Bioethics Knowledge, Attitudes, and Practices among Healthcare Professionals in Cameroon: A survey of doctors and nurses in Cameroon's Southwest Region

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We conducted a study to assess physicians' and nurses' knowledge, attitudes, and behaviours regarding healthcare ethics in Cameroon's southwest region. 469 healthcare professionals were recruited, with 89.8% being nurses and 10.2% being doctors. Women made up 79.6% of nurses, while men made up 60.4% of physicians. The percentage of healthcare professionals who demonstrated good knowledge regarding the most commonly applied biomedical ethics principles varied from 62.9–73.1%. There were significant differences in agreement levels between doctors and nurses on statements such as physician-assisted suicide, physicians not refusing to assist with abortions if the law allowed it, and seeking informed consent only for operations and not tests. Nurses were three times more likely to agree with the statements that doctors cannot refuse abortion if the law allows it and that patients who want assisted suicide should be assisted to get it. Most healthcare providers were found to consistently adhere to healthcare ethics in their practices. However, there was a significant difference in opinion between doctors and nurses when asked if they ordered tests that were not medically necessary but were ordered for patient satisfaction, with nurses having a lower likelihood of agreeing to such practices than doctors. While participants demonstrated a moderate knowledge of healthcare ethics, additional educational interventions are needed to cultivate more favourable attitudes toward specific aspects of healthcare ethics, such as informed consent, patient autonomy, paternalism, and confidentiality. Knowledge healthcare ethics attitudes practices Southwest region Cameroon 1.0. Introduction The need for doctors to offer treatments to patients that optimize benefits while minimizing harm has long been emphasized. This is clearly stated in the Hippocratic oath that doctors take upon completion of their training as well as the Florence Nightingale's Oath for Nurses [ 1 , 2 ]. Adequate knowledge of bioethics could enhance the quality-of-care healthcare professionals (HCPs) deliver to patients and aid them in effectively addressing ethical dilemmas that arise during routine consultations. In developed countries, medical students have testified that training in biomedical ethics has had a positive impact on their attitudes and practices concerning ethical issues [ 3 ]. However, in countries of the global south and particularly in settings with limited resources, awareness of bioethical principles among HCPs has often been reported as limited, as has the practice of the code of ethics [ 4 , 5 ]. In many low- and middle-income nations, studies examining the knowledge, attitudes, and practices of healthcare ethics among health care professionals are lacking. In the Cameroonian setting, the teaching of bioethics is mostly focused on medical schools that educate physicians, as well as some institutions that train nurses and other healthcare workers, including laboratory scientists. The promotion of bioethics education in the country is also facilitated by many institutions, such as the national ethics committee, CAMBIN (Cameroon Bioethics Initiative), and research ethics committees present in the faculty of health sciences across state universities. Despite the bioethics education that has been offered to several doctors and nurses during their training, there have been reports of poor conduct in the past by some physicians and nurses who acted in a manner that was not ethical while consulting or interacting with patients across different hospitals in various regions of the country [ 6 – 8 ]. Carrying out studies to determine the knowledge, attitude, and practice of healthcare ethics among Cameroonian HCPs will enable us to determine whether there is a need for more training and education on bioethics for HCPs in Cameroon, as adequate knowledge of bioethics enables HCPs to carry out ethical practices while fulfilling their professional obligations. Bioethics has been the subject of minimal research in Cameroon; consequently, there have been very few publications on the subject. One study was carried out in 2007 by Ateudjieu and his colleagues to assess the satisfaction with bioethics training among medical students and residents attending medical school in Yaoundé the central region of Cameroon [ 9 ]; however to the best of our knowledge, no other study assessing the bioethics knowledge, attitudes, or practices of HCPs has been carried out in any other part of the country. Our study aims to assess the knowledge, attitudes, and practices of healthcare ethics among Cameroonian HCPs in the Southwest region of Cameroon. 2.0. Methodology 2.1. Study design, setting and population. A cross-sectional study using convenience sampling was performed among doctors and nurses practicing in the Southwest region (SWR) of Cameroon. The SWR is one of the English-speaking regions of the country and has a population of approximately 1.2 million inhabitants [ 10 ]. The inhabitants are unevenly distributed and more concentrated around the urban towns of Limbe, Buea, and Kumba. There are several health care facilities in the urban and rural areas, distributed across 19 health districts and 117 health areas across the SWR. The public sector or government runs most of the health facilities, while others are owned by faith-based institutions (Catholic, Baptist, and Presbyterian health facilities), private corporations such as the Cameroon Development Corporation (CDC), and individuals. The only inclusion criteria for a physician or nurse to take part in this study were that the doctor or nurse must have been practicing for at least one year. In most healthcare facilities within the SWR, physicians often conduct consultations and other medical procedures, while nurses mostly engage in supervising the care of patients who were admitted to wards. Nevertheless, it is worth noting that within certain limited healthcare facilities, consultations are conducted by state registered nurses or senior nurses in the absence of physicians, who would then frequently send complex patients to larger hospitals. The number of doctors in the SWR and Cameroon is often insufficient, resulting in a doctor-patient ratio of 1 doctor for 11,335 inhabitants, in the country [ 11 ]. Due to their frequent interactions with patients, physicians and nurses are an ideal population to study regarding their bioethical attitudes, knowledge, and practices. 2.2. Questionnaire, Sampling procedure and data collection The questionnaire entitled Omani physicians' awareness of bioethics and medical law (OBMLA) was adapted and used for this study [ 12 ]. For the purposes of this study, the law section of the questionnaire was eliminated. Other questions included in the study were obtained by consulting questionnaires that have been used to measure attitudes, knowledge and practices of health professionals towards healthcare ethics in other studies [ 13 – 15 ]. Our final questionnaire was structured into six sections. The first section was on the sociodemographic characteristics of the participants; the second was on the participant’s knowledge of bioethics; the third was on the participant’s attitudes towards healthcare ethics; the fourth was on the participant’s practice of healthcare ethics; the fifth was on doctors and nurses’ opinions on the creation of an ethics committee in their health facility; and the sixth section was on the frequency of encountering ethical problems and doctors and nurses’ preferences on who to consult when they encountered ethical problems. The questionnaire was pre-tested using 5% of the study population at the integrated health centre Buea Road in the Buea Health District. After this process, there was a restructuring of questions that were poorly understood and wrongly interpreted. To accomplish the purpose of this study, we consider the first three sections of the questionnaire and a part of the fourth section. A full version of the questionnaire is available upon request. Between December 2022 and June 2023, one of our team members visited several accessible health facilities in the SWR and explained the significance of the study to hospital administrators, who then briefed their staff on its significance. Hospital administrators then distributed paper versions of the questionnaire which had been submitted to them during the visit of our team member, to doctors and nurses working in their institutions. The team member who paid the visits to the health facilities was also responsible for passing at these centres on weekly basis to collect questionnaires that had been completed. The participants had to provide written informed consent before taking part in the study. The completion of the questionnaire took approximately 15 minutes. Administrative authorizations were obtained from the Regional Delegation of Public Health, District Health Services (Ref No: R11/MINSANTE/SWR/RDPH/PS/551/583), and hospitals, and the study was approved by the institutional review board (IRB) of the University of Buea’s Faculty of Health Sciences (Ref: UB/HOD/PHH/FSH/684/2023 obtained 22/02/2023), which serves as the main IRB in the SWR for assessing studies to ensure adherence to ethical standards. 2.3. Study data analysis Knowledge, Attitude, and practice of respondents regarding medical ethics were assessed using recall questions and case analysis. There were in total 3 knowledge questions (Table 2 ), 13 attitude questions (Table 3 ), and 7 practice questions (Table 4 ). During the analysis, the responses of the attitude questions were condensed from 5 categories (strongly disagree, disagree, not sure, agree, strongly agree) to 3 categories (disagree, not sure, agree). A descriptive analysis was conducted on all variables to determine the frequencies and percentages of categorical variables. The examination of the relationship between various demographic variables and the categorical variables of knowledge, attitude, and practice was conducted by using the Chi-square test. A multivariate analysis using binary logistic regression and ordinal logistic regression was used to assess the influence of profession and other independent explanatory factors on HCPs knowledge, attitudes, and practice of healthcare ethics. The outcome variables were categorized as yes versus no for the practice questions, correct versus incorrect principles for the knowledge questions, and disagree versus not sure versus agree for the attitude questions. Adjusted odds ratio (OR) and corresponding 95% confidence intervals were derived. A two-sided P value less than 0.05 was deemed statistically significant. 3.0. Results The demographic characteristics of the surveyed participants are shown in Table 1 . A total of 469 healthcare professionals completed the questionnaires amongst which most participants were nurses (89.8% nurses versus 10.2% doctors). Most of the participants amongst nurses were females (79.6%), while most of the participants among doctors were males (60.4%). The mean age of the nurses was 33.49 ± 7.96 years, while that of the doctors was 31.98 ± 6.62 years. The variable of age was subsequently split into distinct age groups, wherein the age group of 30–39 exhibited the highest representation among both nurses and doctors. In terms of type of health facility, most of the participants (54.6%) were affiliated with public health facilities, whereas a minority (17.5%) were associated with confessional (faith-based) health facilities. Most participants identified as Christians, comprising 96.4% of the sample. 3.1. Knowledge of Medical ethics 3.1.1. Source of participant knowledge of medical ethics When asked if they were familiar with medical ethics 99.1% (465) responded affirmatively. All doctors said they had heard of medical ethics while 417 (99%) nurses out of 421 said they had heard of medical ethics. When asked about the sources in which they got their knowledge of medical ethics, 60.4% (29) of the doctors said they had obtained knowledge exclusively through their professional training while 39.6% (27) said they obtained knowledge through their professional training including other sources such as the internet and by attending seminars. The proportions were similar for nurses as 66% (278) said they had obtained knowledge exclusively during their training and 34% (143) indicated they obtained knowledge from their training as well as other sources such as the internet and seminars. 3.1.2. Knowledge of the four principles of Biomedical ethics Ninety percent of those surveyed reported being familiar with the four ethical concepts of non-maleficence, beneficence, autonomy, and justice. Physicians (89.4%) and nurses (89.7%) had an equal level of understanding of the principles. To determine if respondents were fully knowledgeable about four principles of medical ethics, respondents were presented hypothetical cases formulated by the authors for them to indicate which ethical principles applied in each situation (Table 2 ). The first case involved a patient who, despite being in need and having a blood transfusion about to be administered, refused it because it was against their religious beliefs. In this case, the principles in conflict were non-maleficence versus autonomy, and equal proportions of nurses and physicians, 72.3% and 72.9%, chose these principles as the principles in conflict. As the patient has lost a lot of blood, the doctor is attempting to protect the patient from further harm (nonmaleficence), but the patient and his family have religious objections to receiving a blood transfusion. Thus, a decision must be made regarding whether to respect the patient's beliefs (patient autonomy) or to go against them and save the patient. Age group and longevity significantly influenced HCPs ability to choose the right ethical principles that were in conflict with a larger proportion of HCPs in the younger age groups selecting the right response. Compared to HCPs who had worked for 1–5 years, those who had worked for 6–10 years were less likely to select the correct response when presented with case one (OR = 0.56; 95% CI: 0.32–0.98). The principles that were in argument in case two were beneficence versus non-maleficence, as there was an urgent need for the insertion of the intravenous catheter for the well-being of the patient, but at the same time, the patient experienced some pain and swelling as a result. The patient’s autonomy is not questioned here as there was no mention of whether the patient wanted treatment or not. The percentage of doctors who selected the correct response, specifically beneficence versus non-maleficence, was found to be higher in comparison to nurses (89.6% vs 71.1%, p = 0.01). Also, more males tend to select the correct response when compared to females (84.5% vs 69.6%, p < 0.01). After adjustment nurses-profession, male gender and age group 40–49 were significantly associated with selecting the right response when presented with case 2 with odd ratios and confidence intervals of 0.37 [0.12–0.91], 1.97[1.1–3.7] and 0.45[0.20–0.99] respectively. Those in the younger age group (20–29) were twice likely to choose the correct principle when presented with scenario 2 than those in the age group 40–49. In the context of case three, the principles that we expect that should be considered by the HCPs in taking a decision are nonmaleficence and justice. Following the same sequence and not giving priority to a patient who arrives at the hospital and is bleeding profusely can result to exacerbated harm to the individual. Here, justice must be considered, and priority ought to be given to the patient based on his or her situation. Like in the other cases, more doctors than nurses choose the right response (72.9% vs. 61.1%). In contrast to private and public facilities, a greater percentage of healthcare professionals (HCPs) from confessional facilities select the correct response to case 3, with 74% versus 52.8% for private and 63.5% for public (p < 0.01). In each of the three cases testing knowledge of medical principles, a greater proportion of physicians correctly identified the applicable principles than nurses. Overall, approximately 70% of healthcare professionals (HCPs) correctly identified the principles that required consideration for cases 1 and 2, whereas 62% identified the principles that were in dispute for scenario 3. 