Are end-of-life practices in Norway in line with ethics and law?

BACKGROUND: End-of-life decisions, including limitation of life prolonging treatment, may be emotionally, ethically and legally challenging. Euthanasia and physician-assisted suicide (PAS) are illegal in Norway. A study from 2000 indicated that these practices occur infrequently in Norway. METHODS: In 2012, a postal questionnaire addressing experience with limitation of life-prolonging treatment for non-medical reasons was sent to a representative sample of 1792 members of the Norwegian Medical Association (7.7% of the total active doctor population of 22,500). The recipients were also asked whether they, during the last 12 months, had participated in euthanasia, PAS or the hastening of death of non-competent patients. RESULTS: Seventy-one per cent of the doctors responded. Forty-four per cent of the respondents reported that they had terminated treatment at the family's request not knowing the patient's own wish, doctors below 50 and anaesthesiologists more often. Anaesthesiologists more often reported to have terminated life-prolonging treatment because of resource considerations. Six doctors reported having hastened the death of a patient the last 12 months, one by euthanasia, one by PAS and four had hastened death without patient request. Male doctors and doctors below 50 more frequently reported having hastened the death of a patient. CONCLUSION: Forgoing life-prolonging treatment at the request of the family may be more frequent in Norway that the law permits. A very small minority of doctors has hastened the death of a patient, and most cases involved non-competent patients. Male doctors below 50 seem to have a more liberal end-of-life practice.

Cross-national comparison of job satisfaction in doctors during economic recession.

BACKGROUND: Job satisfaction in doctors is related to migration, burnout, turnover and health service quality. However, little is known about their job satisfaction during economic recessions. Iceland and Norway have similar health care systems, but only Iceland was affected severely by the 2008 economic crisis. AIMS: To examine job satisfaction in Icelandic and Norwegian doctors, to compare job satisfaction with Icelandic data obtained before the current recession and to examine job satisfaction in response to cost-containment initiatives. METHODS: A survey of all doctors working in Iceland during 2010, a representative comparison sample of Norwegian doctors from 2010 and a historic sample of doctors who worked at Landspitali University Hospital in Iceland during 2003. The main outcome measure was job satisfaction, which was measured using a validated 10-item scale. RESULTS: Job satisfaction levels in Icelandic doctors (response rate of 61%, n = 622/1024), mean = 47.7 (SD = 10.9), were significantly lower than those of Norwegian doctors (response rate of 67%, n = 1025/1522), mean = 53.2 (SD = 8.5), after controlling for individual and work-related factors. Doctors at Landspitali University Hospital (response rate of 59%, n = 345/581) were less satisfied during the recession. Multiple regression analysis showed that cost-containment significantly affected job satisfaction (P < 0.001). CONCLUSIONS: Job satisfaction in doctors was lower in Iceland than in Norway, which may have been attributable partly to the current economic recession.

Moral distress among Norwegian doctors.

BACKGROUND: Medicine is full of value conflicts. Limited resources and legal regulations may place doctors in difficult ethical dilemmas and cause moral distress. Research on moral distress has so far been mainly studied in nurses. OBJECTIVE: To describe whether Norwegian doctors experience stress related to ethical dilemmas and lack of resources, and to explore whether the doctors feel that they have good strategies for the resolution of ethical dilemmas. DESIGN: Postal survey of a representative sample of 1497 Norwegian doctors in 2004, presenting statements about different ethical dilemmas, values and goals at their workplace. RESULTS: The response rate was 67%. 57% admitted that it is difficult to criticize a colleague for professional misconduct and 51% for ethical misconduct. 51% described sometimes having to act against own conscience as distressing. 66% of the doctors experienced distress related to long waiting lists for treatment and to impaired patient care due to time constraints. 55% reported that time spent on administration and documentation is distressing. Female doctors experienced more stress that their male colleagues. 44% reported that their workplace lacked strategies for dealing with ethical dilemmas. CONCLUSION: Lack of resources creates moral dilemmas for physicians. Moral distress varies with specialty and gender. Lack of strategies to solve ethical dilemmas and low tolerance for conflict and critique from colleagues may obstruct important and necessary ethical dialogues and lead to suboptimal solutions of difficult ethical problems.

Impact of feeling responsible for adverse events on doctors' personal and professional lives: the importance of being open to criticism from colleagues.

OBJECTIVE: To investigate the impact of adverse events that had caused patient injury and for which the doctor felt responsible, and the experience of acceptance of criticism among colleagues. DESIGN: Self-reports based on postal questionnaires to 1616 doctors. SETTING: Norway. PARTICIPANTS: A representative sample of 1318 active doctors. RESULTS: 368/1294 (28%) reported that they had experienced at least one adverse event with serious patient injury. Being male and working within a surgical discipline (including anaesthesiology, obstetrics and gynaecology) significantly increased the probability of such reports. 38% of the events had been reported to official authorities and, for 17% of doctors, the incident had a negative impact on their private life; 6% had needed professional help. 50% and 54%, respectively, found it difficult to criticise colleagues for their ethically or professionally unacceptable conduct. Doctors who found it easy to criticise colleagues also reported having received more support from their colleagues after a serious patient injury. CONCLUSION: Male surgeons report the highest prevalence of adverse events. Criticism for professionally and ethically unacceptable conduct is difficult to express among doctors. More acceptance of criticism of professional conduct may not only prevent patient harm, but may also give more support to colleagues who have experienced serious patient injury.

