“The [Customer] Patient is Always Right?”

I recently received email notification of the 2016 update of the “Medscape Ethics Report: Life, Death, and Pain.”  Follow the link to view a slide set summarizing the results from 7505 surveyed physicians, 63% of whom were female:

  • Physician-assisted suicide (PAS) for “terminally ill patients”: DOCTORS now favor it, 57%-29%, up from 46%-41% in 2010. The proportion saying “it depends” remains at 14%.  What’s driving this?  Regard for patient autonomy—something that, as I and others have argued, can be elusive, to say the least, when it comes to PAS.  Sample comments include this one (emphasis mine): “It is shocking that this is a controversial topic.  Medicine is a secular institution and we must honor the wishes of our patients.”  SHOCKING??  When the heart of medicine is a covenant between doctor and patient that should include a regard for life that does NOT rest on whether one accepts there is a God?
  • PAS for “non-terminally ill patients with irremediable suffering”: Yes 28%, No 46%, “it depends” 27%.  To all those who said yes to the first question but something else to the second—you don’t get to make that distinction, IF your concern is patient autonomy.  If you counter that the point is that death sometimes is a better course for the patient, you are substituting some level of professional judgment in place of patient autonomy.  I don’t think one can have it both ways.
  • “Would you treat a family that refuses vaccinations?” 23% say no, 19% say “it depends.”  So much for patient autonomy.  No details about what vaccinations (HPV?)  Oh, and reluctance is HIGHER among pediatricians than family docs or internists.
  • Only 50% would tell a patient he or she is inexperienced in doing a procedure before performing it. I lived through “see one/do one/teach one,” as I assume all physicians do in their training, but I’m tempted to say, so much for informed consent.  In this day of “consumer empowerment,” we should encourage patients to ASK the question, and have an idea what they will accept for an answer.  Or maybe we should make our procedure consent forms a bit more like human research consent forms, and require that a number be specified on the form placed before the patient.
  • Only 49% think a terminally ill patient should be permitted to try “any” experimental treatment. This is a harder one to word a question about. Perhaps more on a future post.
  • 12% say life support is being withdrawn too soon, 88% say it’s not.
  • 21% would treat a patient against his or his family’s wishes, 45% would consider it. Another crack in Fortress Autonomy.
  • An increasing number would perform an abortion in some cases even if personally opposed—45% overall, 55% of OB-GYNs.

There’s more—check it out.  But it looks like this is not my father’s—or my, or Hippocrates’s—profession.

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Joshua Speed
Joshua Speed

Of course I do what our bureaucrats call the “customer” wants. I need to keep my press Gainey scores up.