3.2. Participants attitudes towards issues in healthcare ethics. Table 3 shows the attitudes towards different aspects of medical ethics among doctors and nurses. Regarding informing patients about medical errors, there was a statistically significant difference in agreement between physicians and nurses (66.7% of physicians agreed versus 70.6% of nurses; 22.2% of physicians versus 8.7% of nurses were unsure whether they agree or disagree, p = 0.02). There was also a statistical difference in agreement between doctors and nurses for the following questions: consent required only for operations and not for tests and other procedures (4.4% of physicians agreed versus 20.7% of nurses; 2.2% of physicians versus 3.9% of nurses were unsure whether they agree or disagree, p = 0.03), physicians not refusing to conduct abortion if the law allowed (17.8% of physicians agreed versus 32.2% of nurses; 4.4% of physicians versus 12.0% of nurses were unsure whether they agree or disagree, p = 0.02), acting ethically is only important to avoid legal action (11.1% of physicians agreed versus 31.7% of nurses; 13.3% of physicians versus 12.0% of nurses were unsure whether they agree or disagree, p = 0.02), assisting patients who wished to die (2.2% of physicians agreed versus 17.4% of nurses; 10.4% of physicians versus 3.9% of nurses were unsure whether they agree or disagree, p = 0.03). Doctors’ opinions towards other healthcare ethics topics were not significantly different from that of nurses for the other statements such as: if doctors should receive income for referring patients for medical tests, confidentiality cannot be maintained as medicine is advancing, seeking consent from parents of children before treating them amongst others. Other demographic variables which influenced rating of agreement to some of the attitude questions include facility type with HCPs from confessional facilities having lower levels of agreement than those from private and public facilities to the question of doctors receiving income from referring patients for medical tests (5.8% of HCPs from confessional facilities agreed versus 14.4% and 17.6% from private and public respectively; 7.2% of HCPs from confessional facilities versus 21.6% and 21.6% from private and public respectively were unsure whether they agree or disagree, p < 0.01). Females had higher level of agreements to the question of seeking parental consent being a prerequisite before administering any form of treatment to children (71.6% of females agreed versus 57.3% males, p = 0.03). Gender male was significant after controlling for other variables with odd ratio and confidence interval of 0.55[0.34–0.91]. The level of agreement with the statement that patients' preferences must always be followed, regardless of doctors' opinions, decreases as age increases. The percentages of agreement for different age groups are as follows: 20–29: 63.1%, 30–39: 57%, 40–49: 39.3%, and 50+: 27.8%. Age group 40–49 and age group 50 + were significant after controlling for other variables with corresponding odds ratios and confidence intervals of 0.41[0.19–0.85] and 0.19[0.054–0.64] respectively. The percentage of healthcare providers who agreed that close relatives should be informed of a patient's condition was about 40% across all categories, except for the age groups 40–49 (36.1%) and 50+ (28%). Almost half of the participants across all categories disagreed with the statement, whereas less than 15% of HCPs across all age groups were unclear of whether they agreed or not, except for the oldest age group (50+). The association between age group and the statement on informing close relatives about a patient’s condition was significant (p < 0.01). 3.3. Participants practices and healthcare ethics. Table 4 presents the responses provided by doctors and nurses regarding various healthcare ethics practices. There was a statistically significant difference in the ordering of certain tests for patient satisfaction, even when they were not medically necessary by physicians and nurses (77.3% of doctor’s vs 33.2% of nurses agreed, p < .01). Nurses had a lower likelihood than doctors to agree with the assertion that they had ordered tests for patient satisfaction, even when such tests were not medically required (0.15 [0.063, 0.31]). Compared to HCPs in public health facilities, a higher percentage of doctors and nurses in private and confessional health facilities said they ordered some tests for patient satisfaction even though they were not medically necessary (30.3% in public health facilities vs 47.4% in private health facilities and 45.9% in confessional health facilities, p < 0.01). Furthermore, health professionals with fewer years of experience exhibit a slightly higher tendency to order medically unnecessary tests compared to those with more years of experience (45.4% for 1–5 years, 32% for 6–10 years, and 26.3% for 11 years and above, p < 0.01). There was no statistically significant difference in agreement between doctors and nurses for the remaining six questions. Also, we found no association with other demographic variables for the remaining six questions. Overall, the proportion of HCPs who consistently adhered to the correct practice was at least 70% for each practice question posed, except for inquiries regarding the ordering of unnecessary tests, the interference of overly demanding patients with decision-making processes, and patients having online access to medical guidelines. 4.0. Discussion and Conclusion 4.1. Knowledge of healthcare ethics A large proportion of doctors and nurses surveyed had heard of medical ethics and were familiar with Beauchamp and Childress's four guiding principles of biomedical ethics. One-third of doctors and nurses claimed they had learned medical ethics through their professional training, seminars, and the internet. Our findings indicate that they are interested in the topic and keen to learn more without relying solely on formal educational settings such as classrooms. In general, in the research context, the hours allotted to the teaching of medical ethics in their training are limited, so it is critical for doctors and nurses to seek further training to supplement their knowledge. We observed that when presented with hypothetical cases in which they had to pick the ethical principles that were in conflict, the total proportion of doctors and nurses who could identify the correct ethical principles that were in conflict ranged from 62.4–73.1% for the different cases. The hypothetical situations were designed to assess if HCPs understood the medical ethics principles and how they could be applied in the clinical setting. We found that the percentage of HCPs who chose the correct answers to all cases presented was lower than the percentage of HCPs who stated they knew the ethical principles when asked, "Do you know the four ethical principles?". The lower percentage of doctors and nurses who correctly identified the ethical principles in conflict, when presented with hypothetical cases, compared to those who claimed to know the four ethical principles, suggests that healthcare professionals (HCPs) possess only a moderate understanding of the principles of medical ethics. Furthermore, our research suggests that HCPs, with years of working experience of between one and five years have a more comprehensive understanding of the medical ethics principles in conflict when a patient refuses a necessary medical intervention based on their personal beliefs, compared to those with six years or more of experience. One potential explanation for this phenomenon is that HCPs with fewer years of experience were in the younger age bracket and have recently completed their education and thus still retain a greater amount of medical ethics knowledge acquired throughout their schooling. Additionally, younger individuals tend to possess a higher level of proficiency in utilizing internet resources compared to their older counterparts and could source additional information online. In relation to the hypothetical case concerning the order of examination performed by physicians in the event of an emergency, a significantly lower proportion of HCPs from private health facilities identified conflicting ethical principles that were appropriate than those from public and confessional health facilities. One possible explanation for this difference in knowledge is that public and confessional health facilities frequently organize training sessions on ethics and other relevant subjects to enhance the knowledge and efficiency of their personnel. This could pose a challenge in the private sector, where financial limitations frequently manifest. Overall, doctors outperform nurses in terms of selecting the right principles in conflict when presented with the three cases. A reason for this may be since doctors generally have more extensive medical training than nurses. 4.2. Attitudes towards healthcare ethics issues HCPs opinions on the different healthcare ethics issues presented varied largely from statement to statement. While some statements elicited a clear consensus among HCPs, with a majority either agreeing or disagreeing with the statement, others resulted in a lack of consensus, with roughly equal numbers of HCPs expressing disagreement or agreement. Regarding the issue of obtaining parental consent prior to treating children, approximately 22% of HCPs expressed the belief that it is unnecessary. This suggests the need for raising awareness and educating HCPs on the importance of obtaining well-informed parental consent before administering treatment to children. This is especially crucial in circumstances where the children are unable to make well-informed decisions on their own. We found out being a male HCP, as opposed to being a female HCP was associated with a higher likelihood of having a positive perception of obtaining informed consent from parents before treating children. In terms of confidentiality, one-third of doctors and nearly half of nurses agreed that close relatives of patients should be informed about the health situation of the patient. It therefore appears that the rights and autonomy of many patients are not always respected regarding who may be made aware of their medical condition. This may be because most of the inhabitants of the SWR and Cameroon population in general lacks health insurance and must make all payments on their own, families must sometimes raise funds to treat one of their patients, and as such, the patient's condition will be discussed with relatives [ 16 ]. While HCPs generally strive to uphold ethical principles such as patient confidentiality and autonomy, the socio-economic status of patients can sometimes hinder their ability to do so. HCPs may feel compelled to disclose patient information to the patient's family and friends, who are often financially involved and desire comprehensive updates on the patient's condition. Regarding the question of whether confidentiality must be maintained despite recent technological advancements, nearly all the physicians and nurses agreed about this idea. The proportion of healthcare professionals in our study who expressed agreement regarding the necessity of maintaining confidentiality despite technological advancements is greater than the proportion reported by Aacharya and Shakya in their study on medical interns’ knowledge, attitudes and practices of bioethics among medical students in Bangladesh [ 17 ]. In the context of end-of-life care, very few nurses and physicians were willing to assist a patient who wished to die. In contrast to other western countries where physician-assisted suicide is legally practiced and recognized, in Cameroon, physician-assisted suicide is currently unregulated, which helps explain why so few physicians and nurses agree with this statement. The same reasoning can be applied to the low percentage of positive attitudes that was given by both doctors and nurses when presented with the statement that doctors cannot refuse to perform an abortion if the law permitted it. However, even though the agreement rates were generally low for both doctors and nurses for the question on assisting patients who wished to die have their wishes, nurses were three times more than doctors likely to have positive attitudes towards helping a patient have their wish of assisted suicide granted if it were permitted by the health regulations of the country. Concerning the notion of patient’s autonomy, the fact that 20% of doctors and 33.3% of nurses agree that the doctor’s decision should be final if patients and families disagreed on which procedures or medical treatment the patient will undergo suggests that there is still a form of paternalism going on in many health facilities in the SWR and the violation of patient’s autonomy common. Shared decision making is emphasised worldwide as one of the ideal ways of providing patient care and as such all HCPs should strive to follow this model of administering healthcare to their patients. Compared to HCPs who were younger than 30years old, HCPs who were 40 years old and above were associated with a lower likelihood of having a positive perception that patients wish should always be adhered to irrespective of doctor’s opinion. Younger HCP’s greater knowledge of medical ethics principles can be associated with a more favourable attitude towards patient autonomy, as evidenced by the high proportion of younger HCPs who correctly identified the appropriate principles when presented with hypothetical cases. 