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.

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.

Empathy seems to be on the side of the patient and family, but clinicians also need help in dealing with their feelings after they make a mistake.

What are the ethical obligations of health care providers? Since auditors look to the medical record to validate billing, providers are expected to document thoroughly and completely on every case.

The evidence is consistent: Clinicians believe that their colleagues' prescribing behaviors are impacted by interactions with drug representatives but that their own practices are not. Unfortunately, they are wrong.

The issue of gift giving by patients requires more study, and medical communities would benefit from a sustained effort to examine the complex issues involved in accepting gifts from patients.

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.

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.

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.

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.

The impact of DTCA on patients' expectations and PAs' responsibility to provide bioethical treatment are reviewed.

Patient autonomy does not always transcend to health care workers. The author makes a case for patient safety to be an overruling factor.

A complex patient case illustrates a range of societal and clinical biases and the impact these biases can have on patient care.

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

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?

The team at the clinic faced a dilemma. Should they remove the DBS because it was contributing to the difficulties with nursing home placement? Or should they refuse to remove the DBS because it eased Mrs. D.'s symptoms, even though this would increase the burden of care on her family?

Guadalupe Benitez had been with her same-sex partner for many years. They wanted to start a family, but Ms. Benitez had fertility problems due to polycystic ovarian syndrome. Her primary care physician referred her to an infertility clinic, which had the exclusive contract to provide infertility services for members of her insurance plan.

The PA asks, "May I place the IV and be present at Mr. Y's execution? Is it unethical to do this?

Mr. James is a 98-year-old single gentleman living with his 92-year-old brother in a one-bedroom apartment. Should Mr. James be placed in a nursing home against his will, and if so, how?

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.

Severe acute respiratory syndrome (SARS), sarin gas, anthrax, hurricane Katrina, the September 11th World Trade Center attack—all of these affect not only the general population but also those who have chosen to be health care providers.

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.

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?

Ms. X, a G2P1 23-year-old pregnant Navajo woman, came with her mother to an Indian Health Service clinic on the Navajo reservation. Her complaint was a bloody discharge for 1 week, and Ms. X and her mother were very concerned. The patient had been receiving regular prenatal care but had missed her last appointment.

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.

In previous columns we focused on the issues of medical indications and contextual features. In this case, we will explore patient preference.