Jean-Philippe Cobbaut

Preparing students to deal with and tolerate uncertainty or ambiguity is a major issue in medical education. There are many English-language scales to assess tolerance of uncertainty and ambiguity but no French-language scale has ever demonstrated validity evidence for its scores. We selected the Tolerance of Ambiguity in Medical Students And Doctors (TAMSAD) scale. Through a structured process, the original questionnaire was translated, culturally adapted, and assessed after being administered to a sampling of medical students. Test-retest reliability was verified by presenting the questionnaire to the students again after two months. The assessment of internal consistency revealed satisfactory value. Test-retest reliability is assessed by intraclass correlation that presents good reproducibility of scores obtained by students in first completion and second completion. These results indicate that the French version of the TAMSAD scale can be used to assess French medical students’ tolerance to ambiguity.

À partir d’une analyse détaillée, y compris historique de la dynamique de nos systèmes de soins, la première partie de ce texte entend montrer à la fois que les succès, les difficultés ou les contre-performances de ces systèmes configurent largement les questions éthiques qui s’y posent aujourd’hui et rendent difficile la conception d’une éthique collective dans le domaine des soins de santé. Sur base de ce constat, la deuxième partie de ce texte plaide pour une conception globale de l’éthique de l’accès aux soins, qui puisse réellement relever les défis actuels de cette question. Ce plaidoyer repose lui-même sur une analyse critique des différentes justifications éthiques de l’égalité d’accès aux soins et des discours en termes de limites et de rationnement, pour se terminer par le souhait d’une autre rationalisation des systèmes de soins, du développement d’une éthique contextuelle, notamment en milieu hospitalier, et d’un renforcement de la démocratie sanitaire.

Clinical ethics committees (CECs) have been developing in many countries since the 1980s, more recently in the transitional countries in Eastern Europe. With their increasing profile they are now faced with a range of questions and challenges regarding their position within the health care organizations in which they are situated: Should CECs be independent bodies with a critical role towards institutional management, or should they be an integral part of the hospital organization? In this paper, we discuss the organizational context in which CECs function in Europe focusing on five aspects. We conclude that in Europe clinical ethics committees need to maintain a critical independence while generating acceptance of the CEC and its potential benefit to both individuals and the organization. CECs, perhaps particularly in transitional countries, must counter the charge of “alibi ethics”. CECs must define their contribution to in-house quality management in their respective health care organization, clarifying how ethical reflection on various levels serves the hospital and patient care in general. This last challenge is made more difficult by lack of consensus about appropriate quality outcomes for CECs internationally. These are daunting challenges, but the fact that CECs continue to develop suggests that we should make the effort to overcome them. We believe there is a need for further research that specifically addresses some of the institutional challenges facing CECs