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.
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.
The aim of this questionnaire survey was to investigate whether Norwegian hospitals have guidelines for lifesaving treatment in cases of extreme prematurity and severe morbidity. 66 out of 71 doctors in charge of Norwegian obstetric and paediatric units answered our questionnaire. 79% of the units had guidelines for starting medical treatment, 45% for ending treatment. Gestational age and the infant's vitality were the most important criteria in decisions concerning withholding of treatment. Two out of three units (44) had a lower gestational age limit, varying from 23 to 25 weeks; 41 of these 44 units used 23 or 24 weeks as the lower limit. Disability risk and the infants' suffering were the most important criteria for termination of treatment. One in five respondents attached little or no emphasis on the infants' suffering. Half of the respondents reported that they felt that making life or death decisions for premature infants had become more difficult over the last few years. Unrealistic expectations and pressure from the media and from parents were important reasons for this. We conclude equality of treatment for premature infants calls for an examination of all factors, medical and psychosocial, with a bearing on decisions.
Medicalization, implying that solutions to everyday or existential problems are being sought within the framework of the health care system, seems to be increasing. Morbidity has been related to socioeconomic status. This study aims at finding out how children perceive their own health condition and whether this is related to socioeconomic conditions. 192 pupils aged 12 years from a rural district and from two districts of Oslo with different socioeconomical conditions reported their health condition during the last school term by means of a questionnaire. There was a high prevalence of complaints from the children. 33% reported insomnia, and 14% had frequent episodes of headache. Nearly 50% reported the presence of one or more chronic diseases. The health problems were not related to gender or nationality. Except for dental health, we found no relation between reported sickness and the children's socioeconomic background.
OBJECTIVE--To seek a relation between pregnant women's psychosocial condition, assessed clinically in general practice, and prematurity and birth weight of the child. DESIGN--Clinical assessment early and late in pregnancy of psychosocial condition based on all accessible information, which included an extended history on psychosocial condition supplemented by background information about the woman and her social network and clinical observations. SETTING--Antenatal care in a general practice. RESULTS--The women assessed as having psychosocial difficulties were younger, had less education, and gained less weight in pregnancy. Birth weight was related to parity, body mass index before pregnancy, and total weight gain in pregnancy. A relationship was found between difficult psychosocial conditions and prematurity and low birth weight of the child. If the assessment of psychosocial condition had been based on the women's verbal descriptions of their problems alone, no relationship would have been found between psychosocial difficulties and prematurity and birth weight of the child. CONCLUSION--A clinical assessment of a woman's psychosocial condition, in which all accessible information is used, and an emphasis on emotional and social support for women when needed, may be necessary for improvement of antenatal care.
OBJECTIVES: To summarise the types of case brought to the Clinical Ethics Committee of the National Hospital of Norway from 1996 to 2002 and to describe and discuss to what extent issues of information/communication have been involved in the ethical problems. DESIGN: Systematic review of case reports. FINDINGS: Of the 31 case discussions, (20 prospective, 11 retrospective), 19 cases concerned treatment of children. Twenty cases concerned ethical problems related to withholding/withdrawing of treatment. In 25 cases aspects of information/communication were involved in the ethical problem, either explicitly (n = 3) or implicitly (n = 22). CONCLUSION: Problems related to information/communication may underlie a classic ethical problem. Identification of these "hidden" problems may be important for the analysis, and hence, the solution to the ethical dilemma.
Studies have shown that the present official Norwegian recommendations on iron supplementation during pregnancy are not followed. A meeting was arranged in February 1993 to discuss the need to change the recommendations. The article describes the conclusions of the panel. It was proposed that the iron status of the pregnant woman, determined as serum ferritin concentration, should be measured early (before the 15th week of gestation) and iron supplement should be given as selective prophylaxis based on the serum ferritin level. The Directorate of Public Health has been asked to issue new recommendations.
The paper presents the Norwegian population's attitude to euthanasia and to legal abortion in 1982, 1990 and 1995, and compares the responses given in 1995 with the attitudes of a representative sample of 1,260 Norwegian physicians. The acceptance of legal abortion in the population seems to have remained constant, while the population's attitude towards euthanasia has become more liberal. Social criteria and a potential handicapped baby were less accepted as causes for abortion in 1995 than in 1990. The physicians are more liberal towards abortion and more sceptical towards euthanasia. The physicians are more reluctant, however, to accept a potential handicapped offspring as a reason for abortion.