As an example, in end-of-life care, a family may resist additional treatment for a patient's pneumonia, which is normally not controversial to treat, because they believe the loved one has suffered enough. Yet the doctor may feel additional care is important because pneumonia is treatable with antibiotics. Improved communication may help everyone agree on what the goal of care should be and then understand what may facilitate that goal.
For students in training, the biggest challenge may be handling the feeling of uncertainty when they realize there are different, legitimate answers to the questions they encounter in clinical care settings.
"Students may feel unsettled. However, medical ethics is not only about asking and exploring questions but also about decision-making. Choices have to made one way or another. In clinical care, you can't just sit back and have a discussion with no follow-up action," Kaldjian said.
Instruction focuses on teaching students a way of reasoning that acknowledges there are different ways to judge what is a right answer. The students also are taught how to articulate their reasons for making decisions.
"Ethical decision-making is a complex mix of medical details and ethical values. Doctors have an easier time discussing medical details and are less familiar with articulating ethical values. Our approach helps them with this second task, especially when there are ethical disagreements," Kaldjian said.
"At the very least, we have to let each other know the basis of our disagreements, otherwise decision-making styles can be paternalistic and based more on a physician's position and power than on ethical reasons," he added.
The Hippocratic Oath stressed commitment to the patient and the patient's good -- an important and still meaningful part of today's modern physician oaths -- but it did not promote a patient's autonomy or rights.