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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Physician. Show all posts
Showing posts with label Physician. Show all posts

Monday, June 13, 2022

San Diego doctor who smuggled hydroxychloroquine into US, sold medication as a COVID-19 cure sentenced

Hope Sloop
KSWB-TV San Diego
Originally posted 29 MAY 22

A San Diego doctor was sentenced Friday to 30 days of custody and one year of house arrest for attempting to smuggle hydroxychloroquine into the U.S. and sell COVID-19 "treatment kits" at the beginning of the pandemic.  

According to officials with the U.S. Department of Justice, Jennings Ryan Staley attempted to sell what he described as a "medical cure" for the coronavirus, which was really hydroxychloroquine powder that the physician had imported in from China by mislabeling the shipping container as "yam extract." Staley had attempted to replicate this process with another seller at one point, as well, but the importer told the San Diego doctor that they "must do it legally." 

Following the arrival of his shipment of the hydroxychloroquine powder, Staley solicited investors to help fund his operation to sell the filled capsules as a "medical cure" for COVID-19. The SoCal doctor told potential investors that he could triple their money within 90 days.  

Staley also told investigators via his plea agreement that he had written false prescriptions for hydroxychloroquine, using his associate's name and personal details without the employee's consent or knowledge.  

During an undercover operation, an agent purchased six of Staley's "treatment kits" for $4,000 and, during a recorded phone call, the doctor bragged about the efficacy of the kits and said, "I got the last tank of . . . hydroxychloroquine, smuggled out of China."  

Wednesday, March 11, 2020

Expertise in Child Abuse?

Dr. Woods, from a YouTube video
Mike Hixenbaugh & Taylor Mirfendereski
NBCnews.com
Originally posted 14 Feb 20

Here is an excerpt:

Contrary to Woods’ testimony, there are more than 375 child abuse pediatricians certified by the American Board of Pediatrics in the U.S., all of whom have either completed an extensive fellowship program — first offered, not three, but nearly 15 years ago, while Woods was still in medical school — or spent years examining cases of suspected abuse prior to the creation of the medical subspecialty in 2009. The doctors are trained to differentiate accidental from inflicted injuries, which child abuse pediatricians say makes them better qualified than other doctors to determine whether a child has been abused. At least three physicians have met those qualifications and are practicing as board-certified child abuse pediatricians in the state of Washington.

Woods is not one of them.

Despite her lack of fellowship training, state child welfare and law enforcement officials in Washington have granted Woods remarkable influence over their decisions about whether to remove children from parents or pursue criminal charges, NBC News and KING 5 found. In four cases reviewed by reporters, child welfare workers took children from parents based on Woods’ reports — including some in which Woods misstated key facts, according to a review of records — despite contradictory opinions from other medical experts who said they saw no evidence of abuse.

In one instance, a pediatrician, Dr. Niran Al-Agba, insisted that a 2-year-old child’s bruise matched her parents’ description of an accidental fall onto a heating grate in their home. But Child Protective Services workers, who’d gotten a call from the child’s day care after someone noticed the bruise, asked Woods to look at photos of the injury.

Woods reported that the mark was most likely the result of abuse, even though she’d never seen the child in person or talked to the parents. The agency sided with her. To justify that decision, the Child Protective Services worker described Woods as “a physician with extensive training and experience in regard to child abuse and neglect,” according to a written report reviewed by reporters.

The info is here.

Tuesday, November 19, 2019

Medical board declines to act against fertility doctor who inseminated woman with his own sperm

Image result for dr. mcmorries texas
Dr. McMorries
Marie Saavedra and Mark Smith
wfaa.com
Originally posted Oct 28, 2019

The Texas Medical Board has declined to act against a fertility doctor who inseminated a woman with his own sperm rather than from a donor the mother selected.

Though Texas lawmakers have now made such an act illegal, the Texas Medical Board found the actions did not “fall below the acceptable standard of care,” and declined further review, according to a response to a complaint obtained by WFAA.

In a follow-up email, a spokesperson told WFAA the board was hamstrung because it can't review complaints for instances that happened seven years or more past the medical treatment. 

