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Directive Counsel and Morally Controversial Medical Decision-Making: Findings from Two National Surveys of Primary Care Physicians

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A Capsule Commentary to this article was published on 06 November 2013

ABSTRACT

BACKGROUND

Because of the potential to unduly influence patients’ decisions, some ethicists counsel physicians to be nondirective when negotiating morally controversial medical decisions.

OBJECTIVE

To determine whether primary care providers (PCPs) are less likely to endorse directive counsel for morally controversial medical decisions than for typical ones and to identify predictors of endorsing directive counsel in such situations.

DESIGN AND PARTICIPANTS

Surveys were mailed to two separate national samples of practicing primary care physicians. Survey 1 was conducted from 2009 to 2010 on 1,504 PCPs; Survey 2 was conducted from 2010 to 2011 on 1,058 PCPs.

MAIN MEASURES

Survey 1: After randomization, half of the PCPs were asked if physicians should encourage patients to make the decision that the physician believes is best (directive counsel) with respect to “typical” medical decisions and half were asked the same question with respect to “morally controversial” medical decisions. Survey 2: After reading a vignette in which a patient asked for palliative sedation to unconsciousness, PCPs were asked whether it would be appropriate for the patient’s physician to encourage the patient to make the decision the physician believes is best.

KEY RESULTS

Of 1,427 eligible physicians, 896 responded to Survey 1 (63 %). Physicians asked about morally controversial decisions were half as likely (35 % vs. 65 % for typical decisions, p < 0.001) to endorse directive counsel. Of 986 eligible physicians, 600 responded to Survey 2 (61 %). Two in five physicians (41 %) endorsed directive counsel after reading a vignette describing a patient requesting palliative sedation to unconsciousness; these physicians tended to be male and more religious.

CONCLUSIONS

PCPs are less likely to endorse directive counsel when negotiating morally controversial medical decisions. Male physicians and those who are more religious are more likely to endorse directive counsel in these situations.

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Acknowledgements

The authors gratefully acknowledge the feedback of Michael Combs, Robert Stern, and Helen Shin on an earlier version of this manuscript.

This study was supported by grants from the John Templeton Foundation and the National Center for Complementary and Alternative Medicine (1 K23 AT002749, to Dr. Curlin).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA

    Michael S. Putman MD

  2. The Department of Medicine, The University of Chicago, Chicago, IL, USA

    Michael S. Putman MD, John D. Yoon MD & Farr A. Curlin MD

  3. MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    John D. Yoon MD & Farr A. Curlin MD

  4. Program on Medicine and Religion, The University of Chicago, Chicago, IL, USA

    John D. Yoon MD, Kenneth A. Rasinski PhD & Farr A. Curlin MD

Authors
  1. Michael S. Putman MD
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  2. John D. Yoon MD
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  3. Kenneth A. Rasinski PhD
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  4. Farr A. Curlin MD
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Corresponding author

Correspondence to Farr A. Curlin MD.

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Putman, M.S., Yoon, J.D., Rasinski, K.A. et al. Directive Counsel and Morally Controversial Medical Decision-Making: Findings from Two National Surveys of Primary Care Physicians. J GEN INTERN MED 29, 335–340 (2014). https://doi.org/10.1007/s11606-013-2653-4

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