4.3. Practices and healthcare ethics The results of our survey indicate that for most of the questions posed on practices of HCPs in the healthcare setting, doctors and nurses demonstrated a good adherence to healthcare ethics in their practice. Our findings are similar to those conducted in countries in the global south such as Pakistan, Ethiopia, and Egypt [ 18 – 20 ]. Most of the doctors and nurses reported that they never engaged in healthcare-related acts (history taking, examination, blood sample, radiological procedure, medication prescribing) with a patient without informed consent. However, about a third of doctors and nurses reported they did not seek informed consent from the patient. However, according to the principle of autonomy, informed consent should be sought before any procedure or tests are performed on a patient. The aspect of corruption in the medical setting has been mentioned in some studies conducted in Cameroon in health facilities in the littoral region [ 6 ]. In our survey, we discovered that 20% of doctors and 14% of nurses approved to collecting payment from patients for medical examinations. Normally, tests are usually paid to the finance department of the heath facility and HCPs shouldn’t demand additional payments from patients for their personal gains. Such behavior is unacceptable; but however, it might be linked to the poor wages earned by HCPs in Cameroon [ 21 ]. It is common to encounter highly demanding patients in every clinical setting. In our study, approximately half of the doctors and nurses stated that highly demanding patients are annoying and could interfere in their decision-making, whereas the other half stated that highly demanding patients could not hinder their decision-making. The typical patient appears to be a fragile individual who places a great deal of trust in the medical team to provide the necessary care for recovery; therefore, even if they are difficult, every effort should be made to provide them with the optimal treatment. A small proportion of doctors and nurses said they had ordered some tests, procedures, prescriptions, or imaging only for patient satisfaction, even if not indicated. Most healthcare facilities in remote areas lack proper diagnostic equipment and well-equipped laboratories, which may explain why doctors there are more likely to try alternative treatments in the hopes that their patients will feel better or at least be satisfied. In contrast to developing countries, healthcare providers in developed countries are more inclined to offer essential care and recommend and order only the requisite medical examinations for their patients. This is due to the presence of well-equipped health facilities and a wide range of treatment options. The government of Cameroon has the duty to ensure that health facilities in the SWR, which lack proper infrastructure and equipment, are adequately equipped. This will enable HCPs working in these facilities to provide the most efficient care to the residents of these localities. This is the first study to study the attitudes, knowledge, and practices of both doctors and nurses in the southwest region of Cameroon, and one of the strengths of the study is that it recruited only doctors and nurses with at least one year of experience as such captured impressions of HCPs already working in the field. Also, one of the strengths of our study is the fact it made use of hypothetical cases to test HCPs understanding and application of the four principles of medical ethics. This provided us with the chance to assess the extent to which HCPs comprehended the application of the principles, considering that they were originally asked a question with a binary response ('yes' or 'no') on whether they had knowledge of the four principles of medical ethics. Our study however has some limitations. Firstly, with our sample being a convenient sample makes our generalization of findings to the entire Cameroonian population of doctors and nurses limited. Also, another limitation is that assessing knowledge of medical ethics was limited to knowledge of four ethical principles developed by Beauchamp and Childress and their applications in different cases (Beauchamp and Childress 2009). It will be more informative if in-depth interviews or a discussion was carried on the various scenarios presented to see if the HCPs really demonstrated a good understanding of the four principles of biomedical ethics. Furthermore, it may have been interesting to assess their knowledge of other regular codes, such as the Nuremberg code and the declaration of the Helsinki code, as has been utilized in other studies [ 9 ]. To conclude our study suggests that doctors and nurses working in Cameroon's Southwest Region had a moderate level of understanding of the medical ethics principles, had positive attitudes toward some of the healthcare ethics issues presented, and had implemented good ethical practices in most of the questions asked about the practice of healthcare ethics. Based on our study we find that training opportunities are still highly needed to enabling healthcare professionals to have a good understanding and implementation of key principles in healthcare, such as confidentiality, patient autonomy, shared decision-making, and appropriate referral of patients who decline treatment based on personal beliefs and other pertinent healthcare ethics topics. We recommend that there should be a continued emphasis on raising awareness about healthcare ethics in hospitals in Cameroon and more opportunities for ethics training, such as more frequent seminars to promote medical ethics. The Cameroon Bioethics Initiative (CAMBIN) regularly conducts seminars in Cameroon to provide training on bioethics for healthcare professionals (HCPs). HCPs are strongly encouraged to seize these opportunities whenever they arise. Additionally, hospitals may extend invitations to bioethics experts to conduct educational sessions on bioethics and ethical practice for HCPs at their respective institutions. Declarations Acknowledgements We thank all the doctors and nurses who dedicated their time to participate in the study. Disclosure statement No potential conflict was reported by the authors. Funding No funding was received for conducting this study. Data availability statement The dataset utilized in this study is available upon request. Author Contribution All authors made significant contributions to the development of the article.KTJ.D. conceptualised the idea of the study and the research methodology, took part in data analysis and interpretation, and assisted in writing and editing the first draft of the manuscript. ON.N. actively participated in the collection, entry, analysis, and interpretation of data, as well as the writing of the first draft of the manuscript.EZ.M. took part in developing the research methodology of the study, in data analysis and interpretation, editing the first draft of the manuscript, and co-supervising the research.N.T. conceptualised the idea of the study and the research methodology, supported the in-data analysis and interpretation, edited the first draft of the manuscript, and supervised the research.All authors read and approved the final version of the manuscript. References Oath, H., The hippocratic oath. Am J Med Genet, 1995. 58 : p. 187-94. Miracle, V.A., National nurses week and the Nightingale pledge. Dimensions of Critical Care Nursing, 2009. 28 (3): p. 145-146. Johnston, C. and P. Haughton, Medical students’ perceptions of their ethics teaching. Journal of Medical Ethics, 2007. 33 (7): p. 418-422. 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BMC Med Educ, 2019. 19 (1): p. 5. Embassy of the Republic of Cameroon to the USA, W.D. The 10 Regions . [online] 2018; Available from: https://www.cameroonembassyusa.org/mainFolder/present.html. WHO, Health Analytical profile Cameroon . 2016. Al-Busaidi, A.S., et al., Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman. BMC Med Ethics, 2021. 22 (1): p. 65. Adhikari, S., et al., Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal. BMC medical ethics, 2016. 17 : p. 1-8. Althobaiti, M.H., et al., Knowledge, attitude, and practice of medical ethics among health practitioners in Taif government, KSA. J Family Med Prim Care, 2021. 10 (4): p. 1759-1765. Ismail, T.S. and K. Kulsum, KNOWLEDGE AND ATTITUDE AMONG RESIDENT DOCTORS RELATED TO ETHICAL AND MEDICOLEGAL ISSUES IN A TEACHING HOSPITAL. Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education. 11 (4): p. 349-362. Jacques Cabral, T.T., J.C. Tantchou Tchoumi, and G. Butera, Profile of cardiac disease in Cameroon and impact on health care services. Cardiovasc Diagn Ther, 2013. 3 (4): p. 236-43. Aacharya, R.P. and Y.L. Shakya, Knowledge, attitude and practice of medical ethics among medical intern students in a Medical College in Kathmandu. Bangladesh Journal of Bioethics, 2015. 6 (3): p. 1-9. Tiruneh, M.A., B.T. Ayele, and K.G. Michael Beyene, Knowledge of, and attitudes toward, codes of ethics and associated factors among medical doctors in Addis Ababa, Ethiopia. Medicolegal and Bioethics, 2019: p. 1-10. Jalal, S., et al., Awareness about knowledge, attitude and practice of medical ethics pertaining to patient care, among male and female physicians working in a public sector Hospital of Karachi, Pakistan-A cross-sectional survey. European Journal of Environment and Public Health, 2018. 2 (1): p. 04. AM, M., G. MA, and K. AA, Knowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria hospitals, Egypt. 2012. Amani, A., The health workers crises in Cameroon. 2010. Tables Table 1 Demographic characteristics of study participants Variables Physicians ( N = 48) n (%) Nurses ( N = 421) n (%) Total ( N = 469) n (%) Age group (years) 20–29 18 (37.5) 132 (31.4) 150 (32) 30–39 25 (52.1) 200 (47.5) 225 (48) 40–49 4 (8.3) 69 (16.4) 73 (15.6) 50 + 1 (2.1) 20 (4.8) 21 (4.4) gender Female 19 (39.6) 335 (79.6) 354 (75.5) Male 29 (60.4) 81 (19.2) 110 (23.5) Did not specify their gender - 5 (1.2) 5 (1.1) Type of Health Facility Confessional 7 (14.6) 75 (17.8) 82 (17.5) Private 10 (20.8) 121 (28.7) 131 (27.9) Public 31 (64.6) 125 (53.4) 256 (54.6) Longevity in service (Years) 1–5 32 (66.7) 216 (51.3) 248 (52.9) 6–10 11 (22.9) 125 (29.7) 136 (29) 11 + 5 (10.4) 80 (19) 85 (18.1) Religion Christian 45 (93.8) 407(96.7) 452 (96.4) Muslim 1 (2.1) 9 (2.1) 10 (2.1) Pagan 2 (4.2) 5 (1.2) 7 (1.5) Table 2 Knowledge of ethical principles Hypothetical scenario Response Nurses N = 381 Doctors N = 48 Overall N = 439 Significant demographic variables associated with correct response. (based on overall ) Adjusted significant odds ratio of variables and 95% Confidence Interval associated with the correct response 1. A patient has been in a car accident and is bleeding heavily and is brought into the hospital. When the doctor recommended a blood transfusion, the patient and his family refused out of their religious beliefs Nonmaleficence vs Autonomy 283 (72. 3) 35 (72.9) 318 (72.4) Age group (20–29: 83.7% 30–39: 71.0%, 40–49:59.4%, 50+ : 52.6%, χ 2 2 = 18.76, p < .01). Longevity (1–5: 81.0%, 6–10: 65.4%, 11+ : 58.8%, (χ 2 = 19.29, p < 0.01) Longivity a : OR = 0.56, 95%CI [0.32, 0.98] Non maleficence vs Beneficence 108 (27.6) 13 (27.1) 121 (27.6) 2. A patient in shock who required immediate fluid resuscitation and insertion of an indwelling intravenous catheter experienced pain and swelling because of the treatment Beneficence vs Autonomy 113 (28.9) 5 (10.4) 118 (26.9) Gender (Males : 84.5%, females : 69.6%, χ 2 = 8.08, p = .004). Position (Doctors :89.6%, Nurses :71.1%, χ 2 2 = 6.52, p = 0.01) Profession b : OR = 0.37, 95%CI [0.12, 0.91] Gender c : OR = 1.97, 95%CI [1.1, 3.7]. Agegroup d : OR = 0.45, 95%CI [0.20, 0.99]. Beneficence vs Non-maleficence 278 (71.1) 43 (89.6) 321 (73.1) 3. A patient arrives in a queue (waiting) number 10. Even though the patient was bleeding profusely, the doctor still examined the patient through the sequence of arrival of the patient Autonomy vs Justice 152 (38.9) 13 (27.1) 165 (37.6) Type of facility (Private: 52.8%, Confessional: 74.0%, Public:63.5% , χ 2 = 9.36, p < .01) None Non-maleficence vs Justice 239 (61.1) 35 (72.9) 274 (62.4) a worked for 6–10 years vs worked for 1-5years b Nurses vs doctors c Males vs females d agegroup 40–49 vs agegroup20-29 e agegroup 50 + vs agegroup20-29 f private facilities vs confessional facilities. g publicfacilities vs confessional facilities. Table 3 Attitudes towards healthcare ethics Statements on healthcare ethics Doctors (N = 45) Nurses (N = 357) Overall (N = 402) Significant demographic variables associated with statement. (Based on overall) Adjusted significant odds ratio of variables and 95% Confidence Interval associated with outcome variable Disagree Not sure Agree Disagree Not sure Agree Disagree Not sure Agree Patient's wishes must be adhered irrespective of doctor’s opinion` 11 (24.4) 5 (11.1) 29 (64.4) 137 (38.4) 28 (7.8) 192 (53.8) 148 (36.8) 33 (8.2) 221 (55.0) Age group: Agree- (20–29: 63.1% 30–39: 57.0%, 40–49: 39.3%, 50+: 27.8%); Not sure-(20–29: 9.2% 30–39: 6.2%, 40–49: 13.1%, 50+: 5.6%); (χ 2 = 19.07, p < 0.01) Agegroup d : OR = 0.41, 95%CI [0.19, 0.85]. Agegroup e : OR = 0.19, 95%CI [0.054, 0.64]. Patients must always be informed of medical errors 5 (11.1) 10 (22.2) 30 (66.7) 74 (20.7) 31 (8.7) 252 70.6) 79 (19.7) 41 (10.2) 282 (70.1) Position : Agree- (Doctors :66.7%, Nurses :70.6%, Not sure- (doctors :22.2, Nurses : 8.7% ; χ 2 = 9.15, p = 0.02) None As medicine is advancing, confidentiality cannot be maintained 40 (88.9) 0 (0.0) 5 (11.1) 295 (82.6) 22 (6.2) 40 (11.2) 335 (83.3) 22 (5.5) 45 (11.2) None None Doctors should do their best irrespective of patient's opinion 10 (22.2) 3 (6.7) 32 (71.1) 57 (16.0) 15 (4.2) 285 (79.8) 67 (16.7) 18 (4.5) 317 (78.9) None None Consent is required only for operations – not for tests and medications 42 (93.3) 1 (2.2) 2 (4.4) 269 (75.4) 14 (3.9) 74 (20.7) 311 (77.4) 15 (3.73) 76 (18.9) Position: Agree- (Doctors: 4.4%, Nurses: 20.7%; Not sure-Doctors: 2.2%, nurses: 3.9%, χ2 = 7.58, p = 0.03) None Close relatives should be told of a patient’s condition 30 (66.7) 5 (11.1) 10 (22.2) 183 (51.3) 28 (7.8) 146 (40.9) 213 (53.0) 33 (8.2) 156 (38.8) Age group: Agree – (20–29: 39.2% 30–39: 40.4%, 40–49: 36.1%, 50+: 27.8%), Not sure − (20–29: 13.8% 30–39: 3.1%, 40–49: 8.2%, 50+: 22.2%, χ 2 = 17.7, p < .01)). None Children should never be treated without consent of the parent 12 (26.6) 6 (13.3) 27 (60.0) 93 (26.1) 17 (4.8) 247 (69.2) 105 (26.1) 23 (5.7) 274 (68.2) Gender: Agree – (males :57.3% females: 71.6%), Not sure - (males: 7.3%, females: 5.2%), χ2 = 6.90, p = 0.03). Type of facility: Agree- (private: 60.4% confessional: 55.1%, Public :76.1% ; Not sure- (private :6.3%, confessional: 7.2%, public:5.0%, Χ 2 = 15.5, p < 0.01) Facility type g : OR = 2.77, 95%CI [1.56, 4.93]. Gender c : OR = 0.55, 95%CI [0.34, 0.91]. If a patient wishes to die, he or she should be assisted in doing so 38 (84.4) 6 (13.3) 1 (2.2) 258 (72.3) 37 (10.4) 62 (17.4) 296 (73.6) 43 (10.7) 63 (15.7) Position: Agree- (Doctors: 2.2%, Nurses: 17.4%; Not sure: Doctors: 10.4%, nurses: 3.9%, χ2 = 6.98, p = 0.03) Type of facility: Agree- (private :18.9% confessional: 21.7%, public :12.2% ; Not sure- (private: 9.0%, confessional: 17.4%, public :9.5%, χ2 = 9.86, p = 0.04). Profession b : OR = 3.10, 95%CI [1.36, 8.07] Facility type g : OR = 0.42, 95%CI [0.24, 0.76]. If patients refuse medical treatment because of personal beliefs, they should be directed to another healthcare provider" 24 (53.3) 9 (20.0) 12 (26.7) 168 (47.1) 55 (15.4) 134 (37.5) 192 (47.8) 64 (15.9) 146 (36.3) None None If law allows abortion, doctors cannot refuse to do abortion 35 (77.8) 2 (4.4) 8 (17.8) 199 (55.7) 43 (12.0) 115 (32.2) 234 (58.2) 45 (11.2) 123 (30.6) Position: Agree- (Doctors: 17.8%, Nurses: 32.2%; Not sure: Doctors: 4.4%, Nurses: 12.0%, χ2 = 8.11, p = 0.02) Profession b : OR = 3.46, 95%CI [1.66, 7.84] longivity a : OR = 0.54, 95%CI [0.32, 0.91] If patients/families and medical staff disagree about how to treat a patient, the medical staff's decision is final" 28 (62.2) 8 (17.8) 9 (20.0) 174 (48.7) 64 (17.9) 119 (33.3) 202 (50.2) 72 (17.9) 128 (31.8) None None Ethical conduct is only important to avoid legal action 34 (75.6) 6 (13.3) 5 (11.1) 201 (56.3) 43 (12.0) 113 (31.7) 235 (58.5) 49 (12.2) 18 (29.4) Position: agree- (Doctors: 11.1%, Nurses: 31.7%; not sure: Doctors: 13.3%, Nurses: 12.0%, χ2 = 8.33, p = 0.02) None Doctors receive income from referring patients for medical tests 27 (60) 9 (20) 9 (20) 239 (66.9) 68 (19.0) 50 (14.0) 266 (66.2) 77 (19.2) 59 (14.7) Type of facility: agree- (private :14.4% confessional: 5.8%; public: :17.6% ; Not sure- (private :21.6%, confessional: 7.2%, public :21.6%, χ2 = 16.6, p < 0.01). Facility type f : OR = 3.59, 95%CI [1.68, 8.45]. Facility type g : OR = 4.05, 95%CI [1.99, 9.17]. a worked for 6–10 years vs worked for 1-5years b Nurses vs doctors c Males vs females d agegroup40-49 vs agegroup20-29 e agegroup50+ vs agegroup20-29 f private facilities vs faith based facilities g public facilities vs faith based facilities Table 4 Ethics in Healthcare Practices among Participants Statement on practice of healthcare ethics Doctors (N = 44) Nurses (N = 377) Overall (N = 421) Significant demographic variables associated with question. Based on overall Adjusted significant odds ratio of variables and 95% Confidence Interval associated with the correct response Yes No Yes No Yes No Never engaged in healthcare related acts (history taking, examination, blood sample, radiological procedure, medication prescribing) to a patient without informed consent. 