title: Ethically problematic treatment decisions: a physician survey.
abstract: BACKGROUND
  Experiencing ethical problems requires both ethically problematic situations and ethical sensitivity. Ethically problematic treatment decisions are distressing and might reflect health care quality problems. Whether all physicians actually experience ethical problems, what these problems are and how they vary according to physician age, gender and work sector are largely unknown.
  
  
  METHODS
  A mail survey of all non-retired physicians licensed in Finland (n = 17,172, response rate 75.6%).
  
  
  RESULTS
  The proportion of physicians reporting having made ethically problematic treatment decisions decreased in linear fashion from 60% at ages below 30 years to 21% at ages over 63 years. The only problem that did not decrease in frequency with age was having withdrawn necessary treatments. Women and primary care physicians reported problematic decisions most often, although gender differences were small. Primary care physicians most often reported having performed too many investigations or having pressured patients, whereas hospital physicians emphasized having withdrawn necessary treatments. Performing unnecessary treatments or investigations was explained by pressure from patients or relatives, and performing too few treatments or investigations was explained by inadequate resources.
  
  
  CONCLUSIONS
  In general, young physicians felt pressured to do too much, whereas older physicians felt they could not do enough due to inadequate resources. Older physicians might be less exposed to ethically problematic situations, be more able to handle them or have lower ethical sensitivity. Young physicians could benefit from support in resisting pressure to perform unnecessary treatments, whereas older physicians might benefit from training in recognizing ethical issues.
authors.affiliation: National Public Health Institute, Helsinki, Finland. samuli.saarni@helsinki.fi
authors.forename: Samuli I
authors.initials: SI
authors.lastname: Saarni
authors.forename: Piitu
authors.initials: P
authors.lastname: Parmanne
authors.forename: Ritva
authors.initials: R
authors.lastname: Halila
mesh_terms: D000328:Adult; D000367:Age Factors; D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D005260:Female; D005387:Finland; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics*; D012737:Sex Factors; D019564:Unnecessary Procedures / Q000941:ethics; D028761:Withholding Treatment / Q000941:ethics; D017132:Workplace