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rectly to higher authorities in the hospital. If they are unwilling to deal
with the situation, then he can approach the appropriate physician li-
censing body and ask it to investigate.
BACK TO THE CASE STUDY – B
Dr. P should not have accepted so quickly. She should first find
out more about the project and ensure that it meets all the require-
ments for ethical research. In particular, she should ask to see the pro-
tocol that was submitted to the ethics review committee and any
comments or conditions that the committee put on the project. She
should only participate in projects in her area of practice, and she
should satisfy herself about the scientific merit and social value of the
project. If she is not confident in her ability to evaluate the project, she
should seek the advice of colleagues in larger centres. She should en-
sure that she acts in the best interests of her patients and only enrols
those who will not be harmed by changing their current treatment to
the experimental one or to a placebo. She must be able to explain the
alternatives to her patients so they can give fully informed consent to
participate or not to participate. She should not agree to enroll a fixed
number of patients as subjects since this could lead her to pressure pa-
tients to agree, perhaps against their best interests. She should careful-
ly monitor the patients in the study for unexpected adverse events and
be prepared to adopt rapid corrective action. Finally, she should com-
municate to her patients the results of the research as they become
available.
BACK TO THE CASE STUDY – C
According to the analysis of the physician-society relationship,
Dr. P is right to consider the impact on society of her patient’s behav-
iour. Even if the consultations with the other health practitioner occur
outside of the health system in which Dr. P works and therefore do not
entail any financial cost to society, the patient is taking up Dr.P’s time
that could be devoted to other patients in need of her services. How-
ever, physicians such as Dr.P must be cautious in dealing with situa-
tions such as this. Patients are often unable to make fully rational de-
cisions for a variety of reasons and may need considerable time and
health education to come to an understanding of what is in the best in-
terests of themselves and of others. Dr.P is also right to approach her
medical association to seek a societal solution to this problem, since it