Hurst, S. A., Perrier, A., Pegoraro, R., Reiter-Theil, Stella, Forde, R., Slowther, Anne, Garrett-Mayer, E. and Danis, Marion (2007) Ethical difficulties in clinical practice : experiences of European doctors. Journal of Medical Ethics, 33 (1). pp. 51-57. doi:10.1136/jme.2005.014266 ISSN 0306-6800.

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Abstract

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties.
Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical
difficulties in these countries to provide an evidence base for the development of these services.
Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European
doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent
ethically difficult case and the types of help they would consider useful. The questionnaire was translated and
given to general internists in Norway, Switzerland, Italy and the UK.
Results: Survey respondents (n = 656, response rate 43%) ranged in age from 28 to 82 years, and averaged
25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual
cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decisionmaking
capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of
life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue
considered most difficult. The types of help most often identified as potentially useful were professional
reassurance about the decision being correct (47.5%), someone capable of providing specific advice
(41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help
expected to be useful varied among countries.
Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of
help needed, however, did not vary markedly. The general structure of ethics support services would not have
to be radically altered to suit cultural variations among the surveyed countries.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical ethics -- Europe, Physicians -- Europe
Journal or Publication Title:	Journal of Medical Ethics
Publisher:	BMJ Group
ISSN:	0306-6800
Official Date:	January 2007
Dates:	Date Event January 2007 Published 2 March 2006 Accepted 1 September 2005 Submitted
Volume:	33
Number:	1
Page Range:	pp. 51-57
DOI:	10.1136/jme.2005.014266
Status:	Peer Reviewed
Access rights to Published version:	Restricted or Subscription Access
Funder:	National Institutes of Health (U.S.). Dept. of Clinical Bioethics (NIH), Hôpitaux universitaires de Genève, Oltramare Foundation, Centre lémanique d'éthique

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