The complaint was filed on behalf of 32-year-old Eve Wiley, of Dallas, who only recently learned her biological father wasn't the sperm donor selected by her mother. Instead, Wiley discovered her biological father was her mother’s fertility doctor in Nacogdoches.

Now 65, Wiley's mother, Margo Williams, had sought help from Dr. Kim McMorries because her husband was infertile.

The info is here.

Wednesday, March 6, 2019

A Pedophile Doctor Drew Suspicions for 21 Years. No One Stopped Him.

Christopher Weaver, Dan Frosch and Gabe Johnson
The Wall Street Journal
Originally posted February 8, 2019

Here is an excerpt:

An investigation by The Wall Street Journal and the PBS series Frontline found the IHS repeatedly missed or ignored warning signs, tried to silence whistleblowers and allowed Mr. Weber to continue treating children despite the suspicions of colleagues up and down the chain of command.

The investigation also found that the agency tolerated a number of problem doctors because it was desperate for medical staff, and that managers there believed they might face retaliation if they followed up on suspicions of abuse. The federal agency has long been criticized for providing inadequate care to Native Americans.

After a tribal prosecutor outside of the IHS finally investigated his crimes, Mr. Weber was indicted in 2017 and 2018 for sexually assaulting six patients in Montana and South Dakota. Court documents and interviews with former patients show that Mr. Weber plied teen boys with money, alcohol and sometimes opioids, and coerced them into oral and anal sex with him in hospital exam rooms and at his government housing unit.

“IHS, the local here, they want to just forget it happened,” said Pauletta Red Willow, a social-services worker on the Pine Ridge reservation. “You can’t ever forget how someone did our children wrong and affected us for generations to come.”

The info is here.

Wednesday, December 12, 2018

Why Are Doctors Killing Themselves?

The Practical Professional in Healthcare
October/November 2018

Here is an excerpt:

The nation loses 300 to 400 physicians each year, the equivalent of two large medical school classes, and more than a million patients lose their doctor.  According to a new research study encompassing data from the past ten years, physicians are committing suicide at a rate that’s more than twice as high as the average population—higher even than for veterans.

With a critical shortage of physicians looming and advocates like Pamela Wible calling attention to the problem, the increasingly urgent question remains: Why are doctors killing themselves? And what can be done to help?  In response, researchers are ramping up their efforts to understand the causes of
physician suicide; leading hospitals, medical schools and professional organizations are pioneering new programs and interventions; and regulators are reconsidering how they might revise the licensing/renewal process to support their efforts.

The info is here.

There are several other articles on physician self-care, which applies to other helping professions.

Sunday, November 18, 2018

Bornstein claims Trump dictated the glowing health letter

Alex Marquardt and Lawrence Crook
CNN.com
Originally posted May 2, 2018

When Dr. Harold Bornstein described in hyperbolic prose then-candidate Donald Trump's health in 2015, the language he used was eerily similar to the style preferred by his patient.

It turns out the patient himself wrote it, according to Bornstein.

"He dictated that whole letter. I didn't write that letter," Bornstein told CNN on Tuesday. "I just made it up as I went along."

The admission is an about face from his answer more than two years when the letter was released and answers one of the lingering questions about the last presidential election. The letter thrust the eccentric Bornstein, with his shoulder-length hair and round eyeglasses, into public view.

"His physical strength and stamina are extraordinary," he crowed in the letter, which was released by Trump's campaign in December 2015. "If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency."

The missive didn't offer much medical evidence for those claims beyond citing a blood pressure of 110/65, described by Bornstein as "astonishingly excellent." It claimed Trump had lost 15 pounds over the preceding year. And it described his cardiovascular health as "excellent."

The info is here.

Friday, July 27, 2018

Informed Consent and the Role of the Treating Physician

Holly Fernandez Lynch, Steven Joffe, and Eric A. Feldman
Originally posted June 21, 2018
N Engl J Med 2018; 378:2433-2438
DOI: 10.1056/NEJMhle1800071

Here are a few excerpts:

In 2017, the Pennsylvania Supreme Court ruled that informed consent must be obtained directly by the treating physician. The authors discuss the potential implications of this ruling and argue that a team-based approach to consent is better for patients and physicians.

