Moral issues in day-to-day palliative medicine and their relevance for the education of European general practitioners.
BACKGROUND
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.


METHODS
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.


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 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.


CONCLUSIONS
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.
Department of General Practice, Vrije Universiteit Brussel, Brussels, Belgium.
G
G
Goelen
A
A
Rigo
C
C
Fontaine
B
B
Wanrooij
J
J
De Grève
D005060:Europe; D005194:Family Practice / Q000193:education*; D006801:Humans; D009014:Morals; D010166:Palliative Care