Moral issues in day-to-day palliative medicine and their relevance for theeducation of European general practitioners

Background. Considerations of moral problems in palliative medicine often d eal with extreme situations. This study identified moral issues arising in routine palliative medicine. Their relevance for, the education of European general practitioners is assessed. Methods. Consecutive consultations of c ancer patients with incurable disease were recorded in three outpatient cli nics and one general practice in Belgium. Moral issues were identified by q ualitative analysis of verbal transcripts of 30 of these consultations usin g the grounded-theory approach. The relevance of these issues for medical e ducation was assessed by inter-viewing one educator of general practitioner s from each of the 15 European Union states. Results. Three core categories of moral issues were identified: telling the truth, patient control versus medical dominance, and handling the patient's life-world. The practical re levance of these issues was recognized by the educators. The suggested educ ational methods to deal with these topics were all active learning processe s in small-group settings but varied otherwise. Conclusions. The moral issu es identified in day-to-day palliative medicine may complement the problems evoked in the literature dealing with more extreme situations. An effort t o study the appropriate way for medical education to deal with these topics may be indicated.