Exclusive: How US and UK Physicians' Ethics Differ

Harris Meyer


November 20, 2012

In This Article


US and UK physicians receive medical training so similar that they can readily practice in either the United States or the United Kingdom. They share a common history and culture and speak the same language, more or less.

But a new Medscape survey of nearly 25,000 US and UK physicians found that doctors in the 2 nations hold markedly different views on some thorny medical ethics issues.

There were notable contrasts on attitudes toward what doctors regard as futile care, maintaining patient confidentiality in certain situations, alerting patients about poor-quality physicians, and telling patients the truth about terminal conditions. Their biggest difference seen was about whether to defer to the treatment wishes of patients' families (Table).

Table. Differences in Attitudes Between US and UK Physicians, Medscape 2012 Ethics Report

Question US Physicians UK Physicians
Would you ever go against a family's wishes to end treatment and continue treating a patient whom you felt had a chance to recover? Yes: 23% Yes: 57%
Is it ever acceptable to perform "unnecessary" procedures due to malpractice concerns? Yes: 23% Yes: 9%
Is it right to provide intensive care to a newborn who either will die soon or survive with an objectively terrible quality of life? Yes: 34% Yes: 22%
Would you ever hide information from a patient about a terminal or pre-terminal diagnosis if you believed it would help bolster the patient's spirit? Yes: 10% Yes: 14%
Would you give life-sustaining therapy if you believed it to be futile? Yes: 35% Yes: 22%
Should physician-assisted suicides be allowed in some situations? Yes: 47% Yes: 37%
Would you inform a patient if he or she were scheduled to have a procedure done by a physician whose skill you knew to be substandard? Yes: 47% Yes: 32%
Is it acceptable to breach patient confidentiality if a patient's health status could harm others? Yes: 63% Yes: 74%
Would you ever decide to devote scarce or costly resources to a younger patient rather than to one who was older but not facing imminent death? Yes: 27% Yes: 24%

© Medscape 2012

Several factors contribute to the differences: different views toward patient-centeredness; different medical liability climate; the way physicians are paid; national religious attitudes; and the nature of the relationship between physicians, patients, and patients' families.

The survey was conducted as part of Medscape's Physician Ethics Report 2012. Survey questionnaires were sent to physicians in a wide range of medical specialties in each country. Completed questionnaires were received from more than 24,000 US physicians and 940 UK physicians. The statistical significance of the differences in responses between US and UK doctors was not calculated.

One obvious difference that could affect attitudes is that most US physicians work either independently or for private hospital and medical groups and receive fee-for-service payment, while most UK physicians work directly or indirectly for the country's socialized National Health Service (NHS). In Great Britain, most medical specialists work as salaried staff in publicly operated hospitals, while most primary care physicians work independently and receive a mix of fee-for-service payments, per-patient global payments, and salary.

"The big difference is the way the system is funded and the culture of the United Kingdom," says Brian Jarman, MD, a medical professor at Imperial College in London who serves on the NHS's advisory committee on resource allocation. "I don't think our decisions are as affected by financial considerations as in the US."

Another major distinction: There's less medical malpractice litigation in the UK. On top of that, UK medical specialists receive liability coverage through their hospital, while general practitioners have their premiums offset by NHS payments. In the US, physicians worry a lot more about malpractice suits, and doctors in independent practice are responsible for paying sizable liability premiums on their own.

The largest percentage difference in the survey -- and one of the most provocative findings -- was seen on the question of whether the doctor would ever go against a family's wishes to end treatment and continue treating a patient who the doctor felt had a chance to recover. Most UK physicians in the survey -- 57% -- said yes, compared with just 23% of US physicians. That finding cut against the view that UK doctors are more likely to ration, and it also highlighted an important cultural gap.

"In most places in the world, doctors think they know the right treatment and do it," says Dr. Lachlan Forrow, MD, a Harvard University medical ethicist and palliative care specialist. "My German friends say patients and families expect doctors to make decisions. In the US we might defer more to the patient and family."

On top of that, he adds, families in the US probably express their wishes with more vehemence than in the UK and are more likely to file a lawsuit if the doctor goes against their wishes.