32 (72.7) 12 (27.3) 264 (70.0) 113 (30.0) 296 (70.3) 125 (29.7) None None Do order some tests/procedures /prescriptions/ imaging only for patient satisfaction even if not indicated 34 (77.3) 10 (22.7) 125 (33.2) 252 (66.8) 159 (37.8) 262 (62.2) Position (Doctors: 77.3%, Nurses: 33.2%, χ2 = 30.78, p < 0.01) Longevity (1–5: 45.4%, 6–10: 32.0%, 11+: 26.3%, χ2 = 11.60, p < .01) Gender (Males :49.5% females: 34.1% χ2 = 7.14, p = .008). Type of facility (private:47.4% Confessional: 45.9%, public:30.3% χ2 = 12.18, p < .002). Age group (20–29: 49.2% 30–39: 35.0%, 40–49: 27.9%, 50+: 25.0%, χ2 = 12.12, p < .01) Profession b : OR = 0.15, 95%CI [0.063, 0.31] Facility type f : OR = 0.40, 95%CI [0.22, 0.71]. Always ensure nobody is present other than medical team during assessments or procedures. 36 (81.8) 8 (18.2) 296 (78.5) 81 (21.5) 332 (78.9) 89 (21.4) None None Discuss patient's case with relatives and co-patients all the time. 3 (6.8) 41 (93.2) 27 (7.2) 350 (92.8) 30 (7.1) 391 (92.9) None None Always try to give only what is necessary to the patient regarding his situation. 35 (79.6) 9 (20.4) 326 (86.5) 51 (13.5) 361 (85.8) 60 (14.3) None None Highly demanding patients are annoying and interfering with decision making. 21 (47.7) 23 (52.3) 211 (56.0) 166 (44.0) 232 (55.1) 189 (44.9) None None Patients should not have access to medical guidelines online. 8 (18.2) 36 (81.8) 101 (26.8) 276 (73.2) 109 (25.9) 312 (74.1) None None a worked for 6–10 years vs worked for 1-5years b Nurses vs doctors c Males vs females d agegroup40-49 vs agegroup20-29 e agegroup50+ vs agegroup20-29 f private facilities vs faith based facilities g publicfacilities vs faith based facilities Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4108862","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280069722,"identity":"7482e3fc-ac0a-443e-b9b2-ec95fee4bc65","order_by":0,"name":"Kevin TJ Dzi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIie3RIQrDMBTG8Q8KmQnTLxSWK6SmFR30KoFBayaqRmVhoqYH2DGmBnMdETM9RNXU3Mzk0k5MJnIifwgx70cCDwiF/jCyZwAisFUL6BpQ/oTbSytPgpmANJZ5JxFdn5gaebEWz3SaFGTmIjEflTmhili8z5T9WHJtHWRDpTYchlmSkiVaDS4iHwvhTIyeJKZomAkx4p5E9DtLVKUYLw+WUHJ2Ebrfji/e5IXszEW8m610vvLttwvymg+FQqGQow8SxzK1S4jkXgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Lausanne","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Kevin","middleName":"TJ","lastName":"Dzi","suffix":""},{"id":280069723,"identity":"b594498e-19fe-4612-ab7f-4c7215b542a1","order_by":1,"name":"Oscaline N Ndong","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Oscaline","middleName":"N","lastName":"Ndong","suffix":""},{"id":280069724,"identity":"7a7f5fe2-1c47-4083-8f8f-aec07d34618b","order_by":2,"name":"Elisabeth Z Menkem","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Elisabeth","middleName":"Z","lastName":"Menkem","suffix":""},{"id":280069725,"identity":"e6a74d4c-8f14-4df2-8bfe-f13a12f60759","order_by":3,"name":"Nicholas Tendongfor","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Tendongfor","suffix":""}],"badges":[],"createdAt":"2024-03-15 15:06:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4108862/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4108862/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-025-00419-7","type":"published","date":"2025-01-30T15:57:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75351170,"identity":"260a1def-686d-4756-9a74-84afd54851b2","added_by":"auto","created_at":"2025-02-03 16:07:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2806391,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4108862/v1/84f63305-451b-4b89-9717-653efb2daa67.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bioethics Knowledge, Attitudes, and Practices among Healthcare Professionals in Cameroon: A survey of doctors and nurses in Cameroon's Southwest Region","fulltext":[{"header":"1.0. Introduction","content":"\u003cp\u003eThe need for doctors to offer treatments to patients that optimize benefits while minimizing harm has long been emphasized. This is clearly stated in the Hippocratic oath that doctors take upon completion of their training as well as the Florence Nightingale's Oath for Nurses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Adequate knowledge of bioethics could enhance the quality-of-care healthcare professionals (HCPs) deliver to patients and aid them in effectively addressing ethical dilemmas that arise during routine consultations.\u003c/p\u003e \u003cp\u003eIn developed countries, medical students have testified that training in biomedical ethics has had a positive impact on their attitudes and practices concerning ethical issues [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, in countries of the global south and particularly in settings with limited resources, awareness of bioethical principles among HCPs has often been reported as limited, as has the practice of the code of ethics [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In many low- and middle-income nations, studies examining the knowledge, attitudes, and practices of healthcare ethics among health care professionals are lacking.\u003c/p\u003e \u003cp\u003eIn the Cameroonian setting, the teaching of bioethics is mostly focused on medical schools that educate physicians, as well as some institutions that train nurses and other healthcare workers, including laboratory scientists. The promotion of bioethics education in the country is also facilitated by many institutions, such as the national ethics committee, CAMBIN (Cameroon Bioethics Initiative), and research ethics committees present in the faculty of health sciences across state universities. Despite the bioethics education that has been offered to several doctors and nurses during their training, there have been reports of poor conduct in the past by some physicians and nurses who acted in a manner that was not ethical while consulting or interacting with patients across different hospitals in various regions of the country [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Carrying out studies to determine the knowledge, attitude, and practice of healthcare ethics among Cameroonian HCPs will enable us to determine whether there is a need for more training and education on bioethics for HCPs in Cameroon, as adequate knowledge of bioethics enables HCPs to carry out ethical practices while fulfilling their professional obligations.\u003c/p\u003e \u003cp\u003eBioethics has been the subject of minimal research in Cameroon; consequently, there have been very few publications on the subject. One study was carried out in 2007 by Ateudjieu and his colleagues to assess the satisfaction with bioethics training among medical students and residents attending medical school in Yaound\u0026eacute; the central region of Cameroon [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; however to the best of our knowledge, no other study assessing the bioethics knowledge, attitudes, or practices of HCPs has been carried out in any other part of the country. Our study aims to assess the knowledge, attitudes, and practices of healthcare ethics among Cameroonian HCPs in the Southwest region of Cameroon.\u003c/p\u003e"},{"header":"2.0. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Study design, setting and population.\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eA cross-sectional study using convenience sampling was performed among doctors and nurses practicing in the Southwest region (SWR) of Cameroon. The SWR is one of the English-speaking regions of the country and has a population of approximately 1.2\u0026nbsp;million inhabitants [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. The inhabitants are unevenly distributed and more concentrated around the urban towns of Limbe, Buea, and Kumba. There are several health care facilities in the urban and rural areas, distributed across 19 health districts and 117 health areas across the SWR. The public sector or government runs most of the health facilities, while others are owned by faith-based institutions (Catholic, Baptist, and Presbyterian health facilities), private corporations such as the Cameroon Development Corporation (CDC), and individuals.\u003c/p\u003e\n \u003cp\u003eThe only inclusion criteria for a physician or nurse to take part in this study were that the doctor or nurse must have been practicing for at least one year. In most healthcare facilities within the SWR, physicians often conduct consultations and other medical procedures, while nurses mostly engage in supervising the care of patients who were admitted to wards. Nevertheless, it is worth noting that within certain limited healthcare facilities, consultations are conducted by state registered nurses or senior nurses in the absence of physicians, who would then frequently send complex patients to larger hospitals. The number of doctors in the SWR and Cameroon is often insufficient, resulting in a doctor-patient ratio of 1 doctor for 11,335 inhabitants, in the country [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Due to their frequent interactions with patients, physicians and nurses are an ideal population to study regarding their bioethical attitudes, knowledge, and practices.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Questionnaire, Sampling procedure and data collection\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe questionnaire entitled Omani physicians\u0026apos; awareness of bioethics and medical law (OBMLA) was adapted and used for this study [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. For the purposes of this study, the law section of the questionnaire was eliminated. Other questions included in the study were obtained by consulting questionnaires that have been used to measure attitudes, knowledge and practices of health professionals towards healthcare ethics in other studies [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Our final questionnaire was structured into six sections. The first section was on the sociodemographic characteristics of the participants; the second was on the participant\u0026rsquo;s knowledge of bioethics; the third was on the participant\u0026rsquo;s attitudes towards healthcare ethics; the fourth was on the participant\u0026rsquo;s practice of healthcare ethics; the fifth was on doctors and nurses\u0026rsquo; opinions on the creation of an ethics committee in their health facility; and the sixth section was on the frequency of encountering ethical problems and doctors and nurses\u0026rsquo; preferences on who to consult when they encountered ethical problems.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eThe questionnaire was pre-tested using 5% of the study population at the integrated health centre Buea Road in the Buea Health District. After this process, there was a restructuring of questions that were poorly understood and wrongly interpreted. To accomplish the purpose of this study, we consider the first three sections of the questionnaire and a part of the fourth section. A full version of the questionnaire is available upon request.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eBetween December 2022 and June 2023, one of our team members visited several accessible health facilities in the SWR and explained the significance of the study to hospital administrators, who then briefed their staff on its significance. Hospital administrators then distributed paper versions of the questionnaire which had been submitted to them during the visit of our team member, to doctors and nurses working in their institutions. The team member who paid the visits to the health facilities was also responsible for passing at these centres on weekly basis to collect questionnaires that had been completed. The participants had to provide written informed consent before taking part in the study. The completion of the questionnaire took approximately 15 minutes.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eAdministrative authorizations were obtained from the Regional Delegation of Public Health, District Health Services (Ref No: R11/MINSANTE/SWR/RDPH/PS/551/583), and hospitals, and the study was approved by the institutional review board (IRB) of the University of Buea\u0026rsquo;s Faculty of Health Sciences (Ref: UB/HOD/PHH/FSH/684/2023 obtained 22/02/2023), which serves as the main IRB in the SWR for assessing studies to ensure adherence to ethical standards.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. Study data analysis\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eKnowledge, Attitude, and practice of respondents regarding medical ethics were assessed using recall questions and case analysis. There were in total 3 knowledge questions (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), 13 attitude questions (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), and 7 practice questions (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). During the analysis, the responses of the attitude questions were condensed from 5 categories (strongly disagree, disagree, not sure, agree, strongly agree) to 3 categories (disagree, not sure, agree).\u003c/p\u003e\n \u003cp\u003eA descriptive analysis was conducted on all variables to determine the frequencies and percentages of categorical variables. The examination of the relationship between various demographic variables and the categorical variables of knowledge, attitude, and practice was conducted by using the Chi-square test. A multivariate analysis using binary logistic regression and ordinal logistic regression was used to assess the influence of profession and other independent explanatory factors on HCPs knowledge, attitudes, and practice of healthcare ethics. The outcome variables were categorized as yes versus no for the practice questions, correct versus incorrect principles for the knowledge questions, and disagree versus not sure versus agree for the attitude questions. Adjusted odds ratio (OR) and corresponding 95% confidence intervals were derived. A two-sided P value less than 0.05 was deemed statistically significant.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"3.0. Results","content":"\u003cp\u003eThe demographic characteristics of the surveyed participants are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 469 healthcare professionals completed the questionnaires amongst which most participants were nurses (89.8% nurses versus 10.2% doctors). Most of the participants amongst nurses were females (79.6%), while most of the participants among doctors were males (60.4%). The mean age of the nurses was 33.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.96 years, while that of the doctors was 31.98\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62 years. The variable of age was subsequently split into distinct age groups, wherein the age group of 30\u0026ndash;39 exhibited the highest representation among both nurses and doctors. In terms of type of health facility, most of the participants (54.6%) were affiliated with public health facilities, whereas a minority (17.5%) were associated with confessional (faith-based) health facilities. Most participants identified as Christians, comprising 96.4% of the sample.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1. Knowledge of Medical ethics\u003c/h2\u003e\n\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n\u003ch2\u003e3.1.1. Source of participant knowledge of medical ethics\u003c/h2\u003e\n\u003cp\u003eWhen asked if they were familiar with medical ethics 99.1% (465) responded affirmatively. All doctors said they had heard of medical ethics while 417 (99%) nurses out of 421 said they had heard of medical ethics. When asked about the sources in which they got their knowledge of medical ethics, 60.4% (29) of the doctors said they had obtained knowledge exclusively through their professional training while 39.6% (27) said they obtained knowledge through their professional training including other sources such as the internet and by attending seminars. The proportions were similar for nurses as 66% (278) said they had obtained knowledge exclusively during their training and 34% (143) indicated they obtained knowledge from their training as well as other sources such as the internet and seminars.