Discussions about bioethics, as with anything else, are too often confined to the realm of theory, in which academics debate various hot-button issues without considering the equally important practical concerns. The fact of the matter is that academics do not conduct their lives and make their decisions according to bioethical guidelines, doctors do, and hence doctors’ perspectives on these controversial issues are equally if not more important than those of academics.
As a first example, 46% of doctors reported being in favor of physician-assisted suicide, while 41% were opposed. Such a divide is inevitable and understandable—there are very strong arguments to be made on both sides of this issue, and lay people are equally torn and unsure about it. The fact that even doctors, who presumably understand most of the medical details surrounding physician-assisted suicide, have not come even close to a consensus suggests that this is truly an issue with no clear solution.
In response to another question, 58% of doctors said that it is not ethical to prescribe a placebo to a patient who wants treatment, but 24% said that it is. Although there is a case to be made for giving placebos without informing the patient (it is, after all, the only way that they can work), the lack of informed consent inherent in lying to a patient about the drugs that they are being given sways the pendulum of ethicality firmly in one direction. Perhaps some of the 24% are truly prescribing placebos with the best interests of their patients in mind, but I suspect that some are doing so simply in the hopes that the placebo will miraculously work and they will have something cool to write a paper about.
Many of the other results, however, are not at all acceptable or understandable, and point not to any inherent ethical conundrum but rather to the fact that doctors are just as selfish, greedy, and self-protecting as the rest of us. 40% of doctors said that it is acceptable in some cases to cover up mistakes they have made that will not cause their patient any harm, and 39% said that it is sometimes alright to perform procedures that are not medically necessary simply to protect against future litigation. These statistics reveal that that in a large number of cases, doctors are willing to compromise their ethics to protect themselves. They are of course in a very tough spot in terms of malpractice suits, but this still does not make it okay.
Moving beyond the realm of self-protection and into that of greed, only 47% of doctors said that gifts and perks from pharmaceutical companies should be refused, while 37% said that it is okay to accept them and 16% said “it depends”. Accepting gifts from drug companies is a clear conflict of interest—it incentivizes doctors to prescribe drugs made by those companies, even when their patients might not need them or be able to afford them—and the fact that so many are willing to overlook this in favor of fancy cars and tropical getaways is a dark stain on the image of the infallible physician. We must never lose sight of the fact that doctors are just as human as the rest of us, and we must always frame our ethical debates taking this often-overlooked variable into account.
1 comment:
The problem with accepting gifts is not that the doctors are being greedy, but that the doctors might become biased. I don’t think that doctors enter the profession only because they are trying to help people; money and prestige play a part in the decision. Accepting gifts is not bad in and of itself, especially when those gifts help the doctor to do their job better.
Gifts become troublesome when those gifts introduce bias into the doctor’s recommendations. If doctors are prescribing a particular drug because of a gift from the manufacturer, it is no different than if the doctor was prescribing the drug because he owned stock in the company, and stood to make a profit from increased sales. Still, a significant portion of patients think that professional gifts (like drug samples) are acceptable, but have problems with expensive or personal gifts (like trips, golf outings, etc.) (Licurse 2010).
What makes the situation so dangerous is the fact that we usually can’t recognize bias in ourselves. Don Moore, a researcher from Carnegie Mellon University, did a study that looked at the possible influence of different types of conflicts of interest. In all of the cases, professionals who had a conflict of interest made biased decisions, even when they had a strong motivation to be impartial. In addition, the participants did not see their decisions as being biased, and they thought that they were accurate, even though an outside (and presumably unbiased) opinion was quite different.
The real question, though, is what we should do about it. Pharmaceutical companies spend billions on advertising each year, and if one way for them to influence doctors is ruled out, they will just find another. Still, it makes sense to put some limits on the sort of gifts that can be accepted, so that we don’t have cases of doctors being more or less bribed to prescribe drugs.
Licurse, Adam, et al. “The Impact of Disclosing Financial Ties in Research and Clinical Care.” Archives of Internal Medicine. 170.8 (2010): 675-682.
Moore, Don A., Lloyd Tanlu, and Max H. Bazerman. “Conflict of interest and the intrusion of bias.” Judgment and Decision Making. 5.1 (2010): 37-53.
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