Clinical ethical dilemmas: convergent and divergent views of two scholarly communities
- 1Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- 2Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
- Correspondence to: Dr Anne M Stiggelbout Department of Medical Decision Making, Leiden University Medical Center, P O Box 9600, 2300 RC Leiden, The Netherlands; a.m.stiggelbout{at}lumc.nl
- Received 28 January 2005
- Accepted 3 October 2005
- Revised 30 September 2005
Abstract
Objective: To survey members of the American Society for Bioethics and Humanities (ASBH; n = 327) and of the Society for Medical Decision Making (SMDM; n = 77) to elicit the similarities and differences in their reasoning about two clinical cases that involved ethical dilemmas.
Cases: Case 1 was that of a patient refusing treatment that a surgeon thought would be beneficial. Case 2 dealt with end-of-life care. The argument was whether intensive treatment should be continued of an unconscious patient with multiorgan failure.
Method: Four questions, with structured multiple alternatives, were asked about each case: identified core problems, needed additional information, appropriate next steps and who the decision maker should be.
Observations and results: Substantial similarities were noticed between the two groups in identifying the core problems, the information needed and the appropriate next steps. SMDM members gave more weight to outcomes and trade-offs and ASBH members had patient autonomy trump other considerations more strongly. In case 1, more than 60% of ASBH respondents identified the patient alone as the decision maker, whereas members of SMDM were almost evenly divided between having the patient as the solo decision maker or preferring a group of some sort as the decision maker, a significant difference (p<0.02). In case 2, both groups agreed that the question of discontinuing treatment should be discussed with the family and that the family alone should not be the decision maker.
Conclusion: Despite distinctively different methods of case analysis and little communication between the two professional communities, many similarities were observed in the actual decisions they reached on the two clinical dilemmas.
- ASBH, American Society for Bioethics and Humanities
- ICU, intensive care unit
- SMDM, Society for Medical Decision Making
Footnotes
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Competing interests: None declared.
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Ethical approval: The institutional review boards at the University of Chicago at Illinois, Illinois, USA, and the Leiden University Medical Center, Leiden, The Netherlands, reviewed and approved the study.