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n\u003ch2\u003e3.1.2. Knowledge of the four principles of Biomedical ethics\u003c/h2\u003e\n\u003cp\u003eNinety percent of those surveyed reported being familiar with the four ethical concepts of non-maleficence, beneficence, autonomy, and justice. Physicians (89.4%) and nurses (89.7%) had an equal level of understanding of the principles. To determine if respondents were fully knowledgeable about four principles of medical ethics, respondents were presented hypothetical cases formulated by the authors for them to indicate which ethical principles applied in each situation (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe first case involved a patient who, despite being in need and having a blood transfusion about to be administered, refused it because it was against their religious beliefs. In this case, the principles in conflict were non-maleficence versus autonomy, and equal proportions of nurses and physicians, 72.3% and 72.9%, chose these principles as the principles in conflict. As the patient has lost a lot of blood, the doctor is attempting to protect the patient from further harm (nonmaleficence), but the patient and his family have religious objections to receiving a blood transfusion. Thus, a decision must be made regarding whether to respect the patient's beliefs (patient autonomy) or to go against them and save the patient. Age group and longevity significantly influenced HCPs ability to choose the right ethical principles that were in conflict with a larger proportion of HCPs in the younger age groups selecting the right response. Compared to HCPs who had worked for 1\u0026ndash;5 years, those who had worked for 6\u0026ndash;10 years were less likely to select the correct response when presented with case one (OR\u0026thinsp;=\u0026thinsp;0.56; 95% CI: 0.32\u0026ndash;0.98).\u003c/p\u003e\n\u003cp\u003eThe principles that were in argument in case two were beneficence versus non-maleficence, as there was an urgent need for the insertion of the intravenous catheter for the well-being of the patient, but at the same time, the patient experienced some pain and swelling as a result. The patient\u0026rsquo;s autonomy is not questioned here as there was no mention of whether the patient wanted treatment or not. The percentage of doctors who selected the correct response, specifically beneficence versus non-maleficence, was found to be higher in comparison to nurses (89.6% vs 71.1%, p\u0026thinsp;=\u0026thinsp;0.01). Also, more males tend to select the correct response when compared to females (84.5% vs 69.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). After adjustment nurses-profession, male gender and age group 40\u0026ndash;49 were significantly associated with selecting the right response when presented with case 2 with odd ratios and confidence intervals of 0.37 [0.12\u0026ndash;0.91], 1.97[1.1\u0026ndash;3.7] and 0.45[0.20\u0026ndash;0.99] respectively. Those in the younger age group (20\u0026ndash;29) were twice likely to choose the correct principle when presented with scenario 2 than those in the age group 40\u0026ndash;49.\u003c/p\u003e\n\u003cp\u003eIn the context of case three, the principles that we expect that should be considered by the HCPs in taking a decision are nonmaleficence and justice. Following the same sequence and not giving priority to a patient who arrives at the hospital and is bleeding profusely can result to exacerbated harm to the individual. Here, justice must be considered, and priority ought to be given to the patient based on his or her situation. Like in the other cases, more doctors than nurses choose the right response (72.9% vs. 61.1%). In contrast to private and public facilities, a greater percentage of healthcare professionals (HCPs) from confessional facilities select the correct response to case 3, with 74% versus 52.8% for private and 63.5% for public (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In each of the three cases testing knowledge of medical principles, a greater proportion of physicians correctly identified the applicable principles than nurses. Overall, approximately 70% of healthcare professionals (HCPs) correctly identified the principles that required consideration for cases 1 and 2, whereas 62% identified the principles that were in dispute for scenario 3.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2. Participants attitudes towards issues in healthcare ethics.\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows the attitudes towards different aspects of medical ethics among doctors and nurses. Regarding informing patients about medical errors, there was a statistically significant difference in agreement between physicians and nurses (66.7% of physicians agreed versus 70.6% of nurses; 22.2% of physicians versus 8.7% of nurses were unsure whether they agree or disagree, p\u0026thinsp;=\u0026thinsp;0.02). There was also a statistical difference in agreement between doctors and nurses for the following questions: consent required only for operations and not for tests and other procedures (4.4% of physicians agreed versus 20.7% of nurses; 2.2% of physicians versus 3.9% of nurses were unsure whether they agree or disagree, p\u0026thinsp;=\u0026thinsp;0.03), physicians not refusing to conduct abortion if the law allowed (17.8% of physicians agreed versus 32.2% of nurses; 4.4% of physicians versus 12.0% of nurses were unsure whether they agree or disagree, p\u0026thinsp;=\u0026thinsp;0.02), acting ethically is only important to avoid legal action (11.1% of physicians agreed versus 31.7% of nurses; 13.3% of physicians versus 12.0% of nurses were unsure whether they agree or disagree, p\u0026thinsp;=\u0026thinsp;0.02), assisting patients who wished to die (2.2% of physicians agreed versus 17.4% of nurses; 10.4% of physicians versus 3.9% of nurses were unsure whether they agree or disagree, p\u0026thinsp;=\u0026thinsp;0.03). Doctors\u0026rsquo; opinions towards other healthcare ethics topics were not significantly different from that of nurses for the other statements such as: if doctors should receive income for referring patients for medical tests, confidentiality cannot be maintained as medicine is advancing, seeking consent from parents of children before treating them amongst others.\u003c/p\u003e\n\u003cp\u003eOther demographic variables which influenced rating of agreement to some of the attitude questions include facility type with HCPs from confessional facilities having lower levels of agreement than those from private and public facilities to the question of doctors receiving income from referring patients for medical tests (5.8% of HCPs from confessional facilities agreed versus 14.4% and 17.6% from private and public respectively; 7.2% of HCPs from confessional facilities versus 21.6% and 21.6% from private and public respectively were unsure whether they agree or disagree, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003eFemales had higher level of agreements to the question of seeking parental consent being a prerequisite before administering any form of treatment to children (71.6% of females agreed versus 57.3% males, p\u0026thinsp;=\u0026thinsp;0.03). Gender male was significant after controlling for other variables with odd ratio and confidence interval of 0.55[0.34\u0026ndash;0.91].\u003c/p\u003e\n\u003cp\u003eThe level of agreement with the statement that patients' preferences must always be followed, regardless of doctors' opinions, decreases as age increases. The percentages of agreement for different age groups are as follows: 20\u0026ndash;29: 63.1%, 30\u0026ndash;39: 57%, 40\u0026ndash;49: 39.3%, and 50+: 27.8%. Age group 40\u0026ndash;49 and age group 50\u0026thinsp;+\u0026thinsp;were significant after controlling for other variables with corresponding odds ratios and confidence intervals of 0.41[0.19\u0026ndash;0.85] and 0.19[0.054\u0026ndash;0.64] respectively.\u003c/p\u003e\n\u003cp\u003eThe percentage of healthcare providers who agreed that close relatives should be informed of a patient's condition was about 40% across all categories, except for the age groups 40\u0026ndash;49 (36.1%) and 50+ (28%). Almost half of the participants across all categories disagreed with the statement, whereas less than 15% of HCPs across all age groups were unclear of whether they agreed or not, except for the oldest age group (50+). The association between age group and the statement on informing close relatives about a patient\u0026rsquo;s condition was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3. Participants practices and healthcare ethics.\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e presents the responses provided by doctors and nurses regarding various healthcare ethics practices. There was a statistically significant difference in the ordering of certain tests for patient satisfaction, even when they were not medically necessary by physicians and nurses (77.3% of doctor\u0026rsquo;s vs 33.2% of nurses agreed, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Nurses had a lower likelihood than doctors to agree with the assertion that they had ordered tests for patient satisfaction, even when such tests were not medically required (0.15 [0.063, 0.31]). Compared to HCPs in public health facilities, a higher percentage of doctors and nurses in private and confessional health facilities said they ordered some tests for patient satisfaction even though they were not medically necessary (30.3% in public health facilities vs 47.4% in private health facilities and 45.9% in confessional health facilities, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003eFurthermore, health professionals with fewer years of experience exhibit a slightly higher tendency to order medically unnecessary tests compared to those with more years of experience (45.4% for 1\u0026ndash;5 years, 32% for 6\u0026ndash;10 years, and 26.3% for 11 years and above, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). There was no statistically significant difference in agreement between doctors and nurses for the remaining six questions. Also, we found no association with other demographic variables for the remaining six questions. Overall, the proportion of HCPs who consistently adhered to the correct practice was at least 70% for each practice question posed, except for inquiries regarding the ordering of unnecessary tests, the interference of overly demanding patients with decision-making processes, and patients having online access to medical guidelines.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4.0. Discussion and Conclusion","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Knowledge of healthcare ethics\u003c/h2\u003e \u003cp\u003e A large proportion of doctors and nurses surveyed had heard of medical ethics and were familiar with Beauchamp and Childress's four guiding principles of biomedical ethics. One-third of doctors and nurses claimed they had learned medical ethics through their professional training, seminars, and the internet. Our findings indicate that they are interested in the topic and keen to learn more without relying solely on formal educational settings such as classrooms. In general, in the research context, the hours allotted to the teaching of medical ethics in their training are limited, so it is critical for doctors and nurses to seek further training to supplement their knowledge. We observed that when presented with hypothetical cases in which they had to pick the ethical principles that were in conflict, the total proportion of doctors and nurses who could identify the correct ethical principles that were in conflict ranged from 62.4\u0026ndash;73.1% for the different cases. The hypothetical situations were designed to assess if HCPs understood the medical ethics principles and how they could be applied in the clinical setting. We found that the percentage of HCPs who chose the correct answers to all cases presented was lower than the percentage of HCPs who stated they knew the ethical principles when asked, \"Do you know the four ethical principles?\".\u003c/p\u003e \u003cp\u003e The lower percentage of doctors and nurses who correctly identified the ethical principles in conflict, when presented with hypothetical cases, compared to those who claimed to know the four ethical principles, suggests that healthcare professionals (HCPs) possess only a moderate understanding of the principles of medical ethics. Furthermore, our research suggests that HCPs, with years of working experience of between one and five years have a more comprehensive understanding of the medical ethics principles in conflict when a patient refuses a necessary medical intervention based on their personal beliefs, compared to those with six years or more of experience. One potential explanation for this phenomenon is that HCPs with fewer years of experience were in the younger age bracket and have recently completed their education and thus still retain a greater amount of medical ethics knowledge acquired throughout their schooling. Additionally, younger individuals tend to possess a higher level of proficiency in utilizing internet resources compared to their older counterparts and could source additional information online.\u003c/p\u003e \u003cp\u003e In relation to the hypothetical case concerning the order of examination performed by physicians in the event of an emergency, a significantly lower proportion of HCPs from private health facilities identified conflicting ethical principles that were appropriate than those from public and confessional health facilities. One possible explanation for this difference in knowledge is that public and confessional health facilities frequently organize training sessions on ethics and other relevant subjects to enhance the knowledge and efficiency of their personnel. This could pose a challenge in the private sector, where financial limitations frequently manifest. Overall, doctors outperform nurses in terms of selecting the right principles in conflict when presented with the three cases. A reason for this may be since doctors generally have more extensive medical training than nurses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Attitudes towards healthcare ethics issues\u003c/h2\u003e \u003cp\u003eHCPs opinions on the different healthcare ethics issues presented varied largely from statement to statement. While some statements elicited a clear consensus among HCPs, with a majority either agreeing or disagreeing with the statement, others resulted in a lack of consensus, with roughly equal numbers of HCPs expressing disagreement or agreement.\u003c/p\u003e \u003cp\u003eRegarding the issue of obtaining parental consent prior to treating children, approximately 22% of HCPs expressed the belief that it is unnecessary. This suggests the need for raising awareness and educating HCPs on the importance of obtaining well-informed parental consent before administering treatment to children. This is especially crucial in circumstances where the children are unable to make well-informed decisions on their own. We found out being a male HCP, as opposed to being a female HCP was associated with a higher likelihood of having a positive perception of obtaining informed consent from parents before treating children.\u003c/p\u003e \u003cp\u003eIn terms of confidentiality, one-third of doctors and nearly half of nurses agreed that close relatives of patients should be informed about the health situation of the patient. It therefore appears that the rights and autonomy of many patients are not always respected regarding who may be made aware of their medical condition. This may be because most of the inhabitants of the SWR and Cameroon population in general lacks health insurance and must make all payments on their own, families must sometimes raise funds to treat one of their patients, and as such, the patient's condition will be discussed with relatives [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. While HCPs generally strive to uphold ethical principles such as patient confidentiality and autonomy, the socio-economic status of patients can sometimes hinder their ability to do so. HCPs may feel compelled to disclose patient information to the patient's family and friends, who are often financially involved and desire comprehensive updates on the patient's condition.