A Survey of the 'Ethics Climate' in Hong Kong Public Hospitals

Abstract

To assess the “ethics climate” of Hong Kong public hospitals, the opinion of healthcare professionals (HCPs) including 532 doctors, 1,681 nurses, 394 paramedics and 111 administrative staff in 14 hospitals were surveyed. Ranked in decreasing order of importance, respondents’ ethical concerns were: (1) communication and conflict between HCPs and patients/families, (2) respect for patients’ rights and values, (3) informed consent, (4) patient confidentiality, (5) DNR orders, (6) end-of-life decisions and (7) inter-professional conflicts. All HCPs, except nurses, believed that both healthcare providers and patients perceive quality of patient care is satisfactory. Nurses assessed patients as demanding (72%) more than doctors (66%). All HCPs agreed that informed consent procedures are followed (70.9%) and patients’ autonomy rights recognized (73.9%), but were unsure that patient’s choices are always followed (54.9%), especially in treatment termination decisions of end-of-life patients (49.7%). Paternalistic practices are not uncommon (56.9%), and doctors sometimes yield to families who insist on futile treatments (60.7%). Tolerance of professional incompetence (46.3%) and unprofessional conducts (48.9%) are uncommon. Nurses agreed more than other HCPs that communication channels with peers and supervisors are inadequate, and inter-professional conflicts exist. Polarities in opinion between nurses and doctors were common, and they took extreme positions in opposition to each other in 36 ethical issues. Different ranks of doctors and nurses also had different ethical assessments, and nursing managers and senior nurses often held opinion closer to doctors and administrative staff than their junior colleagues, leaving junior nurses potentially isolated and demoralized. (Percentages represent mean degree of agreement.)