Matthew K. Wynia

Trust, has been defined as placing something of value under another’s care in a position of vulnerability, is a core feature of human relationships (Baier 1986). Defined in this way, trust is espec...

Principlistic equality, the idea that the four principles of bioethics should be considered as nonhierarchical in the abstract, is core to the original conception of principlism, but it is unclear whether clinicians endorse principlistic equality in practice. We surveyed 227 primary and urgent care clinicians (62.8% response rate), finding just over half of respondents (51.9%) endorsed a hierarchy among the principles. Among this group, non-maleficence was most often over-weighted (by 57.1% of these respondents), followed by autonomy (42.0%), justice (35.7%), and beneficence (34.8%). Practicing in a safety net setting (OR = 0.51, 95% CI = 0.27-0.96) and spending less than half of one's time in direct patient care (OR = 0.23, 95% CI = 0.09-0.58) were associated with significantly lower odds of endorsing principlistic equality. Several clinician characteristics were associated with giving additional weight to certain principles. Our findings provide insight into how clinicians value the four ethical principles, which could inform education and training initiatives in bioethics.

This Viewpoint explains the 3 trends—personal conscience, employment contracts, and laws—that challenge physicians from putting their patients first and offers ways to reverse these barriers.

In Reply I value the discussions among colleagues that my Viewpoint article generated, especially because the published letters illustrate our capacity to engag

In this Viewpoint, the author examines whether health care professionals have any responsibilities to speak out about the conflict in the Middle East.

The Physician Payments Sunshine Act (section 6002 of the Patient Protection and Affordable Care Act), implemented in 2014, requires drug and device makers to an