The Vascular Surgeon Facing Clinical Ethical Dilemmas (The VASCUETHICS Study): ‘V’-Shaped Association Between Compassionate Attitudes and Professional Seniority

Abstract

Objective To evaluate the association between compassionate attitudes and seniority in vascular surgeons facing clinical ethical dilemmas (CED). Subjects and methods (1) Design: Cross-sectional. (2) Subjects: Vascular surgeons (residents included) from the 28 vascular teaching departments of one European country. (3) Measurements: Multidisciplinary team-designed, structured and self-administered questionnaire consisting of five clinical ethical dilemmas, of which four had conflict between compassion towards a ‘small’ or ‘very costly’ beneficial action vs. a reasonable but more ‘pragmatic’ allocation of health resources. Participants stated their degree of agreement with eight answers representing the two attitudes on a continuous scale. (4) Statistics: Cluster analysis and logistic regression model adjusted by confounding factors. Results Two hundred and fifty three vascular surgeons (median age 37 years, 74% male) from the 26 participating teaching vascular departments (public hospitals) completed the questionnaire (88% surgeons/department). Cluster analysis identified two groups of surgeons according to their pattern of answers: Group I ( n=63) were mainly compassionate whereas Group II ( n=180) were mainly pragmatic. The multivariate analysis disclosed, after adjusting for additional private practice, on call services and career status, a significant V-shaped relationship between the compassionate behaviour and seniority. Surgeons with 8–15 years experience were the least compassionate. Conclusions The youngest and the most senior vascular surgeons were more prone to favour compassionate attitudes when facing clinical ethical dilemmas. Although both compassionate and pragmatic attitudes may be legitimate ethically, physicians not favouring compassion may be at risk of leaving the patient without an advocate within the health care system.