Physicians increasingly face conflicts between the ethic of
undivided loyalty to patients and pressure to use clinical methods and
judgment for social purposes and on behalf of third parties. The
principal legal and ethical paradigms by which these conflicts are
managed are inadequate, because they either deny or unsuccessfully
finesse the reality of contradiction between fidelity to patients and
society's other expectations of medicine. This reality needs to be
more squarely acknowledged. The challenge for ethics and law is not to
resolve this tension—an impossible task—but to mediate it in myriad
clinical circumstances in a way that preserves the primacy of keeping
faith with patients while conceding the legitimacy of society's other
expectations of medicine.
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