\u003c/p\u003e \u003cp\u003eRegarding the question of whether confidentiality must be maintained despite recent technological advancements, nearly all the physicians and nurses agreed about this idea. The proportion of healthcare professionals in our study who expressed agreement regarding the necessity of maintaining confidentiality despite technological advancements is greater than the proportion reported by Aacharya and Shakya in their study on medical interns\u0026rsquo; knowledge, attitudes and practices of bioethics among medical students in Bangladesh [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of end-of-life care, very few nurses and physicians were willing to assist a patient who wished to die. In contrast to other western countries where physician-assisted suicide is legally practiced and recognized, in Cameroon, physician-assisted suicide is currently unregulated, which helps explain why so few physicians and nurses agree with this statement. The same reasoning can be applied to the low percentage of positive attitudes that was given by both doctors and nurses when presented with the statement that doctors cannot refuse to perform an abortion if the law permitted it. However, even though the agreement rates were generally low for both doctors and nurses for the question on assisting patients who wished to die have their wishes, nurses were three times more than doctors likely to have positive attitudes towards helping a patient have their wish of assisted suicide granted if it were permitted by the health regulations of the country.\u003c/p\u003e \u003cp\u003eConcerning the notion of patient\u0026rsquo;s autonomy, the fact that 20% of doctors and 33.3% of nurses agree that the doctor\u0026rsquo;s decision should be final if patients and families disagreed on which procedures or medical treatment the patient will undergo suggests that there is still a form of paternalism going on in many health facilities in the SWR and the violation of patient\u0026rsquo;s autonomy common. Shared decision making is emphasised worldwide as one of the ideal ways of providing patient care and as such all HCPs should strive to follow this model of administering healthcare to their patients.\u003c/p\u003e \u003cp\u003eCompared to HCPs who were younger than 30years old, HCPs who were 40 years old and above were associated with a lower likelihood of having a positive perception that patients wish should always be adhered to irrespective of doctor\u0026rsquo;s opinion. Younger HCP\u0026rsquo;s greater knowledge of medical ethics principles can be associated with a more favourable attitude towards patient autonomy, as evidenced by the high proportion of younger HCPs who correctly identified the appropriate principles when presented with hypothetical cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Practices and healthcare ethics\u003c/h2\u003e \u003cp\u003e The results of our survey indicate that for most of the questions posed on practices of HCPs in the healthcare setting, doctors and nurses demonstrated a good adherence to healthcare ethics in their practice. Our findings are similar to those conducted in countries in the global south such as Pakistan, Ethiopia, and Egypt [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Most of the doctors and nurses reported that they never engaged in healthcare-related acts (history taking, examination, blood sample, radiological procedure, medication prescribing) with a patient without informed consent. However, about a third of doctors and nurses reported they did not seek informed consent from the patient. However, according to the principle of autonomy, informed consent should be sought before any procedure or tests are performed on a patient.\u003c/p\u003e \u003cp\u003eThe aspect of corruption in the medical setting has been mentioned in some studies conducted in Cameroon in health facilities in the littoral region [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In our survey, we discovered that 20% of doctors and 14% of nurses approved to collecting payment from patients for medical examinations. Normally, tests are usually paid to the finance department of the heath facility and HCPs shouldn\u0026rsquo;t demand additional payments from patients for their personal gains. Such behavior is unacceptable; but however, it might be linked to the poor wages earned by HCPs in Cameroon [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is common to encounter highly demanding patients in every clinical setting. In our study, approximately half of the doctors and nurses stated that highly demanding patients are annoying and could interfere in their decision-making, whereas the other half stated that highly demanding patients could not hinder their decision-making. The typical patient appears to be a fragile individual who places a great deal of trust in the medical team to provide the necessary care for recovery; therefore, even if they are difficult, every effort should be made to provide them with the optimal treatment.\u003c/p\u003e \u003cp\u003eA small proportion of doctors and nurses said they had ordered some tests, procedures, prescriptions, or imaging only for patient satisfaction, even if not indicated. Most healthcare facilities in remote areas lack proper diagnostic equipment and well-equipped laboratories, which may explain why doctors there are more likely to try alternative treatments in the hopes that their patients will feel better or at least be satisfied. In contrast to developing countries, healthcare providers in developed countries are more inclined to offer essential care and recommend and order only the requisite medical examinations for their patients. This is due to the presence of well-equipped health facilities and a wide range of treatment options. The government of Cameroon has the duty to ensure that health facilities in the SWR, which lack proper infrastructure and equipment, are adequately equipped. This will enable HCPs working in these facilities to provide the most efficient care to the residents of these localities.\u003c/p\u003e \u003cp\u003eThis is the first study to study the attitudes, knowledge, and practices of both doctors and nurses in the southwest region of Cameroon, and one of the strengths of the study is that it recruited only doctors and nurses with at least one year of experience as such captured impressions of HCPs already working in the field. Also, one of the strengths of our study is the fact it made use of hypothetical cases to test HCPs understanding and application of the four principles of medical ethics. This provided us with the chance to assess the extent to which HCPs comprehended the application of the principles, considering that they were originally asked a question with a binary response ('yes' or 'no') on whether they had knowledge of the four principles of medical ethics.\u003c/p\u003e \u003cp\u003eOur study however has some limitations. Firstly, with our sample being a convenient sample makes our generalization of findings to the entire Cameroonian population of doctors and nurses limited. Also, another limitation is that assessing knowledge of medical ethics was limited to knowledge of four ethical principles developed by Beauchamp and Childress and their applications in different cases (Beauchamp and Childress 2009). It will be more informative if in-depth interviews or a discussion was carried on the various scenarios presented to see if the HCPs really demonstrated a good understanding of the four principles of biomedical ethics. Furthermore, it may have been interesting to assess their knowledge of other regular codes, such as the Nuremberg code and the declaration of the Helsinki code, as has been utilized in other studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e To conclude our study suggests that doctors and nurses working in Cameroon's Southwest Region had a moderate level of understanding of the medical ethics principles, had positive attitudes toward some of the healthcare ethics issues presented, and had implemented good ethical practices in most of the questions asked about the practice of healthcare ethics. Based on our study we find that training opportunities are still highly needed to enabling healthcare professionals to have a good understanding and implementation of key principles in healthcare, such as confidentiality, patient autonomy, shared decision-making, and appropriate referral of patients who decline treatment based on personal beliefs and other pertinent healthcare ethics topics. We recommend that there should be a continued emphasis on raising awareness about healthcare ethics in hospitals in Cameroon and more opportunities for ethics training, such as more frequent seminars to promote medical ethics. The Cameroon Bioethics Initiative (CAMBIN) regularly conducts seminars in Cameroon to provide training on bioethics for healthcare professionals (HCPs). HCPs are strongly encouraged to seize these opportunities whenever they arise. Additionally, hospitals may extend invitations to bioethics experts to conduct educational sessions on bioethics and ethical practice for HCPs at their respective institutions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe thank all the doctors and nurses who dedicated their time to participate in the study.\u003c/p\u003e\n\u003ch2\u003eDisclosure statement\u003c/h2\u003e\n\u003cp\u003eNo potential conflict was reported by the authors.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003ch2\u003eData availability statement\u003c/h2\u003e\n\u003cp\u003eThe dataset utilized in this study is available upon request.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors made significant contributions to the development of the article.KTJ.D. conceptualised the idea of the study and the research methodology, took part in data analysis and interpretation, and assisted in writing and editing the first draft of the manuscript. ON.N. actively participated in the collection, entry, analysis, and interpretation of data, as well as the writing of the first draft of the manuscript.EZ.M. took part in developing the research methodology of the study, in data analysis and interpretation, editing the first draft of the manuscript, and co-supervising the research.N.T. conceptualised the idea of the study and the research methodology, supported the in-data analysis and interpretation, edited the first draft of the manuscript, and supervised the research.All authors read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOath, H., \u003cem\u003eThe hippocratic oath.\u003c/em\u003e Am J Med Genet, 1995. \u003cstrong\u003e58\u003c/strong\u003e: p. 187-94.\u003c/li\u003e\n\u003cli\u003eMiracle, V.A., \u003cem\u003eNational nurses week and the Nightingale pledge.\u003c/em\u003e Dimensions of Critical Care Nursing, 2009. \u003cstrong\u003e28\u003c/strong\u003e(3): p. 145-146.\u003c/li\u003e\n\u003cli\u003eJohnston, C. and P. 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AA, \u003cem\u003eKnowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria hospitals, Egypt.\u003c/em\u003e 2012.\u003c/li\u003e\n\u003cli\u003eAmani, A., \u003cem\u003eThe health workers crises in Cameroon.\u003c/em\u003e 2010.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic characteristics of study participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePhysicians\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e = 48)\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNurses\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e = 421)\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e = 469)\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge group (years)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132 (31.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e150 (32)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (52.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e200 (47.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e225 (48)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69 (16.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e73 (15.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 +\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (4.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003egender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (39.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e335 (79.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e354 (75.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (60.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81 (19.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110 (23.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDid not specify their gender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of Health Facility\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConfessional\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (14.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75 (17.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e82 (17.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (20.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121 (28.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131 (27.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePublic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (64.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125 (53.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e256 (54.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLongevity in service (Years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e216 (51.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e248 (52.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (22.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125 (29.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e136 (29)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 +\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (10.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85 (18.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChristian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (93.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e407(96.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e452 (96.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMuslim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (2.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePagan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (4.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (1.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eKnowledge of ethical principles\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHypothetical scenario\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eResponse\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNurses\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;381\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDoctors\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;48\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;439\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSignificant demographic variables associated with correct response.\u003c/p\u003e\n\u003cp\u003e(based on overall )\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdjusted significant odds ratio of variables and 95% Confidence Interval associated with the correct response\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1. A patient has been in a car accident and is bleeding heavily and is brought into the hospital. When the doctor recommended a blood transfusion, the patient and his family refused out of their religious beliefs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNonmaleficence vs Autonomy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e283\u003c/p\u003e\n\u003cp\u003e(72. 3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (72.