Ethics education and physician morality

Medical ethics education remains an important venue of moral education. In spite of the intensity of these efforts, the desired outcomes of medical ethics education remain obscure, undefined and largely untested. In the first part of this study, the goals of medical ethics are operationalized along cognitive, behavioral and attitudinal dimensions. This includes a written moral judgment test, a survey of ethical confidence, competence and interest, attitudinal surveys of physician assisted suicide, and aggressive treatment of newborns and, finally, self-reported behavior about the frequency of pro-bono work and treatment of self-abusive patients. Medical ethics education is operationalized by the type, scope and intensity of ethics education throughout a physician's education and subsequent career. Data were collected by a questionnaire distributed to the staff of a large urban hospital in 1996 (n=200, response rate=41%). Causal models measure the effects of medical education. The results suggest that ethics education plays an important but limited role in the attainment of these cognitive, attitudinal and behavioral outcomes. While some outcomes such as moral development, and ethical confidence are unaffected by ethics education, other attitudinal and behavioral objectives, such as ethics interest and pro-bono work are positively associated with formal ethics training as well as with demographic variables such as religious observance and age. Ethics education does not function as an isolated factor but as part of a web of interrelated factors that influence educational outcomes. In addition, it is clear that ethics education resists quantitative analysis to some extent. Rather, it is sometimes viewed as a discipline that is studied for its own sake with the hope that it may contribute to one's all around character in a way that cannot be directly assessed. These implications are explored in the conclusion of the paper.