news Wednesday, March 11, 2015 - 05:30

The News Minute | December 18, 2014 | 06:49 pm IST 

More than 21,000 physicians from the US and Europe participated in an online survey and answered questions on how they feel about medicine's most critical issues.

In a recent report published by Medscape, titled Ethics report 2014, Part One: Life, Death and Pain, physicians answer some of the toughest questions they have to deal with regularly as part of their profession.  The survey was conducted from September through November 2014. This part of the survey is based on the answers given by doctors from the US. Representative respondent comments are also shown in the report, to shed more light on the issues at hand.

Doctors work under tremendous pressure, their decisions could literally mean life or death for their patients. But physicians often have to deal with complex issues, where the answer is not a simple yes or no. 

Would they treat a patient by going against the family's wishes if they felt the patient had a chance to recover? What about withdrawing life support- how do they decide the right time to pull the plug? Would they conduct an abortion if it went against their beliefs? If they had scarce resources, would they use it to treat a younger patient or an older one? Would they deny a potentially more effective treatment to a patient because the insurer won't pay for it?

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These are questions that are subjective. Although for doctors the major focus lies on treating patients and making them better, they constantly have to deal with forces outside their control. 

The survey by Medscape gives a peek into what doctors feel about such situations and whether or not it affects their professional decisions or the way they function. 

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54 percent of respondents said yes when asked whether physician-assisted suicide be allowed.

"I believe terminal illnesses such as metastatic cancers or degenerative neurological diseases rob a human of his/her dignity. Provided there is no shred of doubt that the disease is incurable and terminal, I would support a patient's decision to end their life, and I would also wish the same option was available in my case should the need arise."

"Physicians are healers. We are not instruments of death. This is wrong."

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50 percent of doctors said that they would go against a family's wishes and continue treating a patient whom they felt had a chance to recover. 

"My duty is to the patient, not an inheritor who may want to kill him off to get his estate."

Is it right to provide intensive care to a new born who will either die soon or will survive but will have an objectively terrible quality of life? While 31 percent doctors said yes to this question, 27 percent said no and 43 percent chose the 'it depends' option. 

"What, are we playing God now? How in the world do we know who will have a terrible life? There are many physically healthy people who are miserable and many physically challenged people who lead very meaningful lives."

"I can imagine a situation where all involved, not just the newborn, could be expected to have a terrible life. Then: no intensive care."

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Would you perform an abortion if it were against your personal beliefs? 44 percent said yes, and 41 percent said no. 

"My beliefs collide often with my clinical duty. But with the white coat on, the patient always comes first."

"NO. Abortions should be done for medical emergencies, not convenience. It is not a birth control measure."

"I would only do it if a dead fetus or dying fetus was severely compromising and risking the life of the mother."

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What has been their toughest ethical dilemma? 

The report states that a majority of physicians could name at least one ethical dilemma that they remembered years later. Many of them noted that the situation still bothered them, and that they wished they had acted differently. Others felt that they had done the right thing, despite substantial fallout.

"My grandfather's euthanasia request that he made to me: I did not comply."

"Treating pain in a patient who could not communicate. The family did not want to give pain meds, but the physicians all felt that the patient was in pain."

"Having a patient on life support for close to a year, in a vegetative state, with the family unwilling to withdraw care."

"A family did not want their father to know about his cancer diagnosis. The cancer was treatable, but aggressive, and the family did not want to pursue it because they were afraid of how the father would tolerate it."

Read the full report here

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