Education And Debate

Professional and public attitudes towards unsolicited medical intervention

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7178.251 (Published 23 January 1999) Cite this as: BMJ 1999;318:251
  1. Matjaz Zwitter, radiation oncologist (mzwitter@onko-i.si)a,
  2. Tore Nilstun, moral philosopherb,
  3. Lisbeth E Knudsen, genetic toxicologistc,
  4. Branko Zakotnik, medical oncologista,
  5. Johann Klocker, medical oncologistd,
  6. Stefan Bremberg, general practitionerb,
  7. Gerda Frentz, dermatologiste,
  8. Ursula Klocker-Kaiser, psychiatristf,
  9. Jette Pedersen, project coordinatore
  1. aInstitute of Oncology, Zaloska 2, 1001 Ljubljana, Slovenia
  2. bDepartment of Medical Ethics, Lund University, SE-222 22 Lund, Sweden,
  3. cNational Institute of Occupational Health, DK 2100 Copenhagen O, Denmark,
  4. dOncological Institute, 1st Medical Department, General Hospital, A-9026 Klagenfurt, Austria,
  5. eInstitute of Preventive Medicine, Copenhagen Municipal Hospital, DK 1399 Copenhagen C
  6. fCentre of Mental Health, General Hospital, Klagenfurt
  1. Correspondence to: Dr Zwitter
  • Accepted 14 August 1998

Several studies have investigated medical intervention in common aspects of lifestyle, and the subject has been discussed from a legal, ethical, and practical point of view.1 Fluoridation of water supplies, legal enforcement of safety measures such as compulsory wearing of seat belts or helmets, and restriction of unhealthy habits such as drinking alcohol or smoking are typical examples of paternalistic programmes—actions that aim to prevent harm or promote the good of others, irrespective of the individual's own wishes. 2 3 What is the position, however, when a doctor's action is neither solicited nor part of his or her contractual duties? In such a situation—which we define as unsolicited medical intervention—the doctor can only speculate about whether his or her action will be welcomed and hence understood as an act of beneficence or whether it will be regarded as an unjustified paternalistic intrusion into privacy.4

According to the 1949international code of medical ethics of the World Medical Association5 and to legislation in many different countries, doctors are obliged to offer first aid in an emergency. However, apart from this relatively clear situation, dilemmas in relation to unsolicited medical intervention have rarely been discussed. The European Code of Medical Ethics, issued in Paris in January 1987by representatives of the medical associations of the European Community, emphasises the principle that “doctors can only use professional knowledge to improve and maintain the health of those who put themselves in their care.”5

We aimed to assess the attitudes of doctors and the expectations of the lay public to unsolicited medical intervention by asking them to consider the ethics of unsolicited medical intervention in three scenarios. We believed that a comparison of the responses of doctors, subgroups of doctors, and lay people would help us to identify gaps between expectations and reality. …

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