If a breakdown of trust occurs between physician and patient, it may be necessary to involve a third party, such as another physician. Kaldjian said most hospitals also have an ethics committee or a staff ethicist who can assist. In addition, social workers and chaplains can understand the issues at stake and be very helpful.

"Doctors sometimes need to learn to accept decisions they don't agree with. However, there are some situations in which to go along with a decision would compromise their deepest selves," Kaldjian said.

In their approach to ethical reasoning, the authors emphasize the doctor's own ethical integrity by referring to "conscientious practice," meaning that doctors and other health care providers need to be able to practice medicine in a way that does not contradict their deepest personal and professional values.

As an example, a physician at a hospital that will not provide treatment for a patient without insurance might decide that in order to maintain his or her integrity he or she needs to serve as the patient's advocate and find some way to provide care.

"It is a challenging task for a doctor to sustain a professional life that is consistent with his or her deepest beliefs," Kaldjian said.

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Contact: Becky Soglin
becky-soglin@uiowa.edu
319-335-6660
University of Iowa
10-Feb-2005