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T. Patrick Hill, MA
Red Bank, NJ

Arch Intern Med. 1995;155(21):2356.

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In reply

Unfortunately, Wright begs his central question. Few would deny that the personal values, beliefs, and attitudes of physicians are most important to the way they treat their dying patients. But what precisely are these values, beliefs, and attitudes? And is it enough that they are personal, as Wright asserts? It is not unheard of that personal attitudes, even personal values, are modified beyond recognition by institutional attitudes and values.

I believe, and the data concur, that the endemic inadequacy of education in the care of the dying is indicative of institutional attitudes and values, speaking far more persuasively than any exceptional physician educators, relying upon their individual beliefs, can.

That being the case, the conclusion is inescapable. Something in the way of effective education requires fundamental institutional beliefs against which individuals—teachers and students—can resonably test, confirm, change, and refine their personal beliefs. Fortunately, the growing clinical appreciation of . . . [Full Text PDF of this Article]

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