Open Access Highly Accessed Research article

Ethics takes time, but not that long

Mats G Hansson1, Ulrik Kihlbom12, Torsten Tuvemo3, Leif A Olsen4 and Alina Rodriguez156*

Author Affiliations

1 Centre for Bioethics at Karolinska Institutet and Uppsala University, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

2 Department of Humanities, Örebro University, Örebro, Sweden

3 Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden

4 Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden

5 Department of Public Health Science and General Practice, Oulu University, Oulu, Finland

6 Department of Psychology, Uppsala University, Uppsala, Sweden

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BMC Medical Ethics 2007, 8:6  doi:10.1186/1472-6939-8-6

Published: 24 May 2007



Time and communication are important aspects of the medical consultation. Physician behavior in real-life pediatric consultations in relation to ethical practice, such as informed consent (provision of information, understanding), respect for integrity and patient autonomy (decision-making), has not been subjected to thorough empirical investigation. Such investigations are important tools in developing sound ethical praxis.


21 consultations for inguinal hernia were video recorded and observers independently assessed global impressions of provision of information, understanding, respect for integrity, and participation in decision making. The consultations were analyzed for the occurrence of specific physician verbal and nonverbal behaviors and length of time in minutes.


All of the consultations took less than 20 minutes, the majority consisting of 10 minutes or less. Despite this narrow time frame, we found strong and consistent association between increasing time and higher ratings on all components of ethical practice: information, (β = .43), understanding (β = .52), respect for integrity (β = .60), and decision making (β = .43). Positive nonverbal behaviors by physicians during the consultation were associated particularly with respect for integrity (β =.36). Positive behaviors by physicians during the physical examination were related to respect for children's integrity.


Time was of essence for the ethical encounter. Further, verbal and nonverbal positive behaviors by the physicians also contributed to higher ratings of ethical aspects. These results can help to improve quality of ethical practice in pediatric settings and are of relevance for teaching and policy makers.