COMMENTARY

Romance, Drugs, and Death: Changing Physician Attitudes

Arthur L. Caplan, PhD

Disclosures

March 24, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the New York University Division of Medical Ethics. Interesting results have come in from the Medscape Physician Ethics Report. This is done every 2 years; we survey physicians in many specialties to find out their attitudes on a variety of topics.

An important finding is on a controversial subject, which is physician-assisted suicide. About 10 years ago, there wasn't that much support for physician-assisted suicide. Support for allowing it is growing very rapidly. That's what the survey shows.

Why is that? What's happening? I think older physicians were more opposed to physician-assisted dying, or physician-assisted suicide, than younger ones are. I think we're seeing many states move to legalize this practice with restrictions in the US, most recently in New Jersey. There are many others that have done so.

There don't appear to be abuses of this. There has been no slippery slope toward killing the disabled or the incompetent. I think doctors know that and they tend to support legalization far more than they used to.

The other big reason for the change, I think, is that the topic is being debated more and more by older Americans. They want the opportunity to have a choice — not that they want to end their lives. I think more older Americans say they'd like that option, and that belief leaks back to their doctors. I'm not really surprised in any way to see that it is increasing in support. I think we're going to see more legalization in more states in the years to come.

Disappointment About Drug Testing, Pharma Payments

Random drug testing — here, I am a little surprised. There seems to be a lot of opposition to getting random drug tests, even though we know that drug abuse is a big problem among doctors and nurses. I think 43% of those surveyed this year said they still oppose random drug testing.

I've been here before on this. I support random drug testing. I think we have to be careful about who gets to see the results. I think you should only do it if you have a program to help people with alcohol or drug issues. For safety and to minimize malpractice claims, it still seems to me that random testing is the way to go.

There are many other industries, including the airline industry, the train industry, and trucking, that have random testing. It hasn't resulted in terrible impacts for airplane pilots, and I don't think it will for doctors. I think it will help more than it will hurt. I'm disappointed that there seems to be increased opposition there.

Another one that disappointed me is that 63% of doctors now are saying that they could give speeches at a drug company event and not be influenced by payment. I think that's delusional. Study after study shows that payment influences your opinions and your prescribing habits. We know it's true. People still say, "I can give a talk at a dinner, get a free meal, maybe take an honorarium, and not be influenced by the company paying me." It doesn't square with the empirical data.

I don't think I could do it, even though I feel pretty independent. When you get paid, when you get a free meal, or when someone gives you a free trip, it still engenders a feeling of obligation, subtly, to be nicer to the people who are supporting you.

I still think this is something to be wary of; I don't think it's something we should let our guard down about. I'm not sure that people can really do what they think they can do and maintain the independence. Obviously, many people in the survey just flat out disagree with me and don't think a free meal is going to influence their prescribing behavior. We'll have to agree to disagree on that one.

Are Doctor-Patient Relationships Still Taboo?

Now, on to a more upbeat topic, which is romance. The topic of romance appears on the survey this year and looks back 10 years. The issue is having romantic relationships with patients. Ten years ago, probably less than 1% of people thought that having a relationship while someone was your patient was okay. That crept up a little bit to 2% 10 years later.

I still think it's wrong, that it shouldn't happen, and it's probably illegal in many group practices, institutional settings, and academic settings. They prohibit this. It's not a big increase, but it's one I wouldn't go along with.

If you're not actively seeing a patient and if the doctor-patient relationship is over by 6 months, I think you can reach out and see whether somebody is interested in going forward. You can't bully them, threaten them, or use your position of prior power to initiate a relationship.

We certainly don't want situations where you're trying to do this if you think someone's going to continue to be your patient, but if it's ended, the doctor-patient relationship is over, and you've let some time go by, I'm going to say bravo to romance. Let it flourish. That is one way people meet, and I don't have ethical heartburn about it. I'll end on a happy note for those of you trying to pursue love out there or trying to look for romance.

I'm Art Caplan at the New York University Division of Medical Ethics. Thanks for watching.

(For more results from the biannual ethics report, see Life, Death, and Painful Dilemmas: Ethics 2020.)

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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