Frequency of ethical dilemmas in a medical inpatient service

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Abstract
The frequency of ethical problems in a general medical ward at a university hospital was studied using a quasi-experimental prospective design. In the baseline period, ethical problems were determined by self-report of residents. In the intervention period, a participant-observer was present during attending rounds. Ethical problems were determined by consensus among the attending physician, resident and participant-observer. No significant differences between baseline and intervention periods were found in patient variations, admissions per resident or rating of each resident''s sensitivity to ethical issues. In the baseline period, 7 (3.9%) of 179 cases involved ethical problems. In the intervention period, 16 (17%) of 92 cases involved ethical problems. This difference was significant. The data imply that residents underidentify ethical problems but that sensitization, sympathetic listening, information and advice increase physician recognition of ethical problems.

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