Ethics Opinions

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.

Electronic communication can raise special concerns about privacy and confidentiality, particularly when sensitive information is being conveyed. Physicians using electronic communication hold the same ethical responsibilities to patients as they do during other clinical encounters.

Social networks, and other forms of communication online create new challenges to the patient-physician relationship. Physicians and trainees have an ethical responsibility to weigh a number of considerations when maintaining a presence online: abiding by standards of patient privacy and confidentiality, maintaining appropriate professional boundaries and recognizing that actions online and content posted may negatively affect their reputations.

Informing a patient’s family that the patient has died, is a duty that is fundamental to the patient-physician relationship; In this process, physicians should give foremost attention to the family’s emotional needs and the integrity of the patient-physician relationship.

When physicians wish to express their personal political views to a patient or a patient’s family, the physician must be sensitive to the imbalance of power in the patient-physician relationship, as well as to the patient’s vulnerability and desire for privacy.

To sustain the trust that is the foundation of the patient-physician relationship and to reassure patients that their welfare is the physician’s primary priority, physicians who participate in fundraising should: refrain from directly soliciting contributions from their own patients, Protect patient privacy and confidentiality and be sensitive to the likelihood that they may be perceived to be acting in their professional role when participating in fundraising activities.

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.

Respecting patient privacy is a fundamental expression of respect for patient autonomy and a prerequisite for trust. Patient privacy includes personal space (physical privacy), personal data (informational privacy), personal choices, including cultural and religious affiliations (decisional privacy), and personal relationships with family members and other intimates (associational privacy). Physicians must seek to protect patient privacy in all settings to the greatest extent possible.

When individuals who are not involved in providing care seek to observe patient-physician encounters, physicians should safeguard patient privacy by permitting such observers to be present only when the patient has explicitly agreed to the presence of the observer(s), the presence of the observer will not compromise care, and the observer has agreed to adhere to standards of medical privacy and confidentiality.