Mortality of anesthesiologists, pediatricians, and other specialists in Norway.

BACKGROUND: Following sensational media reports, particularly from Sweden, there has been discussion in Scandinavia during the last couple of years about whether anesthesiologists have shorter life spans than other medical specialists. METHODS: Survival analysis (Cox regression) from the master file of the Norwegian Medical Association was used to compare anesthesiologists with pediatricians and other specialists. Data was taken from 10367 specialists, 533 anesthesiologists, 488 pediatricians, and 9325 other specialists, with Norwegian citizenship. These comprised 574065 man-years, of which 171190 were lived after achieving specialty. CONCLUSION: No differences in mortality were found between the three groups.

The self-perceived health status of Norwegian physicians compared with a reference population and foreign physicians.

AIMS: To compare the self-perceived health status of a representative sample of Norwegian physicians with a general reference population; and to investigate differences in health status among groups of physicians. METHODS: A cross-sectional postal survey was carried out of 1,126 Norwegian physicians and 1,742 subjects in a general reference population, using the widely used general health status questionnaire--Short Form 36 (SF-36). Scores were adjusted for differences in age, gender and education where applicable. RESULTS: The health status of Norwegian physicians was better than that of subjects with a lower level of education in the four dimensions of the SF-36 related to physical health. Male physicians scored better on the physical functioning scale and lower on vitality and social functioning than comparable university graduates. Older physicians scored better than younger in dimensions related to mental health and social functioning. Norwegian general practitioners reported better health status than colleagues in Sweden and the UK. CONCLUSIONS: The self-perceived health status of Norwegian physicians was as good or better than that of the general population. The cross-national differences could be caused by cultural differences, or be related to practice style or job strain.

[Norwegian medical students abroad--background, effort and satisfaction]. / Norske medisinstudenter i utlandet--bakgrunn, studieinnsats og tilfredshet.

BACKGROUND: More than 30% of Norwegian physicians have graduated from medical schools outside Norway, and the number of Norwegian students that attend medical schools abroad is increasing, particularly in Hungary, Poland and the Czech republic. It is of interest to know more about these future Norwegian doctors: where they come from, and how they cope with studying abroad. MATERIAL AND METHODS: A postal survey was carried out among all 1,198 Norwegian medical students that were in the files of the State Education Loan Fund by August 1998. There were 756 responses (63%). The questions covered reasons for going abroad, academic and non-academic outcome, satisfaction, specialty and job preferences, possible motives for career choices, personality traits, smoking status and alcohol use. Comparable data were available from previous studies of medical students in Norway. RESULTS: The social background of students abroad is similar to that of students at home, and their high school grade level is only slightly below. The main reasons for studying abroad is that they were not admitted at a Norwegian university and have a strong wish of becoming a doctor. Language, financial situation, and a number of pragmatic reasons determine which country to go to, choice of university is often incidental. Students abroad spend more time on their studies than students at home do. They are generally satisfied with the academic quality, but satisfaction with how the study is organised is lower in Central and Eastern-European countries. INTERPRETATION: Norwegians who are highly motivated but excluded from Norwegian universities increasingly attend medical schools abroad and are by and large satisfied with the quality of the curriculum.

[Norwegian medical students abroad--career plans, personality, smoking and alcohol use]. / Norske medisinstudenter i utlandet--karriereplaner, personlighet, røyking og alkoholbruk.

BACKGROUND: More than 30% of Norwegian physicians have graduated from medical schools outside Norway, and the number of Norwegian students that attend medical schools abroad is increasing, particularly in Hungary, Poland and the Czech republic. There is a need to know more about these future Norwegian doctors, what their motives and plans are, and how they differ from students at home. MATERIAL AND METHODS: A postal survey was carried out among all 1,198 Norwegian medical students that were in the files of the State Education Loan Fund by August 1998. The questions covered reasons for going abroad, academic and non-academic outcome, satisfaction, specialty and job preferences, possible motives for career choices, personality characteristics, smoking status and alcohol use. Comparable data were available from previous studies of medical students in Norway. RESULTS: There were 756 responses (63%). Surgery, internal medicine and paediatrics were the most popular specialties. Family medicine and psychiatry seem to be less likely specialties for students abroad than for students at home. Traditional gender differences, e.g. interest in aiming for a leadership position, were present and did not differ from those seen among students in Norway. Students abroad were more oriented towards leadership and prestigious specialties, less preoccupied with the possibility of making medical mistakes, and less interested in medico-policial issues than their counterparts at home. Their personality profiles seemed more robust than those of students in Norway. On the other hand, they smoked much more frequently and had a higher risk of alcohol-related problems. INTERPRETATION: Norwegian medical students abroad do not particularly prefer specialties like general practice and psychiatry, where the demand for medical manpower is highest. They seem to have quite traditional preferences according to gender.