Doctors Answer Tough Ethical Questions

In a Medscape poll, 10,000 doctors answered tough ethical questions. Examples: 41% would never assist in suicide; 60% would never hide info about a terminal diagnosis; 1% said they'd have sex with a patient.

Nov. 10, 2010 -- Would doctors help patients die if they asked? Would they have sex with a patient? Would they cover up a mistake that harmed a patient?

These are three of 21 tough ethical questions answered by more than 10,000 doctors in a Medscape survey released today. Medscape is WebMD's web site for medical professionals.

"What came through loud and clear in the survey is that by and large, doctors try to do what they believe is right," Steven Zatz, MD, executive vice president for WebMD Professional Services, says in a news release.

What's also clear is that doctors don't all agree on what is right.

For example, when asked if doctor-assisted suicide should ever be allowed, 41% gave a definitive "no" while 59% said "yes" or "it depends."

The survey kicks off Medscape's special series on medical ethics. Leading bioethics experts will weigh in on why the doctors answered the way they did -- and what this means for the future of medicine.

"Today's doctors face more frequent and more complex bioethical dilemmas than in former times," Thomas H. Murray, PhD, says in the news release. Murray is president of The Hastings Center, a bioethical research center in Garrison, N.Y.

The poll sampled doctors from a broad range of medical specialties, including pediatrics, internal medicine, psychiatry, surgery, oncology, women's health, and family medicine.

Below is a sample of the survey results, with some typical -- and conflicting -- comments from doctors who answered the poll. You can see The full survey results here.

Should physician-assisted suicide be allowed in some cases?

Answers:

  • Yes, 45.8%
  • No, 40.7%
  • It depends, 13.5%

Doctors said:

  • "I'd want it for me when the need arises."
  • "Assisted suicide is murder."

 

Could you become involved in a romantic/sexual relationship with a patient?

Answers:

  • Yes, while that patient is still a patient, 0.8%
  • Yes, but not until at least 6 months after they stopped being a patient, 11.7%
  • It depends, 4.5%
  • No, 83.1%

Doctors said:

  • "It is totally exploitative and wrong."
  • "I did, and 30 years later we are together and happy."

 

Would you ever recommend or give life-sustaining therapy when you judged that it was futile?

Answers:

  • Yes, 23.6%
  • No, 37.0%
  • It depends, 39.4%

Doctors said:

  • "Why waste money and time when results are nil?"
  • "I would do this if I felt it would give the family time to accept the inevitability of death."

 

Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?

Answers:

  • Yes, 19.0%
  • No, 60.1%
  • It depends, 20.9%

Doctors said:

  • "Cover-ups are never OK."
  • "Why make a mountain out of a molehill if it will cause the patient more emotionally upset than simply not saying anything, as long as no physical harm has occurred?"

 

Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?

Answers:

  • Yes, 1.6%
  • No, 94.9%
  • It depends, 3.5%

Doctors said:

  • "I would, but I would contact an attorney first."
  • "We take an oath to do no harm. Covering up is a form of lying."

 

Would you ever undertreat a patient's pain because you’re concerned about repercussions or because you believe that a patient -- even a terminal patient -- might become addicted?

Answers:

  • Yes, 5.6%
  • No, 84.1%
  • It depends, 10.3%

Doctors said:

  • "Pain should not be undertreated, and what's the problem with a terminal patient being addicted and comfortable?"
  • "Having been sanctioned by an out-of-control, vindictive state medical board, such things aren't even in the purview of ethics, but rather a survival mechanism for my ability to continue practicing."

 

Would you ever hide information from a patient about a terminal or preterminal diagnosis in an effort to bolster their spirit or attitude?

Answers:

  • Yes, I soften it and give hope even if there's little chance, 14.6%
  • Yes, unless someone is going to die imminently, I don't tell them how bad it is, 1.7%
  • No, I tell it exactly as I see it, 59.8%
  • It depends, 23.8%

Doctors said:

  • "Most of the time, I tell them exactly as it is; they need to know the truth, and who am I to judge what they should or shouldn't know? If the patient is very frail emotionally and physically and has a very supportive family, I may not."
  • "The truth, delivered with compassion, is a gift."

 

Is it ever acceptable to break patient confidentiality if you know that a patient's health status may be harming others?

Answers:

  • Yes, 53.2%
  • No, 20.2%
  • It depends, 26.6%

Doctors said:

  • "As per Mr. Spock, 'The needs of the many outweigh the needs of the few or the one.' This applies in highly specific circumstances, however, and would be the exception, not the rule."
  • "Owing to ethics and HIPAA, I don't believe that it should or can be done. I would certainly attempt to convince the patient to disclose the information to his or her spouse or partner."

 

Would you agree that you should refuse gifts or perks from pharmaceutical companies because they may influence your medical judgment?

Answers:

  • Yes, 46.8%
  • No, 36.8%
  • It depends, 16.4%

Doctors said:

  • "If by 'gifts' you mean items of value (e.g., expensive pens or outings) then my answer is yes."
  • "I am not so shallow that I can be bought off by a slice of pizza."

 

Should it be legal for people to buy organs for transplant, if they would not be able to receive an organ by waiting their turn through the national database?

Answers:

  • Yes, 19.9%
  • No, 66.5%
  • It depends, 13.6%

Doctors said:

  • "The ability to pay determines a lot of accessibility to medical care. I'm not sure why organ transplants are different."
  • "The sale of human body parts is immoral."

 

Would you perform an abortion in certain situations, even if it were against your own beliefs?

Answers:

  • Yes, 34.1%
  • No, 53.5%
  • It depends, 12.4%

Doctors said:

  • "If I were against it, I would not perform it; there is something called integrity, you know."
  • "It's about the patient, not about me."

 

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