Ethics in the rheumatology literature: a systematic review

To address the perception that ethical issues are underrepresented in the rheumatology literature, a systematic review was conducted using multiple databases to identify articles that addressed ethical and rheumatologic issues.

A rheumatologist, research librarian, and clinician-ethicist designed queries for 4 electronic and ethics databases, searching for articles with content that was relevant to rheumatology/rheumatic diseases and that primarily focused on ethics. Based upon the Beauchamp and Childress framework, the retrieved articles were classified according to their ethical content, and the proportions addressing each Beauchamp and Childress ethical principle were analyzed using Cochran's Q statistic. Correlations between the appearance of discussions involving each of the 4 ethical principles were determined via chi-square analysis.

The total number of manuscripts in the rheumatologic literature with an ethical focus was 104 out of an estimated library of >400,000 rheumatologically oriented manuscripts (0.026%). Very few manuscripts consisted of original research studies. Nonmaleficence (66%) was the most common theme, whereas justice represented the least frequently addressed ethical issue (12%). The differences in the proportions of each ethical principle reached statistical significance (Q = 73.8, P < 0.0001). Only 8 articles addressed >2 ethical principles. Discussion touching on autonomy and nonmaleficence frequently appeared in the same article (Pearson's chi(2) = 14.9, P < 0.001).

Despite the frequency of ethical issues while caring for patients, few reports within the rheumatic disease literature have focused on ethical issues. Further work should ascertain the degree to which the literature addresses the ethical questions in rheumatology.