title: [Ethical conflicts in pediatric surgery: high-performance medicine and the economical environment].
abstract: BACKGROUND
  Healthcare is increasingly influenced by economical constraints which can lead to ethical conflicts for surgeons. The aim of the study was to investigate the incidence of these conflicts and the coping strategies of surgeons.
  
  
  METHODS
  A prospective, standardized staff survey in an academic pediatric surgical department was performed over a period of 4 weeks. The types of conflict and solution strategies were determined. The agreement with given statements was determined using a 5-point Likert scale.
  
  
  RESULTS
  In 155 returned questionnaires 74 ethical conflicts were identified. Most conflicts concerned decisions relating to diagnosis-related groups (DRG) which were economically based. To resolve the ethical conflict surgeons decided to the detriment of patients in 73  % and to the economical benefit in 72 %. In 8  % a medical disadvantage for the patient was noted and in 62  % a disadvantage for patient comfort was seen. Surgeons were highly dissatisfied with the conflict solutions (2.3/5).
  
  
  CONCLUSIONS
  Economical considerations cause ethical conflicts in the daily routine in pediatric surgery. Decisions are made to the benefit of the hospital and cause a decrease in patient comfort. Political solutions for this problem are required in the interest of all those involved.
authors.affiliation: Zentrum Kinderchirurgie Hannover, Medizinische Hochschule Hannover und Kinderkrankenhaus auf der Bult, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Braatz
authors.forename: G
authors.initials: G
authors.lastname: Neitzke
authors.forename: J
authors.initials: J
authors.lastname: Dingemann
authors.forename: B M
authors.initials: BM
authors.lastname: Ure
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D002648:Child; D003625:Data Collection; D003953:Diagnosis-Related Groups / Q000191:economics / Q000941:ethics; D004992:Ethics, Medical; D005858:Germany; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000941:ethics; D008505:Medical Staff, Hospital; D009313:National Health Programs / Q000191:economics* / Q000941:ethics*; D017008:Negotiating; D017060:Patient Satisfaction; D010372:Pediatrics / Q000191:economics* / Q000941:ethics*; D011446:Prospective Studies; D011788:Quality of Life; D013503:Surgery Department, Hospital / Q000941:ethics; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000941:ethics*; D011795:Surveys and Questionnaires