This article covers the most challenging problems that doctors encounter in their practice. Additionally, it discusses the crucial elements doctors should consider before making a decision.

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Would you publicly disclose a PPE shortage at your hospital? Or, if you made a medical error, would you tell the patient? And what if a colleague was spreading vaccine misinformation—would you report or confront them?

These are just some of the gut checks to which Medscape subjected physician readers in its 2022 Right and Wrong in Medicine Report. Their answers illustrate an ethical landscape that continues to evolve along with medicine itself.

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Speaking out about insufficient resources

Remember the early days of the COVID-19 pandemic when PPE was in short supply? The survey reminded readers of this dark chapter in medical history, asking if physicians should go public about shortages of required resources.

Fifty-one per cent said doctors should do so, 33% said it depends, and 15% said no.

According to a June 2020 Journal of the American College of Surgeons ethics essay, one of the salient lessons of the COVID-19 pandemic was the handling of PPE rationing.

“If these decisions must be made, they should be based on sound scientific and ethical principles, executed transparently and equitably, and subject to accountability.”

— Binkely, et al., Journal of the American College of Surgeons

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Disclosing medical mistakes

Accidents will happen. But in medicine, accidents can cost lives. The survey asked physicians: If you were to make a “potentially harmful” medical error, would you disclose it to the patient? Among respondents, 77% said yes, 20% said it depends, and 3% said no.

This is one area in which ethical guidance leaves zero ambiguity. The AMA defines a medical error as “an unintended act or omission or a flawed system or plan that harms or has the potential to harm a patient.”

Withholding information—without a patient’s knowledge or consent—is unethical except in emergency situations, when a patient is incapable of deciding for themselves.

“Disclose medical errors if they have occurred in the patient’s care, in keeping with ethics guidance.”

— AMA

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Managing pain

Well-intended physicians have done their part to stem the destruction of the US opioid epidemic. Part of those efforts includes adherence to the CDC’s pain guidelines, which were updated in November 2022.

One expert told that the previous guidelines, which were codified in 2016, may have prompted physicians to aggressively titrate down dosages, or turn away patients who needed opioids for pain management.

Perhaps these concerns are reflected in the responses to the Medscape survey’s question, “Would you undertreat a patient’s pain for fear of DEA or medical board action?”

Sixty-three per cent of respondents said no, 17% of respondents said yes, and 20% said it depends. In 2010, however, just 6% of respondents said yes.

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Ending life support

For patient families as well as physicians, deciding to terminate life support can be one of the most challenging choices they’ll have to face. The situation gets more fraught when the doctor and the patient’s family aren’t on the same page about this issue.

The survey asked physicians if they would honour a family request to end life support if they thought the patient could survive. Among respondents, 47% said it depends, 35% said no, and 18% said yes.

The data indicated that as time has passed, physicians have become less likely to say no (55% in 2010) and more likely to say it depends (29% in 2010).

According to the AMA, patients who have the capacity to make decisions are within their rights to decline treatment or ask that treatment be discontinued. This is true even if the outcome of the decision is likely death and regardless of whether the illness is terminal.

If a patient is incapacitated, “the patient’s surrogate may decline an intervention or ask that an intervention be stopped in keeping with ethics guidance for surrogate decision making,” the AMA wrote.

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Futile life-sustaining therapy

Sometimes family members need the solace that comes from knowing they tried everything possible to save their loved ones. But should doctors honour all requests for life-saving therapy, even if they believe the therapy to be futile?

Doctors were almost evenly divided on this question. Forty-four per cent said yes, and 41% said it depends. Only 15% said no. In 2010, 24% said yes; 44% said yes in 2020.

The AMA painted these scenarios as a juggling act in which doctors must balance patient autonomy obligations with the need “to be compassionate, yet candid.”

Furthermore, the AMA suggested that doctors discuss care goals with the patient, reassure the patient (or their family) that the patient will receive “medically appropriate interventions,” collaborate to create a care plan, call in the ethics committee as needed, or transfer the patient.

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Drug costs

More than 75% of the doctors surveyed agreed that patient costs should factor into prescription recommendations. Only 7% said no, and 15% said it depends.

“As professionals, physicians individually and collectively have an ethical responsibility to ensure that all persons have access to needed care regardless of their economic means,” the AMA wrote. The association also encouraged physicians to advocate for patients to help ease their financial burdens.

According to a September 2022 US Department of Health & Human Services report, the average price increase per drug was 10% ($150) in January 2022 and 7.8% ($250) in July 2022.

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Vaccinations and medical misinformation

Vaccinations for COVID-19 and other ailments remain hot-button issues in the public discourse. And perhaps not surprisingly, physicians have strong opinions on these matters, too. Among respondents, 65% said flu shots should be mandatory for doctors; 23% said no, and 13% said it depends.

There was less ambiguity on the question of whether physicians should speak out against COVID-19 misinformation by public officials. Seventy-nine per cent said yes, 7% said no, and 14% said it depends.

A poll of 2,200 adults conducted by de Beaumont found that 90% of Americans believe that the dissemination of false COVID-19 information by doctors is “dangerous and irresponsible.”

Seventy-eight per cent said that physicians who share COVID-19 misinformation “should be disciplined in some way,” including license suspension or revocation.

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This story is contributed by Joe Hannan and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.