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  • Print publication year: 2001
  • Online publication date: February 2015

Prologue. Breaking the silence


Hardly a week passes that print and news media fail to herald emerging dilemmas in medicine, whether it be the future of genetic testing, human cloning, or new technologies in assisted reproduction. Consequently, the expanding world of biotechnology and the ethical problems it raises are part of common conversations everywhere, and medical trainees are apt to be more familiar with their complexities and nuances than they are with the issues that confront them daily as they struggle to become physicians.

Unfortunately, the bioethics literature does not serve the everyday needs of trainees well. Although books on bioethics have proliferated rapidly, as did the bioethics curricula for doctors in training over the past 25 years, few resources address the key ethical dilemmas that student doctors face as they enter the clinical wards. Instead, the focus is typically on the meaning and application of bioethics principles, or a variety of moral theories, with emphasis on such issues in patient care as: foregoing life-sustaining treatment, access to health care, allocation of resources, euthanasia, abortion, impaired newborns, etc. Important as these issues are, the dilemmas posed are essentially beyond the scope of trainees' decision making and choice points whose moral struggles continue, for the most part, unnoticed and unaddressed. On the wards theories and intellectual debate, so stimulating in a classroom, are eclipsed or disappear altogether in an atmosphere of time pressures.