Practical concerns with ethical dimensions in the management of diabetic retinopathy

In this chapter we will cover a number of diverse, yet practical topics, rarely covered in a book on diabetic retinopathy. What ties them together is the common thread of possessing an ethical dimension. Our goal will be to identify issues that arise daily in the care of patients with diabetic retinopathy that require a response by the ophthalmologist and examine what motivates the possible alternative behaviors by ophthalmologists. Scientific studies touching these topics are few. Whereas analogous issues arise in all fields of medicine, by tying them to our emphasis here on diabetic retinopathy the author hopes to establish immediacy. The perspective will be discursive, but not directive, because in many cases, a correct answer or solution based on evidence may not be clearly discernible or may be controversial. In each case, the concept of medicine as a profession operating under a tacit social contract is crucial. This social contract states that physicians are allowed a high degree of autonomy in their professional affairs in return for vowing to use their medical and scientific expertise solely to promote the interests of their patients and the welfare of the public. In fact, the use of the word solely in this quotation indicates that the assertion is aspirational, not factual. Cases abound demonstrating that ophthalmologists are human and heir to self-interest. Ophthalmologists exhibit professionalism to the degree that we approach the goal and abjure self-interest and the perception of such in favor of our patients' interest and that of the public. © 2010 Springer-Verlag New York.

Duke Scholars

Author David Judson Browning Ophthalmology