Dataset Information

Is it morally permissible for general practitioners to disclose their opinion on a woman's decision on abortion?

ABSTRACT: BACKGROUND:This paper considers ethical dilemmas arising where a patient asks their General Practitioner for advice and their personal opinion regarding whether or not to have an abortion. Patients often seek their General Practitioner's advice regarding treatments and procedures, which may occasionally lead to the General Practitioner facing a difficult dilemma of whether to share their personal opinion with their patient. As General Practitioners are more accessible as the first point of contact for patients and often have a closer relationship with them, they may be particularly exposed to such situations. Additionally, the significance of abortion as a sensitive topic and the fact the General Practitioner may have their own personal viewpoint on its morality may make it particularly difficult for them to know how to respond to such a request. MAIN TEXT:This paper explores the difficulties arising in such a situation and considers whether it could ever be ethically justifiable for General Practitioners to express their opinions on such a matter. We consider the duties of a doctor, and highlight the need for clearer guidance for healthcare professionals on managing tensions in their professional boundaries between their personal moral views and their professional responsibilities. A range of ethical viewpoints are considered to explore how a doctor might ap, in particular the principle of autonomy, virtue ethics, and consequentialism. CONCLUSIONS:This article recognises that a General Practitioner in a situation such as this faces many ethical challenges. We propose that offering their opinion to the patient where specifically requested may be morally justifiable. A virtue ethics approach in particular requires that the General Practitioner applies practical wisdom to make this decision, and where they do disclose their opinion ensure this is done so in such a manner that it does not harm the patient and promotes flourishing. We encourage GPs and other healthcare professionals to consider their own moral perspectives on sensitive issues such as abortion, and reflect on how their moral viewpoints have the potential to influence their practice. In doing so, we hope clinicians can be better should they be faced with a situation such as this.

SUBMITTER: Aung L

PROVIDER: S-EPMC7068960 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Is it morally permissible for general practitioners to disclose their opinion on a woman's decision on abortion?

Aung Lynnlette L Knight Selena S

BMC medical ethics 20200312 1

<h4>Background</h4>This paper considers ethical dilemmas arising where a patient asks their General Practitioner for advice and their personal opinion regarding whether or not to have an abortion. Patients often seek their General Practitioner's advice regarding treatments and procedures, which may occasionally lead to the General Practitioner facing a difficult dilemma of whether to share their personal opinion with their patient. As General Practitioners are more accessible as the first point ...[more]

PMID: 32164682

Similar Datasets

Project description:BackgroundGeneral practitioners (GPs) provide the most antidepressant prescriptions and psychologist referrals in Australia, yet little is known about how they decide between treatments for depressive symptoms.AimsThis study examined the decision cues that GPs use when deciding how to treat depressive symptoms and the meaning they attribute to these associations.MethodsStructured interviews were conducted with 16 Australian GPs in a "think-aloud" verbal protocol analysis format. The transcripts were analyzed using content coding and thematic analysis, informed by the dual processes model of decision making.ResultsParticipants associated prescribing antidepressants with severe depressive symptoms, and psychologist referrals were the preferred initial treatment provided patients were willing to engage. Four main themes emerged from the thematic analysis: 1) psychologist as default, 2) the risk is just too high, 3) medication as supplement, and 4) drivers of antidepressants. Contrary to previous findings, participants identified a strong heuristic association between depressive symptoms and psychologist referral. Antidepressant prescription was associated with severe symptoms, higher risk, and a cluster of cues that lead them away from psychologist referral.ConclusionsParticipants demonstrated an oversensitivity to depressive symptom severity, associating psychologist referrals with subclinical depressive symptoms, and starting antidepressants for suicidal ideation and significant functional decline.HighlightsPsychologist referrals were the default preference for GPs when treating depressive symptoms, whereas antidepressants were reserved for patients with elevated risk from severe depressive symptoms and suicidal ideation.Participants' conceptualization of depression severity was oversensitive compared with treatment guidelines.Contrary to treatment guidelines, GPs in this study demonstrated their discomfort for referring patients with suicidal ideation to a psychologist without initiating antidepressants.GPs should consider whether patients within their mild to moderate assessment range can be treated exclusively with more cost-effective means than psychological therapy such as e-mental health programs, guided self-help, and lifestyle changes alone.

