The medical hierarchy and perceived influence on technical and ethical decisions.

Abstract

OBJECTIVE: To investigate the influence of hierarchial position and perceived influence on ethical and technical decisions. DESIGN: The study was conducted as a postal questionnaire survey. SUBJECTS: A random sample of 329 Danish physicians working at departments of internal medicine and related subspecialties. Of these, 270 (82%) returned a completed questionnaire. MAIN OUTCOME MEASURE: Self-reported perceived influence in discussions about technical and ethical issues in connection with decisions to terminate treatment for patients with terminal malignant illness. RESULTS: The odds ratio for perceived influence between consultants and house officers is 14.9 for ethical issues, 44.9 for technical issues, and 652.3 for questions concerning departmental policy. Gender plays no role, when one controls for hierarchial position. CONCLUSIONS: Hierarchial position is the major determinant of perceived influence on technical and ethical decisions. Position seem to play a larger role in technical than in ethical decisions.