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Paternalism in practice: informing patients about expensive unsubsidised drugs
  1. Tim Dare1,
  2. Mike Findlay2,
  3. Peter Browett3,
  4. Karen Amies4,
  5. Sarah Anderson1
  1. 1Department of Philosophy, The University of Auckland, Auckland, New Zealand
  2. 2Cancer Trials New Zealand (CTNZ), Discipline of Oncology, Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand
  3. 3Department of Molecular Medicine & Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  4. 4Department of Oncology, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Dr Tim Dare, Department of Philosophy, The University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand; t.dare{at}auckland.ac.nz

Abstract

Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73–99% in New Zealand and 72–94% in Australia depending on the scenario) the percentage who would not discuss expensive unfunded drugs was substantially lower in New Zealand (6.4–11.1%) than it was in Australia (28–41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians' decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced.

  • Paternalism
  • medical ethics
  • expensive treatments
  • treatment information
  • patient autonomy

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Footnotes

  • Funding University of Auckland Philosophy research funds.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Auckland Human Participants Ethics Committee (August 13, 2008, Ref. 2008/Q/039).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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