Priority setting in cardiac surgery: a survey of decision making and ethical issues.

OBJECTIVES The aim of this study was to examine priority setting for coronary artery bypass surgery, and to provide an overview of decisions and rationales used in clinical practice. METHOD Questionnaires were sent to all permanently employed cardiologists, cardiothoracic surgeons, and anaesthesiologists at nine Swedish hospitals performing adult cardiothoracic surgery. RESULTS A total of 208 physicians responded (a 44% return rate). There was considerable agreement concerning the criteria that should be used to set priorities for coronary artery bypass interventions (clusters of factors in synthesis). However, there was a lack of accord regarding the use of national guidelines for priority setting and risk indexes. CONCLUSIONS Basic training and the strong support of ethical principles in priority setting are lacking. The respondents indicated a need for clearer guidelines and an open dialogue or discussion. The lack of generally acknowledged plans and guidelines for priority setting may result in unequal, conditional, and unfair treatment.