Abstract
BackgroundTo investigate whether Swedish physicians, contrary to Swedish health care policy, employ considerations of patient responsibility for illness when rationing expensive treatments.MethodsA random sample of oncologists and pulmonologists made up the main study-group (n = 296). A random sample of GPs (n = 289) and participants from the general population (n = 513) was used as contrast group. The participants randomly received one version of a questionnaire containing a case description of a terminally ill lung cancer patient. The two versions differed in only one aspect: in one version the patient was a smoker and in the other a non-smoker. The main questions were whether to offer a novel, expensive and marginally life-prolonging treatment and whether the patient could be held responsible for her illness. The quantitative data was analysed using Chi2-tests and comments were analysed using content analysis.ResultsAmong oncologists and pulmonologists, 78% (95% CI: 72-85) would offer the treatment to the non-smoker and 66% (95% CI: 58-74) to the smoker (Chi-2 = 5.4, df = 1, p = 0.019). Among the GPs, 69% (95% CI: 61-76) would treat the non-smoker and 56% (95% CI: 48-64) the smoker (Chi-1 = 4.9, df = 1 and p = 0.026). Among the general population the corresponding proportions were 84% (95% CI: 79-88) and 69% (95% CI: 63-74).ConclusionThis study indicates that applying an experimental design allowed us to go beyond the official norms and to show that, compared to a smoking patient, both the general population and physicians are more inclined to treat a non-smoking patient. This clearly runs counter to the official Swedish health care norms. It also seems to run counter to the fact that among the physicians studied, there was no association between finding the patient responsible for her disease and the inclination to treat her. We think these paradoxical findings merit further studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12910-015-0019-7) contains supplementary material, which is available to authorized users.
Highlights
To investigate whether Swedish physicians, contrary to Swedish health care policy, employ considerations of patient responsibility for illness when rationing expensive treatments
Both the physicians and the members of the general population were significantly less willing to offer the new and expensive treatment if the patient had been smoking. This difference was larger among the general population (Chi-2 = 15.98; df = 1, p = 0.000064) than among the whole group of physicians (Chi-2 = 10.55; df = 1, p = 0.0012)
When subgrouping according to medical specialities, we found the above-mentioned disinclination to treat the smoker compared to the non-smoker among oncologists and GPs only (Chi-2 = 6.1; df = 1, p = 0.013 and Chi-2 = 4.9; df = 1, p = 0.026 respectively)
Summary
To investigate whether Swedish physicians, contrary to Swedish health care policy, employ considerations of patient responsibility for illness when rationing expensive treatments. Justice is one of the central virtues in medical ethics, and how to create a just health care system a question of perennial debate [1]. With medical costs rising faster than the capacity to pay, fair priority setting stands out as an increasingly important aspect of health care justice [2]. The Rawls-via-Daniels view that health care should be distributed according to patients’ needs but not to deserts or responsibility has been dominant [3]. But not all, health care systems currently. One (but not the only [8]) current defence of the responsibility principle is so-called luck egalitarianism, a view that differentiates between inequalities arising from factors within the individual’s control and those that are
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