Why Medical Ethics Should Matter to Patients

Medical ethics has properly gained a foothold in the public square. There is a national conversation about euthanasia, stem cell research, fertilization and embryo implantation techniques, end-of-life care, prenatal diagnosis of serious diseases, defining death to facilitate organ donation, cloning and financial conflicts of interest. Nearly every day, we read (or click) on a headline highlighting one of these or similar ethical controversies. These great issues hover over us.

We physicians face ethical dilemmas every day. They won’t appear in your newspapers or pop up on your smart phones, but they are real and they are important. Here is a sampling from the everyday ethical choices that your doctor faces.

How would you act under the following scenarios?

1. A physician has one appointment slot remaining on his schedule. Two patients have called requesting this same day appointment. The first patient who called has no insurance and owes the practice money. The second patient has medical insurance coverage. Neither patient is seriously ill. Who should get the appointment?

2. Two hours before a doctor is to see a patient, her husband calls to relate private information that he fears the patient will not share with the physician. Should the physician disclose this conversation to the patient? What is the risk if she discovers at a later time that a confidential conversation occurred?

3. A patient has been non-compliant with medical care. He has missed appointments and does not take his medication reliably. The physician is contacted by a local emergency room after the patient arrives there for a medical evaluation. Can the doctor ethically decline to treat this patient who has repeatedly rejected the physician’s advice?

4. Many physicians dispense medication samples to their patients. Is this practice ethical in that it raises drug prices for everyone since drug companies must fund these giveaways

5. An attorney contacts a physician to testify against a fellow doctor who is accused of committing medical malpractice. The physician and the accused doctor both work in a small community hospital. The facts suggest that a medically negligent act has occurred. Is the physician ethically obligated to testify against his colleague?

6. A cardiologist decides not to accept smokers in his practice as he views this behavior as a direct attack on his medical treatment and strategy. All smokers in his practice are notified that if they do not quit within 6 months that they will need to select another physician. The cardiologist states he will actively counsel and treat all smokers on the available options for nicotine addiction. Can this physician ethically dismiss smokers from his practice who can’t or won’t quit?

7. A patient asks a doctor to fill out a temporarily disability form for back pain present for 2 weeks prior to the office visit. During this time, the patient did not seek any medical care. Is it ethical for the doctor to sign off on this request?

While none of the examples above will make the front page of your morning newspapers, they are newsworthy. They are under the radar, but need to be exposed. While the public square is crowed with the monumental ethical controversies of the day, we need to reserve a small corner there for everyday ethics.  Ethics in the office should not be a private matter.

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3 replies »

  1. i would really like to know Dr.Mike, what exactly are the ethical guidelines for a general surgeon, because a surgeon did sugery on my mum’s abscess without the use of anesthesia and i want to no if that is wrong or not because she went through excruciating pain after the surgery and she had dealt with post traumatic stress after he incident.
    so i want to know if this is an ethical problem or not.

  2. 1) the one more likely to pay since all other things appear to be equal. No ethical dilemma here – send the other one to urgent care.
    2) Try and get the patient to disclose, otherwise can’t bring up the husband’s info
    3) Make the ER follow up appt, but next time he no-shows you should dismiss as you two obviously don’t connect.
    4) Not an ethics question.
    5) There are no facts other than the ones you personally know until proven at trial. You should testify if you know facts, not to provide “expert” opinion – that should come from someone outside the community who will have no bias one way or the other.
    6) Absolutely. He can dismiss anybody he wants, as long as he follows community standards on carrying out a dismissal.
    7) It is ethical if the doc thinks it is reasonable based on his history and exam. It is also ethical if the doc declines based on principle alone, even if otherwise justified by history and exam.

    If you feel something is wrong, then to do or not to do becomes a question of morality for you, but that does not make it a question of ethics for another. Ethics are based on standards specific to the situation, or if specific standards are lacking, then on broader standards of the community at large. Just because your heart bleeds does not make it an ethical dilemma for me.

  3. Nice examples. No pat, cookie-cutter answers to “ethical” issues.

    [1] First come, first served.
    [2] That one is REALLY tough. As much a legal issue as an ethical one.
    [3] At that exigent point of care, I would argue that the physician is morally obligated (but that he/she should note the relevant concerns in the encounter record).
    [4] Make detail reps’ giving free samples away illegal (good luck with that), otherwise there’s no net problem here. The aggregate costs are gonna be what they are. You could argue that a patient with INSURANCE “raises costs for everyone else” (i.e., risk pooling)
    [5] Yes. The doc may get a subpoena in any event, and have to decide how far to go in testimony under Oath.
    [6] Yes.
    [7] No.

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