Executive Summary

There is a mismatch between the reproductive issues that bioethics educators consider most important and the ethical dilemmas that physicians actually face in daily practice, according to a recent Hastings Center report. The authors recommend the following:

• that the bioethics and medical communities work together to develop appropriate content in bioethics curricula;

• that clinical consultation be more fully integrated into the practice of reproductive medicine;

• that bioethics programs gather additional data on areas of relevance to practicing physicians.

 

There is a mismatch between the reproductive issues that bioethics educators consider most important and the ethical dilemmas that physicians actually face in daily practice, according to a recent Hastings Center report.1

Researchers conducted parallel surveys of directors of graduate bioethics training programs and obstetrician-gynecologists (OB/GYNs) in order to learn whether reproductive health education in bioethics programs reflected real-life concerns for practicing physicians. They found a mismatch between what was covered in bioethicist training programs and the realities of clinical practice.

“In many ways it wasn’t surprising. But it gave specificity to a problem we had discussed amongst ourselves as scholars of reproductive ethics,” says Michelle L. McGowan, PhD, associate professor of women’s studies and bioethics at the Pennsylvania State University in University Park.

The bioethics graduate program directors reported prioritizing these topics: assisted reproductive technology, theories of reproductive ethics, prenatal genetic testing, and abortion ethics.

The physician sample, which was drawn from the American Medical Association’s database of practicing OB/GYNs, had a different set of priorities. “They focused on abortion and prenatal testing, and also topics such as sexuality and contraception, which are very rarely covered in standard bioethics curriculum,” says McGowan.

Bioethics programs typically spend a lot of time on controversial cases that make headlines. “But most of medicine is not practiced in those cutting-edge areas. We need to be more aware of the routine concerns that face practicing physicians” says Jessica Berg, JD, MPH, one of the study’s authors. Berg is a professor of law and bioethics at Case Western Reserve University in Cleveland.

Practicing physicians are mainly focused on fundamental areas such as pregnancy termination, contraception, infectious disease, and sexuality, says Berg. These topics aren’t prioritized in bioethics programs; in some cases, they’re not covered at all. “Even where there was agreement, in most areas the priority assigned by bioethics programs was at odds with the priority assigned by physicians,” says Berg.

The researchers recommend that:

• Bioethics programs gather additional data on areas of relevance to practicing physicians.

• Specialty groups review course coverage. For instance, the American College of Gynecology might create priority lists of reproductive topics based on members’ experiences.

“Bioethics training directors should be more cognizant of problems facing practicing clinicians,” says McGowan. “And there should be more cross-talk between these entities.”

Bioethics programs might invite more clinicians to give guest lectures, in order to give students a sense of the real-world problems practitioners are facing. Bioethics students could also do clinical shadowing to understand how reproductive medicine and ethics come up in everyday practice.

Rather than focusing solely on the exceptional cases, bioethics programs should also cover “the ethics of the mundane,” says McGowan. “Things like contraception and post-menopausal health get very scant attention in bioethics curriculum now, but often arise in the clinical context.”

Reference

  1. Farrell RM, Metcalfe JS, McGowan, ML, et al. Emerging ethical issues in reproductive medicine: Are bioethics educators ready? Hastings Center Report, 2014; 44: 21–29.

SOURCES

• Jessica Berg, JD, MPH, Professor of Law and Bioethics, Case Western Reserve University, Cleveland, OH. Phone: (216) 368-6363. Fax: (216) 368-2086. Email: jessica.berg@case.edu.

• Michelle L. McGowan, PhD, Associate Professor, Women’s Studies and Bioethics, The Pennsylvania State University, University Park, PA. Phone: (814) 865-5480. Email: mlm73@psu.edu.