Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

Is there a special Mediterranean approach to Bioethics and if so what are the roots of this approach? And why not a Bosphorus, or a ‘lake Michigan’ bioethics? The answer to such a question depends on the focus one takes on defining ‘Mediterranean’? On the one hand one can refer to the Mediterranean region which includes the surrounding coasts, having Europe on its northern coast line, northern Africa on its southern coast line (and these will include the north and South (...) West coasts), and in the Eastern region countries which border with Middle-Eastern countries. This approach is the approach currently being taken by European Parliamentarians when they speak about the Mediterranean, namely including countries like France, Italy and Libya. On the other hand there is the look upon the Mediterranean as ‘Southern Europe’; this is a more ‘traditional’ way on how westerners view the Mediterranean. This common approach is often recognized when, for example, we speak of ‘Mediterranean diet’, or, ‘Mediterranean Temperament’. It would include Eastern countries like Greece and Cyprus. This article focuses on these two approaches to Mediterranean ethics after discussing issues pertaining to the region which are important to define in this context. It then analyses the need for having a Mediterranean approach to bioethical issues. (shrink)

Background In Spain, there has been great effort by lawmakers to put Advance Directives into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little (...) impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: the training of health professionals about the end of life and AD is lacking; there has been no public process to increase awareness about AD, and therefore people know little about them; the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future. (shrink)

This paper reflects on the presumption that there are distinct ethical differences between the supposedly ‘Anglo-Saxon liberal’ and ‘Latin (Southern European) paternalist’ ethical traditions. The predominance of the bioethical paradigm (principalism) is measured by a comparative analysis of regional moral opinion reflected in nation-state health laws. By looking at the way the ethico-legal concept figures into various national ordinances, we attempt to ascertain the extent and nature of variation (if any) between localities by exploring the understanding and application of principalism’s (...) keystone: patient autonomy. (shrink)

This paper reflects on the presumption that there are distinct ethical differences between the supposedly ‘Anglo-Saxon liberal’ and ‘Latin (Southern European) paternalist’ ethical traditions. The predominance of the bioethical paradigm (principalism) is measured by a comparative analysis of regional moral opinion reflected in nation-state health laws. By looking at the way the ethico-legal concept figures into various national ordinances, we attempt to ascertain the extent and nature of variation (if any) between localities by exploring the understanding and application of principalism’s (...) keystone: patient autonomy. (shrink)