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We often talk about the medical ethics or ethical clinical practice that should be the hallmark of a "good" physician. Did we ever think that how many dilemmas a clinician may face while implementing those ethical aspects in their practice? This article tries to list out some big ethical dilemma a clinician face at some pint of their life. Reporting an incompetent or impaired colleague If a physician colleague of yours is impaired, like sick, alcohol or drug addicted or is no longer competent to do surgery or treating a critically ill patient and still he/she is refusing your help, what should be the right step? Should you report it to concerned authority, like the medical council or your employer? Patient confidentiality and your clinical conscience When one-half of a couple is HIV positive and the other half doesn't know, how should a physician handle such situation? Should he still bother about the confidentiality of patient data or reveal it to the other half of the couple, so that a fast and effective treatment can be started. Prolonging futile care for a dying patient Many times you find it futile to give a life-sustaining therapy but you need to prolong such therapy due to different kinds of associated pressure. Similarly, many times you find that there is a pressure from patient’s family to halt the life support when you still think it is premature. It raises the everlasting dilemma of legalizing the physician-assisted termination of life. Whether to honor a family's request not to tell a relative that he/she has a terminal illness It is really a conflict between your medical ethics and emotional demand of patient’s family that torn the doctor apart mentally. Sometimes, it is the physician who himself decided not to reveal the fact to the patient to bolster his confidence. Exaggerating a patient's condition to get insurance coverage The patient often demands an exaggerated and falsified note from a doctor about his/her condition to get a higher insurance coverage or to get a medical leave from the employer. Treating a family member or friend This dilemma has been discussed earlier in this platform too and received a mixed opinion. However, most of the doctors opined that doctor should perform their duty irrespective of his relation with the patients. Still the other opinion also surfaced out. The emotional attachment, conflict of financial interest, or fear of failure of treatment keep the doctor in a dilemma to treat his family and friends. Placebo or defensive medicine Did not it happen ever that your patient got dissatisfied as you did not write a medicine for him/her? Would you consider writing a placebo for the patient? Studies says placebo works on many occasions. Still it remains a physician’s personal choice whether to satisfy with a placebo or just denying straight on his face. Being in a Romantic or physical relationship with patient An international survey reported that physicians generally tend to avoid a relationship with his/her patient beyond clinical periphery. However, a loss of such restriction may put both the patient and doctor into a great dilemma. The same survey reported a section of doctor have no objection to get emotionally involved with the patients after a certain period of time such as 6-8 months post completion of treatment, but never during the tenure of treatment. It has become a trend to recommending a diagnostic test or treatment or even surgery that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as the potential plaintiff. As patient can sue the doctor for delayed or under-diagnosis but never for over-diagnosing. Besides the points mentioned above, there can be many other ethical issues that leave a doctor indecisive in his practice such as treating a non-paying or underpaying patient, hiding a medical error that won't affect the treatment outcome and much more. However, the decision making is highly relative and depends on the particular situation and obviously on the moral, confidence and experience of the individual physician. What is the toughest ethical dilemma you have faced in your practice?
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