Abstract
Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: (1) defensive medicine is deceptive and undermines patient autonomy; (2) defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; (3) defensive medicine exposes patients to harm without benefit; (4) defensive medicine undermines trust in the profession; and (5) defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism.
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I should point out: while many analyses seem to bear out that defensive medicine adds significant healthcare cost and that systems changes and initiatives can decrease defensive practice and related cost (Hermer and Brody 2010; Lyu et al. 2017; Mello et al. 2010; Van Der Steegen et al. 2017), at least one analysis maintains that while defensive practice is widespread, the cost impact of defensive medicine on overall healthcare spending is actually relatively small, and changes in the malpractice environment does not seem to change defensive practice that much (Thomas, Ziller and Thayer 2010).
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Bester, J.C. Defensive practice is indefensible: how defensive medicine runs counter to the ethical and professional obligations of clinicians. Med Health Care and Philos 23, 413–420 (2020). https://doi.org/10.1007/s11019-020-09950-7
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DOI: https://doi.org/10.1007/s11019-020-09950-7