Laurence B. McCullough

Physician and parental decision making in newborn resuscitation.

Clinical facts and physicians’ ethical obligations are critical in resolving disagreements between parents and physicians about resuscitation of an extremely premature infant. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The Professional Responsibility Model of Ethics in Obstetrics and Gynecology

The professional responsibility model of ethics in obstetrics and gynecology should guide decision-making and behavior in clinical practice, research, and education. The model is based on the ethical concept of medicine as a profession, introduced into the histories of medicine and medical ethics by the Scottish physician-ethicist, John Gregory (1724–1773), and the English physician-ethicist, Thomas Percival (1740–1804). They showed that, to be a professional in the ethically significant sense of the word, physicians should commit themselves to scientific and clinical excellence and to the protection of the patient’s health-related interest, keeping self-interest systematically secondary. To fulfill these commitments, physicians should cultivate the professional virtues of integrity, compassion, and self-sacrifice and conform clinical practice to the ethical principles of beneficence and self-sacrifice. The professional responsibility model uses these ethical concepts to create an account of the obstetrician-gynecologist’s ethical obligations to pregnant, fetal, and neonatal patients. The implications of virtue-based, beneficence-based, and autonomy-based obligations to patients must be all considered to reach deliberative judgments about professionally responsible patient care, research, and education.

Preventing incremental drift away from professionalism in graduate medical education

Professionalism is a core competency of graduate medical education programs, stipulated by the Accreditation Council for Graduate Medical Education. We identify an underappreciated challenge to professionalism in residency training, the risk of incremental drift from professionalism, and a preventive ethics response, which can occur in residency programs in countries with oversight similar to that of the Accreditation Council for Graduate Medical Education. Two major, welcome changes in graduate medical education-required duty hours and increased attending supervision-create incentives for drift from professionalism. This article analyzes these incentives based on the ethical concept of medicine as a profession, introduced into the history of medical ethics in late 18th century Britain. This concept calls for physicians to make 3 commitments: to scientific and clinical competence; to the protection and promotion of the patients health-related interests; and to keeping individual and group self-interest systematically secondary. Some responses of programs and residents to these incentives can undermine professionalism, creating a subtle and therefore hard-to-detect drift away from professionalism that in its worst form results in infantilization of residents. Program directors and educators should prevent this drift from professionalism by implementing practices that promote professionally responsible responses to the incentives created by required duty hours and increased attending supervision.

Guild interests: an insidious threat to professionalism in obstetrics and gynecology

&NA; Powerful incentives now exist that could subordinate professionalism to guild self‐interest. How obstetrician‐gynecologists respond to these insidious incentives will determine whether guild self‐interests will define our specialty. We provide ethically justified, practical guidance to obstetrician‐gynecologists to prevent this ethically unacceptable outcome. We describe and illustrate 2 major incentives to subordinating professionalism to guild self‐interest: demands for productivity; and compliance and regulatory pressures. We then set out the professional responsibility model of ethics in obstetrics and gynecology to guide obstetrician‐gynecologists in responding to these incentives so that they preserve professionalism. Obstetrician‐gynecologists should identify guild interests affecting their group practices, set ethically justified limits on self‐sacrifice, and prevent incremental drift toward dominance of guild self‐interests over professionalism. Guild self‐interests could succeed in undermining professionalism, but only if obstetrician‐gynecologists allow this to happen. When guild self‐interest becomes the deciding factor in patient care, professionalism withers and insidious incentives flourish.

The professional responsibility model and patient requests for nonindicated early delivery.

A patients request for a treatment does not establish that treatment as medically reasonable according to evidence-based deliberative clinical judgment.

Can Physicians’ Contractual Obligations Limit Their Professional Obligations? Commentary 1

Physicians can fulfill their professional responsibilities to patients when those responsibilities conflict with moral commitments of the hospital or clinic where the patient encounter occurs. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Physician and Parental Decision Making in Newborn Resuscitation, Commentary 2

Clinical facts and physicians’ ethical obligations are critical in resolving disagreements between parents and physicians about resuscitation of an extremely premature infant. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.