Table 1

Exceptions to the traditional view of physician obligations

Patient valuesRespect beliefsAdminister saline not blood to a Jehovah's Witness
Respect autonomyAllow patient to refuse potentially beneficial treatment
Loved onesDonationRemove healthy kidney for donation to sibling
Parental interestsChoose treatment based on parents' schedule
Other patientsDuties of rescueLeave patient bedside to respond to code
ScheduleDivide time and attention between patients
StaffingCover patients of sick colleague
RelationshipsAllow second-best treatment ordered by colleague
TriagePostpone care of less acute cases in emergency room
Acts vs practicesAvoid prescribing treatments that can be abused
Societal interestsProtecting othersWithhold antibiotic to avoid resistance in community
Reducing costsPrescribe less expensive and less effective drug
VaccinationGive vaccine for herd immunity
ReportingReport infectious diseases to public health officials
QuarantineIsolate patients with multi-drug resistant tuberculosis
Physician trainingInstruct intern to make incision for the first time
Research resultsWithhold interim findings from the public
AutopsyPerform autopsy for public safety reasons
Physician interestsPhysicians' livesIntensive care unit physicians taking vacation; retirement
Professional integrityWrite do not resuscitate when very low chance of successful cardiopulmonary resuscitation
Personal integrityDo not steal for patient; do not lie to third-party payers
Citizen obligationsVolunteer for public duty during time of war
Professional interestsDecline to refer patient to experienced colleague
LiabilityChose treatments to avoid legal culpability
OtherLegal medicineWithhold information in legal cases
Military medicinePrepare soldiers for battle
Sports medicineBandage ankle so athlete can participate in game