Physicians' Refusals of Service on Grounds of Conscience.

What is conscience, and when should we let it be our guide? Only when it threatens indictment for nonadherence to an ethically valid duty? How do we know when that is? Doesn't conscience change? And shouldn't we change it intentionally sometimes, for example, on the basis of an all-things-considered judgment? Is conscience subject to reason-guided amendment? Mightn't it be immune to change based on a cost-benefit analysis? Isn't that its deontic characteristic? Suppose we can't help fearing conscience, should we be excused for knuckling under to it? Is conscience then a bully we can't evade? When should society and the law respect physicians' divergent consciences? Mustn't physicians subordinate their interest in being on good terms with conscience to the fiduciary duty owed to patients? Isn't that what fidelity to the goals of medicine requires? Whose medicine? Wouldn't dogmatism about this eradicate physicians' moral agency? This essay provides partial and tentative answers to these questions.

Volume-outcome disparities and informed consent: what should surgeons disclose?

It has been repeatedly shown that higher procedure volumes, by hospital and by physician, are associated with better outcomes. Buttressed by large-scale selective service purchasing, surgical care for many volume-sensitive operations has been regionalized. However, the implications of outcome disparity data for obtaining valid patient consent remain uncertain.

Association of Clinical Researchers and Educators a statement on relationships between physicians and industry.

Collaborations between physicians, particularly those in academic medicine, and industries that develop pharmaceutical products, medical devices, and diagnostic tests have led to substantial advances in patient care. At the same time, there is a strong awareness that these relationships, however beneficial they may be, should conform to established principles of ethical professional practice. Through a writing committee drawn from diverse disciplines across several institutions, the Association of Clinical Researchers and Educators (ACRE) has written a code of conduct to provide guidance to physicians in observing these principles.

Time to 'walk the walk' about industry ties to enhance health.

Overwhelming evidence that relationships between universities, physicians and the medical products industry benefit patients explains the ubiquitous calls to encourage such relationships. Yet accumulating 'conflict of interest' regulations in academic health centers, government and industry have had the opposite effect. Justifications underlying the regulations lack quantitative rigor, and the rules they enforce impose costly bureaucratic requirements of dubious benefit.

Drug reps off campus! Promoting professional purity by suppressing commercial speech.

In the name of restoring professionalism, an influential group of physician-educators have urged academic medical centers to take the lead in purging the house of medicine of the conflicts of interest created by industry's marketing. I argue that this revivalist movement is misguided, uses "conflict of interest" as an epithet, creates counter-productive incentives, and fails the duty to prepare physicians for ethical engagement with their commercial partners in patient care.

Two cheers for physicians' conflicts of interest.

This paper will attempt to demonstrate that conflict of interest is an unavoidable feature of medical practice, medical institutions, medical publications, and medical research. It also seeks to show how and why current regulations are ineffective in curbing fraud and abuse. The paper goes on to argue that, in light of the incentives incorporated into current reimbursement arrangements, physicians have to learn how to manage the conflicts they face and keep true their fiduciary responsibility to patients.