Appropriate scope of practice Conflicts of Interest Serving the best interest of patients Obligations to promote patient autonomy and privacy Obligations beyond patients to others in the society Ethics of research Informing on unethical or illegal behavior of colleagues

Vagueness as to duties and prohibitions Incompleteness as to duties Excessive concern with promotion and prestige of profession Vagueness in regard to self regulation and peer enforcement Excessive concern with financial and business interests

Considered gatekeeping functions where you look out for the interests of the profession and of others in a similar practice

Taking ill of

A result of our professional obligations and training, which lead to a strong sense of collegiality with others in our practice

Not only are we responsible for our actions in regard to the patient but we are also charged with the duty to ensure that the rest of the health team is practicing appropriate care.

Manner that stretches the truth. The practitioner is attempting to get around the system and is willing to lie in the process

Gaming is often done to get around the time consuming process of challenging the rules and applying for an exception to the rules for a particular patient.

Gaming is not even done for the practitioner’s benefit but is being done in behalf of a patient or at a patient’s request

To be truthful To keep promises To be fair

Lying ineitably undermines a person’s credibility If an individual clinician is found to be lying, this can have a harmful effect on the entire health care profession Gaming can harm other patients

Deception is problematic even if it is motivated by good intentions

Where a group of indivduals join together performing a business venture

Any commercal reationship between a practitioner and a company, in which the practitioner has a material interest that could form the basis for a conflict of interest, should be spelled out in a disclosure statement.

It seems clear that to self refer to an establishment in which you do not provide service but have an economic interest is at least suspect and perhaps unethical

A practitioner who changes his way of practice through any motive other than patient benefit

The relationship between practitioner and patient is always unequal.

Rests on the patient’s belief that the health care provider is dedicated to her welfare and that there are no other motives or considerations

Create emotional factors that interfere with the theraputic relationship and the needed objective judgement

When the practitioner feels that a potential for misunderstanding is possible or that there is the potential for mutual feelings of romantic interest.

Whatever time it takes until the emotions derived from the relationship cannot be misused or manipulated.

We remain within our scope of legitimate practice. One does not cross the line without willful intention.

Bureaucratic Model Physician Advocate Model

In which the emphasis is on the maintenance of social order at the expense of the individual patient’s welfare

In which the goal is to enhance the authority of the physician

Impaired colleagues places clients at risk

Absenteeism Illogical decision making Excessive Errors

The question that must be faced is not whether the practitioner has a duty to intervene, but rather the manner of the intervention.

The healthcare provider must be confronted and be made to seek effective assistance

The practitioner recieves effective help Those with the knowledge of the situation treat the impaired colleague humanely as we would any patient who needed our assistance

Offers guidelines regarding the decision as to whether the practitioner has a moral duty to treat or whether the decision is left as a moral option.

The patient is at significant risk of harm, loss, or damage if the practitioner does not assist The practitioner’s intervention or care is directly relevant to preventing harm The practitioner’s care will probably prevent harm, loss, or damage to the patient The benefit the patient will gain outweighs any harm the practitioner might incur and does not present more than a minimal risk to the healthcare provider

If the practitioner can answer yes to all four criteria, it would seem that a moral duty to treat would exist under the principle of beneficence If the circumstances place the practitioner in such a position that all criteria could not be answered with a yes, then the decision to treat would become a moral option rather than a duty

The obligation that each practitioner has in maintaining not only a high level of technical practice but also maintaining the common field in which all health specialists practice

An interdisciplinary body of healthcare providers, community represetatives, and non medical professionals who address ethical questions within the health care institution, escially on the care of patients.

Court Litigation

They are seen as a way to safeguard the patient’s interests by serving on a consultative basis to analyze ethical dilemmas; educate healthcare providers, patients, and families; and guide hospital policy

A multidisciplinary group that includes physicians, nurses, social workers, philosophers, laypersons, lawyers, administrators, and religious leaders

Often the philosophy of the committee reflects the nature of the institution

Doing it serves neither our profession nor our patients

To render service to humanity. Under no circumstances may the practitioner place his financial interest above the welfare of his patients.