PMID: 9426933Jan 14, 1998Paper

Ethical conflicts in home care. Patient autonomy and physician advocacy

Canadian Family Physician Médecin De Famille Canadien
M E BoillatF Bellavance

Abstract

To identify whether and how family physicians practising home care resolve ethical dilemmas in clinical management of homebound patients and to examine whether the self-reported, theoretical ethical positions of these physicians match their actual patient management. Cross-sectional survey. Quebec community-based home care program. Quebec family physicians actively involved in community-based home care: 85 men and 65 women. Physician level of agreement with theoretical ethical statements about autonomy, caregiver needs, and resource allocation; management options chosen for a clinical case vignette; and mechanisms used for resolving conflicts. There were 209 respondents to the 279 questionnaires sent (75%). Of these, 59 who were not currently involved in home care were excluded, leaving 150 participants. Most (83.3%) physicians surveyed agreed with the ethical principle of patient autonomy; 88.7% agreed that the interests of family caregivers are important in decisions regarding patients, and 72.0% agreed that limiting home care services is reasonable in the context of limited resources. In managing a patient, 65.3% of physicians thought the patient should be placed in a nursing home against her wishes because of "danger to sel...Continue Reading

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