Goelen G, Rigo A, Fontaine C, Wanrooij B, De Grève J
Department of General Practice, Vrije Universiteit Brussel, Brussels, Belgium.
J Cancer Educ. 2001 Spring;16(1):12-4. doi: 10.1080/08858190109528716.
Considerations of moral problems in palliative medicine often deal with extreme situations. This study identified moral issues arising in routine palliative medicine. Their relevance for the education of European general practitioners is assessed.
Consecutive consultations of cancer patients with incurable disease were recorded in three outpatient clinics and one general practice in Belgium. Moral issues were identified by qualitative analysis of verbal transcripts of 30 of these consultations using the grounded-theory approach. The relevance of these issues for medical education was assessed by interviewing one educator of general practitioners from each of the 15 European Union states.
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 relevance of these issues was recognized by the educators. The suggested educational methods to deal with these topics were all active learning processes in small-group settings but varied otherwise.
The moral issues identified in day-to-day palliative medicine may complement the problems evoked in the literature dealing with more extreme situations. An effort to study the appropriate way for medical education to deal with these topics may be indicated.
姑息医学中对道德问题的考量常常涉及极端情况。本研究确定了常规姑息医学中出现的道德问题，并评估了这些问题对欧洲全科医生教育的相关性。
在比利时的三个门诊诊所和一个全科诊所记录了患有不治之症的癌症患者的连续会诊情况。采用扎根理论方法，通过对其中30次会诊的言语记录进行定性分析，确定道德问题。通过采访来自15个欧盟国家的每位全科医生教育工作者，评估这些问题对医学教育的相关性。
确定了道德问题的三个核心类别：讲真话、患者自主与医学主导以及处理患者的生活世界。教育工作者认识到这些问题的实际相关性。针对这些主题建议的教育方法均为小组环境中的主动学习过程，但在其他方面有所不同。
日常姑息医学中确定的道德问题可能补充了文献中所提及的更极端情况下引发的问题。或许有必要努力研究医学教育处理这些主题的恰当方式。
