Ethical Questions Vex Physicians in Surveys

Marcia Frellick

December 18, 2018

Answers to two Medscape surveys that asked physicians to weigh in on ethical matters drew some sharp lines regarding romance, finances, interactions with patients, and life-and-death decisions.

On some questions in the surveys, which included questions for more than 5200 physicians in 29 specialties, doctors were overwhelmingly in support of or against a practice. But, in many cases, there was great ambiguity or a need for more information.

One question that divided respondents asked whether physicians should have random testing for drug and alcohol abuse. While 39% said yes, 42% said no, and 19% said "it depends."

The answers varied greatly by specialty. Those in neurologic surgery were the least likely to say yes to random testing (16%), while endocrinologists were most likely to say yes (52%), followed by anesthesiologists at 50%.

Physician-assisted Dying

The number of physicians who say physician-assisted dying should be legal for terminally ill patients has risen from 46% in 2010 to 58% in this year's survey.

However, physician support for the practice is still far below the 72% of the public who said in the latest Gallup poll that physicians should be able to help terminally ill patients die.

Ethical decisions on abortion continue to vex many in the medical community.

The survey asked whether physicians would perform an abortion in certain circumstances even if it were against their personal beliefs. The number saying yes grew from 34% in 2010 to 45% in this year's survey. The numbers saying yes were higher in obstetrics-gynecology, where 49% said yes, 38% said no, and 12% said "it depends."

Answers ranged from that of an emergency medicine physician who said, "Yes, if there was possible harm to the mother if I did not," to that of an ob-gyn who said, "I have never performed an abortion and never will. Period."

Opt-out for Organ Donation?

Most physicians (62%) were against an opt-out policy for organ donation. Thirty-two percent said there should be an opt-out policy and 6% said "it depends."

Among the comments was one from a general surgeon who said, "People may have religious objections to donating their organs. The family should not have to prove this when their loved one is dead/dying."

However, an HIV/infectious disease specialist said, "This would be lifesaving and has been successful in several other countries."

Another survey question asked if physicians would refer a patient outside of their own health system despite pressure to refer within, and 86% said they would, 3% said no, and 11% said "it depends."

"I try to do what I would want done for me, but if it's at the risk of my income, then no, as long as the patient would get acceptable results," one family physician wrote.

Romance With a Patient?

Is it ever OK to become romantically or sexually involved with a patient? Very few doctors said that would be OK while they were still a patient (2%) but 25% said it would be acceptable 6 months to 1 year after the patient was in their care.

"People find love in all places," a neurologist commented. "If it were to be a truly meaningful relationship, I don't see why someone shouldn't be able to start a relationship. I would think they would end the patient-doctor relationship by referring to a colleague."

Many more male than female physicians were likely to say it would be acceptable 6 months to a year later (28% vs 19%).

Another question addressed what to do about a patient who doesn't need treatment but demands something. Would you give such a patient a placebolike treatment? Again, physicians were sharply divided: 42% said yes, 39% said no, and 19% said "it depends."

A family physician commented: "Patient education is key. Treat the underlying problem."

An orthopedist commented, "Placebo therapy under the conditions noted above should be accepted, since placebo works in 30% to 35% of research studies on drug management."

What If a Family Refuses to Get Vaccinated?

Physicians were asked whether they would refuse to treat a family that refused to get the recommended vaccines for themselves or their children.

More than half (54%) said they would treat them, 25% said no, and 21% said "it depends."

Answers varied within primary care: 63% of family physicians said they would treat the families while 56% of internists and 44% of pediatricians said they would.

"I would fully educate them on the risks they are taking, and make them sign a waiver that they are risking their children's lives," a family physician commented.

However, a pediatrician wrote: "We have a no-acceptance policy for parents that don't give core vaccines."

The Medscape Ethics Report 2018: Life, Death, and Pain and the Medscape Ethics Report 2018: Money, Romance, and Patients reflect survey results taken from July 27 through September 30.

The margin of error was +/- 1.35% at a 95% confidence interval, using a point estimate of 50%.

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