Results of a Norwegian survey published in the Journal of Medical Ethics shows an existing discord between the number of ethical dilemmas faced by doctors in clinical practice and individuals taught at the academic level, primarily based on the variation among practicing physicians regarding what many consider an ethical dilemma.
Data were collected from a postal survey of clinicians in the Norwegian Medical Association (n=1261) from 2014 to 2015. Investigators asked physicians whether they perceived specific clinical examples as an ethical dilemma (eg, prescribing placebos, ritual circumcision, prescribing addictive drugs, performing an abortion, etc). In addition, investigators questioned voluntary participants regarding priority setting, personal responsibility for health, and physicians work and health.
Female physicians were more likely than male physicians to support abortion referrals, referring lesbian couples to in vitro fertilization, or prescribing an intrauterine device with abortive capability. General practitioners were also more likely to see little ethical dilemma in prescribing antibiotics or accepting gifts from patients when compared with specialist physicians. A vast majority of surveyed physicians (65%) reported that concealing a major medical error would be considered an ethical dilemma vs 1% who were unsure.
There was greater variation among physicians with regard to whether legal physician-assisted suicide would be ethical, with 65% reporting that they would not perform this task vs 23% who reported that they didn’t know one way or the other. Approximately 72% of physicians considered ritual circumcision of boys to be an ethical dilemma. Only 9% of physicians said they would not perform force-feeding in a patient with anorexia vs 29% who didn’t know; up to 61% of doctors considered this task to be ethically challenging.
Limitations of the study include the use of a cohort of Norwegian doctors, which limits generalizability, and the reliance on questionnaire data which is prone to social bias.
The investigators suggest “structuring discussions of dilemmas according to the conflicts that arise between 2 or more of the roles described…can be a fruitful way to handle demanding situations.”
Bringedal B, Isaksson Rø K, Magelssen M, Førde R, Aasland OG. Between professional values, social regulations and patient preferences: medical doctors’ perceptions of ethical dilemmas. J Med Ethics. 2018;44(4):239-243.