Ethics Opinions

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 are not required to offer or to provide interventions that, in their best medical judgment, cannot reasonably be expected to yield the intended clinical benefit or achieve agreed-on goals for care. Respecting patient autonomy does not mean that patients should receive specific interventions simply because they (or their surrogates) request them.

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.

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.

Physicians have an obligation to inform patients about all appropriate treatment options, the risks and benefits of alternatives, and other information that may be pertinent, including the existence of payment models, financial incentives, formularies, guidelines, or other tools that influence treatment recommendations and care.

Physicians within institutions that have or are contemplating a merger of secular and faith-based institutions have a responsibility to protect the community that the institution serves as well as the integrity of the institution, and other physicians and professionals who practice in association with it, while recognizing that physicians’ primary obligation is to their patients.

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.

Short-term global health clinical encounters provide needed care to individual patients in under-resourced settings and address global health inequities. Physicians engaging in short-term global health clinical encounters have an ethical obligation to prioritize benefits for the host community and ensure quality care while maintaining awareness for cultural differences. Sponsors of short-term global health clinical encounters should ensure the provision of resources, that team members practice within the limits of their skills, and that a mechanism for meaningful data collection is in place.