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Implications in Pennsylvania and Beyond

Shinal has already had a profound effect in Pennsylvania, where it represents a substantial departure from typical consent practice.  More than half the physicians who responded to a recent survey conducted by the Pennsylvania Medical Society (PAMED) reported a change in the informed-consent process in their work setting; of that group, the vast majority expressed discontent with the effect of the new approach on patient flow and the way patients are served.  Medical centers throughout the state have changed their consent policies, precluding nonphysicians from obtaining patient consent to the procedures specified in the MCARE Act and sometimes restricting the involvement of physician trainees.  Some Pennsylvania institutions have also applied the Shinal holding to research, in light of the reference in the MCARE Act to experimental products and uses, despite the clear policy of the Food and Drug Administration (FDA) allowing investigators to involve other staff in the consent process.

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Selected State Informed-Consent Laws.

Although the Shinal decision is not binding outside of Pennsylvania, cases bearing on critical ethical dimensions of consent have a history of influence beyond their own jurisdictions.

The information is here.

Wednesday, June 13, 2018

The Burnout Crisis in American Medicine

Rena Xu
The Atlantic
Originally published May 11, 2018

Here is an excerpt:

In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, and refer their patients to other providers, increasing the overall complexity (and with it, the cost) of care. They’re also at high risk of attrition: A survey of nearly 7,000 U.S. physicians, published last year in the Mayo Clinic Proceedings, reported that one in 50 planned to leave medicine altogether in the next two years, while one in five planned to reduce clinical hours over the next year. Physicians who self-identified as burned out were more likely to follow through on their plans to quit.

What makes the burnout crisis especially serious is that it is hitting us right as the gap between the supply and demand for health care is widening: A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.

The article is here.

Thursday, February 8, 2018

What I’ve learned from my tally of 757 doctor suicides

Pamela Wible
The Washington Post
Originally published January 13, 2018

Here are two excerpts:

Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.

Many doctors have lost a colleague to suicide. Some have lost up to eight during their career — with no opportunity to grieve.

We lose way more men than women. For every female physician on my suicide registry, there are seven men. Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India, doctors have been found hanging from ceiling fans.

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Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate ­self-punishment. In several cases, the death of a patient seemed to be the key factor in pushing them over the edge.

Malpractice suits can be devastating. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court, on TV and in newspapers (that live online forever). Many continue to suffer the agony of harming someone else — unintentionally — for the rest of our lives.

Academic distress kills medical students’ dreams. Failing medical-board exams and not getting a post-medical-school assignment in a specialty of choice has led to suicides. Doctors can be shattered if they fail to gain a residency: Before his suicide, Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out a system that he said ruined his career.

The information is here.

Friday, February 2, 2018

Confidential deals can obscure sexual misconduct allegations against doctors

Jayne O'Donnell
USA TODAY
Originally published January 5, 2018

Here are two excerpts:

Hospitals will often take over doctors' liability in confidential settlements, which Washington plaintiffs' attorney Patrick Malone calls a "frequent dodge" to keep medical negligence claims out of the National Practitioners Data Bank. Before they hire doctors, hospitals check the data bank, which also includes disciplinary actions by hospitals, medical societies and boards, which also have access to it.

Duncan's case, however, was a "miscellaneous tort claim," filed after Ohio's one-year statute of limitations for medical malpractice claims had passed.

That's just one of the many laws working in the favor of the Cleveland Clinic and the health care industry in Ohio. Plaintiff lawyer Michael Shroge, a former Cleveland Clinic associate general counsel, says major health care systems are "very often more interested in protecting their brand than protecting the health of patients."

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Critics of settlement deals' gag clauses say they compromise patients' health and safety and are unethical.

Confidential settlements are particularly problematic when it comes to health care, as "we take off our clothes in front of doctors," said Malone, who specializes in medical malpractice cases. "For a doctor to violate that in a sexual way is the ultimate wrong," he said, adding that he only agrees to confidential settlements if his client insists and only of the settlement amount.

The information is here.