Project description:BackgroundGeneral practitioners (GPs) make numerous care decisions throughout their workdays. Extended periods of decision making can result in decision fatigue, a gradual shift toward decisions that are less cognitively effortful. This study examines whether observed patterns in GPs' prescribing decisions are consistent with the decision fatigue phenomenon. We hypothesized that the likelihood of prescribing frequently overprescribed medications (antibiotics, benzodiazepines, opioids; less effortful to prescribe) will increase and the likelihood of prescribing frequently underprescribed medications (statins, osteoporosis medications; more effortful to prescribe) will decrease over the workday.MethodsThis study used nationally representative primary care data on GP-patient encounters from the Bettering the Evaluation and Care of Health program from Australia. The association between prescribing decisions and order of patient encounters over a GP's workday was assessed with generalized linear mixed models accounting for clustering and adjusting for patient, provider, and encounter characteristics.ResultsAmong 262,456 encounters recorded by 2,909 GPs, the odds of prescribing antibiotics significantly increased by 8.7% with 15 additional patient encounters (odds ratio [OR] = 1.087; confidence interval [CI] = 1.059-1.116). The odds of prescribing decreased significantly with 15 additional patient encounters by 6.3% for benzodiazepines (OR = 0.937; CI = 0.893-0.983), 21.9% for statins (OR = 0.791; CI = 0.753-0.831), and 25.0% for osteoporosis medications (OR = 0.750; CI = 0.690-0.814). No significant effects were observed for opioids. All findings were replicated in confirmatory analyses except the effect of benzodiazepines.ConclusionsGPs were increasingly likely to prescribe antibiotics and were less likely to prescribe statins and osteoporosis medications as the workday wore on, which was consistent with decision fatigue. There was no convincing evidence of decision fatigue effects in the prescribing of opioids or benzodiazepines. These findings establish decision fatigue as a promising target for optimizing prescribing behavior.HighlightsWe found that as general practitioners progress through their workday, they become more likely to prescribe antibiotics that are reportedly overprescribed and less likely to prescribe statins and osteoporosis medications that are reportedly underprescribed.This change in decision making over time is consistent with the decision fatigue phenomenon. Decision fatigue occurs when we make many decisions without taking a rest break. As we make those decisions, we become gradually more likely to make decisions that are less difficult.The findings of this study show that decision fatigue is a possible target for improving guideline-compliant prescribing of pharmacologic medications.

Project description:BackgroundThe coronavirus disease (COVID-19) has become an urgent and serious global public health crisis. Community engagement is the first line of defense in the fight against infectious diseases, and general practitioners (GPs) play an important role in it. GPs are facing unique challenges from disasters and pandemics in delivering health care. However, there is still no suitable mobile management system that can help GPs collect data, dynamically assess risks, and effectively triage or follow-up with patients with COVID-19.ObjectiveThe aim of this study is to design, develop, and deploy a mobile-based decision support system for COVID-19 (DDC19) to assist GPs in collecting data, assessing risk, triaging, managing, and following up with patients during the COVID-19 outbreak.MethodsBased on the actual scenarios and the process of patients using health care, we analyzed the key issues that need to be solved and designed the main business flowchart of DDC19. We then constructed a COVID-19 dynamic risk stratification model with high recall and clinical interpretability, which was based on a multiclass logistic regression algorithm. Finally, through a 10-fold cross-validation to quantitatively evaluate the risk stratification ability of the model, a total of 2243 clinical data consisting of 36 dimension clinical features from fever clinics were used for training and evaluation of the model.ResultsDDC19 is composed of three parts: mobile terminal apps for the patient-end and GP-end, and the database system. All mobile terminal devices were wirelessly connected to the back end data center to implement request sending and data transmission. We used low risk, moderate risk, and high risk as labels, and adopted a 10-fold cross-validation method to evaluate and test the COVID-19 dynamic risk stratification model in different scenarios (different dimensions of personal clinical data accessible at an earlier stage). The data set dimensions were (2243, 15) when only using the data of patients' demographic information, clinical symptoms, and contact history; (2243, 35) when the results of blood tests were added; and (2243, 36) after obtaining the computed tomography imaging results of the patient. The average value of the three classification results of the macro-area under the curve were all above 0.71 in each scenario.ConclusionsDCC19 is a mobile decision support system designed and developed to assist GPs in providing dynamic risk assessments for patients with suspected COVID-19 during the outbreak, and the model had a good ability to predict risk levels in any scenario it covered.

