Survey on today’s dilemmas in healthcare

Excerpted from "Life-and-Death Decisions That Keep Doctors Up at Night," Medscape. December 15, 2014 — Few professions invoke such a sweeping array of ethical questions as medicine. Although ethics may factor into life-and-death decisions, they can also play a role in everyday decision-making, such as whether or not to accept a lunch invitation from a pharmaceutical representative or ask a former patient on a date. On many of these issues, physicians are sharply divided.

Although six 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. Still, a passionate minority (31%) protest that assisted suicide violates the Hippocratic Oath.

When it comes to owning a harmful error that would affect a patient, 9 out of 10 (91%) of doctors say honesty is the only policy. Despite this near unanimous consensus, 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. Others acknowledge that in a perfect world, they would step forward, but are less inclined to do so in light of the danger of malpractice suits.

When it comes to accepting perks, most doctors are adamant that they cannot be "bought." Nearly 6 out of 10 (59%) say that perks, such as meals and speaking fees, won't sway their decisions. Many regard restrictions on interactions with pharmaceutical representatives as "puritanical." Still others (30%) say that although they like to believe they couldn't be swayed, they recognize that data indicate otherwise and therefore oppose such interaction.

Commentary

Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM: “Medscape recently distributed a survey to more than 21,500 physicians from the U.S. and Europe asking their opinions or practices on several dilemmas in clinical and professional ethics. The results are interesting and varied, but we must be cautious in interpreting these results. Decisions about right and wrong are not a matter of a majority vote. Perhaps your mother, like mine, taught me that, ‘Just because everybody is doing it doesn’t make it right.’

“There have been numerous reports of physician surveys on the legalization of physician-assisted suicide (PAS), and we know results vary depending on the wording of the question. Recent surveys in the U.S. show that 35 to 55 percent of physicians support legalization of PAS; physician support has consistently been higher in Europe. The most recent comparable international survey found 65 percent opposed legalization. Importantly, when some surveys asked about personal beliefs rather than public policy, a large majority (about 75 percent) of physicians have said that they would be unwilling to participate even if it were legal. In addition, in at least one survey a large majority said they believed it would be impossible to ensure protection from abuse.

“Physician opinions about honesty in reporting harmful errors not surprisingly show the great divide between the moral ideal versus the reality of human psychology. It reminds me of the ongoing struggle Paul describes in Romans 7. The survey results suggest that the moral ideal persists in regard to conflicts of interest (i.e., most physicians believe their practices cannot be altered by accepting ‘perks’ from vendors). However, empiric research consistently shows the opposite. One fascinating study showed that only 2 percent of respondents felt gifts from pharmaceutical reps influenced their prescribing practice, though 30 percent of the same sample believed those same gifts influenced their colleagues. It’s the Pharisee (‘God, I thank you that I am not like other people…’) versus the tax collector (‘God, have mercy on me, a sinner’) (Luke 18:9-13, NIV 2011).

“Whether you rely on Paul, Luke or my mother, don’t take the Medscape survey results too seriously.”

Resources

Physician-Assisted Suicide Fact Sheet
CDD STAT Interview with Kara Tippetts
CMDA Ethics Statement on Industry Relationships