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Medical Ethics

Should PAs assess and address the impact of implicit bias on patient care?

Jim Anderson, PA-C, ATC April 24, 2012

Implicit bias is so subtle that colleagues may not recognize it in themselves. Among the signs to watch for are loss of patient autonomy and lack of fairness in treatment.

Surrogate decision makers: What if a  surrogate cannot decide?

Jim Anderson, PA-C, ATC February 29, 2012

When a surrogate feels ill-equipped to make medical decisions, the first step for clinicians is to be aware of the laws that govern surrogacy.

"Love the  way you lie"*

Alexandra Godfrey, MS, PA-C May 17, 2011

Is it acceptable to sacrifice the best interests of one patient to the confidentiality rights of another? Is it ethical for a clinician not to tell the truth?

HIV exceptionalism and ethical  concerns surrounding HIV testing

Kevin Michael O'Hara, MMSc, PA-C, AAHIVS April 28, 2011

As medical and public health professionals, PAs are sworn to do no harm, but the varied ways to obtain consent for HIV testing challenge this oath.

When your mother wants a script: The ethics of treating family members

Helene Hill, MPAS, RPA-C, Matthew Hill, MDiv February 24, 2011

Ethical principles say that health care providers should not treat family members, but many do so anyway. Careful reflection can help to produce a good outcome.

Is it ethical to substitute restraints for  adequate treatment resources?

Alexandra Godfrey, MS, PA-C, Reamer Bushardt, PharmD, PA-C December 08, 2010

Given that the potential for abuse is considerable, the authors suggest that a policy of minimally restraining patients, increased training, and optimizing restraint alternatives is vital to prevent unethical practice.

Is it ethical to provide enteral tube feedings for patients with dementia?

Zachary Hartsell, MPAS, PA-C, Jennifer S. Williams, MMS, PA-C October 01, 2010

Research does not offer any clear support for or against this practice, making this a difficult decision for both the patient's family and the clinician.

Does the right to bear children guarantee access to treatment for infertility?

Torry Grantham Cobb, MPH, MHS, PA-C June 21, 2010

The law protects the right of all patients to procreate, but clinicians should consider the welfare of the child born as a result.

Why physician assistants should consider joining the hospital ethics committee

Jim Anderson, PA-C, ATC February 18, 2010

Service on an ethics committee allows PAs to learn how to apply bioethical principles, and it allows their colleagues to learn more about PAs.

The ethics of using placebos for diagnosis and treatment in clinical practice

F. J. Gianola, PA, DFAAPA December 21, 2009

The case of a man with lifelong allergies suggests that a placebo, used honestly and openly, may be a useful therapeutic tool.

Extremes of opinion about this PA's 'Day'

July 09, 2009

A Day in the Life: Michelle M. Howe, MPAS, PA-C

Terminating your professional relationship with a patient

F. J. Gianola, PA, DFAAPA April 02, 2009

In a previous installment of this column, we discussed the duty to treat in times of health and safety disasters. Does the same duty to treat exist when personal threat, abuse, and possible injury are being committed by a member of your patient's family?

Potions, powders, and patients: An Rx for healing

Brian T. Maurer, PA-C August 01, 2008

Osler's words reverberated inside my head: "The practice of medicine is an art, not a trade: a calling, not a business, a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders...."

Confidentiality, trust, and sexually transmitted infections

F. J. Gianola, PA, DFAAPA December 01, 2007

You test a patient for sexually transmitted infections (STIs) at her request. She tests positive for Chlamydia trachomatis infection. You give her medication for the infection, and you counsel her to refrain from having sex with anyone—especially with anyone with whom she has had sex in the past 60 days, until those persons are treated. You ask her to encourage her recent sex partners to be tested and, if necessary, treated. You also provide patient education about chlamydia. You suggest strongly that the patient return for a routine retest and examination in 6 months, explaining carefully that any of her partners who are not effectively treated for chlamydia may reinfect her.

Improving care of the dying: What do the experts say?

James F. Cawley, MPH, PA-C, Joan Malespina, PA-C, MS November 01, 2007

This article reviews nine key points that experts at an NIH conference said characterize the challenges associated with improving end-of-life care.

Say "No" to unnecessary antibiotics

Michael Guerra, PA-C, MS October 01, 2007

Estimates are that more than 100 million prescriptions for antibiotics are written annually in the United States. Many of these prescriptions are given to patients with acute, uncomplicated bronchitis, sinusitis, pharyngitis, and other nonspecific upper respiratory infections (URIs). These conditions are largely self-limited in nature. The media has rightfully acknowledged public health concerns in regard to the increase in bacterial drug resistance perpetuated by frequent, often unnecessary, antibiotic administration. So, why do clinicians give in to their patients' requests for antibiotics? There

Apologizing for adverse outcomes

GARC September 01, 2007

The Institute of Medicine has have focused public attention on a serious problem in this country— the prevalence of medical errors as a leading cause of death.

On the OxyContin scandal: Don't abandon patients in pain

Sarah Zarbock, PA-C July 01, 2007

Purdue Pharma recently announced a resolution to a 4-year investigation involving the promotion of OxyContin tablets.

Is "reparative" therapy in the best interest of the patient?

F. J. Gianola, PA, DFAAPA June 01, 2007

The physician (who is the PA's supervising physician) shares his concerns with the PA about the patient's homosexuality, which he says is an "unhealthy" lifestyle.

Who is responsible for the patient's adherence to treatment?

F. J. Gianola, PA, DFAAPA April 01, 2007

Is it the PA's ethical responsibility to determine the reasons for Mr. S.'s lack of adherence? When can a patient be asked to leave the practice because of nonadherence?

Perfected and strengthened through trials and suffering

Dave Martin, MPAS, PA-C January 01, 2007

It began just like any other day in my small community, and it ended with my gaining strength from God as I assumed my role as a provider of medical care.

DNA, race, and a new era in medicine

Monica Payton, BS, PA-C September 01, 2006

The Human Genome Project, a 13-year international research effort, ended in 2003 with the complete mapping of the human genetic sequence. The US Department of Energy and the National Institutes of Health sponsored this project, which may be described as a "gateway" through which an architectural paradigm of the biology of human essence is provided.

"Can I have that drug I saw on TV?"

Mark A. Graber, MD July 01, 2006

Justice, cost-effectiveness, and the ethics of prescribing

In defense of full disclosure

Steve Wilson, PA-C, DFAAPA, FAPACVS June 01, 2006

I was struck by an article in The Wall Street Journal announcing that the Journal of Thoracic and Cardiovascular Surgery had prohibited some authors from publishing in it because they did not fully disclose their affiliations with the companies that produced the products they discussed in their submitted and accepted manuscripts.

The case of Ms. C.

F. J. Gianola, PA, DFAAPA April 01, 2006

The core issue of this case is the use of opioids in the treatment of chronic nonmalignant pain. Complicating the case is the patient's history of addiction. Of the ethics papers that I review for PA students and the ethics questions I receive from PA colleagues, approximately one third involve pain control and the use of opioids. The questions commonly involve patients with a current or past history of addiction.

It’s 8 AM. Do you know who your gay and lesbian patients are?

Kay Christian, MS, PC-C October 01, 2005

While applying for PA school, I shadowed a PA at a busy pediatric clinic. During a wellness visit, the PA asked a 16-year-old male if he had a girlfriend. The young man shifted his gaze downward and bashfully answered "no." The PA had assumed that this patient was heterosexual when to me he appeared to be gay. This assumption, however benign it may seem on the exterior, probably sent a subtle yet powerful message to this young man: It's not okay to be gay; you aren't like the rest of us.