Divided loyalties for physicians: social context and moral problems

Abstract

An examination of the notion of divided loyalties dilemmas in medicine, situated within their social contexts, yields insight into the contemporary social and moral position of medicine in the United States. In a review of the literature, the author identifies four concepts important to gaining an understanding of the position that divided loyalties play in medicine and the physician-patient relationship. After describing some of the situations in which these dilemmas affect physicians' responses to patients' health care needs, interests, and choices, the author argues that divided loyalties dilemmas are not rare, and will probably increase with the changes in U.S. medicine. Candor and awareness of the importance of the public belief in physician loyalty are seen as necessary in preventing these changes from becoming destructive of the physician-patient relationship.

KIE: Divided loyalty dilemmas for physicians occur in a variety of contexts, such as in the military, in the practice of psychiatry, in prisons, in occupational medicine, in public health, and in sports medicine. Murray proposes a conceptual analysis of these dilemmas that will permit linking them with the social conditions nurturing them and that will yield an understanding of the role they play in medicine and in the physician patient relationship. He contends that candor and awareness of the importance of the public belief in physician loyalty are necessary to prevent social pressures from destroying the physician patient relationship.