Addicts quickly learn the diagnoses that cannot be definitively confirmed or ruled out by examinations or test results but that elicit prescriptions for opioid pain management.
Physicians working in close-knit communities, whether small towns or urban neighborhoods, have to manage relationships with people who may be simultaneously patients and neighbors, friends, and business associates.
When deciding whether to offer deep brain stimulation earlier than usual for Parkinson disease, it is important to consider not only the patient’s autonomy but also the validity of the evidence and concepts of harm that are being used to form practice policies.
Clinical equipoise—the idea that the community of medical experts is uncertain about the relative therapeutic merits of the arms of a clinical trial at its outset—mitigates physicians’ responsibility for patients’ poor outcomes when patients are assigned to the control arm or are harmed by an investigational agent.
AMA J Ethics. 2015;17(12):1108-1115. doi:
10.1001/journalofethics.2015.17.12.ecas1-1512.
Meera Balasubramaniam, MD, MPH and Yesne Alici, MD
A 15-year-old advance directive made when the patient was in much better health and not updated can bring more confusion than clarity to the decision-making process.