “expressed interest in the ethical aspects of intensive medicine,” only a small percentage (12%) had any education in bioethics. An even smaller percentage of ICU physicians (7%) indicated an interest in receiving education about bioethics in the future. With respect to efforts to make headway on education in this area, it will be important to understand the discrepancy between the physician respondents’ “expressed interest” in bioethics, which is high, and their interest in receiving more training in this area, which is low. In addition, understanding exactly why interest in additional education is low will be crucial to any attempts to involve and motivate learners.

With respect to Giannini’s point that the data and perspectives we present (related to deficiencies in bioethics knowledge and skill) “are almost exclusively confined to the cultural context of North America,” we agree that the empirical evidence we cite is primarily from studies conducted in North America. However, our reference number 5 is published in Acta Anaesthesiologica Scandinavica,1An International Journal of Anaesthesiology and Intensive Care, Pain, and Emergency Medicine; it is the official Journal of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. One of the coauthors of this article is based at a hospital in Switzerland, and one of the studies cited in this article, published in Lancet,2 was conducted in the United Kingdom by authors based at a hospital in London. In addition, we devote an entire section of our article to the importance of appreciating and skillfully attending to cultural diversity when addressing bioethical issues in clinical medicine, and we identify this as a core ethics educational goal in Table 2 of our article. The relevance of bioethics in clinical practice certainly extends to the global community, and we thank Dr. Giannini for emphasizing this point.

References
Manser, T, Staender, S Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure.Acta Anaesthesiol Scand2005;49,728-734. [PubMed] [CrossRef]
 
Vincent, C, Young, M, Phillips, A Why do people sue doctors? A study of patients and relatives taking legal action.Lancet1994;343,1609-1613. [PubMed]
 

Figures

Tables

References

Carrese, JA, Sugarman, J (2006) The inescapable relevance of bioethics for the practicing clinician.Chest130,1864-1872. [PubMed] [CrossRef]
 
European Society of Intensive Care Medicine.. Guidelines for training in intensive care medicine.Intensive Care Med1994;20,80-81. [PubMed]
 
Giannini, A, Pessina, A, Tacchi, EM End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting.Intensive Care Med2003;29,1902-1910. [PubMed]
 
Ministero dell’Istruzione, dell’Università e della Ricerca. Riassetto scuole di specializzazione di area sanitaria; decreto ministeriale 1 Agosto 2005, Gazzetta Ufficiale 5 Novembre 2005, No. 258, supplemento ordinario No. 176; 5–8.
 
Singer, PA, Pellegrino, ED, Siegler, M Clinical ethics revisited.BMC Med Ethics2001;2,E1. [PubMed]
 
Manser, T, Staender, S Aftermath of an adverse event: supporting health care professionals to meet patient expectations through open disclosure.Acta Anaesthesiol Scand2005;49,728-734. [PubMed] [CrossRef]
 
Vincent, C, Young, M, Phillips, A Why do people sue doctors? A study of patients and relatives taking legal action.Lancet1994;343,1609-1613. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543