Medical students' cases as an empirical basis for teaching clinical ethics

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.