Table 1

Exceptions to the traditional view of physician obligations

Category	Exception	Example
Patient values	Respect beliefs	Administer saline not blood to a Jehovah's Witness
Patient values	Respect autonomy	Allow patient to refuse potentially beneficial treatment

Loved ones	Donation	Remove healthy kidney for donation to sibling
Loved ones	Parental interests	Choose treatment based on parents' schedule

Other patients	Duties of rescue	Leave patient bedside to respond to code
	Schedule	Divide time and attention between patients
	Staffing	Cover patients of sick colleague
	Relationships	Allow second-best treatment ordered by colleague
	Triage	Postpone care of less acute cases in emergency room
	Acts vs practices	Avoid prescribing treatments that can be abused

Societal interests	Protecting others	Withhold antibiotic to avoid resistance in community
	Reducing costs	Prescribe less expensive and less effective drug
	Vaccination	Give vaccine for herd immunity
	Reporting	Report infectious diseases to public health officials
	Quarantine	Isolate patients with multi-drug resistant tuberculosis
	Physician training	Instruct intern to make incision for the first time
	Research results	Withhold interim findings from the public
	Autopsy	Perform autopsy for public safety reasons

Physician interests	Physicians' lives	Intensive care unit physicians taking vacation; retirement
	Professional integrity	Write do not resuscitate when very low chance of successful cardiopulmonary resuscitation
	Personal integrity	Do not steal for patient; do not lie to third-party payers
	Citizen obligations	Volunteer for public duty during time of war
	Professional interests	Decline to refer patient to experienced colleague
	Liability	Chose treatments to avoid legal culpability

Other	Legal medicine	Withhold information in legal cases
	Military medicine	Prepare soldiers for battle
	Sports medicine	Bandage ankle so athlete can participate in game