Introduction

Ethical principles and behavior are an integral part of the practice of medicine. For this reason, the ability to recognize and act on ethical issues is an essential qualification of the competent ophthalmologist.

Imagine, for example, that several patients have contacted you recently for a second opinion on the urgent need for cataract extraction. Each surgery was recommended by one particular ophthalmologist in your community. In each case, you find that new glasses improve the patient's vision to a level entirely satisfactory to the patient. What do you tell the patients? Do you have a larger responsibility to protect other patients from unnecessary surgery? What obligation do you owe the other ophthalmologist?

Another example: a 3-year-old boy with developmental delay and cerebral palsy is brought to you for evaluation of esotropia and moderate hyperopia by concerned parents. The parents tell you that the child was recently examined by another eyecare professional who told them it was impossible to determine whether the child could see, and that the correction of strabismus with glasses and surgery was not advised because “it would really be just for cosmetic purposes and wouldn’t last.” What do you tell the parents?

Neither of these two examples constitutes a life and death matter, and neither would be considered an ethical crisis. Yet, such situations raise a host of issues that test the ophthalmologist's knowledge, understanding, sensitivity, compassion, and moral judgment - in brief, his or her ethical awareness and behavior. Similar predicaments, some more mundane, some more dramatic, are part of the practice of medicine. Yet practical guidance in how to deal with these events has largely escaped attention in most of the books that fill our professional libraries. There is no Duke Elder or Duane's textbook to provide instruction. We may recognize the ethical competence of our physician role models and we can learn from them, but a specific presentation of ethical issues that permeate the practice of ophthalmology could prove a useful adjunct. Such a guide might serve to increase our moral awareness and competence in managing the obligations of our profession. These courses attempt to fill that need.

It should be clear, this is not a "cookbook" or "how-to" handbook for ethical conduct. It is only a guide. You will note that there are questions related to the various case studies presented. These are offered to illustrate the fact that, in many instances, no single response is the only correct course of action. Conflicting ethical concerns may be present; alternatives exist, and the physician must bear the choices based on the ethical principles that pertain to the conditions of the situation described.

Hopefully, this activity can aid the teaching and learning process in which physicians become better healers: healers of their patients, their communities, and themselves.