Project description:BackgroundMedical decision-making relies partly on the probability of disease. Current recommendations for the management of common diseases are based increasingly on scores that use arbitrary probability thresholds.ObjectiveTo assess decision-making in pharyngitis and appendicitis using a set of clinical vignettes, and the extent to which management is congruent with the true probability of having the disease.DesignWe developed twenty-four clinical vignettes with clinical presentations corresponding to specific probabilities of having disease defined by McIsaac (pharyngitis) or Alvarado (appendicitis) scores. Each participant answered four randomly selected web-based vignettes.ParticipantsGeneral practitioners (GP) working in primary care structures in Switzerland and the USA.Main measuresA comparison between the GP's management decision according to the true probability of having the disease and to the GP's estimated probability, investigating the GP's ability to estimate probability of disease.Key resultsThe mean age of the GPs was 48 years (SD 12) and 66% were men. The correlation between the GP's clinical management decision based on the vignette and the recommendations was stronger for appendicitis than pharyngitis (kw = 0.74, 95% CI 0.70-0.78 vs. kw = 0.66, 95% CI 0.62-0.71). On the other hand, the association between the clinical management decision and the probability of disease estimated by GPs was more congruent with recommendations for pharyngitis than appendicitis (kw = 0.70, 95% CI 0.66-0.73 vs. 0.61, 95% CI 0.56-0.66). Only a minority of GPs correctly estimated the probability of disease (29% for appendicitis and 39% for pharyngitis).ConclusionsDespite the fact that general practitioners often misestimate the probability of disease, their management decisions are usually in line with recommendations. This means that they use other approaches, perhaps more subjective, to make decisions, such as clinical judgment or reasoning that integrate factors other than just the risk of the disease.

Project description:IntroductionThe participation of general practitioners (GPs) in primary care research is variable and often poor. We aimed to develop a substantive and empirical theoretical framework to explain GPs' decision-making process to participate in research.MethodsWe used the grounded theory approach to construct a substantive theory to explain the decision-making process of GPs to participate in research activities. Five in-depth interviews and four focus group discussions were conducted among 21 GPs. Purposeful sampling followed by theoretical sampling were used to attempt saturation of the core category. Data were collected using semi-structured open-ended questions. Interviews were recorded, transcribed verbatim and checked prior to analysis. Open line-by-line coding followed by focus coding were used to arrive at a substantive theory. Memoing was used to help bring concepts to higher abstract levels.ResultsThe GPs' decision to participate in research was attributed to their inner drive and appreciation for primary care research and their confidence in managing their social and research environments. The drive and appreciation for research motivated the GPs to undergo research training to enhance their research knowledge, skills and confidence. However, the critical step in the GPs' decision to participate in research was their ability to align their research agenda with priorities in their social environment, which included personal life goals, clinical practice and organisational culture. Perceived support for research, such as funding and technical expertise, facilitated the GPs' participation in research. In addition, prior experiences participating in research also influenced the GPs' confidence in taking part in future research.ConclusionsThe key to GPs deciding to participate in research is whether the research agenda aligns with the priorities in their social environment. Therefore, research training is important, but should be included in further measures and should comply with GPs' social environments and research support.

Dataset Information

Is it morally permissible for general practitioners to disclose their opinion on a woman's decision on abortion?

Publications

Is it morally permissible for general practitioners to disclose their opinion on a woman's decision on abortion?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets