Written by Joanna Hughes

While chemistry, biology, anatomy and other medical school subjects are pretty straightforward, the fact is that there is a lot of ambiguity in clinical medicine -- particularly when you factor in the ethical dilemmas that often arise. And while it is not possible to be prepared for every potential quandary, familiarizing yourself with these five ethical issues can help you be ready for them if they do come up.

1. Speaking out against wrongdoings.

Imagine that you’re a first-year intern and you witness an esteemed surgeon make a mistake during a routine surgery without acknowledging it. What do you do? Due to the hierarchical nature of medicine and fear of reprisal, these kinds of issues frequently arise.

The good news? Medical schools and administrators are increasingly aware of the issue and are incorporating training aimed at facilitating safer speaking out.

2. Harassment.

When we think of ethical issues in medicine, things like organ donation, pain management, and physician-assisted suicide may come first to mind.  However, one dismayingly common issue does not even involve patients. We’re talking about harassment.

The #MeToo movement has shined the light on the issue of sexual harassment against women in medicine. Will you know what to do if you are harassed or if you witness the harassment of someone else? If not, you should. To that end, experts are calling for this training to be incorporated into medical school curricula.

Med school dean Karen Antman, MD, argues in a JAMA Viewpoint essay, “Medical schools must equip learners, faculty and staff to prevent or escape abuse, not only to protect themselves but also to intervene if they observe a colleague being targeted.”

3. Reporting impaired or unethical colleagues.

The AMA Code of Ethics makes it quite clear: physicians are obligated to report incompetent or unethical behaviors by their colleagues. Unfortunately, this can be easier said than done -- particularly if you’re dealing with a friend or authority figure.

In fact, just under 12 percent of respondents answered 'it depends,' when asked whether they would report an impaired or incompetent physician friend or colleague to a superior or the state medical board. One said, “I would like to think I would, but it has happened when I did and didn’t.”

4. Use of social media.

Social media is credited with revolutionizing medical care. However, for medical professionals it can be tricky territory.

A recent Pharmacy & Therapeutics article explains, “Many social media tools are available for health care professionals (HCPs), including social networking platforms, blogs, microblogs, wikis, media-sharing sites, and virtual reality and gaming environments. These tools can be used to improve or enhance professional networking and education, organizational promotion, patient care, patient education, and public health programs. However, they also present potential risks to patients and HCPs regarding the distribution of poor-quality information, damage to professional image, breaches of patient privacy, violation of personal–professional boundaries, and licensing or legal issues.”  

Because of this, many institutions and organizations, such as the UK’s General Medical Council, have set forth their own guidelines for social media use. Taking the time to thoroughly understand these rules can help protect you and your patients.

5. Accepting gifts from patients.

Many patients have profound gratitude for their doctors. And this is not wrong. In fact, one American College Of Physicians position paper asserts that “A small gift to a physician as a token of appreciation is not ethically problematic.”

At the same time, however, the implications of receiving the gift, as well as the motivations for bestowing it, must be considered.”

An American Family Physician article recommends considering the following when receiving gifts from patients: “What motivated the patient to give the gift? What does the gift mean to the patient? Is it a small token of warmth and appreciation or a presumed attempt to manipulate or influence care? Is it intended to minimize the inherent power differential between the patient and physician or perhaps an attempt to transform the professional relationship into a more personal or intimate one? Is this patient from a culture in which gift-giving is the only means to ensure quality health care? Physicians should remember that patient motivations can be conscious or unconscious.”

The American Medical Association, meanwhile, explains, “An interaction of complex factors means physicians should consider sensitively before accepting or declining a gift.”

You are far from alone if facing these ethical questions sounds overwhelming to you. The good news? You do not have to do it alone. Taking a class on medical ethics can help you develop a better understanding of these challenges in order to more effectively navigate them.

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Joanna worked in higher education administration for many years at a leading research institution before becoming a full-time freelance writer. She lives in the beautiful White Mountains region of New Hampshire with her family.
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