Julianne Mann, M.D., Portland, Ore., makes her choice using a handheld device Saturday during 'Ethical Economics in Dermatology and Derm Surgery.'

The ethics of medical practice were discussed Saturday in a lively, interactive session, "Ethical Economics in Dermatology and Dermatologic Surgery," which had audience members using audience response keypads to respond to questions.

Following a discussion of the fundamentals of medical ethics, a panel of dermatologists presented a series of practice situations that, in some cases, generated ethical dilemmas. Attendees then voted on how they'd respond.

"There is no right or wrong answer, necessarily," said forum director, Alexander Miller, M.D. "This is all set up to elicit how you feel about certain situations."

The panel, together with the audience, then explored the ethical ramifications of the vignettes and the tallied audience responses.

Along with Dr. Miller, other doctors who presented ethical scenarios during the forum included Kent Stuart Aftergut, M.D.; Kenneth E. Bloom, M.D.; Scott Andrew Buckta Collins, M.D.; Steven P. Rosenberg, M.D.; and Carl A. Johnson, M.D.

Through the session, attendees learned how to evaluate and contrast various ethical dilemmas faced in dermatologic practice and assess how their individual practice patterns relate to accepted ethical standards.

Clifford Warren Lober, M.D., who is also an attorney, began the forum by defining the term "ethics" during his presentation, "Fundamentals of Medical Ethics." Most ethics textbooks — even those for medical and law schools — don't actually define the term. When a definition of the word is found, it typically uses general words, such as "correct," "good" and "moral," he said, but that doesn't leave people with a measurable standard.

"Ethics are behavioral ideals defined by fundamental beliefs," he said. "These beliefs are either arbitrarily accepted as true in and of themselves or are derived inductively or deductively from other fundamental beliefs."

Ethics, he added, are inherently subjective.

"If we change our fundamental beliefs, our ethics will change," he said. "Ethics will certainly differ in different societies. Human sacrifice is either an ideal to please the gods or absolutely abhorrent."

And just because something may be legal, such as abortion or the death penalty, doesn't mean it's ethical.

"Never conclude that something is ethical because it is legal or unethical because it is illegal," Dr. Lober said.

Scenarios shared by presenters and voted on by attendees ran the gamut, from funny to contentious. All, however, were applicable in some way.

Dr. Johnson presented a scenario involving fees for a renowned physician trained at an Ivy League medical school who does not accept insurance. The first mention of fees in medicine, Dr. Johnson said, was Hammurabi's Code, written in 1790 B.C. According to the code, a nobleman was charged 10 shekels of silver, a poor freeman was charged five shekels and a slave was charged two.

Thankfully, he said, medical ethics have changed drastically since then.

"If the nobleman died from the procedure, you were killed," Johnson said. "If the poor man died you would lose the appropriate limb or corresponding part of your body. If the slave died, you would simply have to find a replacement for his owner."

Another scenario examined during the forum challenged attendees on whether they should treat an elderly female patient from a nursing home with a case of dementia, no power of attorney present and a visible 1.2 cm irregularly pigmented nodule of the forehead that appears to be consistent with a nodular melanoma. Another example asked participants, based on their pro-life or pro-choice leanings, if they would prescribe isotretinoin for a 16-year-old female who's clinically deemed a candidate for the medication.

"I commend everybody in the audience for being here," Dr. Rosenberg said. "It's very gratifying to see all these people taking ethics seriously. Hopefully next year the other 15,000 attendees will be here."