๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Cosmetic dermatologic surgery
Cosmetic dermatologic surgery
Dermatologic surgeons perform a significant proportion of all cosmetic procedures worldwide.81 Patients may present for cosmetic intervention with a variety of concerns, and a reluctance to rely on paternalism, coupled with the economic realities of an outof-pocket reimbursement schedule, has led to the embrace of a patient-as-client phenomenon. Yet the ethical obligations of the physician remain unchanged, regardless of whether the patient is presenting for cosmetic or medical treatment.
Body dysmorphic disorder is a common condition, and identifying such patients is an important challenge for the cosmetic dermatologist, not least because the patient is likely to be dissatisfied after any intervention.82โ98 Ethically, performing a procedure on a patient with body dysmorphic disorder, or even a patient with clearly unrealistic expectations, is problematic. From a principlist standpoint, this would violate the principle of nonmaleficence and from a Kantian perspective, the physicianโs motivation is likely not the patientโs best interests.
Clinical research As with other situations resulting from solicitations, it is important to consider the
motivations for performing clinical research. This Kantian approach is helpful in evaluating the ethical merits of performing this type of work, and the appropriate interactions that should take place both with the research sponsor and the clinical trial participants.
Clinical research is a burgeoning area in medicine overall, and indeed a necessary component in the development of both novel and generic medications.99โ102 While it should not be pursued solely as a potential profit center, fair reimbursement for clinical research work is reasonable and indeed necessary.
Industry funding Despite significant efforts to protect medical education from the impact of industry funding and potential bias, a significant proportion of continuing medical education (CME) material is industry sponsored, either directly or indirectly.103โ108
Industry funding in dermatology is pervasive, as demonstrated by a recent manuscript highlighting the range of payments from pharmaceutical companies to dermatologists.109 Accepting payments from industry is not ethically fraught per se, though significant evidence has demonstrated that even accepting drug samples has an impact on prescribing patterns.110,111
CONCLUSIONS
Dermatologic surgeons face ethical challenges on a daily basis. A basic appreciation of the various approaches to ethical decision making is helpful for the practicing clinician as well as the academic dermatologic surgeon. Ultimately, most ethical guidelines set only a floor for ethical action, limiting frankly unethical actions. Aspiring to a higher level of patient-centered surgical care aids dermatologic surgeon and patient alike.