Sunday, September 17, 2017

Genitals photographed, shared by UPMC hospital employees: a common violation in health care industry

David Wenner
The Patriot News/PennLive.com
Updated September 16, 2017

You might assume anyone in healthcare would know better. Smart phones aren't new. Health care providers have long wrestled with the patient privacy- and medical ethics-related ramifications. Yet once again, smart phones have contributed to a very public black eye for a health care provider.

UPMC Bedford in Everett, Pa. has been cited by the Pennsylvania Department of Health after employees snapped and shared photos and video of an unconscious patient who needed surgery to remove an object from a genital. Numerous employees, including two doctors, were disciplined for being present.

It's not the first time unauthorized photos were taken of a hospital patient and shared or posted on social media.

  • Last year, a nurse in New York lost her license after taking a smart phone photo of an unconscious patient's penis and sending it to some of her co-workers. She also pleaded guilty to misdemeanor criminal charges.
  • The Los Angeles Times in 2013 wrote about an anesthesiologist in California who put a sticker of a mustache on the face of an unconscious female patient, with a nurse's aid then taking a picture. That article also reported allegations of a medical device salesman taking photos of a naked woman without her knowledge.
  • In 2010, employees at a hospital in Florida were disciplined after taking and posting online photos of a shark attack victim who didn't survive. No one was fired, with the hospital concluding the incident was the "result of poor judgement rather than malicious intent," according to an article in Radiology Today. 
  • Many such incidents have involved nursing homes. An article published by the American Association of Nurse Assessment Coordination in 2016 stated, "In the shadow of the social media revolution, a disturbing trend has begun to emerge of [nursing home] employees posting and sharing degrading images of their residents on social media." An investigation published by ProPublica in 2015 detailed 47 cases since 2012 of workers at nursing homes and assisted living facilities sharing photos or videos of residents on Facebook. 

Sunday, June 4, 2017

Physicians, Firearms, and Free Speech

Wendy E. Parmet, Jason A. Smith, and Matthew Miller
N Engl J Med 2017; 376:1901-1903
May 18, 2017

Here is an excerpt:

The majority’s well-reasoned decision, in fact, does just that. By relying on heightened rather than strict scrutiny, the majority affirmed that laws regulating physician speech must be designed to enhance rather than harm patient safety. The majority took this mandate seriously and required the state to show some meaningful evidence that the regulation was apt to serve the state’s interest in protecting patients.

The state could not do so for two reasons. First, the decision to keep a gun in the home substantially increases the risk of death for all household members, especially the risk of death by suicide, and particularly so when guns are stored loaded and unlocked, as they are in millions of homes where children live.  Second, the majority of U.S. adults who live in homes with guns are unaware of the heightened risk posed by bringing guns into a home.  Indeed, by providing accurate information about the risks created by easy access to firearms, as well as ways to modify that risk (e.g., by storing guns unloaded and locked up, separate from ammunition), a physician’s counseling can not only enhance a patient’s capacity for self-determination, but also save lives.

Given the right to provide such counsel, professional norms recognize the responsibility to do so. Fulfilling this obligation, however, may not be easy, since the chief impediments to doing so — and to doing so effectively — are not and never have been legal barriers. Indeed, the court’s welcome ruling does not ensure that most clinicians will honor this hard-won victory by exercising their First Amendment rights.

The article is here.

Monday, May 22, 2017

Half of US physicians receive industry payments

Michael McCarthy
BMJ 2017; 357

Nearly half of US physicians receive payments from the drug, medical device, and related medical industries, and surgeons and male physicians are more likely to do so, a US study has found.

The study leader, Jona A Hattangadi-Gluth, of the University of California, San Diego, based in La Jolla, said that most payments were relatively small but that many specialists receive more than $10 000 (£7750; $9160) a year from industry, including 11% of orthopedic surgeons, 12% of neurologists, and 13% of neurosurgeons.

She said, “The data suggest that these payments are much more pervasive than we thought and [that] there is much more money going directly to physicians than maybe people recognized.”

