Between professional values, social regulations and patient preferences: medical doctors' perceptions of ethical dilemmas

Bringedal, Berit; Rø, Karin Isaksson; Magelssen, Morten; Før­de, Rei­dun; Aasland, Olaf Gjerløw

doi:10.1136/medethics-2017-104408

Cited by 25 publications

(26 citation statements)

References 15 publications

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“…Selv om en handling er ulovlig og generelt vurderes som uetisk, kan det finnes ekstreme situasjoner der helsepersonellet vurderer at loven og den etiske normen har urimelige konsekvenser og at det er gode grunner til å handle på tvers av dem for å gjøre det som oppleves som riktig for den enkelte pasient. Leger står overfor dilemmaer som ikke bare skyldes verdikonflikter, men også rollekonflikter (11,12). Legen har minst fire, potensielt motstridende, roller: som samfunnets portvokter med ansvar for at lover blir fulgt og ressurser fordelt rettferdig, som pasientens talsmann, som profesjonsutøver og som privatperson.…”

Section: Diskusjonunclassified

“…Legen har minst fire, potensielt motstridende, roller: som samfunnets portvokter med ansvar for at lover blir fulgt og ressurser fordelt rettferdig, som pasientens talsmann, som profesjonsutøver og som privatperson. Et lite mindretall leger kan i spesielle situasjoner vaere villige til å bryte loven eller nekte å gjennomføre lovpålagt praksis (11). En studie fra 2014 indikerte riktignok at svaert få norske leger selv har utført aktiv dødshjelp og slik gått ut over lovens rammer (4).…”

Section: Diskusjonunclassified

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Gaasø¹,

Rø²,

Bringedal³

et al. 2019

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Section: Diskusjonunclassified

Legers holdninger til aktiv dødshjelp

Gaasø¹,

Rø²,

Bringedal³

et al. 2019

Tidsskriftet

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“…They are obliged to be both the patient’s advocate and a steward of societal resources at the same time. Further, as a member of a profession, their duty is to act in accordance with professional norms, but as private individuals their obligations extend beyond the professional (eg, they may have conflicts regarding their personal values or time commitments) 12. Knowing which role(s) a doctor is loyal to when making a decision can explain variations in practice and justifications.…”

Section: Introductionmentioning

confidence: 99%

Do you recommend cancer screening to your patients? A cross-sectional study of Norwegian doctors

et al. 2019

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ObjectiveGuidelines for cancer screening have been debated and are followed to varying degrees. We wanted to study whether and why doctors recommend disease-specific cancer screening to their patients.DesignOur cross-sectional survey used a postal questionnaire. The data were examined with descriptive methods and binary logistic regression.SettingWe surveyed doctors working in all health services.ParticipantsOur participants comprised a representative sample of Norwegian doctors in 2014/2015.Primary and secondary outcome measuresThe primary outcome is whether doctors reported recommending their patients get screening for cancers of the breast, colorectum, lung, prostate, cervix and ovaries. We examined doctors’ characteristics predicting adherence to the guidelines, including gender, age, and work in specialist or general practice. The secondary outcomes are reasons given for recommending or not recommending screening for breast and prostate cancer.ResultsOur response rate was 75% (1158 of 1545). 94% recommended screening for cervical cancer, 89% for breast cancer (both established as national programmes), 42% for colorectal cancer (upcoming national programme), 41% for prostate cancer, 21% for ovarian cancer and 17% for lung cancer (not recommended by health authorities). General practitioners (GPs) adhered to guidelines more than other doctors. Early detection was the most frequent reason for recommending screening; false positives and needless intervention were the most frequent reasons for not recommending it.ConclusionsA large majority of doctors claimed that they recommended cancer screening in accordance with national guidelines. Among doctors recommending screening contrary to the guidelines, GPs did so to a lesser degree than other specialties. Different expectations of doctors’ roles could be a possible explanation for the variations in practice and justifications. The effectiveness of governing instruments, such as guidelines, incentives or reporting measures, can depend on which professional role(s) a doctor is loyal to, and policymakers should be aware of these different roles in clinical governance.

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“…6 In a 2015 survey, 56% of Norwegian doctors would be unwilling to participate in the procedure. 7 Our interpretation is that CO to abortion receives relatively low support ( as with many respondents in the case of abortion, they are likely to reject CO, not necessarily being swayed by the contention that toleration is feasible in practice without burdens for patients (as was often claimed in Norwegian debate to be the case for abortion providers).…”

Section: Acceptable Attitudes and The Limits Of Tolerance (H1and2)mentioning

confidence: 86%

Acceptable attitudes and the limits of tolerance: Understanding public attitudes to conscientious objection in healthcare

et al. 2019

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Background. The public's attitudes to conscientious objection (CO) are likely to influence political decisions about CO and trust towards healthcare systems and providers. Few studies examine the public's attitudes in an in-depth way. Methods. Six hypotheses about public attitudes to CO were devised and a questionnaire designed in order to test them. 1,617 Norwegian citizens completed the online questionnaire. Results. Support for toleration of CO was strongest in the case of ritual circumcision of infant boys, lower for assisted dying and abortion. Attitudes to the procedure itself negatively predicted attitudes to CO for the procedure. Respondents were more accepting of CO to performing abortion than of CO to referrals for abortion. There was stronger support for CO as an outcome of local pragmatic arrangements than for CO as a statutory right. Conclusions. Instead of viewing CO as a 'moral safety valve' or minority right which is due also to those with whom we disagree strongly, a portion of the public approaches the issue from the angle of what moral attitudes they deem acceptable to hold. The gap between this approach on the one hand and human rights principles on the other is likely to give rise to tensions in political processes whenever policies for CO are negotiated.

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Between professional values, social regulations and patient preferences: medical doctors' perceptions of ethical dilemmas

Cited by 25 publications

References 15 publications

Legers holdninger til aktiv dødshjelp

Legers holdninger til aktiv dødshjelp

Do you recommend cancer screening to your patients? A cross-sectional study of Norwegian doctors

Acceptable attitudes and the limits of tolerance: Understanding public attitudes to conscientious objection in healthcare

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