AMA Journal of Ethics Clinical Case Studies
American Medical Association (All cases gathered from the AMA Journal of Ethics website)
- Unnecessary Antibiotics - A physician in a new group pediatrics practice notices colleagues violating a good clinical protocol for the sake of building a solid patient, and financial, base for the practice.
- Hidden Costs of Free Samples - A physician is highly skeptical of the overall educational quality of pharmaceutical representatives, but appreciates the benefits of free medical samples they provide.
- The Gift-Giving Influence - A medical school administration member is concerned that his students are unwilling to accept that their behavior can be influenced by pharmaceutical industry gift-giving.
- Drug Company Sponsorship of Clinical Conferences - A director of a residency program has some reservations about inviting a pharmaceutical company to buy lunch for residents during noon conferences.
- Clinician and Researcher - A physician sees the potential benefits of enrolling some of his patients into a clinical trial, and wonders what the ideal conditions of a clinitian-turned-researcher contract would be.
- Physician Work Stoppages as Activism - Can the overall goal of advocating for sustained access to care for patients be achieved by denying care during a work stoppage?
- Is the Surgery Necessary Now? The Surgeon's Conflict of Interest - A young surgeon recognizes his conflict of interest when a patient asks him to recommend the best treatment for her pain
- Peer Reporting of Suspected Physician Misconduct - A group partnership learns a member has been billing for services he did not provide, and they debate the best course of action.
- Physician Service to the Underserved - Charity care vs. meeting the bottom line, what is the proper balance?
- The Pitfalls of Drug Company Sample Use - A physician starts to regret the decision of not accepting free samples for her practice after a financially burdened patient requests some.
- "Can We Just Drop the Copay?" - A patient asks his physician if he could forgive his copay so he can continue to visit this office, mentioning that 80% of the bill for services will still be paid by insurance.
- Splitting the Difference: Patient Preference versus Conservation of Resources - A physician eager to find new ways to cut costs is asked by a patient to prescribe a more expensive option.
- HMO-Dictated Patient Discharge - A physician's clinical judgment interferes with established HMO policy.
- "Concierge" Practice and the Profession's Contract with Society - Should a physician institute a $3000 membership fee to access her practice, in the hope of being able to afford to provide higher quality care?
- Dermatology Lab Referrals: Cash Cow or Ethical Trap? - A physician wonders if a lab referral proposal is ethical, or even legal, and what consequences the partnership will have on the practice.
- Physicians and Advanced Practice Registered Nurses: The Supervisor-Employer Relationship - Ethical issues of conflicts of interest arise when a nurse practitioner employs a physician to oversee her practice.
American College of Physicians Case Study Series
American College of Physicians (All cases gathered from their website)
- Are Health Plan Incentives Hurting Generalist-Specialist Relationships? - A physician struggles with limitations and pressures put onto her and other physicians by HMOs.
- When are Industry-Sponsored Trials a Good Match for Community Doctors? - When community physicians are paid for enrolling patients into a clinical trial, the lines between physician and researcher can become blurred.
- Physician Work Stoppages and Political Demonstrations: Economic Self-Interest or Patient Advocacy? Where is the Line? - Should a physician group shut down their practice for a day to attend a tort reform demonstration?
- The HMO Physician's Duty to Cut Costs - A physician has a duty to providing the best treatment for his patient, but does a similar duty apply to providing treatment at the most reasonable cost? (Link to JSTOR Article available with SLU access)
Bander Center for Medical Business Ethics
Exploring Integrity in Medicine: The Bander Center for Medical Business Ethics Casebook
Stanford University Ethics Case Studies
Selected cases in medical business ethics are listed below. For a list of all cases and associated PDFs, go to their website.
- Conflicting Allegiance - As a consultant for two different companies in addition to being a University employee, questions are raised about gifts, proper compensation and conflicts of commitment.
- Invitation to Dinner - When you are given an offer to attend a pharmaceutical company sponsored dinner, you weigh the choice between attending and not attending.
- Patient Recruitment - Your supervisor is in need of patients for an important clinical trial, and pushes you to recruit more patients from the clinic, however you have some doubts about your supervisor's involvement with the study sponsor.
- The Clinical Specialist - An company-provided clinical specialist is often present in the operating room helping with implementation of a new device, however you wonder if her influence over the medical center's purchase decisions is appropriate.
More cases on topics in medical business ethics are currently being developed. For comments and suggestions, please contact us at (314) 977-6667 or at firstname.lastname@example.org.