The Ethics of Ambiguity

Understanding and embracing uncertainty are critical for effective teacher–learner relationships as well as for shared decision-making in the physician–patient relationship. However, ambiguity has not been given serious consideration in either the undergraduate or graduate medical curricula or in the role it plays in patient-centered care. In this article, the author examines the ethics of ambiguity and argues for a pedagogy that includes education in the importance of, and tolerance of, ambiguity that is inherent in medical education and practice. Common threads running through the ethics of ambiguity are the virtue of respect, and the development of a culture of respect is required for the successful understanding and implementation of a pedagogy of ambiguity.

[1]  Gail Geller,et al.  Tolerance for ambiguity: an ethics-based criterion for medical student selection. , 2013, Academic medicine : journal of the Association of American Medical Colleges.

[2]  I. Heath.  Illness and Culture in the Postmodern Age , 2000, BMJ : British Medical Journal.

[3]  D. Shapiro,et al.  UC Irvine UC Irvine Previously Published Works Title Coping with loss of control in the practice of medicine , 2022 .

[4]  J. Shapiro.  Philosophy, Ethics, and Humanities in Medicine Walking a mile in their patients' shoes: empathy and othering in medical students' education , 2022 .

[5]  G A Chase,et al.  Measuring Physicians' Tolerance for Ambiguity and its Relationship to Their Reported Practices Regarding Genetic Testing , 1993, Medical care.

[6]  E. Beresford,et al.  Uncertainty and the shaping of medical decisions. , 1991, The Hastings Center report.

[7]  Kathryn Wright.  The patient as teacher. , 2004, Journal of palliative medicine.

[8]  K. Pitkala,et al.  Tolerance of uncertainty and fears of making mistakes among fifth-year medical students. , 2012, Family medicine.

[9]  P. Haidet,et al.  Role Modeling Humanistic Behavior: Learning Bedside Manner from the Experts , 2006, Academic medicine : journal of the Association of American Medical Colleges.

[10]  G. Bordage,et al.  Student Uncertainties Drive Teaching During Case Presentations: More So With SNAPPS , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[11]  D M Eddy,et al.  Variations in physician practice: the role of uncertainty. , 1984, Health affairs.

[12]  D. Sklar.  Faculty supervision of residents--creating important moments of magic. , 2013, Academic medicine : journal of the Association of American Medical Colleges.

[13]  Simone de Beauvoir,et al.  The Ethics of Ambiguity , 1950 .

[14]  P. Slattery,et al.  Simone de beauvoir's ethics and postmodern ambiguity: The assertion of freedom in the face of the absurd , 1999 .

[15]  S. Crandall,et al.  Commentary: ambiguity and uncertainty: neglected elements of medical education curricula? , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[16]  A. Suchman,et al.  Uncertainty and control: learning to live with medicine's limitations. , 1993, Humane medicine.

[17]  C. Thi Nguyen.  An Ethics of Uncertainty , 2011 .

[18]  S. Budner.  Intolerance of ambiguity as a personality variable. , 1962, Journal of personality.

[19]  Mark J Graham,et al.  Role‐modelling in the operating room: medical student observations of exemplary behaviour , 2011, Medical education.

[20]  P. Teunissen,et al.  Opportunity or threat: the ambiguity of the consequences of transitions in medical education , 2011, Medical education.

[21]  V. Entwistle,et al.  Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care , 2013, The American journal of bioethics : AJOB.

[22]  M. Young,et al.  Residents as Role Models: Impact on Undergraduate Trainees , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[23]  Merold Westphal,et al.  Oneself as Another , 1994 .

[24]  L. Leape,et al.  Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[25]  W. Berry.  The Specialization of Poetry , 1975 .

[26]  R. Zaino,et al.  Preparing residents for practice. An opportunity to teach professionalism and communication skills as well as diagnostic criteria. , 2010, Human pathology.

[27]  Humility and respect: core values in medical education , 2014, Medical education.

[28]  J. Kimmelman.  Ethics, Ambiguity Aversion, and the Review of Complex Translational Clinical Trials , 2012, Bioethics.

[29]  J. Katz,et al.  Why doctors don't disclose uncertainty. , 1984, The Hastings Center report.

[30]  S. Wayne,et al.  The Association Between Intolerance of Ambiguity and Decline in Medical Students' Attitudes Toward the Underserved , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[31]  R. Epstein.  The Ambiguity of Personhood , 2013, The American journal of bioethics : AJOB.

[32]  Gerald B Healy,et al.  Perspective: a culture of respect, part 2: creating a culture of respect. , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[33]  P. Dobkin,et al.  Multiple influences contribute to medical students' well‐being and identity formation , 2014, Medical education.

[34]  J. Thornby,et al.  Uncertainties and ambiguities: measuring how medical students cope , 1994, Medical education.

[35]  E. John Orav,et al.  The Association of Physician Attitudes about Uncertainty and Risk Taking with Resource Use in a Medicare HMO , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[36]  J. J. Steinberg,et al.  Residency as Identity Transformation: The Life Stages of the Homo medicalis. , 2010, Journal of graduate medical education.

[37]  J. Proops,et al.  Humankind and the Environment: An Anatomy of Surprise and Ignorance , 1992, Environmental Values.

[38]  Etienne Mullet,et al.  Why do Primary Care Physicians in the United States and France Order Prostate-Specific Antigen Tests for Asymptomatic Patients? , 2003, Medical decision making : an international journal of the Society for Medical Decision Making.

[39]  C. D'Orsi,et al.  Radiologist Uncertainty and the Interpretation of Screening , 2004, Medical decision making : an international journal of the Society for Medical Decision Making.

[40]  G. Geller,et al.  Tolerance for ambiguity among medical students: implications for their selection, training and practice. , 1990, Social science & medicine.

[41]  D R Holtgrave,et al.  Physicians' Risk Attitudes, Laboratory Usage, and Referral Decisions , 1991, Medical decision making : an international journal of the Society for Medical Decision Making.

[42]  R. Gibbons.  The Poet's work : 29 poets on the origins and practice of their art , 1989 .