[Ethical dilemmas in gastroenterology practice in Latin-American countries: the AIGE survey]

A survey sponsored by the Interamerican Association of Gastroenterology (AIGE) related to decision making in conflictive ethical situations in the setting of gastroenterological practice was designed (AJ-JCG). Seven problem-cases with 3 to 5 pre-established and not-excluding answers each, demographic and occupational data were included, by public invitation during 1996-97 AIGE educational activities in La Plata (Argentina), Montevideo (Uruguay) and Santo Domingo (Dominican Republic). Data were inserted in a computerised data base, and chi square, Fischer and Maentel-Henzel tests were used for statistical studies. 118 out of 460 doctors registered to educational activities answered at the survey (25.6%). Mean age was 42 +/- 15 years and 57.6% were male; 48.5% were under 10 years of professional practice and 19.5% were over 20 years. Gastroenterology was the main specialty in 89.8%. Although only 15.2% of participants reported as not having Ethical Committee (EC) in their institutions, the option of consulting was not very frequently selected, except in cases of request about pregnancy interruption in the HCV infected mother (22.9%), inclusion of the young alcoholic cirrhotic man in the waiting list for liver trasplant (17.8%), and the Jehova's Witness conscious patient with bleeding esophageal varices (13.5%). Cases of direct communication to the patient of early colon cancer diagnosis (66.1%), and inclusion of the young end stage alcoholic cirrhotic patient in the waiting list for liver trasplantation (65.2%), had the higher consensus. On the other hand, lower consensus (39%) was seen in the case of variceal bleeding in the encephalopathic Witness of Jehova patient. Differential criterla were observed related to sex: 38% of women versus 14.7% of men (p < 0.01) refuse the interruption of pregnancy to the infected HCV patient because of personal convictions against abortion. In the case of suspected HIV co-infection in the IVD HBsAG + carrier, 46% of women vs. 27.9% of men (p < 0.05) indicate HIV screening test without any explanation to the patient because "he could transmit a fatal disease". In this same case, time from graduation was related to differences in option selection: 80.9% in the group > 20 years of professional exercise asked for patient consent and accepted his decision, versus 52.7 and 27.5% in 0-9 and 10-19 years group respectively (p < 0.05). Usual medical and social worries as communication (truth, informed consent), the autonomic decision of biological death versus the sacrament of life, justice in allocation resources, confidentiality and social concern, abortion, and many other controversies linked to tecno-scientific development, impact the practice of Gastroenterology in latinoamerican countries. However medical answers to ethical dilemmas are not uniform. Although our results ought to be verified by other studies they clearly suggest the needs for systematic incorporation of applicated Ethics in pre and postgraduate Gastroenterology curricula, besides the regular activities of our regional institutions.