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Ethically problematic treatment decisions in different medical specialties
  1. S I Saarni1,
  2. R Halila2,
  3. P Palmu3,
  4. J Vänskä4
  1. 1
    National Public Health Institute, Department of Mental Health and Alcohol Research, Helsinki, Finland
  2. 2
    The National Advisory Board on Health Care Ethics, Helsinki, Finland
  3. 3
    GeneOS Ltd, Helsinki, Finland
  4. 4
    Finnish Medical Association, Helsinki, Finland
  1. Dr S I Saarni, Mannerheimintie 166, 00300 Helsinki, Finland; samuli.saarni{at}


Background: Ethical dilemmas are an integral part of medicine. Whether physicians actually feel that they have made ethically problematic treatment decisions or choices in their work is largely unknown. Identifying physicians with ethical problems, and the types of problems and underlying factors, might benefit organisational and educational efforts to help physicians solve ethical dilemmas in a constructive way. We investigated how the frequency and types of ethically difficult treatment decisions vary by specialty.

Method: A mail survey of all non-retired Finnish physicians (n = 17 172, response rate 75.6%) was conducted in 2004. Of those who had made any ethically problematic treatment decisions, the types of decisions and reasons given for these decisions were asked for. Factor analysis was used to investigate clustering of ethically problematic treatment decisions, and logistic regression to investigate the effect of specialty, adjusted for age and gender.

Results: Psychiatrists experienced ethically problematic treatment decisions most frequently, followed by pulmonologists, internists and neurologists. Problems were reported least often by pathologists, laboratory physicians and ophthalmologists. Overtreatment was more common than undertreatment in most specialties, with the exception of psychiatrists who emphasised undertreatment and patient rights issues.

Conclusion: Physicians of different specialties differ significantly regarding frequency and types of ethically problematic treatment decisions they have made. Psychiatrists differ from all other specialists in reporting more undertreatment and patient rights issues. Experiencing ethically problematic decisions might affect the quality of care and physician well-being in many ways. The findings could be useful for both under- and postgraduate ethics education.

  • ethical dilemmas
  • ethical problems
  • medical specialties
  • survey
  • physicians

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  • Funding: The mailing of the questionnaire and statistical analyses were funded by the Finnish Medical Association.

  • Competing interests: None.

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