By Matt Sloane
WebMD Health News
Reviewed by Brunilda Nazario, MD
Dec. 22, 2014 -- Sometimes we forget that our doctors are not simply patient-care robots. They are human beings with feelings, families, and a deep-seated passion for their work.
Underneath a confident facade is someone just like you who has doubts, internal (and external) debates, and power limited to their abilities as a mere mortal.
To get an idea of some of the toughest ethical dilemmas doctors are facing, our sister site, Medscape, released its annual ethics report -- a survey of more than 21,000 doctors in the U.S. and Europe -- about their feelings on a variety of medicine's toughest choices.
On the list: assisted suicide, abortion, patient confidentiality, and medical mistakes, along with more salacious things like whether it's OK to date a patient.
Life and Death
Among the most difficult decisions for any doctor are those that deal with the life and death of a patient.
Of the doctors surveyed, 19% said they would give life-sustaining therapy to a patient even if they believed the efforts would be futile. But 46% said it would depend on the situation they were facing.
And 1 in 5 doctors also said they would soften the news of a terminal diagnosis if they thought it would give the patient hope.
Half (50%) of respondents said they may even go against a family's wishes and keep treating a patient who they thought had a chance of surviving. Twenty-two percent said they absolutely would do so.
On the flip side, 86% of doctors said they don't believe patients are kept on life support too long, and over half believe doctor-assisted suicide should be allowed. That number is up 17% from the 2010 survey, possibly indicating a shift in attitudes toward "death with dignity" issues.
Possibly the most controversial topic in modern medicine, abortion, was also addressed in the survey.
Almost half of doctors (44%) said they would perform an abortion even if it went against their personal beliefs, and another 15% said it depended on the situation.
About a quarter of doctors believe late-term abortions (after 20 weeks) should be legal, while a third said it would depend on the circumstances.
Another controversial issue, prescription drug abuse, came up in the survey as well.
Nine percent of doctors said they would consider undertreating a patient if they feared the person might become addicted to a certain drug, or for fear they themselves might get in trouble.
That number has gone up slightly since the 2010 survey, but 76% still said they would not undertreat based on those fears. In 2010, 84% said they would not undertreat.
Finances, insurance status, and other money questions were part of the survey, including the question of whether to deny a patient certain treatments if their insurance wouldn't pay for it.
A majority of respondents -- 69% -- said they would not deny the treatment, and 22% said it would depend on the circumstances.
Most doctors admitted, though, that these are difficult decisions to make, and pointed out they must consider the realities of whether or not their bills would be paid.
One-quarter of doctors say they would "upcode" or overstate a patient's condition in order to get their insurance to pay, despite the fact that doing so could harm their careers.
On the topic of whether consistently unhealthy patients should be paying more for health insurance, most doctors agree: Yes.
Patients who smoke, refuse to diet, or are otherwise unwilling to participate in their own care should be forced to pay more because they represent a greater burden on the medical system, according to 69% of survey respondents.
Interestingly, there was a gender split on this issue, with 17% more men agreeing with higher payment than women.
Meanwhile, 3% of doctors say they would perform a procedure that was not medically necessary just to generate income.
On the topic of medical mistakes and malpractice, the majority of doctors said they would not cover up evidence of a mistake, even if the mistake wouldn't harm the patient, but almost 20% of doctors said they would cover it up, with another 22% saying it depended on the circumstances.
The consensus was much clearer in cases where a mistake would harm a patient, with 91% of doctors saying they would fess up to the error.
One in 5 doctors said they would perform extra or unwarranted procedures because of fears over malpractice. The highest number of those answers came from neurologists and emergency room doctors.
Sex, Drugs, and Confidentiality
What may be the most salacious question on the survey -- whether or not you would engage in a sexual or romantic relationship with a patient -- had some interesting results.
Absolutely not, under any circumstances, says 68% of respondents, and 10% said "it depends."
Only 1% of doctors said it was acceptable to hook up with a current patient, but a full 22% said they'd give the green light only if the patient left their care more than 6 months prior.
Interestingly, older doctors were much more comfortable with a doctor-patient affair. Twenty-four percent of 55- to 59-year-old doctors were OK with dating patients after a 6-month waiting period, and that number continued to climb as the age of the doctor increased.
On a more serious note, a large number of doctors -- 89%, to be exact -- said they have let suspected domestic or sexual abuse go unreported in a patient, oftentimes because the patient denied it.
Most doctors said if they had concrete proof of abuse or a cooperative patient, they would absolutely report it to authorities.
In a similar vein, 77% of doctors said they would report a doctor friend they suspected was impaired by drugs, alcohol, or illness to administrators or authorities. But 20% of respondents said it would depend on the circumstances.
Thirty-nine percent of doctors believe doctors in general should be subject to random drug and alcohol testing, while 17% said "it depends." On top of the list of doctors who support drug testing were kidney specialists and anesthesiologists.
On the topic of patient confidentiality, 66% of doctors said they would breach their patients' trust if they knew the patient's health status could harm others -- such as in cases where one partner may have a sexually transmitted disease that could be given to the other partner.
The Placebo Effect
A surprising number of doctors -- about 42% -- said they would prescribe a placebo, or an innocuous treatment, to a patient who doesn't need any treatment at all but demands it. That number is up 75% from 2010, but still 37% of doctors said they would not engage in the practice.
Overall, doctors said their toughest ethical dilemmas included suspecting abuse but being unable to act; being pressured to give patients treatments they don't need; dealing with impaired colleagues; keeping brain-dead patients alive at a family's request; and withholding intensive care from newborns with severe and disabling medical conditions.
The Medscape Ethics Report 2014 surveyed 21,531 doctors from Sept. 18 and Nov. 12, 2014. The margin of error is +/- 0.72% for the U.S. sample and +/- 1.55% for the European sample at a 95% confidence level.
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