Physician perspectives on the ethical aspects of disability determination

Abstract

Objective: To evaluate physician's attitudes and responses to the ethical conflicts involved in certifying patients for welfare disability.

Design: A mailed questionnaire survey that used case scenarios and general questions.

Setting: Massachusetts.

Participants: A random sample of 347 internists and family practitioners and a convenience sample of 100 neighborhood health center physicians from three large cities (NHC sample). The response was 53% and 76%, respectively.

Measurements and main results: Physician responses to case scenarios representing difficult decisions about patient requests for welfare disability determination and general questions about the welfare disability system. Physicians reported a willingness to exaggerate clinical data to help a patient they thought deserving of welfare disability benefits (39% random sample; 56% NHC sample). Physicians did not report confidence in their ability to determine who was disabled as measured by a visual analog scale (4.4 cm random sample, 4.6 cm NHC sample; 0 = very confident, 10 = very uncertain). They did feel burdened by their participation in welfare disability determinations when compared with other administrative chores as measured on a visual analog scale (2.8 cm random sample, 2.5 cm NHC sample; 0 = more burdensome, 10 = less burdensome). Eighty-two percent of the random sample physicians and 86% of the NHC sample physicians thought that filling out a disability form could adversely affect the physician-patient relationship, and 62% of physicians in each sample thought that it represented a conflict of interest. Eighty percent of physicians in both samples thought that it would be better if an independent group of physicians were designated to determine disability.

Conclusions: Physicians perceive an ethical bind as they try to satisfy the conflicting demands of patients and the welfare disability system. They will frequently decide in favor of their patient's interests. This has implications for welfare policy planners.