Ethical issues in occupational medicine practice: knowledge and attitudes of occupational physicians.

Views on ethical conduct in occupational medicine practice can vary from country to country and even between occupational health practitioners. However, there are many areas of common agreement, and this is apparent on comparing guidance documents on ethics produced by several different organizations. The usefulness of these documents will depend in part on how aware practitioners are of their existence. A standardized questionnaire administered to 70 occupational physicians in the Netherlands, UK, and Singapore showed that there was a lack of awareness of guidance documents on ethics, even for publications from their own countries. Only five of the 70 respondents consulted an ethics document in the past year. In addition to publications, other avenues were used for advice on ethical issues. There was a difference in opinion between the physicians from Singapore and those from the two European countries on whether specific occupational health activities were ethical. These findings reinforce the need for international guidance on ethics to take into account differences in attitudes and practice between countries. On many issues there was no unanimity of opinion, even between occupational physicians from the same country. This may be an indication of the complexity of ethical matters, and provides a rationale for publishing guidance on ethics in occupational medicine.