Summarize this content to 100 words While the ethical conflicts discussed in medical school once focused primarily on patient privacy, end-of-life issues, and conflicts of interest with pharmaceutical companies, today, the list of ethical dilemmas facing physicians has risen to include everything from gender care and vaccine issues to weight loss drug access and abortion regulations in some states.This is something Alisha Thompson Bennett, DO, a family medicine physician in Bessemer, Alabama, knows all too well.”It’s been challenging on our end in that we’re confronted with patients who are in need of services that aren’t available to them here in the state of Alabama,” Bennett said. “I feel that my job as a physician is to direct them, to educate them, and to provide them with resources — completely independent of my personal belief system.”So, what happens when a physician’s expertise clashes with local, state, or national politics?“This is a complicated topic,” Bennett said. “I care about my patients mentally, physically, and emotionally. There are so many different reasons someone may be looking for abortion services, yet these women are hundreds of miles away from where they need to go to get services if they so choose. I see the desperation and it worries me.”Gray AreasPatients asking for, say, Ozempic or Wegovy off-label prompt yet another set of ethical dilemmas, especially if there are shortages. In addition, drug costs can often influence a patient’s care — prompting difficult decisions for physicians.Judy Wright, MD, a family physician and founder of JW Health Consulting in New York City, works hard to build a rapport with her patients, whether they’re coming in for a well-care visit or symptoms or they have a diagnosis.And, once her patients need a certain medication — or need to change the one they’re on — inevitably, the cost becomes yet another stressor and a moral dilemma should the price dictate the drug the patient can afford.”Let’s say the formulary changes, or there needs to be a change from one medication to another due to government regulations or a mandate by an insurance company,” Wright said. “That can cause an upheaval and makes this face-to-face relationship all the harder because there’s nothing you can do to help them [patients] beyond doing your best to fight for them.”Taking Medicine Out of Doctors’ HandsFor Todd Thames, MD, a practicing physician, vice president of clinical affairs at Included Health, and a professor at Trinity University in San Antonio, Texas, Senate Bill 8, which passed in 2021, bars abortions after the detection of a “fetal heartbeat,” and it exponentially changed the dynamics for him and the patients he cares for.”We’re working in a very different landscape due to the sweeping nature of that bill,” said Thames, who also has a master’s in bioethics/medical ethics and often speaks with top employers like Walmart about how to cover things like abortion, gender care, vaccines, and weight loss drugs across increasingly complicated and differing state laws.”If I’ve got a patient in my exam room or in the emergency room who is having an acute issue, I will be honest and say that it’s an incredibly ambiguous time right now.”The credo of “do no harm” may feel constantly challenged as a physician.”There are specific things that would otherwise be considered standard of care that you can no longer do due to the legal framework we’re operating in,” Thames told Medscape Medical News.Hospital systems are putting their hands up and suggesting that doctors figure it out. “It’s hard to get clarity on what to do.”Ultimately, Thames remains guided by the principle of always practicing within the scope of “standard of care.””Texas is sticky, and the wording of this bill in particular is ambiguous,” he said. “I tell my peers that when you get into a hard stop from a legal standpoint, the best thing to do is to take a step to transfer them [patients] to get them the care they need. But this means that doctors working within this environment are very nervous.”This, in turn, has led to an increased feeling of frustration — and it’s frightening to consider the consequences, Thames said.”We’re trained to put the needs of patients first,” he told Medscape Medical News. “You want to get patients what they need and do no harm in the meantime. Many of these situations confront that ethical and moral impetus head-on in ways that are affronting.”Thames believes it’s critical to have direct and frank conversations with patients on any issue that might affect their lives, including regularly talking to them about such topics as safe gun storage and vaccines.”I’ve had patients express their hesitancy about vaccines for my entire family medicine career,” Thames said. “I believe there are fair questions that patients should be allowed to ask without judgment.”By keeping the conversation open — and nonjudgmental — Thames believes he has been able to better understand where a patient is coming from when it comes to their opinion on vaccines generally.”Engaging in shared decision-making usually helps a patient come to a point where they’re comfortable getting a vaccine,” he said, urging colleagues to follow that shared-decision model, especially due to the mistrust in the medical community at large right now. “When we remain at an impasse, where the patient still doesn’t believe we need vaccines, I accept that, too. After all, autonomy is a core principle of bioethics.”In the end, physicians stress that no matter the challenge, making the best decisions means putting yourself in a patient’s shoes.”I’m in Alabama, a conservative state, but I’m not here to morally judge anyone,” Bennett said. “My job is to serve my patients and even when I’m limited on how I can do that, I remain committed to serving them in the best way I can.”Lambeth Hochwald is a New York City–based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.
Exploring Ethical Dilemmas
