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Ethical difficulties in clinical practice: experiences of European doctors
  1. S A Hurst1,
  2. A Perrier2,
  3. R Pegoraro3,
  4. S Reiter-Theil4,
  5. R Forde5,
  6. A-M Slowther6,
  7. E Garrett-Mayer7,
  8. M Danis8
  1. 1Institute for Biomedical Ethic, Medical Faculty, University of Geneva, Geneva, Switzerland
  2. 2General Internal Medicine Service, Geneva University Hospital, Geneva
  3. 3Fondazione Lanza, Padova, Italy
  4. 4Institute for Applied Ethics and Medical Ethics, University of Basle, Basle, Switzerland
  5. 5The Research Institute, Norwegian Medical Association, Oslo, Norway
  6. 6The Ethox Centre, Oxford University, Headington, UK
  7. 7Johns Hopkins University, Baltimore, Maryland, USA
  8. 8Department of Clinical Bioethics, National Institutes of Health, Bethesda, Maryland
  1. Correspondence to:
 M Danis
 Department of Clinical Bioethics, Building 10, Room 1C118, National Institutes of Health, Bethesda, MD 20892, USA; mdanis{at}


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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  • Competing interests: None.

  • The views expressed here are the authors’ own and do not reflect the position of the National Institutes of Health, the Public Health Service, the Department of Health and Human Services, the University Hospitals of Geneva, the Oltramare Foundation or the Centre Lémanique d’Ethique.

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