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Ethical dilemmas: How education is shifting with bioethics

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With changes in patient confidentiality and health care access, the landscape of bioethics is shifting — but so are the educational programs that cover it. Medical ethics education programs have traditionally focused on issues like end-of-life choices, palliative care and informed consent directives, but new challenges facing health care and fiercer legal pressures affecting practitioners are giving rise to a greater need for bioethics education among those working in the field.

Colleges have responded in kind. Bioethics education programs ranging from one-day workshops to full-scale doctoral programs have spread like wildfire in both online and brick-and-mortar formats, with more students enrolling every day. Georgetown University, for example, recently announced that its "Introduction to Bioethics" massive open online course has attracted more than 25,000 enrollees across 155 countries.

"Most of the bioethics that we think of kind of grew up in an era where we were talking about patient rights, patient autonomy, physician choice in treatments or recommendations," says Dr. Bruce White, director of the Alden March Bioethics Institute at Albany Medical College in New York. "Now we're concerned about justice, fairness, equality — particularly with access to care and distribution of scarce resources."

Ethics training and malpractice

Currently, only a small handful of states require practicing doctors to earn continuing education credits specifically in ethics, but further training is often preferred for those in physician, caregiving and administrative roles across a wide array of health care organizations. That's in part because ethics education is arguably more crucial now than ever, particularly in light of the uptick of medical malpractice suits that have hit physicians and caregivers in recent years.

A physician practicing today has a one-in-14 chance of having a malpractice suit filed against them in any given year, according to a study published in the New England Journal of Medicine in 2011. In specialties like general surgery, thoracic-cardiovascular surgery and neurosurgery, the odds more than double. What's perhaps more disturbing is that many never see it coming. In a survey of about 1,400 physicians who were sued for medical malpractice, nearly three out of four were surprised by the suit, reports the Medscape Malpractice Report.

This makes educating health care professionals — not only about what ethical issues they may face, but also on the associated professionalism, communication and risk management skills they'll need — all the more important, says Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus in Denver.

"These are things like how to talk to patients if there's been an adverse event," he says. "... If a mistake was made — or even if a mistake wasn't made but someone had a worse outcome than they expected — how to structure that conversation, who needs to be there, how do you broach those topics in a sensitive way, being honest with patients about what happened and if there's something that you're going to do differently moving forward, being explicit about apologizing. That's been a big issue recently."

There are also numerous new ethical issues involving confidentiality, cost sharing and patient protection as part of the Affordable Care Act that health care workers will need to address both professionally and legally. A study by the RAND Corporation released in April estimates that the Affordable Care Act changes may increase the volume of malpractice suits by up to 5 percent in some states, because insured patients are statistically more likely to file claims than uninsured ones. However, several economists and medical experts have debated these estimates.

Educating the health care community

Physicians and surgeons aren't the only students heading back to the classroom for bioethics refresher courses. Dr. Aviva Katz, director of the Consortium Ethics Program at the University of Pittsburgh, says that her school's continuing ed classes are also populated with nurses, social workers and those in organizational roles.

"More and more we're seeing hospital administrators come through the program, … and it's not just hospitals," she says. "It's long-term care facilities. It's health plans where we're really primarily speaking to people in organizational or administrative roles. We can speak to all of those needs."

There certainly are more bioethics education curricula now than in years past, but not all are created equal. Katz recommends that working adults who are thinking about further education seek out programs that offer a practical education and can highlight current issues working professionals face.

"You want to look at who the faculty is," she says. "Does the faculty have a background in ethics? Especially if you're a health care provider and you're primarily a clinician, it's nice to know that at least some of the faculty also has a background in clinical medicine or nursing so that they can bring you the perspective from the field."

Sources:

"How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs," David I. Auerbach, Paul Heaton and Ian Brantley, RAND Corporation, April 2014,
http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR493/RAND_RR493.sum.pdf

"Georgetown's Online Intro to Bioethics Set to Begin Next Week," Georgetown University, April 8, 2014,
http://www.georgetown.edu/news/bioethics-mooc-launches-2014.html

"Malpractice Risk According to Physician Specialty," Anupam B. Jena, Seth Seabury, Darius Lakdawalla and Amitabh Chandra, New England Journal of Medicine, Aug. 18, 2011,
http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

"Medscape Malpractice Report: The Experience of Getting Sued," Leslie Kane, Medscape, July 24, 2013,
http://www.medscape.com/features/slideshow/malpractice-report/public#1

Dr. Aviva Katz, Director of the Consortium Ethics Program at the University of Pittsburgh, Interviewed by the author, April 30, 2014

Continuing Medical Education for MDs/DOs, Texas Medical Board,
http://www.tmb.state.tx.us/page/resources-cme-for-md-dos

Dr. Bruce White, Director of Alden March Bioethics Institute at Albany Medical College, Interviewed by the author, April 30, 2014

Dr. Matthew Wynia, Director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus, Interviewed by the author, April 30, 2014