OBJECTIVE: To identify the ethical dilemmas that internists encounter, the strategies they use to address them, and the usefulness of
ethics consultation.
DESIGN: National telephone survey.
SETTING: Doctors’ offices.
PARTICIPANTS: General internists, oncologists, and critical care/pulmonologists (N=344, 64% response rate).
MEASUREMENTS: Types of ethical dilemmas recently encountered and likelihood of requesting ethics consultation: satisfaction with resolution
of ethical dilemmas with and without ethics consultation.
RESULTS: Internists most commonly reported dilemmas regarding end-of-life decision making, patient autonomy, justice, and conflict
resolution. General internists, oncologists, and critical care specialists reported participating in an average of 1.4, 1.3,
and 4.1 consultations in the preceding 2 years, respectively (P<.0001). Physicians with the least ethics training had the
least access to and participated in the fewest ethics consultations; 19% reported consultation was unavailable at their predominant
practice site. Dilemmas about end-of-life decisions and patient autonomy were often referred for consultation, while dilemmas
about justice, such as lack of insurance or limited resources, were rarely referred. While most physicians thought consultations
yielded information that would be useful in dealing with future ethical dilemmas (72%), some hesitated to seek ethics consultation
because they believed it was too time consuming (29%), might make the situation worse (15%), or that consultants were unqualified
(11%).
CONCLUSIONS: While most internists recall recent ethical dilemmas in their practices, those with the least preparation and experience
have the least access to ethics consultation. Health care organizations should emphasize ethics educational activities to
prepare physicians for handling ethical dilemmas on their own and should improve the accessibility and responsiveness of ethics
consultation when needed.
Key Words questionnaires - internal medicine - ethics - clinical - ethicists - referral and consultation
This study was conducted while Dr. DuVal was a fellow in the Department of Clinical Bioethics at the Clinical Center of the
National Institutes of Health. Funding was provided by the Clinical Center of the National Institutes of Health.
The opinions expressed here are solely those of the authors and do not reflect the views or policies of the Department of
Health and Human Services or the National Institutes of Health.