The Limits and Obligations
of Fidelity: Resource Use
Physicians, it would seem, are trapped between the proverbial rock and hard place. On the one hand, traditional fidelity requires them to promote their patients' best interests, using whatever resources are necessary for good medical care. On the other hand, they have lost much of their accustomed control over those resources. Similarly, traditional fidelity requires the physician to place the patient's interests above his own. And yet, as we have seen, the physician now must sometimes pay a serious personal price for doing so. As the physician exercises clinical authority over resources owned by others, those economic agents influence clinical decisions by placing the physician's own interests in jeopardy.
The simplistic, absolute ideals of the past may have been inspiring, but in the cold realities of medicine's new economics they must be reexamined. If once we could focus exclusively on the requirements of fidelity, it is time now to consider the boundaries of fidelity. That is, as we inquire what the physician owes his patient, we must also consider what he does not owe. In this chapter we will examine physicians' obligations regarding material resources, both medical and monetary. We will then, in the next chapter, reassess the physician's obligations over his own resources—his professional knowledge, skills, and effort.
In order to redefine physicians' obligations regarding others' resources, we must look more closely at the predicament in which they find themselves. We have already seen that traditional resource expectations have outlived the physician's power to meet them.1 Even if in a technical sense the physician can still order whatever interventions