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e318 (72.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAge group (20\u0026ndash;29: 83.7%\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39: 71.0%,\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49:59.4%,\u003c/p\u003e\n\u003cp\u003e50+ : 52.6%,\u003c/p\u003e\n\u003cp\u003e\u0026chi;\u003csub\u003e2\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;18.76, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01).\u003c/p\u003e\n\u003cp\u003eLongevity (1\u0026ndash;5: 81.0%,\u003c/p\u003e\n\u003cp\u003e6\u0026ndash;10: 65.4%,\u003c/p\u003e\n\u003cp\u003e11+ : 58.8%, (\u0026chi;\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;19.29, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLongivity\u003csup\u003ea\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;0.56, 95%CI [0.32, 0.98]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon maleficence vs Beneficence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e108 (27.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (27.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e121 (27.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2. A patient in shock who required immediate fluid resuscitation and insertion of an indwelling intravenous catheter experienced pain and swelling because of the treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBeneficence vs Autonomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e113\u003c/p\u003e\n\u003cp\u003e(28.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e(10.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e118 (26.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender (Males : 84.5%,\u003c/p\u003e\n\u003cp\u003efemales : 69.6%,\u003c/p\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;8.08, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004).\u003c/p\u003e\n\u003cp\u003ePosition (Doctors :89.6%, Nurses :71.1%, \u0026chi;\u003csub\u003e2\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;6.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eProfession\u003csup\u003eb\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;0.37, 95%CI [0.12, 0.91]\u003c/p\u003e\n\u003cp\u003eGender\u003csup\u003ec\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;1.97, 95%CI [1.1, 3.7].\u003c/p\u003e\n\u003cp\u003eAgegroup\u003csup\u003ed\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;0.45, 95%CI [0.20, 0.99].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBeneficence vs Non-maleficence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e278 (71.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43 (89.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e321 (73.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3. A patient arrives in a queue (waiting) number 10. Even though the patient was bleeding profusely, the doctor still examined the patient through the sequence of arrival of the patient\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAutonomy vs Justice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e152 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (27.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e165 (37.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eType of facility (Private: 52.8%,\u003c/p\u003e\n\u003cp\u003eConfessional: 74.0%,\u003c/p\u003e\n\u003cp\u003ePublic:63.5% ,\u003c/p\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;9.36, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNon-maleficence vs Justice\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e239\u003c/p\u003e\n\u003cp\u003e(61.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (72.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e274 (62.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eworked for 6\u0026ndash;10 years vs worked for 1-5years\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eNurses vs doctors\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eMales vs females\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003ed\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eagegroup 40\u0026ndash;49 vs agegroup20-29\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003ee\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eagegroup 50\u0026thinsp;+\u0026thinsp;vs agegroup20-29\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003ef\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eprivate facilities vs confessional facilities.\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cstrong\u003eg\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003epublicfacilities vs confessional facilities.\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAttitudes towards healthcare ethics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStatements on healthcare ethics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDoctors (N\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eNurses (N\u0026thinsp;=\u0026thinsp;357)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eOverall (N\u0026thinsp;=\u0026thinsp;402)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSignificant demographic variables associated with statement.\u003c/p\u003e\n\u003cp\u003e(Based on overall)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdjusted significant odds ratio of variables and 95% Confidence Interval associated with outcome variable\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDisagree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot sure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAgree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDisagree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot sure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAgree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDisagree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot sure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAgree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient's wishes must be adhered irrespective of doctor\u0026rsquo;s opinion`\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003cp\u003e(24.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e(11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003cp\u003e(64.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e137\u003c/p\u003e\n\u003cp\u003e(38.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003cp\u003e(7.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e192 (53.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e148\u003c/p\u003e\n\u003cp\u003e(36.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (8.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e221\u003c/p\u003e\n\u003cp\u003e(55.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group: Agree- (20\u0026ndash;29: 63.1%\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39: 57.0%,\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49: 39.3%,\u003c/p\u003e\n\u003cp\u003e50+: 27.8%); Not sure-(20\u0026ndash;29: 9.2%\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39: 6.2%,\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49: 13.1%,\u003c/p\u003e\n\u003cp\u003e50+: 5.6%);\u003c/p\u003e\n\u003cp\u003e(\u0026chi;\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;19.07, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAgegroup\u003csup\u003ed\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;0.41, 95%CI [0.19, 0.85].\u003c/p\u003e\n\u003cp\u003eAgegroup\u003csup\u003ee\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;0.19, 95%CI [0.054, 0.64].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatients must always be informed of medical errors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e(11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e(22.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003cp\u003e(66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003cp\u003e(20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003cp\u003e(8.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e252\u003c/p\u003e\n\u003cp\u003e70.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003cp\u003e(19.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003cp\u003e(10.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e282\u003c/p\u003e\n\u003cp\u003e(70.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition : Agree- (Doctors :66.7%, Nurses :70.6%,\u003c/p\u003e\n\u003cp\u003eNot sure- (doctors :22.2, Nurses : 8.7% ; \u0026chi;\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;9.15, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAs medicine is advancing, confidentiality cannot be maintained\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003cp\u003e(88.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e(11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e295\u003c/p\u003e\n\u003cp\u003e(82.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003cp\u003e(6.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003cp\u003e(11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e335\u003c/p\u003e\n\u003cp\u003e(83.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003cp\u003e(5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003cp\u003e(11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDoctors should do their best irrespective of patient's opinion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e(22.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e(6.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003cp\u003e(71.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003cp\u003e(16.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003cp\u003e(4.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e285\u003c/p\u003e\n\u003cp\u003e(79.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67\u003c/p\u003e\n\u003cp\u003e(16.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (4.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e317\u003c/p\u003e\n\u003cp\u003e(78.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConsent is required only for operations \u0026ndash; not for tests and medications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003cp\u003e(93.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e(2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e(4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e269\u003c/p\u003e\n\u003cp\u003e(75.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003cp\u003e(3.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003cp\u003e(20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e311\u003c/p\u003e\n\u003cp\u003e(77.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003cp\u003e(3.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76\u003c/p\u003e\n\u003cp\u003e(18.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition: Agree- (Doctors: 4.4%, Nurses: 20.7%; Not sure-Doctors: 2.2%, nurses: 3.9%, \u0026chi;2\u0026thinsp;=\u0026thinsp;7.58, p\u0026thinsp;=\u0026thinsp;0.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClose relatives should be told of a patient\u0026rsquo;s condition\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003cp\u003e(66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e(11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e(22.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e183\u003c/p\u003e\n\u003cp\u003e(51.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003cp\u003e(7.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003cp\u003e(40.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e213\u003c/p\u003e\n\u003cp\u003e(53.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003cp\u003e(8.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e156\u003c/p\u003e\n\u003cp\u003e(38.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group: Agree \u0026ndash;\u003c/p\u003e\n\u003cp\u003e(20\u0026ndash;29: 39.2%\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39: 40.4%,\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49: 36.1%,\u003c/p\u003e\n\u003cp\u003e50+: 27.8%), Not sure \u0026minus;\u0026thinsp;(20\u0026ndash;29: 13.8%\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39: 3.1%,\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49: 8.2%,\u003c/p\u003e\n\u003cp\u003e50+: 22.2%,\u003c/p\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;17.7, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01)).\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChildren should never be treated without consent of the parent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e(26.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003cp\u003e(13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003cp\u003e(60.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93\u003c/p\u003e\n\u003cp\u003e(26.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003cp\u003e(4.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e247 (69.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e105\u003c/p\u003e\n\u003cp\u003e(26.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003cp\u003e(5.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e274\u003c/p\u003e\n\u003cp\u003e(68.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender: Agree \u0026ndash;\u003c/p\u003e\n\u003cp\u003e(males :57.3%\u003c/p\u003e\n\u003cp\u003efemales: 71.6%), Not sure - (males: 7.3%, females: 5.2%),\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;6.90, p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e\n\u003cp\u003eType of facility: Agree- (private: 60.4%\u003c/p\u003e\n\u003cp\u003econfessional: 55.1%, Public :76.1% ; Not sure- (private :6.3%,\u003c/p\u003e\n\u003cp\u003econfessional: 7.2%, public:5.0%,\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026Chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;15.5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFacility type\u003csup\u003eg\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;2.77, 95%CI [1.56, 4.93].\u003c/p\u003e\n\u003cp\u003eGender\u003csup\u003ec\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;0.55, 95%CI [0.34, 0.91].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIf a patient wishes to die, he or she should be assisted in doing so\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003cp\u003e(84.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003cp\u003e(13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e(2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e258\u003c/p\u003e\n\u003cp\u003e(72.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003cp\u003e(10.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62 (17.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e296\u003c/p\u003e\n\u003cp\u003e(73.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003cp\u003e(10.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003cp\u003e(15.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition: Agree- (Doctors: 2.2%, Nurses: 17.4%; Not sure: Doctors: 10.4%, nurses: 3.9%, \u0026chi;2\u0026thinsp;=\u0026thinsp;6.98, p\u0026thinsp;=\u0026thinsp;0.03)\u003c/p\u003e\n\u003cp\u003eType of facility: Agree- (private :18.9%\u003c/p\u003e\n\u003cp\u003econfessional: 21.7%, public :12.2% ; Not sure- (private: 9.0%,\u003c/p\u003e\n\u003cp\u003econfessional: 17.4%, public :9.5%,\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;9.86, p\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfession\u003csup\u003eb\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;3.10, 95%CI [1.36, 8.07]\u003c/p\u003e\n\u003cp\u003eFacility type\u003csup\u003eg\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;0.42, 95%CI [0.24, 0.76].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIf patients refuse medical treatment because of personal beliefs, they should be directed to another healthcare provider\"\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e(53.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e(20.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e(26.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e168\u003c/p\u003e\n\u003cp\u003e(47.