Physicians' practices when frustrating patients' needs: a comparative study of restrictiveness in offering abortion and sedation therapy.

In this paper it is argued that physicians' restrictive attitudes in offering abortions during 1946-1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians' values influenced their assessment of the facts presented--that is, the women's' trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It is also argued that a similar tacit practice could currently be applied by palliative care physicians. Such practice might allow palliative care physicians to be restrictive when offering sedation therapy without appearing paternalistic or declaring conscientious objections. However, the practice runs counter to patients' right to participate in making decisions. The women seeking abortion began to oppose the situation and eventually a new abortion law was introduced 1975. Patients at the end of life will never be able to protest against palliative care physicians' restrictive attitudes. This is a vulnerable and weak group, unable to lodge complaints after the treatment. In order to respect patients' autonomy, even suffering patients at the end of their lives, it is suggested that physicians should openly declare their values when it comes to providing treatments that might shorten life. Such transparency might facilitate more genuine shared decision-making and accordingly less suboptimal end-of-life care.