Moral and ethical decisions come with the turf of being a doctor.
Some of those decisions have massive consequences that affect people's lives forever. Other ethical issues, although not life-and-death, have a huge impact on patient well-being as well as on doctors' careers and their own sense of integrity.
To find out what doctors would do if faced with those difficult situations, Medscape surveyed physicians' attitudes about some of the most frequent and wrenching ethical issues of our time. Over 10,000 physicians responded to the survey, which asked about end-of-life dilemmas; pain treatment; insurance reimbursement; colleague relations; withholding information from a patient with a terminal disease; patient privacy at the expense of other people; romantic relationships with patients; and others. The survey was fielded in August - September 2010.
Medscape also asked doctors, "What was your toughest ethical dilemma," and received almost 7000 responses -- many of them clearly emotional.
What came through loud and clear is that by and large, doctors tried to do what they believed was right. However, the better path was not always clear. Some of the questions clearly struck a nerve, and showed how tough it is to make the right decision -- if there even is a right decision. "Being a virtuous person is not what this is about," says Kenneth W. Goodman, PhD, Co-Director of the University of Miami's Ethics Programs and Professor in the University of Miami's Department of Medicine, Miami, Florida. "It's about critical thinking."
Today's doctors face more frequent and more complex bioethical dilemmas than in former times, says Thomas H. Murray, PhD, President of The Hastings Center, a bioethical research institute in Garrison, New York.
"In medicine, doctors can do far more than they could in the past," says Murray. "They can do interventions that were unimaginable a few decades ago. Every time you give those kinds of power, they come with difficult situations and tough ethical choices.
"For example, when we didn't have penicillin, you'd have an old person lying in bed, and there was no decision to be made. God or Nature decided if they would live or die, and the doctor just kept them comfortable. But the increased power to intervene now requires that doctors make choices whether to do so or not."
Ethical Dilemmas Have Increased
More ethical dilemmas also occur today because of increased perception and awareness, says Murray.
"Doctors were always making a large number of moral choices, but were not labeling them or seeing them as such; much of the decisions were unconscious," Murray says. For example, deciding whom to talk to in a patient's family, or getting informed consent, were previously done on the basis of a doctor's judgment or what would bring the best results. However, according to Murray, due to legalities and regulations doctors need to think: "What are my obligations? Who do I talk to?"
Numerous external influences affecting the healthcare profession have also increased the number and nature of ethical issues, says Murray. Reimbursement and insurance issues now come into play as a result of government regulations and other factors that set conditions for physicians' practices.
Still, feeling morally challenged by ethical issues is a positive sign, says Murray. "If a physician recognizes that he or she is having a tough ethical dilemma, it shows that this is a morally conscious individual trying to do the right thing. The doctor can feel good that they've noticed the issue and it bothered them. It's a good need," says Murray.
Now and in the coming weeks, Medscape will examine the individual ethics questions and explore doctors' responses. Some of the nation's leading bioethics experts will weigh in on why doctors answered the way that they did, and what this means for the future of medicine.
The following pages contain an overview of the questions and answers from Medscape's Exclusive Ethics Survey.