Life, Death, and Heartache: Ethical Dilemmas Get Tougher

November 15, 2012

Introduction

Battles of the heart and mind are the toughest fights, and many of them continue to haunt physicians for a long time after they're over.

Medscape's 2012 Ethics Survey of over 24,000 physicians in more than 25 specialties showed that doctors are sharply and emotionally divided over the ethical issues they frequently encounter. Some ethical issues are life-and-death struggles; some involve one's personal value to help patients at all cost vs legal mandates; and still others deal with temptation vs self-interest.

Some of the ethical issues that doctors talked about in Medscape's 2012 Ethics Survey Report were:

• Treating when you believe it will be futile;

• Doing unnecessary medical procedures to generate income;

• Deciding to devote costly resources to a younger rather than an older patient;

• Accepting lunches from drug reps;

• Becoming romantically or sexually involved with a patient;

• Hiding a mistake that would not harm a patient;

• Telling a patient that you believe his or her specialist has substandard skills; and

• Participating in physician-assisted suicide.

According to Dr. Kenneth Prager, MD, Chairman of the Medical Ethics Committee at Columbia University Medical Center, New York, New York, physicians confront more ethical issues than do members of most other professions, and the ethical problems facing doctors have become more frequent and more complex.

"Doctors face ethical issues every day; almost every doctor/patient interaction could bring up ethical decisions," said Dr. Prager. "There are millions of such questions that occur all the time."

Why the huge increase in ethical quandaries? Technology is a key factor, said Dr. Prager, and appropriation of resources has created a huge number of related decisions.

"Doctors face more ethical issues than they did in the past, particularly as technology has increased," said Dr. Prager. "Ethical issues used to be mostly about truth-telling; for example, do I tell the patient he has advanced cancer or not? But those types of issues have been going on since time immemorial. It's technology that has made a huge difference." Because doctors now have the medical ability to use surgical, procedural, and testing advances, issues arise as to when they are appropriate to use.

Ethical issues have also become more frequent as appropriate expenditure of resources becomes a key mandate. And in a perfect storm of interacting factors, people are living longer than ever before. "Living longer injects the issues of the technological," he said.

"We are heading into an era where the budget is going to be broken, and the government will set standards and guidelines for using technology. Then, all hell will break loose," said Dr. Prager. "For example, do you do CT on a patient whose brother died of lung cancer, but he is not considered to be in a high-risk category?"