Last year, a course in clinical medical ethics for paediatricians had to be cancelled owing to lack of interest. To find the reason for this, and to learn what ethical problems the physicians encountered in the course of their work, how they solved them, and their attitude towards education in medical ethics, a questionnaire was sent to all members of The Norwegian Paediatric Association, to be answered anonymously. The most frequent excuses for not attending the course were pressure of work and lack of time. 37% claimed that they very often or often encountered ethical problems during their work. 20% often solved these problems alone, and two out of three after discussing them with colleagues. 51% felt a need to improve their competence to solve ethical problems. Only 16% reported having no such need. The authors discuss the form and content of the education in medical ethics.
Men and women in the work force are also among the top consumers of alcohol. The medical and social consequences of drinking, which are extensive, cause much absenteeism and reduce productivity. However, the workplace is also a good place for prevention of alcohol related problems, and for long term follow-up of individuals who are addicted to alcohol or drugs.
This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.
This is a retrospective study of alcohol-related admittances to the medical department of Molde District Hospital. All cases with certain diagnoses where alcohol is mentioned as a possible cause were recorded, and compared with a reference group of matched, non-alcohol-related cases. During the period 1980-86, 228 patients were admitted 350 times to the medical wards of the hospital. These patients had a significantly higher number of admittances than the reference patients, both to the medical ward and to other wards. They also had a higher frequency of emergency admittances. The average age of patients admitted for alcohol-related causes was much lower than that of the general patient population. The relative number of recorded alcohol-related admittances to the medical ward increased over the seven year period, from 3.8 to 5.5% for men and from 0.7 to 1.6% for women.
A representative sample of 310 long-term unemployed in Norway was followed for 2 years with clinical examinations and the AUDIT questionnaire. 30% of the men and 8% of the women scored over the cut-off point for an alcohol use disorder. This gives a probable prevalence of 16%. The test predicted return to employment in this sample. The AUDIT answers were also used as a basis for dividing into three groups: 'normal', 'hazardous' and 'harmful'. At 2 year follow-up, 27% had changed group, 32 respondents to the worse and 24 to the better. This 'unstable' group was characterized by weaker social network and more frequent drinking. The AUDIT was judged as a useful instrument both in a routine health examination and as an epidemiological tool.
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.
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.
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.
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.