title: Empirical and philosophical analysis of physicians' judgments of medical indications.
abstract: The aim of this study was to investigate whether physicians who felt strongly for or against a treatment, in this case a moderately life prolonging non-curative cancer treatment, differed in their estimation of medical indication for this treatment as compared to physicians who had no such sentiment. A further aim was to investigate how the notion of medical indication was conceptualised.
  
  
  
  A random sample of GPs, oncologists and pulmonologists (n = 646) comprised the study group. Respondents were randomised to receive either version of a case presentation; in one version, the patient had smoked and in the other version she had never smoked. The physicians were labelled value-neutral (65%) and value-influenced (35%) on the basis of their attitude towards the treatment.
  
  
  
  In the 'value-influenced' group, there was a significant difference in the estimation of medical indication for treatment depending upon whether the patient had smoked (50% (95% CI: 41-59) or never smoked (67% (95% CI: 58-76) (Chi-2 = 5.8, df = 1;p= 0.016)). There was no such difference in the 'value-neutral' group.
  
  
  
  This study shows that compared to value-neutral physicians, value-influenced physicians are more likely to base decisions of medical indication on medically irrelevant factors (in this case: the patient's smoking status). Moreover, medical indication is used in an ambiguous manner. Hence, we recommend that the usage of 'medical indication' be disciplined.
authors.affiliation: Department of Research and Development, Region Kronoberg, Karolinska Institute of Medicine, Stockholm Sweden; Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institute, LIME Stockholm, Sweden.
authors.forename: Joar
authors.initials: J
authors.lastname: Björk
authors.affiliation: Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institute, LIME Stockholm, Sweden.
authors.forename: Niels
authors.initials: N
authors.lastname: Lynöe
authors.affiliation: Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institute, LIME Stockholm, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Juth
keywords: Resource allocation; clinical ethics; concept of clinical ethics; health; health care; health care economics; public health; right to health care