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, Vol.33 (No.1). pp. 51-57. 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 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
Date:	2007
Volume:	Vol.33
Number:	No.1
Page Range:	pp. 51-57
Identification Number:	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
References:	1 Lo B, Schroeder SA. Frequency of ethical dilemmas in a medical inpatient service. Arch Intern Med 1981;141:1062–4. 2 Slowther A, Johnston C, Goodall J, et al. Development of clinical ethics committees. BMJ 2004;328:950–2. 3 Reiter-Theil S. Ethics consultation in Germany: the present situation. HEC Forum 2001;13:265–80. 4 Salathe´ M, Leuthold M, Amstad M, et al. Clinical ethics committees in Switzerland: the current situation (German translation). Bull Swiss Physicians 2003;84:2264–7. 5 Meulenbergs T, Vermylen J, Schotsmans PT. The current state of clinical ethics and healthcare ethics committees in Belgium. J Med Ethics 2005;31:318–21. 6 La Puma J, Stocking CB, Darling CM, et al. Community hospital ethics consultation: evaluation and comparison with a university hospital service. Am J Med 1992;92:346–51. 7 Orr RD, Moon E. Effectiveness of an ethics consultation service. J Fam Pract 1993;36:49–53. 8 Day JR, Smith ML, Erenberg G, et al. An assessment of a formal ethics committee consultation process. HEC Forum 1994;6:18–30. 9 McLung JA, Kramer RS, DeLuca M, et al. Evaluation of a medical ethics consultation service: opinions of patients and health care providers. Am J Med 1996;100:456–60. 10 Heilicser BJ, Meltzer D, Siegler M. The effect of clinical medical ethics consultation on healthcare costs. J Clin Ethics 2000;11:31–8. 11 Schneiderman LJ, Gilmer T, Teetzel HD, et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 2003;290:1166–72. 12 Gracia D. The intellectual basis of bioethics in Southern European countries. Bioethics 1993;7:97–107. 13 Mino JC.Why are there no clinical ethicists in France? Camb Q Healthcare Ethics 2001;10:341–4. 14 Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978;88:251–8. 15 Blackhall LJ, Murphy ST, Frank G, et al. Ethnicity and attitudes toward patient autonomy. JAMA 1995;274:820–5. 16 Brody H. Medical bioethics and cultural diversity. Indian J Pediatr 1997;64:277–84. 17 Tangwa GB. Bioethics: an African perspective. Bioethics 1996;10:183–200. 18 Szeremeta M, Dawson J, Manning D, et al. Snapshots of five clinical ethics committees in the UK. J Med Ethics 2001;27(Suppl 1):i9–17. 19 DuVal G, Clarridge B, Gensler G, et al. A national survey of U.S. internists’ experiences with ethical dilemmas and ethics consultation. J Gen Intern Med 2004;19:251–8. 20 Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50:1129–36. 21 Reiter-Theil S. Balancing the perspectives. The patient’s role in clinical ethics consultation. Med Health Care Philos 2003;6:247–54. 22 Hurst SA, Hull SC, DuVal G, et al. How physicians face ethical difficulties: a qualitative analysis. J Med Ethics 2005;31:7–14. 23 Forde R, Vandvik IH. Clinical ethics, information, and communication: review of 31 cases from a clinical ethics committee. J Med Ethics 2005;31:73–7. 24 Robles PH. Evaluation of healthcare ethics committees: the experience of an HEC in Spain. HEC Forum 1999;11:263–76. 25 Reiter-Theil S. Ethics consultation on demand: concepts, practical experiences and a case study. J Med Ethics 2000;26:198–203. 26 Agich GJ. The question of method in ethics consultation. Am J Bioethics 2001;1:31–41. 27 Steinkamp N, Gordijn B. Ethical case deliberation on the ward. A comparison of four methods. Med Health Care Philos 2003;6:235–46. 28 Bebeau MJ. The defining issues test and the four component model: contributions to professional education. J Moral Educ 2002;31:271–95. 29 Zoloth-Dorfman L, Rubin SB. Navigators and captains: expertise in clinical ethics consultation. Theor Med 1997;18:421–32.
URI:	http://wrap.warwick.ac.uk/id/eprint/34568

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