How do we decide?Scientific knowledge, the law, professional regulation, the organisations within which we work and the political and social environment all influence how we practise medicine. Quite apart from law and regulation, and sometimes in contravention to it, people have expectations about healthcare: who should be consulted over decisions and how we should approach death ABSTRACTMaking diffi cult decisions with older patients on medical wards Key pointsOlder people are medically complex, the information needed to make decisions is often uncertain and the impact of cognitive impairment can make decision making difficult A systematic and thorough approach is required; the principlist approach of considering benefits, burdens, autonomy and justice can be applied, but principles often conflict

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This study sought to evaluate the awareness of bioethics among faculty at Shifa College of Medicine, Islamabad, Pakistan, and to assess their interest in becoming part of a bioethics discussion group and enhancing their knowledge of this subject. 122 faculty members from the medical college, hospital and school of nursing filled out a questionnaire on ethics. 53% were aware of bioethics as a specialty. 85% showed an interest in educating themselves further in the subject and 61% were interested in becoming part of a bioethics discussion group. Only 50 out of 122 faculty members knew what an ethical dilemma was and only 38 were able to describe one in detail. The awareness level of bioethics as a specialty increased with seniority. However the enthusiasm to join a bioethics discussion group was greater among those at a junior level.

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