Perception of compliance with ethical principles during clinical
consultation for termination of pregnancy
B.A. Gbolade
Fertility Control Unit, St. James’s University Hospital, Leeds, UK
Introduction: Everyone should have the right to make fully informed
and voluntary decisions about their reproductive health care. Reproductive
health can present clinicians with ethical problems because of the complex
interaction between the individual patient and clinician. Informed consent is
generally required for patients who undergo an invasive medical procedure, such
as induced abortion. A prerequisite for informed consent is that each individual
understands the information provided and voluntarily agrees to receive the
treatment. During the consultation, the clinician attempts to adhere to certain
ethical principles required for informed choice and informed consent. The
literature on perception of ethical problems is scarce and perception of
compliance with medical ethical principles during clinical consultations may be
similar or different between patients and independent observers.1 Differing
perceptions of adherence to ethical principles may generate patient-clinician
conflict and may hamper the quality of care.
Aims and Methods: To ascertain perception of compliance with medical
ethical principles during clinical consultation for termination of pregnancy,
explore congruence / discordance between medical students’ and patients’
perception of adherence to ethical principles and to test the hypothesis that
for each patient, medical students’ perception of compliance with medical
ethical principles will differ from the patients’ perception by as much as
50%. Patients were recruited by way of a convenience sample of volunteers
already referred to the clinic. 44 women consented to participate (of whom, 41
returned their questionnaires). Medical students were those participating in a
third year Ethics Special Study Module. Each medical student observed closely
the general appearance, behaviour and body language of each patient during
consultations and completed a questionnaire. Each patient completed a similar
questionnaire independently.
Results: Both patients and medical student perceived that medical
ethical principles were complied with by the clinicians. However, there was 10 %
discordance in overall perception between the two groups. In real terms, this
meant greater patient confidence that medical ethical principles had been
complied with during clinical consultations.
Conclusions: While the perceptions of both groups were close, patients’
perceptions are possibly of more value than the medical students’ as theirs
are highly speculative involving attempted objective assessment of essentially
highly subjective feelings. However, it is reassuring that clinicians
unconsciously attempt to comply with to medical ethical principles during
clinical consultations for termination of pregnancy.
Reference: Walker RM, Miles SH, Stocking CB, Siegler M. Physicians’
and nurses’ perceptions of ethics problems on general medical services. J
Gen.Intern.Med 1991;6:424–429.
