AAD
  • Registration
  • Daily Coverage
  • Industry Highlights
  • Product Samples
  • Small Exhibit Spotlight
  • Program
Topics
  • Daily Coverage
  • Industry Highlights
  • Product Samples
  • Small Exhibit Spotlight
  • Program
Resources
  • Registration
Facebook iconInstagram iconTwitter icon
Mar 20, 2023

Ethical dilemmas hiding in plain sight

Livingood lecture spotlights the unintended consequences of decision-making.


Jane Margaret Grant-Kels, MD, FAAD
Jane Margaret Grant-Kels, MD, FAAD

Like anyone else, dermatologists like to think of themselves as ethical people and ethical practitioners. But what exactly does ethical mean? And how, in the often-frenetic days of seeing 40, 50, even 60 patients, can a dermatologist take the time to consider all the ethical implications of everyday decisions?

“The practice of medicine has changed radically in recent decades,” said Jane Grant-Kels, MD, FAAD, professor of dermatology, pathology, and pediatrics, and director of the Cutaneous Oncology Center and Melanoma Program at the University of Connecticut. “Very famous and well-known charismatic academic research dermatologists who have contributed immensely to our field have been accused of not behaving ethically in the past. And none of us, including myself, recognized that what they were doing at the time was unethical because we didn’t think about it. Just because you’re not breaking the rules doesn’t mean that you are acting in an ethical manner.” 

Dr. Grant-Kels explored the importance of ethics and the nuanced boundaries of ethical behavior during Sunday's “P151 – Plenary” Clarence S. Livingood, MD Memorial Award and Lectureship, “Dermatoethics: Ethics and the Practice of Dermatology.” Very few decisions in medicine, or in life, are simple black or white choices, she said. Unintended consequences can transform what seems to be a clear-cut decision into an ethical quagmire.

Decision-making dilemmas common

“Some dermatologists make the decision to not care for patients on Medicaid,” Dr. Grant-Kels said. “Reimbursement is so low that a practice loses money for each patient encounter. A practice cannot sustain those kinds of losses. But if you aren’t seeing these patients, someone else must take care of them. This results in the unintended consequence of placing the burden on your colleagues, most often colleagues in university clinics. Our choices have consequences — unintended consequences, with important ethical implications.”

Additionally, ethics have been a topic for discussion in medicine for decades, she said. The Nuremburg Trials after World War II focused attention on medical ethics. So did the Helsinki Accords, and the growing focus on informed consent.

“Just because we went to medical school doesn’t make us superhuman,” she said. “All of us have faults and boundary issues and are capable of making human mistakes. We don’t do it on purpose; we are so busy that we often don’t ask ourselves, objectively, is this decision right or wrong? We just don’t have the time to be introspective and think about ethics in a busy day of clinical practice. It happens to us as we parent our children. It happens to us as citizens of the world. And it happens in our offices as well.”

Analyzing nuances in everyday life

Physicians can create some of their own ethical dilemmas by not thinking through their decisions and the ramifications, said Dr. Grant-Kels. Some ethical quandaries are imposed from the outside. Insurance coverage, reimbursement policies, malpractice liability, patient mix, business structure, practice locations, and other factors can push decisions in one direction or another with ethical implications.

“There are always new nuances to ethics,” Dr. Grant-Kels said. “Since the Roe v. Wade mandate has been overturned, how do we handle patients we are putting on teratogenic medications? What happens if that patient becomes pregnant and we have them on a medication that can cause birth defects? This is particularly an issue if you are practicing in a state where abortion isn’t available. There are ethical implications that didn’t exist a year ago.”

Finally, there are times ethical questions can arise at unexpected moments, she said.

“There are times when there are no clear right or clearly wrong decisions, just ethical choices,” Dr. Grant-Kels said. “I don’t think any of us are making decisions based on a lack of ethics. But we all occasionally make decisions with a lack of sensitivity to ethical issues. We should all try to pay more attention to the unintended consequences of our decisions.”

Visit AAD DermWorld Meeting News Central for more articles.

Interesting Stories
What makes a biosimilar and an Interchangeable biosimilar different?
Presented by Boehringer Ingelheim
What makes a biosimilar and an Interchangeable biosimilar different?
Join Us to Learn More About SOTYKTU<sup>TM</sup> (deucravacitinib):
Presented by Bristol Myers Squibb
Join Us to Learn More About SOTYKTUTM (deucravacitinib):
Beyond the Scalp: Deciphering the Complexities of Alopecia Areata...
Presented by Pfizer Inc.
Beyond the Scalp: Deciphering the Complexities of Alopecia Areata...
Advancing Therapeutic Conversations
Presented by AbbVie
Advancing Therapeutic Conversations
Prurigo Nodularis and Atopic Dermatitis:
Presented by Sanofi and Regeneron Pharmaceuticals, Inc.
Prurigo Nodularis and Atopic Dermatitis:
Residents and Young Physicians: Your Guide to the AAD Annual Meeting
Presented by Neutrogena
Residents and Young Physicians: Your Guide to the AAD Annual Meeting
Janssen-Sponsored Symposium
Presented by Janssen Biotech, Inc.
Janssen-Sponsored Symposium
More in AAD 2023 Annual Meeting
Safi Bahcall
AAD 2023 Annual Meeting
Nurture the unexpected
Mar 20, 2023
Richard L. Gallo, MD, PhD, FAAD
AAD 2023 Annual Meeting
New approach uses microbiome to treat skin disease
Mar 20, 2023
Camp Discovery 92
AAD 2023 Annual Meeting
Refer a patient to Camp Discovery!
Mar 20, 2023
Amy J. McMichael, MD, FAAD
AAD 2023 Annual Meeting
A question of belonging
Mar 20, 2023
David J. Margolis, MD, PhD, FAAD
AAD 2023 Annual Meeting
Dermatologists top the list in antibiotic prescriptions
Mar 20, 2023
22 698 Ia23 Web Card 3x2
AAD 2023 Annual Meeting
Mark your calendar for Innovation Academy 2023
Join the learning
Mar 20, 2023
Getty Images 479036574
AAD 2023 Annual Meeting
Save the date for the 2024 Annual Meeting
Mark you calendar for AM2024
Mar 20, 2023
2022 03 21 12 20 34 6238b40dd1e28
AAD 2023 Annual Meeting
Access your Certificate of Attendance
Download online
Mar 20, 2023
2022 03 21 12 26 25 6238b55bf2d38
AAD 2023 Annual Meeting
Claim CME
Claim CME
Mar 20, 2023
Aad March20
AAD 2023 Annual Meeting
Session highlights for Monday
Mar 20, 2023
John T. Schiller, PhD
AAD 2023 Annual Meeting
Taking on cervical cancer, one shot at a time
Mar 20, 2023
Cause Marketing
AAD 2023 Annual Meeting
Support your patients, win prizes!
Mar 19, 2023
AAD
Facebook iconInstagram iconTwitter icon
© Ascend Media All rights reserved. DermWorld Meeting News Central is a publication of the American Academy of Dermatology.