Finding a Common Ethical Language for Healthcare: the Case of Symptomatic Uterine Fibroids

Objective: At a healthcare policy level, there is often acknowledgement that physicians are motivated by payment for their services and business relationships in addition to medical knowledge in patient care; yet at a clinical level, these motivations are often characterized as conflicts of interest. This can leave an impression that there is a choice between selfless patient care and selfish personal gains, discouraging a thorough discussion of factors that influence clinical decision-making. We intend to investigate these factors by focusing on a single clinical scenario, treatment of symptomatic uterine fibroids, and develop an integrated ethical model for balancing these factors with historic medical virtues. Methods: Up to fifteen clinicians will be interviewed from each of three specialties: interventional radiology, gynecology, and vascular surgery. The interventional radiologists and gynecologists will be asked about the treatment options they offer patients to ascertain how these options differ and what motivations may influence that difference. All specialists will be asked about their clinical decision making process to incorporate new procedures from outside their specialty. Interview transcripts will be analyzed according to grounded theory, a well-established qualitative research method. We will also analyze literature on symptomatic uterine fibroid treatment efficacy and ethical theories for additional insight. Potential Significance: We hope that an integrated ethical framework will supply a common language for balancing the many factors affecting clinical decisions and be useful at multiple levels including medical education, clinical practice, and policy development. The goal of this research is to help medical professionals better align and balance the many factors influencing clinical decisions to improve patient care.