Ethics Opinions

Financial obstacles to medical care can directly affect patients’ well-being and may diminish physicians’ ability to use their knowledge and skills on patients’ behalf. Physicians should not be expected to risk the viability of their practices or compromise quality of care by routinely providing care without compensation. Patients should make reasonable efforts to meet their financial responsibilities or to discuss financial hardships with their physicians.

Health disparities across patient populations reflect deeply embedded, historically rooted socioeconomic and political dynamics. Physicians and health care institutions have a duty to serve as agents of change to address these structural barriers to optimal health for all.

Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must respond to the needs of patients at the end of life.

At the heart of medicine lie relationships founded in a “covenant of trust” between patient and physician in which physicians commit themselves to responding to the needs and promoting the welfare of patients.

Physicians have an ethical obligation to provide care in cases of medical emergency; Physicians must also uphold ethical responsibilities not to discriminate against prospective patients on the basis of personal or social characteristics that are not clinically relevant; Physicians are nevertheless not ethically required to accept all prospective patients.

The health and well-being of patients depends on a collaborative effort between patient and physician in a mutually respectful alliance.

Physicians’ fiduciary responsibility to patients entails an obligation to support continuity of care for their patients.

Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience is important for preserving the integrity of the medical profession as well as the integrity of the individual physician; Physicians’ freedom to act according to conscience is not unlimited; They are expected to provide care in emergencies, honor patients’ informed decisions to refuse life-sustaining treatment, respect basic civil liberties and not discriminate against patients on the basis of arbitrary characteristics.

Disrespectful, derogatory, or prejudiced language or conduct, or prejudiced requests for accommodation of personal preferences on the part of either patients or physicians can undermine trust and compromise the integrity of the patient-physician relationship.

Efforts to provide a comfortable and considerate atmosphere for the patient and the physician are part of respecting patients’ dignity. These efforts may include providing appropriate gowns, private facilities for undressing, sensitive use of draping, and clearly explaining various components of the physical examination. They also include having chaperones available. Having chaperones present can also help prevent misunderstandings between patient and physician.