introduction

1. 3. Fiduciary duty

2. Fiduciary duty
 fiduciary - derived from the latin term “fiducia”, meaning trust
 an individual in whom another has placed the utmost trust
and confidence to manage and protect property or money
 A fiduciary relationship exists when one party, because of
superior knowledge, skill, and authority, assumes
responsibility for the welfare of another party who is in a
position of reliance
 fiduciary duty refers to the legal obligation of one party to act
solely in the best interest of another party or principal , rather
than serving their own interests
 In this trust-based relationship, fiduciaries have heightened
obligations, including the moral imperative to put the interests
of reliant parties ahead of their own interests
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3. Fiduciary duty …
 the care professional placed the best interest of the patient
first and was, in fact, the patient’s advocate
 A fiduciary obligation exists whenever
 one person, the client, places special trust and confidence
in another person and relies upon that person, the
fiduciary, to exercise his discretion or expertise in acting
for the client; and
 the fiduciary knowingly accepts that trust and confidence
and thereafter undertakes to act in behalf of the client by
exercising his, the fiduciary's, own discretion and expertise
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4.  There are three different kinds of models of doctor-patient
relationship:
1. Paternalistic model: the doctor is the professional;
or she gives the order, the patient obeys
2. Contractual model: the doctor and patient "contract"
for each other's mutual benefit; the patient determines
or agrees to the doctor’s decisions
3. Fiduciary model: the patient confidently entrusts his
her health care to the doctor, who takes on the
obligation of working for the benefit of the patient
 Based on mutual trust and confidence
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Fiduciary duty …

5.  the doctor-patient relationship has been defined, through
rules of ethics and rules of law, as a fiduciary one, as a
relationship founded in trust
 the patient agrees to take the physician into her
confidence, to reveal to him even the most secret and
intimate information related to her health
 the physician, in turn, agrees to honor that trust, and to
become the patient’s advocate in all matters related to her
health, placing her interests above all others - including his
own personal or financial concerns
 the loss of this doctor-patient relationship has obvious
consequences for patients
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Fiduciary duty …

6. Fiduciary duty …
 Fiduciary duties fall into two broad categories:
1. The duty of loyalty: fiduciaries should
 act in good faith in the interests of their beneficiaries,
 should not engage in transactions that involve a conflict of
interest called "self-dealing" transactions
 not act for the benefit of themselves or a third party
2. The duty of prudence (duty of care):
 fiduciaries should act with due care, skill and diligence,
investing as an ‘ordinary prudent man’ would do
 the duty to pay attention and to try to make good decisions
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7. Fiduciary duty …
 A conflict of interest is a potential conflict exists whenever
 an employee or an employee’s close friend(s), relative(s),
or associate(s) has a strong personal life interest,
 the employee is involved in decision making on behalf of
the organization and
 the employee’s interest may cause (or may be perceived as
causing) the employee to exercise his or her
organizational decision-making power to further personal
interest rather than the organization’s mission,
 to the detriment of the organization
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8. Conflicts of interest…
 physicians should not allow a conflict of interest to
influence medical judgment
 In some cases, conflicts are hard to avoid, and
doctors have a responsibility to avoid entering such
situations
 Research has shown that conflicts of interests are
very common among both academic physicians and
physicians in practice
 Health service providers can be affected by conflict of
interest by the following situations among others
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9. Conflicts of interest…
 Referral
 For example, doctors who receive income from referring
patients for medical tests have been shown to refer more
patients for medical test
 Fee splitting and the payments of commissions to attract
referrals of patients is considered unethical and
unacceptable in most parts of the world
 Treatment of family members
 Many doctors treat their family members
 Doctors who do so must be vigilant not to create conflicts
of interest or treat inappropriately
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10. Conflicts of interest…
 Vendor relationships
 Studies show that doctors can be influenced by drug company
inducements, including gifts and food
 Many patients surveyed in one study agreed that physician gifts
from drug companies influence prescribing practices
 Many academic institutions banned pharmaceutical industry-
sponsored gifts and food to diminish the influence of
pharmaceutical industry on prescribing practices of physicians
 Sexual relationships
 Sexual relationships between doctors and patients can create
ethical conflicts, since sexual consent may conflict with the
fiduciary responsibility of the physician
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