The Institute for Studies of the Medical Profession, PO Box 1152, Oslo, 0107, Norway.
BMC Med Ethics. 2024 Mar 25;25(1):36. doi: 10.1186/s12910-024-01035-x.
Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views.
To study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time.
Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014).
Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing.
A substantial minority of doctors agreed that lifestyle should be a priority criterion, possibly contrary to Norwegian legislation and professional ethics. The finding might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. We conclude that attitudes to normative questions are unstable and depend on context. A substantial minority of doctors seems to be positive to deprioritizing patients allegedly responsible for their illness. However, what deprioritization implies in practice is not clear.
患者的生活方式是否应优先考虑治疗是生命伦理学中的一个有争议的问题。关于临床医生的观点，人们知之甚少。
研究临床医生对患者责任和优先顺序问题的态度随时间的变化。
对挪威医生进行 2008 年、2014 年和 2021 年的调查。调查问卷包括关于患者生活方式对护理优先级的重要性的陈述，以及优先级案例的情景描述（仅在 2014 年）。
2008 年至 2021 年期间，态度相当稳定。17%/14%的医生同意患者的生活方式应该被考虑，而 19%/22%的医生同意生活方式应涉及到稀缺器官的较低优先级。42/44%的医生同意吸烟者应具有较低的优先级。2014 年的比例明显更高。回归分析表明，男性、在医院工作和年龄较小的医生更有可能同意这一观点。
相当一部分医生认为生活方式应该成为优先考虑的标准，这可能与挪威的立法和职业道德相悖。这一发现可能是由于优先顺序的含义不明确、对稀缺性的认识提高，或者是个体主义的社会文化趋势所致。2014 年的结果表明存在框架效应；情景描述可能使受访者倾向于接受生活方式作为一个标准。我们的结论是，对规范问题的态度是不稳定的，取决于具体情况。相当一部分医生似乎对将据称对自己的疾病负责的患者降序处理持积极态度。然而，降序处理在实践中意味着什么尚不清楚。
