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October 3, 1986

On Ethics and Advocacy

JAMA. 1986;256(13):1786-1787. doi:10.1001/jama.1986.03380130114039

WE ARE presently witnessing an apparent divergence of the statements of traditional ethical standards and the actual practice of physicians. This circumstance is a serious threat to our own perception of the validity of our ethical ideals and to the public's perception of our professional integrity. It has recently been urged1,21,2 that organized medicine take a firmer stand in declaring physician participation in the business aspects of medicine to be unethical. The primary stated goals of those urgings are to maintain the professionalism of medical practice and to strengthen the physician's role of patient advocacy. I believe, however, that some basic fallacies in the arguments create the likelihood of the opposite effects if such a course is pursued.

The first of these fallacies involves the identification of the alternatives being compared. The implication is that either we will see physician-entrepreneurs, responding to the business exigencies of the "bottom