Medscape Ethics Survey: Life-and-Death Decisions Keeping Doctors Up at Night

Survey of 21,000 Physicians Reveals Similarities and Differences in Attitudes on Challenging Ethical Issues

Dec 17, 2014, 11:05 ET from Medscape

NEW YORK, Dec. 17, 2014 /PRNewswire/ -- Newly released findings of a biannual survey about medical ethics revealed that, when it comes to having a romantic relationship with a patient or disclosing mistakes, there is near universal alignment of opinion among physicians.  However, when it comes to other challenging ethical issues, such as physician-assisted suicide, abortion, and withholding information from a patient, physicians are largely divided and in many cases, conflicted.  Questions about these and many other ethical issues, spanning everyday dilemmas and life-and-death decisions, were posed to more than 21,000 U.S. and European physicians across 25 different specialties by Medscape, the leading source of health information for healthcare professionals.

"This is a very important and unique survey, as ethics is the focus," said Arthur Caplan, PhD, founding director of the Division of Medical Ethics at New York University's Langone Medical Center. "This is a huge sample of physicians' ethical attitudes and behaviors on a variety of emerging and often controversial topics."

Divided Opinions

Physician-Assisted Suicide

Although five U.S. states have laws permitting physician-assisted suicide, doctors—like much of the general public—are deeply divided over the issue.

A slim majority of doctors (54%) say they favor allowing physician-assisted suicide, commenting that patients have a right to a dignified death in the face of incurable illness.  Support among physicians for assisted suicide has increased in recent years.  When asked the same question in 2010, only 46% of physicians expressed support.   European physicians are more equally divided on the issue, with 41% supporting physician-assisted suicide and 41% in opposition.

Performing Abortions

Regarding abortion, 44% of physicians say they would perform an abortion, even if it were against their personal beliefs, while 41% said they would not. The responses were consistent for both male and female physicians. When asked if late-term abortions should be legal, only 23% responded "yes," while 41% responded "no" and 36% said "it depends."

Random Drug-and-Alcohol Testing

Doctors were divided regarding their attitudes toward random testing for drug-and-alcohol abuse, with 39% of physicians saying "yes" and 43% stating "no." 

Similar Attitudes

People With Unhealthy Lifestyles Should Pay More for Insurance  

More than two-thirds (69%) of respondents say patients who practice unhealthy behaviors – such as smoking or poor diet – and ignore treatment recommendations, should pay more for health insurance. Fewer than 1 in 5 (18%) flatly oppose factoring behavior into the cost equation.

Doctor-Patient Romantic or Sexual Relationships

The vast majority of doctors (99%) responded that it is not acceptable to have a romantic or sexual relationship with a current patient. This percentage was the same when Medscape asked the question in 2010.  Physicians are not as strongly opposed to starting a romantic or sexual relationship with a patient when the factor of time is introduced.  According to the survey, 22% of physicians said starting a relationship is acceptable when 6 or more months have elapsed since the time they stopped treating a patient, which is up from 2010, when only 12% physicians expressed support.  

Disclosure of Physician Mistakes

About 9 out of 10 physicians (91%) believe that it is never acceptable to cover up or avoid revealing a mistake that would harm a patient. Only 6% of respondents say there are, or could be, situations in which it would be acceptable to cover up or fail to disclose a mistake.

Unnecessary Procedures to Generate Income

An overwhelming majority of doctors (91%) stated they would not do a medical procedure that's unnecessary to generate income.

Domestic Abuse

The survey findings provide interesting perspective in light of recent headlines. The majority of doctors (89%) surveyed said that they have suspected domestic abuse, but have not reported it, in many cases, because proof was lacking and often because patients denied the situation.

Physicians Conflicted

Providing Life-Sustaining Therapy – Futility

When confronted with the question of whether or not to provide life-sustaining therapy in futile situations, 19% said they would provide it even if they believed it to be futile, while 46% said they might do so depending upon the circumstances. Doctors who provided written comments offered outside factors, including the wishes of the patient and family members, such as helping people "come to grips" with the situation.

Medical Resource Allocation: Younger vs. Older

Is age a factor when determining medical resource allocation? When asked a theoretical question about whether they would ever allocate scarce or costly resources to a younger patient rather than an older one, roughly 4 in 10 (38%) responded unequivocally, "no." One-quarter (26%) said they would, but even more (36%) said they might, depending upon the situation. The youngest physicians surveyed (between the ages of 28 and 34) were the most likely to respond either "yes" (32%) or "it depends" (37%), while the oldest (those 70 and older) were the least likely to respond "yes" (22%) or "it depends" (34%).

Withhold Information – Family Request

Would physicians withhold information from a patient at the family's request? Almost half (49%) stated "it depends," while 39% said "no," and 12% said they would. Some considerations impacting doctors' decisions: if illness has impaired a patient's judgment or cognition. 

Click to view the 2014 Medscape Ethics Report slideshow, Part 1: Life, Death and Pain.
Part 1: http://www.medscape.com/features/slideshow/public/ethics2014-part1 

On Monday, December 22, Medscape will publish part two of its 2014 Ethics Report, which explores physicians' attitudes and behaviors about money, romance, and patients.

WebMD/Medscape Ethics Survey Methods

Medscape physician members and nonmembers from the United States and Europe were invited to participate in an online survey. Sample Size: 21,531 physicians across 25+ specialties met the screening criteria. Respondents participated from September 18 through November 12, 2014. The margin of error for the survey was +/- 0.72% for the U.S. sample and +/- 1.55% for the European sample at a 95% confidence level.

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SOURCE Medscape



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