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Are physicians obligated always to act in the patient's best interests?
  1. David Wendler
  1. Correspondence to David Wendler, Department of Bioethics, NIH Clinical Center, Building 10, Room 1C118, Bethesda, MD, USA 20892-1156; dwendler{at}


The principle that physicians should always act in the best interests of the present patient is widely endorsed. At the same time, and often within the same document, it is recognised that there are appropriate exceptions to this principle. Unfortunately, little, if any, guidance is provided regarding which exceptions are appropriate and how they should be handled. These circumstances might be tenable if the appropriate exceptions were rare. Yet, evaluation of the literature reveals that there are numerous exceptions, several of which pervade clinical medicine. This situation leaves physicians without adequate guidance on when to allow exceptions and how to address them, increasing the chances for unfairness in practice. The present article considers the range of exceptions, illustrates how the lack of guidance poses ethical concern and describes an alternative account of physician obligations to address this concern.

  • Obligations
  • Fairness
  • Best Interests
  • Risks
  • philosophy
  • education for healthcare professionals

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  • Funding This work was funded by the NIH Clinical Center, USA.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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