Whatever roles physicians may play in the system of health care delivery, when they use the knowledge and values they gained through medical training and practice in roles that affect the care and well-being of individual patients or groups of patients, they are functioning within the sphere of their profession.
When physicians take on roles that require them to use their medical knowledge on behalf of third parties, physicians must uphold their core obligation to promote patients’ best interests.
Physicians who are simultaneously employees and clinical supervisors of nonphysician practitioners must give precedence to their ethical obligation to act in the patient’s best interest and exercise independent professional judgment, even if that puts the physician at odds with the employer or supervisee.
Physicians must recognize that providing medical care for a fellow professional can pose special challenges for objectivity, open exchange of information, privacy and confidentiality, and informed consent. Physicians have the same fundamental ethical obligations when treating peers as when treating any other patient.
Nurses hold a primary ethical obligation to promote patients’ well-being; while physicians have overall responsibility for the quality of care that patients receive, good nursing practice requires that nurses voice their concerns when, in the nurse’s professional judgment, a physician order is in error or is contrary to good medical practice. Physicians’ relationships with nurses should be based on mutual respect and trust.
Although physicians have overall responsibility for the quality of care that patients receive, allied health professionals have training and expertise that complements physicians’. Allied health professionals share a common commitment to patient well-being. Physicians’ relationships with allied health professionals should be based on mutual respect and trust.
Physicians have a responsibility to protect patient interests and thus have a corresponding obligation to exercise good professional judgment in inviting industry representatives into the clinical setting. Physicians should recognize that in this setting appropriately trained industry representatives function as consultants.
Ethics committees offer assistance in addressing ethical issues that arise in patient care and facilitate sound decision making that respects participants’ values, concerns, and interests. Ethics committees may also assist in ethics-related educational programming and policy development within their institutions.
The goal of ethics consultation is to support informed, deliberative decision making on the part of patients, families, physicians, and the health care team. By helping to clarify ethical issues and values, facilitating discussion, and providing expertise and educational resources, ethics consultants promote respect for the values, needs, and interests of all participants, especially when there is disagreement or uncertainty about treatment decisions.
In health care, teams that collaborate effectively can enhance the quality of care for individual patients. Physicians are uniquely situated to serve as clinical team leaders to synthesize the diverse professional perspectives and recommendations of the team into an appropriate, coherent plan of care for the patients.