Medical practice in the 21st century has changed substantially from the eras of Hippocrates and Nightingale, but physicians and nurses are still taught, and take an oath, to uphold the primacy of patient welfare. The tenets of ethical principlism that serve patient welfare include respect of autonomy, beneficence, non-maleficence, and justice.3  Nurses and physicians have sworn an oath to advocate for patients. However, if they are employed by a health care organization, they are also contracted to abide by that organization’s rules and regulations, including obedience to its chain of command. When the realities of complex organizations collide with the primacy of the patient, what is the clinician-employee to do? The following case-example explores the tension inherent in these 2 obligations:

This scenario is likely to have played out at many hospitals over the past several years as developments in health care collided with economic duress. The 2008 recession...

You do not currently have access to this content.