Conflicts of Interest: Concepts, Conundrums, and Course of Action

Ronald W. Pies, MD


November 11, 2013

In This Article

Conflict of Interest: Ethical Context

The term "conflict of interest" is bandied about quite loosely these days, often as a cudgel aimed at allegedly corrupt or unethical physicians. This is understandable, because COI is usually discussed in the context of a physician's failure to disclose a COI. Thus, the congressional hearings conducted by Sen Charles Grassley (R, Iowa) called attention to a group of academic psychiatrists who allegedly failed to disclose income from pharmaceutical companies.[1]

From the standpoint of medical ethics, however, the pejorative connotation attached to the term "conflict of interest" is not entirely or necessarily warranted. As many medical ethicists understand COI, it is neither an action nor an ethical lapse; rather, it is a situation or set of conditions in which ethical decisions are incumbent upon the physician, and which may or may not eventuate in unethical or unprofessional behavior. The mere existence of a COI does not necessarily signify a breach of medical ethics.

Whereas ethicists, journals, and medical organizations define COI in various ways, the following general definition of COI is a reasonable starting point. According to Columbia University, a COI entails "...a situation in which financial or other personal considerations have the potential to compromise or bias professional judgment and objectivity."[2]

Note that this definition does not require actual biased actions or decisions, on the part of the "conflicted" person; rather, the Columbia definition stipulates that "...a conflict of interest exists whether or not decisions are affected by a personal interest; a conflict of interest implies only the potential for bias, not a likelihood."[2]

Although the notion of COI often carries the connotation of self-interest, greed, or a desire for monetary gain, COI per se does not entail a "bad character" or "bad faith" on the part of the conflicted individual. As ethicist James DuBois[3] has pointed out, a conflict of interest "does not imply that a professional intends to put his or her personal interests first; it does not in itself imply any wrong-doing."


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