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Physicians’ Access to Ethics Support Services in Four European Countries

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Abstract

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available.

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Acknowledgments

The authors wish to thank Gary Gensler and Gordon DuVal MD, for allowing us to use parts of their questionnaire, the NIH Clinical Center Library for their outstanding translation service, and MEDTAP international for their excellent data collection work, Elizabeth Garrett-Mayer, for statistical support, as well as the anonymous reviewers, for very useful and constructive comments. We also wish to thank all the physicians who took the time to complete the questionnaire. This work was funded by the Department of Clinical Bioethics at the National Institutes of Health, and was conducted while SAH was a fellow at this Department. SAH was funded in part by the University Hospitals of Geneva, by the Oltramare Foundation, by the Centre Lemanique d’Ethique, and by the Swiss National Science Foundation.

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Correspondence to Marion Danis.

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Hurst, S.A., Reiter-Theil, S., Perrier, A. et al. Physicians’ Access to Ethics Support Services in Four European Countries. Health Care Anal 15, 321–335 (2007). https://doi.org/10.1007/s10728-007-0072-6

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