Exclusive Ethics Survey

Choices

Pundits may theorize about physician-assisted suicide, but you're the one who looks into the anguished eyes of a terminally ill patient wracked with pain who's asking for medication to end her life.

When a delightful elderly patient, frail but fiercely independent, fails his vision test, you're the one who must report him to the local motor vehicle agency, knowing that your call will mean the end of his freedom.

You bear the responsibility of keeping confidentiality for an HIV-positive patient, knowing that deadly harm could befall his unwary partner—who is also your patient.

Decisions like these, which clutch at your deepest values and sympathies are part of your everyday routine. With each patient who walks into your examining room, you may be confronted with a life-altering ethical challenge.

We've captured those dilemmas in our 2002 Ethics Survey. The survey is important because it's real. It reflects the hard choices doctors on the front lines make when confronted with issues that tear society apart—assisted suicide, pain control, medical errors, abortion, managed care, patients' rights, cloning, impaired physicians, relations with drug reps.

To uncover the reality of these issues, we surveyed 5,000 physicians. More than 750—mostly family physicians, general practitioners, internists, cardiologists, ob/gyns, and pediatricians—shared deeply personal experiences. The average age of the respondents was 50; 80 percent were male.

What we learned was inspiring. Despite the burdens of managed care, despite the public pounding the medical profession sometimes takes, most of you clearly have a straight-to-the-soul sense of purpose and belief in the power and responsibility that you hold, and how it should be used.

Our respondents opened their hearts. They revealed the truth about what they do when ethical problems arise. They confessed to actions that didn't make them look like heroes, and admitted that sometimes, self-interest wins out. They told us how they struggle over doing what's morally right or what's legal. Getting a patient the tests and treatment he needs, for instance, or writing the "proper" code that will probably result in a denial by a third party.

Their stories poignantly illustrate the complexity of today's ethical dilemmas. No matter what is theoretically "right," what ethicists proclaim to be the correct choice, or even what you think you'll do, such philosophical considerations often fly out the window when you're confronted with reality at your patient's bedside.

It's clear from the responses we got that some situations make you proud. Most often, you're the only one who knows what you struggle with and what courage you summon in order to do what you believe is right.

It's also clear that other situations make you question what kind of person you are for falling short of your ideals. Often, it seems, your actions are neither noble nor self-serving. They merely fell within the daily purview of critical decisions made in split seconds while standing next to a patient's hospital bed . . . or in your examining room . . . or in your office as you fill out paperwork. Yet your choices have the power to affect lives forever.

While most respondents seem content with their ultimate decisions, it's clear how strongly these issues affect them—and all physicians. Some of the situations you deal with leave scars. When we asked about the biggest ethical dilemma you've ever faced, some doctors recounted episodes from years-past as emotionally as if they'd occurred last week.

The pages that follow reflect it all. Your struggles. The dilemmas you face, and the decisions you make that can stay with you for years. Our survey shows honesty and self-examination. It reveals what's really happening as physicians confront issues that may have no clear-cut "best" answer.

As many of you have discovered—and continue to learn—doing the right thing doesn't always make life easy. But most of you choose to do it, anyway.

 

Leslie Kane. Exclusive ethics survey: Choices. Medical Economics 2002;19:47.