The researchers analyzed data from 2015 collected from Open Payments, a program created by the 2010 Affordable Care Act that requires biomedical manufacturers and group purchasing organizations to report all general payments, ownership interests, and research payments paid to allopathic and osteopathic physicians in the US.

The article is here.

Friday, May 19, 2017

Conflict of Interest: Why Does It Matter?

Harvey V. Fineberg
JAMA. 2017;317(17):1717-1718.

Preservation of trust is the essential purpose of policies about conflict of interest. Physicians have many important roles including caring for individual patients, protecting the public’s health, engaging in research, reporting scientific and clinical discoveries, crafting professional guidelines, and advising policy makers and regulatory bodies. Success in all these functions depends on others—laypersons, professional peers, and policy leaders—believing and acting on the word of physicians. Therefore, the confidence of others in physician judgment is of paramount importance. When trust in physician judgment is impaired, the role of physicians is diminished.

Physicians should make informed, disinterested judgments. To be disinterested means being free of personal advantage. The type of advantage that is typically of concern in most situations involving physicians is financial. When referring to conflict of interest, the term generally means a financial interest that relates to the issue at hand. More specifically, a conflict of interest can be discerned by using a reasonable person standard; ie, a conflict of interest exists when a reasonable person would interpret the financial circumstances pertaining to a situation as potentially sufficient to influence the judgment of the physician in question.

The article is here.

Thursday, March 30, 2017

Risk considerations for suicidal physicians

Doug Brunk
Clinical Psychiatry News
Publish date: February 27, 2017

Here are two excerpts:

According to the American Foundation for Suicide Prevention, 300-400 physicians take their own lives every year, the equivalent of two to three medical school classes. “That’s a doctor a day we lose to suicide,” said Dr. Myers, a professor of clinical psychiatry at State University of New York, Brooklyn, who specializes in physician health. Compared with the general population, the suicide rate ratio is 2.27 among female physicians and 1.41 among male physicians (Am J Psychiatry. 2004;161[12]:2295-2302), and an estimated 85%-90% of those who carry out a suicide have a psychiatric illness such as major depressive disorder, bipolar disorder, alcohol use and substance use disorder, and borderline personality disorder. Other triggers common to physicians, Dr. Myers said, include other kinds of personality disorders, burnout, untreated anxiety disorders, substance/medication-induced depressive disorder (especially in clinicians who have been self-medicating), and posttraumatic stress disorder.

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Inadequate treatment can occur for physician patients because of transference and countertransference dynamics “that muddle the treatment dyad,” Dr. Myers added. “We must be mindful of the many issues that are going on when we treat our own.”

Monday, February 27, 2017

King Introduces End-of-Life Counseling Bill

Jan 11, 2017
Press Release

Congressman Steve King released the following statement after re-introducing the End-of-Life Counseling Bill:

“A year ago this month, the government increased control over one of the most highly personal healthcare decisions an individual can make when the Centers for Medicare and Medicaid Services (CMS) began paying doctors to counsel patients about end-of-life care,” said King. “Allowing the federal government to marry its need to save dollars with the promotion of end-of-life counseling is not in the interest of millions of Americans who were promised life-sustaining care in their older years in exchange for their compelled funding of the program during their working years.

Furthermore, this exact provision was removed from the final draft of Obamacare in 2009 as a direct result of public outcry. The worldview behind the policy has not changed since then and government control over this intimate choice is still intolerable to those who respect the dignity of human life. My legislation prohibits Medicare payments for end-of-life counseling, blocking this harmful regulation before our government imposes yet another life-devaluing policy on the American people. ”

The bill is here.

"Just because you do not take an interest in politics doesn't mean politics won't take an interest in you." -Pericles

Friday, February 17, 2017

There is something rotten inside the medical profession

Anonymous
kevinmd.com
Originally published January 26, 2017

In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.

Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients — which is often sadly a given, but for the doctors training inside it. Every generation always looks down on the generation training after it — no one ever had it as hard as them, and thus deserve to suffer just as much, if not more. This dubious school of thought has long been acknowledged as standard practice. To be a good doctor, you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing, and if you admit to struggling, the unspoken opinion (or often spoken) is that you simply couldn’t hack it.

