In his article, Dayan1 nicely addresses the shifting of ethical guidelines for the medical profession, primarily due to the influence of dynamic societal viewpoints and intrusion from external entities, namely, US regulatory agencies. He also rightfully points out that the medical profession is trained to apply credible judgment in patient care, which has developed over years of didactic education, clinical experience, and collegial interaction. Indeed, physician judgment and clinical decision making are being compromised in several arenas, including the placement of limits on patient access to a wide range of diagnostic and therapeutic options and the disallowing of certain procedures that the physician may recommend based on the diagnosis and needs of the patient. It is certainly discouraging for many physicians to see the erosion of the unfettered application of physician judgment to the therapeutic milieu. Dayan is correct in making that point. However, I believe that physicians who have exhibited questionable or downright poor judgment over the years have contributed to the intrusion of regulatory agencies into the practice of medicine. Our profession has not been as effective at self-regulation as it should have been, and we must acknowledge our complicity in what is happening. Even so, for the vast majority of physicians, excessive external regulation is unwarranted.
Holt GR. Ethical Behavior and the Practice of Medicine. Arch Facial Plast Surg. 2011;13(3):214. doi:10.1001/archfacial.2011.21