Communication with the seriously ill: Physicians' attitudes in Saudi Arabia

Objectives-To study some ethical problems created by accession of a previously nomadic and traditional society to modern invasive medicine, by assessment of physicians' attitudes towards sharing information and decision-making with patients in the setting of a serious illness. Design-Self-completion questionnaire administered in 1993. Setting-Riyadh, Jeddah, and Buraidah, three of the largest cities in Saudi Arabia. Survey sample-Senior and junior physicians from departments of internal medicine and critical care in six hospitals in the above cities. Results-A total of 249 physicians participated in the information on diagnosis and prognosis of serious and those who spoke Arabic fared better than other groups. The majority (75%) preferred to discuss information with close relatives rather than patients, even when the patients were mentally competent. Most of the physicians (72%) felt patients had the right to refuse a specific treatment modality, and 68% denied patients the right to demand such a treatment if considered futile. Further analysis showed that physicians' attitudes varied along a spectrum from passive (25%) to paternalistic (21%) with the largest group (47%) in a balanced position. Conclusions-In traditional societies where physicians are regarded as figures of authority and family ties are important, there is a considerable shift of access to information and decision-making from patients to their physicians and relatives in a manner that threatens patients' autonomy. Ethical principles, wider availability of invasive medical technology and a rise in public awareness dictate an attitude change.