In Reply

Medical Ethical Knowledge and Moral Attitudes Among Physicians in Bavaria by Jana Wandrowski, Dr. rer. nat. Tibor Schuster, Wolfgang Strube, Prof. Dr. med. Florian Steger in Heft 8/2012

We are delighted about the interest taken by our correspondents, who have written letters to the editor and approached us directly with their queries.

We agree with the correspondents of the first readers’ letter, that a need exists for communicating and teaching knowledge of medical ethics. The selected topics, which have far reaching consequences for patients, have already highlighted fundamental insecurities in dealing with medical ethical questions. Using case examples takes into account the complexity of clinical ethical problems and uses as examples situations from clinical practice. Furthermore, as the correspondents themselves describe, they contribute to the consolidation of knowledge and to correcting inaccuracies. We defined the term “medical ethical knowledge,” and our definition is much wider than the authors described.

The second correspondent’s comments relating to the prognoses are understandable in the sense of “preservation of life,” but they acknowledge only one dimension of physicians’ fundamental objectives. The statement that the patient would naturally want life-preserving measures until the prognosis is clear is just that, a statement. It is problematic and confirms many patients’ fears of “high-tech medicine developing a momentum of its own.” Whether life-preserving measures are beneficial for a patient depends on many factors—for example, quality of life and attitudes to life—and should therefore be up to the patient’s discretion. Our correspondent rightly states that for medical measures, a legally competent patient’s consent is needed, but this is also true for life-preserving measures. If the patient cannot actually speak and give consent then the patient’s wishes, in whatever form these have been expressed, are the crucial issue. As has become obvious again, physicians’ personal values and moral attitudes play an important part. They affect not only the way in which the informed consent process is handled but also the patient’s own decision-making process. Moreover they influence the treatment options that will be offered by the physicians.

DOI: 10.3238/arztebl.2012.0666

Jana Wandrowski

Prof. Dr. med. Florian Steger

Martin-Luther-Universität Halle-Wittenberg

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Wandrowski J, Schuster T, Strube W, Steger F: Medical ethical knowledge and moral attitudes among physicians in Bavaria. Dtsch Arztebl Int 2012; 109(8): 141–7.