Physicians in Europe are much more likely to favor random drug testing for doctors, are less likely to report an impaired colleague, and are more comfortable with the attitude of "the doctor knows what's best for the patient," according to Medscape's recent Physician Ethics Report 2014.
Diverse cultures affect the roles of physicians and patients, and the different legal environments contribute to varied patient-care decisions, according to this fascinating look at the differences in medical ethics between US and European physicians.
The survey reports opinions from over 21,000 physicians, including almost 4000 in Europe. European respondents were from the United Kingdom, Italy, France, Germany, Spain, and 25 other countries.
The ways in which US and European physicians see many issues differently reveals much about how diverse cultures view the roles of physicians and patients, as well as the legal environment that contributes to many patient-care decisions.
Some of the key differences:
• European doctors are far more willing to oppose a patient's family. Would you oppose the family and continue treating in some situations? Yes: United States: 22%; Europe: 55%.
• European doctors are more likely to downplay treatment risks if they think the patient will benefit. Would you downplay risks? No: United States: 76%; Europe: 49%.
• European doctors are more likely to keep quiet about mistakes. Is it acceptable to cover up or avoid revealing mistakes? Yes: United States: 3%; Europe: 9%.
• More European doctors support random drug and alcohol testing for physicians; Yes, support: United States: 39%; Europe: 56%.
• European doctors are less likely to report an impaired physician. Would you report? Yes: United States: 77%; Europe: 45%.
We looked at several areas of ethics: life and death, pain, romance, money, and patients.
Should physician-assisted suicide be allowed?
Physician-assisted suicide is hotly debated in the United States and Europe. More than one half (54%) of US doctors and 41% of European doctors say physician-assisted suicide (called "physician-assisted death" in Europe) should be allowed.
Five US states have legislation or case rulings allowing aid-in-dying practices, and a handful of European countries either allow physician-assisted dying or enable doctors to prescribe—but not administer—lethal drugs. Although many doctors on both continents say they favor allowing patients to make life-ending choices, they don't want to play a supporting role.
One UK physician noted, "Assisted dying may become a valid legal option. However, I believe that we have to create another professional body, but NOT [composed of] actively practicing physicians, to take on the responsibility for this."
Would you go against a family's wishes and continue treating a patient whom you felt had a chance to recover?
This question highlights a major difference that revolves around European physicians' greater sense of being the medical arbiter for patients, but also the fact that US physicians may encounter more legal repercussions if they go against the family.
More than one half (55%) of European doctors say they would be willing to oppose a patient's family and continue treating that patient if they believed that he or she had a chance to recover. That compares with 22% of US doctors. In their comments, European doctors repeatedly noted that "the family opinion matters, but they cannot make medical decisions" and that "the wish of the patient counts and nothing else." As a French gastroenterologist noted, "The contract is made with the patient, not with his family."
Dr Kevin Donovan, director of the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center, notes that European doctors' responses indicate that they "give more precedence to their own thinking" than to the opinions of family members.
If you're convinced that a treatment or procedure will help a patient, would you be less aggressive about describing the risks in order to encourage the patient's informed consent?
European physicians are more likely (28%) than US physicians (10%) to downplay the risks of a treatment if they feel that it will help the patient. Dr Donovan attributes the differences to a European ethos that leans toward "weak paternalism," while the American attitude favors "strong patient autonomy."
Voicing an opinion expressed by many European doctors, a German pulmonologist said, "Most patients aren't educated or responsible enough to decide all by themselves; they need advice." A UK family practitioner said a doctor should "act as a patient advocate while they are in a stressful position."
Would you ever hide information about a terminal diagnosis to bolster a patient's attitude?
Whereas only 21% of US physicians said they would withhold such information, almost one half (46%) of European physicians said they would do so. US doctors are more forthright with their patients when delivering bad news. But many European doctors wrote that they take an incremental approach to delivering news of a terminal illness.
"When I had to deal with such problems, I tried to give full information progressively so it could be integrated step by step if the context made this possible," writes a Swiss psychiatrist. "I always tell my patients what they have, but the form and the time to transmit the news make all the difference," notes a Portuguese neurologist. "I say everything by steps and with carefully chosen words." While insisting that he never lies to a patient, a Spanish physician says he "manages information as a process."
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