Purpose. To identify ethical issues that interns encounter in their clinica
l education and thus build a more empirical basis for the required contents
of the clinical ethics curriculum.
Method. The authors analyzed a total of 522 required case reports on ethica
l dilemmas experienced by interns from September 1995 to May 1999 at the me
dical school of Vrije Universiteit in Amsterdam. They identified four regul
arly described and numerous less frequently described topics.
Results. The interns addressed a wide range of ethical themes. In 45% of th
e cases, they mentioned disclosure or non-disclosure of information and inf
ormed consent; in 37%, medical decisions at the end of life; in 16%, medica
l failures; and in 9%, problems transferring patients from one caregiver to
another. The interns also identified 27 themes linked to their unique posi
tion as interns and 19 themes related to specific types of patients.
Conclusion. Based on self-reported experiences, the authors conclude that c
linical ethics teachers should reflect on a multitude of dilemmas. Special
expertise is required with respect to end-of-life decisions, truth telling,
medical failures, and transferring patients from one caregiver to another.
The clinical ethics curriculum should encourage students to voice their op
inions and deal with values, responsibilities, and the uncertainty and fail
ings of medical interventions.