Croatian physicians' and nurses' experience with ethical issues in clinical practice

Aim: To assess ethical issues in everyday clinical practice among physicians and nurses of the University Hospital Rijeka, Rijeka, Croatia. Subjects and methods: We surveyed the entire population of internal medicine, oncology and intensive care specialists and associated nurses employed at the University Hospital Rijeka, Rijeka, Croatia (n=532). An anonymous questionnaire was used to explore the type and frequency of ethical dilemmas, rank of their difficulty, access to and use of ethics support services, training in ethics and confidence about knowledge in ethics. Physicians (n=113, 55% of them female) ranged in age from 27 to 61 years, and nurses (n=251, 95% female), from 20 to 52. Results: The most frequent ethical dilemmas concerned uncertain or impaired decision-making capacity (66% of physicians, 47% of nurses, p=0.008), limitation of treatment at the end of life (60% of physicians, 31% of nurses, p < 0.001) and disagreements among family members (47% of physicians, 31% of nurses, p=0.025). The most difficult dilemmas concerned euthanasia and physician-assisted suicide (49% of physicians, 52% of nurses) and limitation of treatment at the end of life (14% of physicians, 18% of nurses). Only a minority reported ever using any kind of ethics support services (12% of physicians, 3% of nurses, p=0.001) or being very confident about knowledge in ethics (5% of physicians, 6% of nurses). Conclusions: Similar ethical difficulties are present in the clinical practice of both physicians and nurses, with important differences in access and use of ethics support services. A need for systematic ethics educational activities was identified. Inclusion of individual ethics consultants in Croatian healthcare ethics support services is strongly advised.