Ethics Opinions

Physicians’ primary ethical obligation is to promote the well-being of individual patients includes an obligation to collaborate on a discharge plan that is safe for the patient.

Telehealth and telemedicine span a continuum of technologies; As in any mode of care, patients need to be able to trust that physicians will place patient welfare above other interests, provide competent care, provide the information patients need to make well-considered decisions about care, respect patient privacy and confidentiality, and take steps to ensure continuity of care.

In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their children’s physical health and well-being and to nurture their children’s developing personhood and autonomy; Physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment; The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients’ assent to treatment.

Decisions not to initiate care or to discontinue an intervention can be emotionally wrenching for the parents of a seriously ill newborn. Physicians should help parents, families, and fellow professionals understand that there is no ethical difference between withholding and withdrawing treatment, when an intervention no longer helps to achieve the goals of care or promote the quality of life.

Genetic testing of children implicates important concerns about the minor patient’s present and future autonomy and best interests. Decisions to test must balance multiple considerations, including: likely benefits, the risks of knowing genetic status, features unique to the condition(s) being tested for (such as age of onset), and the availability of effective preventive, therapeutic, or palliative interventions.

Surgical co-management refers to the practice of allotting specific responsibilities of patient care to designated clinicians. Such arrangements should be made only to ensure the highest quality of care.

A patient who has decision-making capacity appropriate to the decision at hand has the right to decline or halt any medical intervention even when that decision is expected to lead to his or her death, When a patient lacks appropriate capacity, the patient’s surrogate may halt or decline any intervention. There is no ethical difference between withholding and withdrawing treatment. When an intervention no longer helps to achieve the patient’s goals for care or desired quality of life, it is ethically appropriate for physicians to withdraw it.

Orders not to attempt resuscitation (DNAR orders) direct the health care team to withhold resuscitative measures in accord with a patient’s wishes. Physicians should address the potential need for resuscitation early in the patient’s course of care, while the patient has decision-making capacity, and should encourage the patient to include his or her chosen surrogate in the conversation.

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.

Offering financial incentives for donation raises ethical concerns about potential coercion, the voluntariness of decisions to donate, and possible adverse consequences, including reducing the rate of altruistic organ donation and unduly encouraging perception of the human body as a source of profit. These concerns merit further study to determine whether, overall, the benefits of financial incentives for organ donation outweigh their potential harms.