How stable are moral judgements? A longitudinal study of context dependency in attitudes towards patient responsibility

Abstract

Abstract Background Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views. Methods Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only 2014). Focus group with six GPs in 2019. Data analysed by descriptive statistics, linear regression, and text analysis. Results Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing. The focus group interview demonstrated that "lower priority" was unclear, and that attitudes changed from more to less positive to lowering priority due to lifestyle during discussion. Conclusion Many doctors agreed that lifestyle should be a priority criterion, contrary to Norwegian legislation and professional ethics. This might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. The interview demonstrated that moral views are changeable. Three lessons are drawn: Attitudes to normative questions are unstable and depend on context. The practical implication of "lower priority" should be specified. Many doctors are positive to deprioritizing patients allegedly responsible for their illness.