Life-and-Death Decisions That Keep Doctors Up at Night

Shelly Reese


December 16, 2014

In This Article

Physicians Face a Wide Range of Tough Decisions

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.

As part of Medscape's 2014 Ethics Survey, more than 21,000 physicians from 25 different specialties shared their thoughts and experiences regarding such fraught issues as:

Physician-assisted suicide;

Treatment in the face of futility;

Allocating scarce medical resources on the basis of a patient's age;

Willingness to prescribe a placebo;

Whether insurance costs should be tied to patients' health behaviors;

Romance with patients;

Deciding whether or not to hide a harmful mistake; and

The impact of pharmaceutical company perks on prescribing habits.

Difficult as many of these issues may be, they're not new, notes Dr David Fleming, director of the University of Missouri School of Medicine's Center for Health Ethics. What is new is the challenging environment in which they are being considered.

Today's doctors are under an enormous amount of pressure to control cost while maintaining quality, sustaining productivity, and utilizing new technologies, he says. "Doctors are feeling 'penned in,'" he says, and that can affect their decision-making.

Physicians are likewise making decisions against a shifting societal backdrop, says Arthur Caplan, founding director of the Division of Medical Ethics at NYU Langone Medical Center. Health challenges relating to patient behaviors, such as obesity, are more prevalent. An aging population, pressure to contain costs, and accountability to third parties are forcing physicians to move away from their exclusive role as patient advocates and take on the mantle of societal stewards.

"It's not that we didn't have these conversations 25 years ago," says Caplan. "But today they are more intense."


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