Development of Bioethics and Clinical Ethics in Bulgaria

Abstract

Background: Bioethics and clinical ethics emerged from the classical medical ethics in the 1970s of the 20th century. Both fields are new for the Bulgarian academic tradition. Aim: The aims of this paper were to demarcate the subject fields of medical ethics, bioethics, and clinical ethics, to present the developments in the field of medical ethics in Bulgaria, to delineate the obstacles to effective ethics education of medical professionals, and to present the results of the application of an adapted bottom-up methodology for clinical ethics consultation in several clinical units in Bulgaria. Materials and methods: Extended literature review and application of an adapted METAP methodology for clinical ethics consultation in six clinical units in the Northern Bulgaria between May 2013 and December 2014. Results: Teaching of medical ethics in Bulgaria was introduced in the 1990s and still stands mainly as theoretical expertise without sufficient dilemma training in clinical settings. Earlier studies revealed need of clinical ethics consultation services in our country. METAP methodology was applied in 69 ethics meetings. In 31.9% of them non-medical considerations affected the choice of treatment and 34.8% resulted in reaching consensus between the team and the patient. Participants’ opinion about the meetings was highly positive with 87.7% overall satisfaction. Conclusion: Development of bioethics in Bulgaria follows recent worldwide trends. Several ideas could be applied towards increasing the effectiveness of ethics education. Results of the ethics meetings lead to the conclusion that it is a successful and well accepted approach for clinical ethics consultation with a potential for wider introduction in our medical practice.

Conhecimento sobre ética médica e resolução de conflitos na graduação

“…In the case involving medical records and its confidentiality, the difference in correct answers between G1 and G2 was less than 2.5%, justified by passive learning of the entire sample in emergency rooms, outpatient clinics, hospitals and even on group talks between professionals and colleagues 2,4,7,28 . However, deficiencies in formal ethics teaching are visible, being insufficient for the learning of a subject so complex 1,2,30,32 .…”

“…However, this research revealed low overall performance of G1, which, when added to the cases of superior performance of G2, shows that the instruction of students, even among those who attended at least one of the two disciplines that address medical ethics, is insufficient to deal with other dilemmas. To reverse this situation, medical ethics should be addressed in more than one moment in graduation, facilitating the clinical application of the concepts learned 1,2,[30][31][32]39 . The university where this research was conducted seeks to correct this flaw with the inclusion of the academic discipline Medical Ethics and Communication Skills.…”

“…The medical curriculum should be complemented by round tables, lectures, summer courses and direct experience exchanges among professionals, since the greater the exposure to ethics content, the better the learning and solving of dilemmas. Thus, medical ethics should be included in the student's daily life since his or her university entry, going through all his or her academic education [1][2][3][4] , encompassing medical residencies 5 and along the professional practice 6 .…”

“…It is necessary, in addition to longer time of contact with the theme, that diversified methods be used in the learning process. There are several nontraditional teaching resources that can be applied in this case, such as movies, dilemma scenarios, casuistry, stagings, theatre plays, simulations, video conferences, seminars, lectures, workshops and case discussions 1,3,5,[29][30][31][32]34,38,39,41 .…”

“…In the health area, the professional's ability to solve dilemmas is often challenged, and it is essential to know guiding principles of ethical conduct. Thus, it is necessary to study medical ethics from the beginning of the medical course, advancing during the internship [1][2][3][4] , medical residency 5 and the practice of profession 6 . Ethics is part of philosophy and constitutes rational knowledge based on three main pillars: the first one involves awareness or perception of conflicts; the second deals with the autonomy and ability of the individual to position himself or herself between reason and emotion; and the third is based on the coherence of the individual 3,7 .…”