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003cp\u003e(15.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e134\u003c/p\u003e\n\u003cp\u003e(37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e192\u003c/p\u003e\n\u003cp\u003e(47.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003cp\u003e(15.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003cp\u003e(36.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIf law allows abortion, doctors cannot refuse to do abortion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003cp\u003e(77.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e(4.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003cp\u003e(17.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e199\u003c/p\u003e\n\u003cp\u003e(55.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003cp\u003e(12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e115\u003c/p\u003e\n\u003cp\u003e(32.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e234\u003c/p\u003e\n\u003cp\u003e(58.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003cp\u003e(11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e123\u003c/p\u003e\n\u003cp\u003e(30.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition: Agree- (Doctors: 17.8%, Nurses: 32.2%; Not sure: Doctors: 4.4%, Nurses: 12.0%, \u0026chi;2\u0026thinsp;=\u0026thinsp;8.11, p\u0026thinsp;=\u0026thinsp;0.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfession\u003csup\u003eb\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;3.46, 95%CI [1.66, 7.84]\u003c/p\u003e\n\u003cp\u003elongivity\u003csup\u003ea\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;0.54, 95%CI [0.32, 0.91]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIf patients/families and medical staff disagree about how to treat a patient, the medical staff's decision is final\"\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003cp\u003e(62.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003cp\u003e(17.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e(20.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e174\u003c/p\u003e\n\u003cp\u003e(48.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003cp\u003e(17.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119 (33.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e202\u003c/p\u003e\n\u003cp\u003e(50.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003cp\u003e(17.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e128\u003c/p\u003e\n\u003cp\u003e(31.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEthical conduct is only important to avoid legal action\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003cp\u003e(75.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003cp\u003e(13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e(11.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e201\u003c/p\u003e\n\u003cp\u003e(56.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003cp\u003e(12.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e113\u003c/p\u003e\n\u003cp\u003e(31.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e235\u003c/p\u003e\n\u003cp\u003e(58.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003cp\u003e(12.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003cp\u003e(29.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition: agree- (Doctors: 11.1%, Nurses: 31.7%; not sure: Doctors: 13.3%, Nurses: 12.0%, \u0026chi;2\u0026thinsp;=\u0026thinsp;8.33, p\u0026thinsp;=\u0026thinsp;0.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDoctors receive income from referring patients for medical tests\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003cp\u003e(60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e(20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e(20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e239\u003c/p\u003e\n\u003cp\u003e(66.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003cp\u003e(19.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50 (14.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e266\u003c/p\u003e\n\u003cp\u003e(66.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003cp\u003e(19.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003cp\u003e(14.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eType of facility: agree- (private :14.4%\u003c/p\u003e\n\u003cp\u003econfessional: 5.8%; public: :17.6% ; Not sure- (private :21.6%,\u003c/p\u003e\n\u003cp\u003econfessional: 7.2%, public :21.6%,\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;16.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFacility type \u003csup\u003ef\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;3.59, 95%CI [1.68, 8.45].\u003c/p\u003e\n\u003cp\u003eFacility type\u003csup\u003eg\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;4.05, 95%CI [1.99, 9.17].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eworked for 6\u0026ndash;10 years vs worked for 1-5years\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eNurses vs doctors\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eMales vs females\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003ed\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eagegroup40-49 vs agegroup20-29\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003ee\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eagegroup50+ vs agegroup20-29\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003ef\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eprivate facilities vs faith based facilities\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"12\"\u003e\u003csup\u003e\u003cstrong\u003eg\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003epublic facilities vs faith based facilities\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eEthics in Healthcare Practices among Participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStatement on practice of healthcare ethics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDoctors (N\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNurses (N\u0026thinsp;=\u0026thinsp;377)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOverall (N\u0026thinsp;=\u0026thinsp;421)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSignificant demographic variables associated with question.\u003c/p\u003e\n\u003cp\u003eBased on overall\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdjusted significant odds ratio of variables and 95% Confidence Interval associated with the correct response\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNever engaged in healthcare related acts (history taking, examination, blood sample, radiological procedure, medication prescribing) to a patient without informed consent.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 (72.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (27.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264 (70.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e113 (30.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e296 (70.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125 (29.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDo order some tests/procedures /prescriptions/ imaging only for patient satisfaction even if not indicated\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (77.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (22.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125 (33.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e252 (66.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e159 (37.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e262 (62.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosition (Doctors: 77.3%, Nurses: 33.2%, \u0026chi;2\u0026thinsp;=\u0026thinsp;30.78, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/p\u003e\n\u003cp\u003eLongevity (1\u0026ndash;5: 45.4%, 6\u0026ndash;10: 32.0%, 11+: 26.3%, \u0026chi;2\u0026thinsp;=\u0026thinsp;11.60, p\u0026thinsp;\u0026lt;\u0026thinsp;.01)\u003c/p\u003e\n\u003cp\u003eGender (Males :49.5%\u003c/p\u003e\n\u003cp\u003efemales: 34.1%\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;7.14, p\u0026thinsp;=\u0026thinsp;.008).\u003c/p\u003e\n\u003cp\u003eType of facility (private:47.4%\u003c/p\u003e\n\u003cp\u003eConfessional: 45.9%, public:30.3%\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;12.18, p\u0026thinsp;\u0026lt;\u0026thinsp;.002).\u003c/p\u003e\n\u003cp\u003eAge group (20\u0026ndash;29: 49.2%\u003c/p\u003e\n\u003cp\u003e30\u0026ndash;39: 35.0%,\u003c/p\u003e\n\u003cp\u003e40\u0026ndash;49: 27.9%,\u003c/p\u003e\n\u003cp\u003e50+: 25.0%,\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;12.12,\u003c/p\u003e\n\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfession\u003csup\u003eb\u003c/sup\u003e : OR\u0026thinsp;=\u0026thinsp;0.15, 95%CI [0.063, 0.31]\u003c/p\u003e\n\u003cp\u003eFacility type\u003csup\u003ef\u003c/sup\u003e: OR\u0026thinsp;=\u0026thinsp;0.40, 95%CI [0.22, 0.71].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlways ensure nobody is present other than medical team during assessments or procedures.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (81.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (18.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e296 (78.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81 (21.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e332 (78.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e89 (21.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiscuss patient's case with relatives and co-patients all the time.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (6.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41 (93.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (7.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e350 (92.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (7.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e391 (92.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlways try to give only what is necessary to the patient regarding his situation.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (79.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (20.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e326 (86.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51 (13.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e361 (85.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60 (14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHighly demanding patients are annoying and interfering with decision making.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (47.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (52.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e211 (56.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e166 (44.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e232 (55.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e189 (44.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatients should not have access to medical guidelines online.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (18.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (81.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101 (26.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e276 (73.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109 (25.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e312 (74.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eworked for 6\u0026ndash;10 years vs worked for 1-5years\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eNurses vs doctors\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eMales vs females\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003ed\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eagegroup40-49 vs agegroup20-29\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003ee\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eagegroup50+ vs agegroup20-29\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003ef\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003eprivate facilities vs faith based facilities\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e\u003csup\u003e\u003cstrong\u003eg\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003epublicfacilities vs faith based facilities\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Knowledge, healthcare ethics, attitudes, practices, Southwest region Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-4108862/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4108862/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eKnowledge of bioethics could assist healthcare professionals in working ethically, thus enhancing the quality of patient care. We conducted a study to assess physicians' and nurses' knowledge, attitudes, and behaviours regarding healthcare ethics in Cameroon's southwest region. 469 healthcare professionals were recruited, with 89.8% being nurses and 10.2% being doctors. Women made up 79.6% of nurses, while men made up 60.4% of physicians. The percentage of healthcare professionals who demonstrated good knowledge regarding the most commonly applied biomedical ethics principles varied from 62.9\u0026ndash;73.1%. There were significant differences in agreement levels between doctors and nurses on statements such as physician-assisted suicide, physicians not refusing to assist with abortions if the law allowed it, and seeking informed consent only for operations and not tests. Nurses were three times more likely to agree with the statements that doctors cannot refuse abortion if the law allows it and that patients who want assisted suicide should be assisted to get it. Most healthcare providers were found to consistently adhere to healthcare ethics in their practices. However, there was a significant difference in opinion between doctors and nurses when asked if they ordered tests that were not medically necessary but were ordered for patient satisfaction, with nurses having a lower likelihood of agreeing to such practices than doctors. While participants demonstrated a moderate knowledge of healthcare ethics, additional educational interventions are needed to cultivate more favourable attitudes toward specific aspects of healthcare ethics, such as informed consent, patient autonomy, paternalism, and confidentiality.\u003c/p\u003e","manuscriptTitle":"Bioethics Knowledge, Attitudes, and Practices among Healthcare Professionals in Cameroon: A survey of doctors and nurses in Cameroon's Southwest Region","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 11:46:11","doi":"10.21203/rs.3.rs-4108862/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T05:41:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-30T19:39:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-08-27T11:57:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311643039373939435218176494062630462058","date":"2024-07-04T17:31:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-24T19:20:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"425d93d5-a088-40bd-8e60-6faa10453fe1","date":"2024-04-21T01:27:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-18T16:34:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-11T03:15:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-11T03:15:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2024-03-15T15:04:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93432bf6-7e38-4278-8a24-3a1a5a2409d6","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T15:59:58+00:00","versionOfRecord":{"articleIdentity":"rs-4108862","link":"https://doi.org/10.1186/s12982-025-00419-7","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-01-30 15:57:08","publishedOnDateReadable":"January 30th, 2025"},"versionCreatedAt":"2024-03-20 11:46:11","video":"","vorDoi":"10.1186/s12982-025-00419-7","vorDoiUrl":"https://doi.org/10.1186/s12982-025-00419-7","workflowStages":[]},"version":"v1","identity":"rs-4108862","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4108862","identity":"rs-4108862","version":["v1"]},"buildId":"CiT4i_kKBbxQbnFL0ufpk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}