Empirical and philosophical analysis of physicians’ judgments of medical indications

Abstract

BackgroundThe 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.MethodsA 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.ResultsIn 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.ConclusionThis 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.

Existential decision-making in a fatal progressive disease: how much do legal and medical frameworks matter?

“…Still, it is the physician who makes the final decision regarding which treatment is offered. Physicians are not legally obligated to offer life-sustaining treatment for which they see no medical indication, even if this might be against the wishes of a well informed, competent patient [ 49 ]. In the case of NIV ineffectiveness, for instance, the physician would decide whether to offer IV or palliative symptom control.…”

What are the medical indications for providing extremely premature infants with intensive care?

“…The judgement about whether or not there was a medical indication for a Caesarean in this situation may also have been influenced by the physicians’ values. Even though medical indications are traditionally considered as a purely medical matter, a study published in 2016 indicated that physicians’ personal values may influence how they interpret medical indications – a phenomenon called value‐impregnated factual judgements . Thirdly, the regional differences may have represented differences in competitive spirit with regard to which clinic can save the most premature newborn infants, with or without impairments.…”

Indikationsqualität. Konzeption und professionsethische Implikationen

“…Die Bundesärztekammer bezeichnet die Indikation als ein "normatives Korrektiv", das dem Patientenwohl dient [9]. In der Literatur existieren unterschiedliche Verständnisse der Indikation [s. Beiträge in 6, 10, 15, 16], die teilweise neue Unterkategorien einführen [16], teilweise ausschließlich evidenzbasiert diskutieren [15]. Der Verlauf einer Entscheidungsfindung zwischen Arzt und Patient lässt sich folgendermaßen konzeptualisieren ▶Abb.…”

“…Es kann aber nicht davon abgesehen werden, dass in der Realität nicht nur professionsethische, sondern persönliche Wesenszüge und Haltungen des Arztes eine Rolle spielen. Etwa ein Viertel [36] bis ein Drittel [15] befragter Ärzte ließ nichtmedizinische "private values" in die Indikationsstellung einfließen. Darunter sind individuelle "private" Haltungen des Arztes (z.…”