CLINICAL ETHICS

Ethical difficulties in clinical practice: experiences of European doctors

S A Hurst¹, A Perrier², R Pegoraro³, S Reiter-Theil⁴, R Forde⁵, A-M Slowther⁶, E Garrett-Mayer⁷ and M Danis⁸

¹ Institute for Biomedical Ethic, Medical Faculty, University of Geneva, Geneva, Switzerland
² General Internal Medicine Service, Geneva University Hospital, Geneva
³ Fondazione Lanza, Padova, Italy
⁴ Institute for Applied Ethics and Medical Ethics, University of Basle, Basle, Switzerland
⁵ The Research Institute, Norwegian Medical Association, Oslo, Norway
⁶ The Ethox Centre, Oxford University, Headington, UK
⁷ Johns Hopkins University, Baltimore, Maryland, USA
⁸ Department of Clinical Bioethics, National Institutes of Health, Bethesda, Maryland

Correspondence to:
Correspondence to:
M Danis
Department of Clinical Bioethics, Building 10, Room 1C118, National Institutes of Health, Bethesda, MD 20892, USA; mdanis{at}cc.nih.gov

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 decision-making 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.

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