Objectives-To study some ethical problems created by accession of a pr
eviously nomadic and traditional society to modern invasive medicine,
by assessment of physicians' attitudes towards sharing information and
decision-making with patients in the setting of a serious illness. De
sign-Self-completion questionnaire administered in 1993. Setting-Riyad
h, Jeddah, and Buraidah, three of the largest cities in Saudi Arabia.
Survey sample-Senior and junior physicians from departments of interna
l medicine and critical care in six hospitals in the above cities. Res
ults-A total of 249 physicians participated in the information on diag
nosis and prognosis of serious and those who spoke Arabic fared better
than other groups. The majority (75%) preferred to discuss informatio
n with close relatives rather than patients, even when the patients we
re mentally competent. Most of the physicians (72%) felt patients had
the right to refuse a specific treatment modality, and 68% denied pati
ents the right to demand such a treatment if considered futile. Furthe
r analysis showed that physicians' attitudes varied along a spectrum f
rom passive (25%) to paternalistic (21%) with the largest group (47%)
in a balanced position. Conclusions-In traditional societies where phy
sicians are regarded as figures of authority and family ties are impor
tant, there is a considerable shift of access to information and decis
ion-making from patients to their physicians and relatives in a manner
that threatens patients' autonomy. Ethical principles, wider availabi
lity of invasive medical technology and a rise in public awareness dic
tate an attitude change.