In the cutthroat, often brutalizing culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent — death by their own hand.

The blog post is here.

Friday, December 16, 2016

How a doctor convicted in drugs-for-sex case returned to practice

Danny Robbins
Atlantic Journal Constitution
Part of a series on Physical and Sexual Abuse

Here is an excerpt:

“The pimp with a prescription pad” is what one prosecutor called him during a trial in which it was revealed that more than 400 sexually explicit photos of female patients and other women had been discovered in his office.

In some states, where legislatures have enacted laws prohibiting doctors who commit certain crimes from practicing, Dekle’s career would be over. But in Georgia, where the law gives the medical board the discretion to license anyone it sees fit, he was back in practice two years after leaving prison.

More than a dozen years later, that decision still leads some to wonder what the board was thinking.

“It’s particularly damning that he was using his ability to write prescriptions to further his sexual activities,” said Chris Dorsey, the Georgia Bureau of Investigation agent who led the probe that sent Dekle to prison. “A doctor burglarizes a house and then pays his debt to society, could he be a good doctor? I could argue it both ways. But when you have someone who abused everything centering on a medical practice to victimize all these people, that’s really a separate issue.”

The article is here.

Monday, December 12, 2016

Preventing Conflicts of Interest of NFL Team Physicians

Mark A. Rothstein
The Hastings Center Report
Originally posted November 21, 2016

Abstract

At least since the time of Hippocrates, the physician-patient relationship has been the paradigmatic ethical arrangement for the provision of medical care. Yet, a physician-patient relationship does not exist in every professional interaction involving physicians and individuals they examine or treat. There are several “third-party” relationships, mostly arising where the individual is not a patient and is merely being examined rather than treated, the individual does not select or pay the physician, and the physician's services are provided for the benefit of another party. Physicians who treat NFL players have a physician-patient relationship, but physicians who merely examine players to determine their health status have a third-party relationship. As described by Glenn Cohen et al., the problem is that typical NFL team doctors perform both functions, which leads to entrenched conflicts of interest. Although there are often disputes about treatment, the main point of contention between players and team physicians is the evaluation of injuries and the reporting of players’ health status to coaches and other team personnel. Cohen et al. present several thoughtful recommendations that deserve serious consideration. Rather than focusing on their specific recommendations, however, I would like to explain the rationale for two essential reform principles: the need to sever the responsibilities of treatment and evaluation by team physicians and the need to limit the amount of player medical information disclosed to teams.

Monday, September 19, 2016

How Should Clinicians Treat Patients Who Might Be Undocumented?

Commentary by Jeff Sconyers and Tyler Tate
AMA Journal of Ethics. March 2016, Volume 18, Number 3: 229-236.
 doi: 10.1001/journalofethics.2016.18.03.ecas4-1603.

Here is an excerpt:

Ethical Considerations

In terms of the ethical analysis of this case, there is no better place to start than the Hippocratic Oath. While the oath never explicitly states primum non nocere (first do no harm), a phrase it is often assumed to contain, it does give us the informative statement “Into whatever homes I go, I will enter them for the benefit of the sick…whether they are free men or slaves” [10]. The normative claim implicit here is that it is the duty of the physician to take care of anyone who comes to him or her for care, regardless of that person’s societal status. This claim is intimately related to the principle of beneficence, which is a broad concept encompassing acts of mercy, kindness, charity, altruism, love, humanity, and a deep concern for the promotion of the good of others [11]. At times, the demands of beneficence can conflict with an agent’s desire for a comfortable life; this conflict will influence Dr. Connelly’s analysis of a relationship with Ms. Nunez.

We believe that if a patient has an acute life-threatening condition (for example, a stroke, respiratory distress, or ongoing blood loss), it is the physician’s moral obligation to treat him or her, except under rare and extenuating circumstances—such as certain risk of dangerous exposure, injury, or death from attempting treatment. (This moral obligation is different from the legal rules outlined above.) If a patient is in extremis, a physician must attempt to treat. However, these clear obligations need not apply in less acute scenarios like that of Dr. Connelly and Ms. Nunez.

The article is here.