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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Doctors routinely wrestle with ethical decisions involving everything from pain and death to money and romance. In 2020, as the COVID-19 pandemic created a shortage of personal protective equipment and caused many people to lose their jobs and their employer-sponsored health insurance, doctors faced an array of new ethical questions. Medscape surveyed more than 5000 physicians about the ethical challenges they face. Here's what oncologists had to say.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

The scarcity of personal protective equipment during COVID-19 has left many physicians feeling exposed and betrayed. More than half of the oncologists surveyed say physicians should speak out publicly if their needs are not being met, but they also insisted that such complaints should not be "real issues, as opposed to mindless carping" and that, when raising their concerns, doctors should be "well advised of all the facts." As one oncologist noted, "The enemy is the virus."

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

The percentage of oncologists endorsing mandatory flu shots increased from 73% in 2018, while those who equivocated on the subject, saying "it depends," declined from 17%. Paul Helft, MD, an oncologist and director of the Charles Warren Fairbanks Center for Medical Ethics at Indiana University, suggests that the coronavirus pandemic may have sharpened the focus on viral risks for all types, particularly for oncologists, who work with immune-compromised patients. As one respondent noted, "Our patients may have a significantly higher risk of morbidity and mortality from influenza than we as presumably healthy physicians do. Therefore, if we are exposed and unvaccinated, we may do significant damage to our own patients by spreading the virus."

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

More than 9 out of 10 oncologists say they have been diligent about investigating or reporting any suspected cases of domestic abuse, although a handful admit that they have failed to do so. Among physicians in general, some of the most common reasons for not reporting suspected abuse include the absence of mandatory reporting requirements in their state, the patient's denial of any abuse, and the physician's doubt about their own suspicions.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

More than half of oncologists support the legalization of physician-assisted suicide/dying for terminally ill patients, compared with 49% in 2018. The increase may reflect the fact that the practice is now mandated under state law or court rulings in nine states and the District of Columbia, and that "familiarity breeds comfort," Helft says. However, numerous respondents insisted that physician-assisted suicide/dying "must involve a team."

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

The share of oncologists who believe that it should be legal for doctors to help those with incurable suffering to end their lives increased from 23% in 2018, while the percentage of those opposing the practice dropped to 40% from 53% two years ago. "Which is better: suffering for a short time or suffering for years?" asked one.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Oncologists are more likely to oppose the idea of doctors becoming romantically involved with patients or former patients than are physicians as a whole (62%). Helft speculates that oncologists, whose specialty often calls for long-term clinical relationships with patients during particularly vulnerable periods in their lives, are probably more attuned to the physician-patient power imbalance compared with physicians in specialties where interactions with patients might be more episodic and less intimate.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Nine out of ten oncologists say they would report an impaired peer, but the majority say they would do so only after first speaking to him or her about the problem. "It is critical to protect the patients from harm," said one. Others noted that their decision to report would depend upon whether the physician was impaired at work or in a social setting.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Oncologists are more likely to oppose the idea of random drug testing than are physicians as a whole (43%). Many insist that targeted testing based on an individual's history or behavior is more appropriate. "If random substance testing is required, then what about random cognitive tests, random vision tests, random hand coordination tests?" asked one.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Although 8 out of 10 oncologists categorically condemned upcoding, often calling it "fraud" or "illegal," that's less than the 86% opposing it in 2018. At the same time, "it depends" responses increased from 7%. "It's never a good idea to lie; however, occasionally, the best interest of the patient must prevail," said an oncologist.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Oncologists are more likely to believe that they could accept speaking fees or meals from a pharmaceutical company without it affecting their prescribing practices than are physicians in general (63%). "I can absolutely say as a very hungry resident who had no money left over after paying student loans that I'd gladly accept pizza from anyone and rarely knew who made a medicine," replied a retired oncologist. "In my later years I missed the useful quick tips about a product that might be passed on at a lunch."

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

In light of an often polarizing political scene, the share of oncologists who believe that it is acceptable to discuss their political beliefs with their patients dropped from 22% in 2018. Some felt that such conversations were ethically acceptable if the patient initiated them, but others objected to the idea for purely pragmatic reasons. "With so many patients who want to have long political discussions, I would never get through the clinic schedule," said one oncologist.

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Nearly 8 out of 10 oncologists say they would not "weed out" patients with comorbidities, or those who overuse resources, to improve the bottom line under a capitated plan. Although some said they would dismiss a patient who would not "engage in taking care of themselves" or someone whose overuse of resources was "unnecessary," others said they would instead "limit the resources to those patients who expect excessive resource access."

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

Economic upheaval caused by the pandemic has caused millions of people to lose their jobs as well as their employer-based health insurance. Only 1 in 10 oncologists said they would — or already do — limit the number of Medicaid patients they would take. That said, some, particularly hospital-based physicians, acknowledged that "the administration makes these decisions, often without my knowledge."

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

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Medscape Oncology Ethics Report 2020

Shelly Reese | January 29, 2021 | Contributor Information

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