When Patients’ Values Challenge Professional Integrity: Which Way Out?

Patients’ values and choices sometimes conflict with health-care providers’ professional integrity. Increasingly, health-care teams face requests for care they deem inappropriate, particularly around decisions near the end of life. Professional standards are useful in some ways, but are insufficient from an ethical point of view. Indeed, it can be important to remember that patients’ values do not necessarily lose their legitimacy when they conflict with physicians’ professional integrity. By examining a paradigmatic clinical ethics consultation case, this essay explores a possible way to address situations in which doctors’ integrity and patients’ values clash. In order for professional integrity to play a constructive rather than adversary role in decision making, it should be understood in an inclusive way, as a combination of interconnected values in play: professional, contextual, and personal.