Endocrinologists Share Thoughts on Ethical Challenges

Endocrinologists share their opinions on an array of ethical topics and sometimes gut-wrenching decisions encountered in clinical practice in a new Medscape Slideshow entitled, Right and Wrong in Medicine: Endocrinologists Confront Difficult Decisions.  

The report — part of a larger survey of 4151 US physicians who completed an online survey between April and July 2022 — details endocrinologists’ responses to questions covering some of the most thorny issues they currently face, ranging from patient privacy, concerns around sexual harassment, appropriate social media involvement, and physician-assisted dying.

In general, endocrinologists’ responses reflected those of the broader sample of US physicians — but not all.

Asked about physician-assisted dying, for example, only 41% of endocrinologists said they felt the practice — which is legal in 10 US states and the District of Columbia — should be allowed for terminally ill patients, compared with 52% of physicians overall.

About a third (31%) of endocrinologists surveyed reported that, “no,” the practice should not be legal, and 28% said “it depends.”

“The public and physicians are getting more comfortable with [the idea of physician-assisted dying],” said Eric Mathison, PhD, a clinical ethicist with the University of Toronto, in the report. “Physicians are seeing it used in practice and hearing from other physicians who are participating.”

On the topic of whether endocrinologists’ social media posts are unprofessional if the posts are not related to medical practice, 74% of respondents said “no,” with 13% each saying “yes,” or “it depends.”

The corresponding responses by physicians overall were similar, with 69% saying “no,” 17% saying “it depends,” and 14% saying “yes.”

On the touchy subject of whether it is acceptable to breach patient confidentiality when someone’s health could be threatened, 56% of endocrinologists replied “yes,” while 29% said “it depends,” and 15% said “no.”

“I teach that if you know someone faces a direct risk from catching a deadly disease, and you know who that person is, then you have a duty to warn,” noted medical ethicist Arthur L. Caplan, PhD, a New York University professor of bioethics.

“The disease has to be serious for [breaching confidentiality] to be morally defensible, and your disclosure has to be actionable,” he added.

The survey also inquired about various issues relating to physician behavior. On the issue of whether endocrinologists should be randomly tested for drugs and alcohol, for instance, only 39% of participants responded “yes”, with 46% saying “no” and 16% responding “it depends.”

The issue can be uncomfortable for physicians. “Doctors may feel like they are being treated unprofessionally, like drug addicts, or question the accuracy of testing,” Caplan commented. But he underscored the “moral fight to protect patient safety and trying to drive down malpractice costs.”

And on the topic of whether a romantic relationship with a patient is appropriate, 67% of endocrinologists responded “no”; 22% responded “yes, after they’ve stopped being your patient for 6 months,” 9% replied “it depends,” and only 1% flatly said “yes.”

Commenting on this, Thomas May, PhD, a bioethicist at Washington State University, noted: “I’m not sure 6 months after they stop being your patient is long enough. I’d think something like 2 years as a minimum. If I were your oncologist and helped save your life it may never be appropriate.”

And in terms of whether they would report a fellow doctor for sexual harassment or bullying, 75% of endocrinologists said “yes,” with 15% responding “it depends,” and 10% saying “no.”

Regarding reporting a fellow doctor for making racist remarks, 53% of endocrinologists said “yes,” vs 29% saying “it depends,” and 18% saying “no.”

And in terms of speaking up when physicians spread dangerous misinformation, US Surgeon General Vivek Murthy, MD, in 2021 urged Americans to speak out against health misinformation during the COVID-19 pandemic, and the vast majority of survey respondents agreed that likewise, endocrinologists should speak out publicly against COVID-19 misinformation by government or elected officials, with 76% responding “yes,” to the suggestion; only 13% saying that “it depends,” and 11% saying “no.”

On the issue of pharmaceutical industry influence, the survey asked whether “[you could] accept a meal or speaking gig from a pharma without it influencing your prescription habits,” to which 77% of endocrinologists responded “yes,” they could, with 12% reporting “no,” and 11%, “it depends.”

Caplan questions whether some are fooling themselves. “Humans get a sense of debt when they receive gifts,” he says in the report. “Physicians are no exception. If you get a meal or an invitation to do a talk for a small fee you may still say ‘this is nothing to me,’ but subconscious favoritism can result.”

And in the ongoing debate of whether clinicians are ethically obligated to accept some Medicaid patients, 46% of endocrinologists responded “yes,” while 35% responded “no,” and 19% said “it depends.”

The proportion of those agreeing with the statement was somewhat lower than the 53% reported by physicians overall,” with 34% saying “no” and 12% saying “it depends.”

One respondent made the notable point that “all of us benefited in our education and residency from public funding. We owe those who cannot afford our care.”

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