Defensive Practice Is Indefensible: How Defensive Medicine Runs Counter to the Ethical and Professional Obligations of Clinicians

Document Type

Article

Publication Date

4-17-2020

Publication Title

Medicine, Health Care and Philosophy

First page number:

1

Last page number:

8

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.

Keywords

Defensive medicine; Fiduciary obligations; Professionalism; Medical ethics; Clinical ethics

Disciplines

Bioethics and Medical Ethics

Language

English

UNLV article access

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