PHYSICIANS ’ ETHICAL POSITIONS AND THEIR RESPONSES TO A DEMENTIA THEMED ETHICAL DILEMMA: A CROSS-CULTURAL STUDY*.

1. PHYSICIANS’ ETHICAL POSITIONS AND THEIR RESPONSES TO A DEMENTIA THEMEDETHICAL DILEMMA: A CROSS-CULTURAL STUDY*. D. C. Malloy, M. J. Goldberg, P. R. Sevigny, T., Hadjistavropoulos (University of Regina, Regina, Canada), & E. Fayeh-McCarthy (Trinity College, Dublin, Ireland) P. Liu, (Shandong University, Jinan, China) H. Peng, (Hunan University, Changsha, China) *Funded by a SSHRC Standard Research Grant held by DC Malloy;

2. Conflict of Interest DisclosureDavid Cruise Malloy, PhD Has no real or apparent conflicts of interest to report.

3. Objectives: • Physicians (all healthcare professionals) are often confronted with challenging ethical dilemmas especially when dealing with cases of dementia among the geriatric population. • Solutions to these issues are usually unclear and physicians from different cultures may have differing decision making patterns that could potentially lead to inconsistent judgment. • The purpose of this study is to look at the effect of the ethical position of physicians from different cultures on their responses to a single dementia themed ethical dilemma.

4. Theoretical Background: Cultural Dimensions: Hofstede (1997) • Individualism vs. Collectivism • Ontologically • person-as-individual vs. Person-as-member of family • Power Distance • Masculinity • Uncertainty Avoidance

5. Theoretical Background: Ethical Theory • Deontology vs. Confucianism vs. Teleology • Duty • Deontology & Justice & Confucianism • Outcome/Consequences • Teleology & Relativism

6. Multidimensional Ethics Scale(Reidenbach & Robin, 1990) • Based upon deontology, justice, relativism, & teleology • Factor analysis reduced 33 items to 8 representing three dimensions: • Broad-based moral equity (aspects of deontology, justice, & relativism): “Decisions are evaluated in terms of their inherent fairness, justice, goodness and rightness…a reflection of early training by family…sociocultural context” • Relativistic –“how the game is played around here” • Contractualism –“abide by rules, contracts duties”

7. Ethics Position Questionnaire (EPQ) • Based upon the Ethics Position Theory (Forsyth, 1980) • Measures: • Idealism – universal goodness • Relativism – universal principles

8. Methods: MES Scenerios • Original scenarios of MES were Business-oriented; • Scenario* for this study was based upon interview data collected as part of the qualitative aspect of the SSHRC project (*see Malloy, D.C. Williams, J., Hadjistavropoulos, T., Krishnan, B., Jeyaraj M. Fahey McCarthy, E., Murakami M., Paholpak, S. Mafukidze, J. & Hillis, B. (2008) Ethical decision-making about older adults and moral intensity: An international study of physicians. Journal of Medical Ethic, 34, 285-296).

9. Vignette • Mr. R has brought his 67-year-father to the physician’s office to receive the results of tests performed earlier in the year – early onset of dementia is suspected. Before taking his father into the examining room, Mr. R speaks to the physician privately and requests that if there is any bad news (i.e., confirmed dementia) that his father not be informed because the news will be devastating to him and it is ultimately a family obligation. • Action: The physician does not tell the patient that he is developing dementia.

10. Methods: • A sample consisting of 86 physicians from China and one consisting of 73 from western countries (i.e., Canada, Ireland); • Completed the Ethics Position Questionnaire (EPQ) and the Multidimensional Ethics Scale (MES). • Differences between the scores on the MES for the two samples were examined as well as to what extent the two subscales of the (EPQ), Relativism and Idealism, predicted scores on the MES.

11. Results: • Results indicated that ethical decision making scores significantly differed (p < .05) between the two samples. • Physicians from countries ranking high in individualism (e.g., Canada, Ireland) judged the action to not inform the patient for which dementia is suspected is considered more unethical compared to physicians from countries scoring high in collectivism (e.g., China). • Furthermore, results showed that Relativism for the physicians from the two western countries significantly predicted scores on the MES (p < .05), • This was not the case for the sample from China. Idealism was not a significant predictor for both samples (see McNab et al., 2010, Journal of Cross Cultural Psychology).

12. Conclusion: • The results highlight differences between the two samples with respect to intrinsic cultural values regarding ethical decision making for a dementia themed ethical dilemma. • The study also points out the need for healthcare professionals and patients/clients to be cognisant of cultural values and the potential impact on the decision-making process for treatment and care.

13. Thank YouDC Malloy, PhDDavid.malloy@uregina.ca

14. Descriptive Statistics for Canada & Ireland • MES mean = 4.714 • Std.Deviation =1.2626673 • ethical idealism; EPQ 1-10: • Mean: 6.6387 • SD=1.16577 (n=73) • ethical relativism; EPQ 11-20: • Mean: 4.5132 • SD=1.35583 (n=73)

15. Descriptive Statistics for China • MES mean: 2.8825 • Std. Deviation: .89421 (n=86) • ethical idealism; EPQ 1-10 • Mean: 6.8488 • SD.8769986; (n=86) • ethical relativism; EPQ 11-20 • Mean= 5.4767 • SD: 1.30543; (n=86)

16. Ethical Position Theory (Forsyth, 1980)