Doctors Describe Their Toughest Ethical Dilemmas

Shelly Reese

Disclosures

February 23, 2017

In This Article

First, Do No Harm

The world in which physicians practice is growing increasingly complex. Every day, doctors confront ethical challenges while contending with external players (patients, families, administrators, payers) and internal forces (biases, cultural norms, religious beliefs) that cast confusing shadows on their seemingly straightforward goal to do no harm.

As part of Medscape's Physician Ethics Survey 2016, we asked doctors to describe the most difficult ethical challenges they face. Although their stories are varied and unique, many doctors describe wrestling with the same handful of challenges: reporting impaired colleagues; caring for patients who don't try to help themselves or don't "deserve" treatment; prescribing "placebo-like treatments" to satisfy patients; undertreating pain; and physician-assisted dying.

Here's how they're grappling with these issues.

Reporting an Impaired Colleague

Even in situations where the choice seems clear—reporting an impaired colleague—physicians face inner turmoil. Although nearly all physicians say they would (78%) or might (18%) report an impaired colleague, the decision is fraught.

Reporting a colleague enables the impaired physician to get the help he or she needs and it protects patients, but doctors know it can also cripple a coworker's career, destroy a friendship, and result in professional backlash.

Many doctors describe the cost of reporting:

  • "It jeopardized his benefits for his family, but he was harming patients."

  • "I have done so twice. Both physicians I reported lost their medical licenses."

  • "He has never forgiven me."

  • "I have, and I have paid for that too."

  • "I would confront them first, and I have done so. It is not fun."

  • "He did not get the treatment he needed, and he lost his license."

  • "Everybody crapped on me, and I was hated for doing it."

"Finding the right answer is easy; it's the actual doing that is hard," says Kenneth Goodman, PhD, director of the Institute for Bioethics and Health Policy at the University of Miami. "If you are of the view that your primary loyalty is to the patient, then the idea that friendship or your own self-interest could be a factor in your decision is really hard to defend. This takes moral courage."

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