Having implied that a particular clinical decision had been made to “free up a hospital bed,” the attending physician walked away without further comments to the residents or talking with the patient.
There are few situations in which the standard of care is so clear-cut as to preclude physician judgment. Assessing the degree of need (not just the standard of care) when asking a patient to spend money requires judgment.
If a medical decision about high-value care involves a conflict between the principles of beneficence and justice, an explicit analysis of the individual case is necessary to ensure that the interests of both the patient and society are served.
AMA J Ethics. 2015;17(11):1022-1027. doi:
10.1001/journalofethics.2015.17.11.ecas1-1511.
Decision-making capacity can be preserved in patients with mental illness and should be formally assessed in the context of their values and past decisions.
AMA J Ethics. 2017;19(5):416-425. doi:
10.1001/journalofethics.2017.19.5.ecas1-1705.