- A survey was conducted of internal medicine and family medicine residents at UCSD to examine their willingness to prescribe sildenafil (Viagra) in different ethically challenging scenarios. - The survey presented 10 scenarios that varied factors like HIV status, sexual orientation, safe sex practices, and relationship status. - The results showed residents were less likely to prescribe sildenafil to those with risky behavior, HIV-positive patients, and those in adulterous relationships, indicating extra-therapeutic factors influenced their decisions. - The study concluded residency programs should help residents balance respecting patient autonomy with protecting society and addressing biases and moral views that could impact patient care.

1. Neil J. Farber, MD, FACP Lynette Cederquist, MD Mary Devereaux, PhD Ed Brown, MD University of California San Diego La Jolla, CA

6. Demographics of 81/128 (63%) Respondents Age 29 +/_ 2.7 years Gender Male 43 (53%) Female 37 (46%) Residency IM 64 (79%) FM 16 (20%) Yr of Residency 1 st Year 27 (33%) 2 nd Year 22 (27%) 3 rd Year 31 (38%)

7. Attitudes of 379 Respondents Attitude Agree Disagree Patient Has Priority 59 (73%) 20 (25%) Low Morals No Rights 8 (10%) 69 (85%) Protecting Society 49 (60%) 27 (33%) Protect Pt From Himself 70 (86%) 8 (10%)

8. Figure 1 % of Respondents Likely to Prescribe Sildenafil Based On Risk P < 0.001

9. Figure 2 % of Respondents Likely to Prescribe Sildenafil Based on HIV P < 0.001

10. Figure 3 % of Respondents Likely to Prescribe Sildenafil Based On Morality P < 0.001

11. Association of Attitudes With Likelihood of Prescribing Sildenafil * p = 0.005 Agree Disagree Patient Priority 6.3 +/- 2.2 6.7 +/- 1.7 Morals No Rights 5.2 +/- 2.6 6.6 +/- 2.0 Protect Society 6.5 +/- 2.1 6.8 +/- 2.1 Paternalism * 6.2 +/- 2.1 8.1 +/- 1.4