title: The medical hierarchy and perceived influence on technical and ethical decisions.
abstract: OBJECTIVE
  To investigate the influence of hierarchial position and perceived influence on ethical and technical decisions.
  
  
  METHODS
  The study was conducted as a postal questionnaire survey.
  
  
  METHODS
  A random sample of 329 Danish physicians working at departments of internal medicine and related subspecialties. Of these, 270 (82%) returned a completed questionnaire.
  
  
  METHODS
  Self-reported perceived influence in discussions about technical and ethical issues in connection with decisions to terminate treatment for patients with terminal malignant illness.
  
  
  RESULTS
  The odds ratio for perceived influence between consultants and house officers is 14.9 for ethical issues, 44.9 for technical issues, and 652.3 for questions concerning departmental policy. Gender plays no role, when one controls for hierarchial position.
  
  
  CONCLUSIONS
  Hierarchial position is the major determinant of perceived influence on technical and ethical decisions. Position seem to play a larger role in technical than in ethical decisions.
authors.affiliation: Department of Medical Philosophy and Clinical Theory, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Holm
mesh_terms: D003657:Decision Making; D003718:Denmark; D034462:Dissent and Disputes; D004992:Ethics, Medical; D006126:Group Processes; D006801:Humans; D007388:Internal Medicine; D008505:Medical Staff, Hospital; D024802:Nurse's Role; D016017:Odds Ratio; D011209:Power, Psychological; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D028761:Withholding Treatment