This document discusses the ethical duties and responsibilities of pathologists. It notes that pathologists owe duties to patients, other physicians, technologists, and the medical community. A key responsibility is making accurate diagnoses from tissue samples, as clinical treatment decisions depend on these diagnoses. Misdiagnoses can lead to unnecessary medical procedures, delayed treatment, or premature death. The document emphasizes that when errors occur, pathologists should take responsibility and never cover up mistakes, in order to uphold their ethical duties as physicians.

1. The Ethical Pathologist

2. Odontologicalethics Duty in good faith is ethical (independent of outcome) Consequence-based ethics Acting to increase health benefit is ethical Classical clinical ethics (4-principles) Autonomy & beneficence justice Ethics in medicine (briefly)

3. Clinical ethics applied to pathology 4-principles apply but are clumsy Designed for face-to-face patient care Ethics in pathology Autopsy and tissue retention Surgical pathology: not much written! Ethics in pathology

4. 'Now this quack wants me to see a specialist- what the hell is a PATHOLOGIST!?

5. Leave clinical ethics aside Concentrate on ethics for pathologists See how this can help us be ethical pathologists Our approach in this Lecture

6. Pathologists are Guardians of the Wax

7. Legal issues and the pathologist Civil liability Licensure & disciplinary actions Torts and discipline Misdiagnosis of biopsies and cytology Breast, prostate, lung, pap smears Misdiagnosis of forensic autopsies Murder, child abuse Ethical issues are often legal

8. How can we be ethical pathologists?

9. To whom we owe a duty Trust relationships: Patients Other physicians Pathologists, surgeons, oncologists Technologists Histology and cytology Medical community Public Courts and Coroner

10. Surgical pathology and cytopathology Medical autopsy Forensic autopsy Second opinion reviews*** Oncology: Cancer treatment Forensic: Expert witness Today we will concentrate on surgical pathology The scope of our work: ethicseverywhere

11. Ethical issues most frequent with misdiagnosis Misinterpretation (under & over-call) Disclosure of errors Shared decision-making for patients Pathologist = tissue diagnosis Clinicians = clinical diagnosis Who is responsible for an inappropriate treatment decision? The ethical surgical pathologist

12. Over-call misinterpretation Un-necessary operation (organ removal) Chemo and radiation therapy Premature death by therapeutic complications Under-call misinterpretation Delayed diagnosis (increased stage) Delayed therapy Premature death by disease Pathologic misdiagnosis

13. Clinical & radiologic Mobile nodule (3 cm) Not cystic or microcalcified Needle core biopsy High-grade invasive ductal carcinoma No excisionalbiopsy Radical mastectomy No quick section or sentinel node biopsy 50 year old woman with abreast lump

14. Primary breast lymphoma Un-necessary radical operation Treatment would have been different Post-operative complications Wound infection Lymphedema of arm Increased risk of other complications Radical mastectomy

15. Pathologist-patient relationship Punch's view of one patient's reaction to the new methods of diagnosis

16. PATIENT Right diagnosis Blind trust Definitive Since therapy is based on it Anonymous Faceless pathologist “The Lab”

17. PATHOLOGIST Tissue diagnosis Gold standard Objective Scientific and minimally subjective Anonymous Faceless patient Patient is a number

18. A slide is part of a patient Not only an exercise in pattern recognition We often dissociate reading slides with a pivotal medical act Pressures of work often make us concentrate on signing out rather than our role as medical consultants The ethics of diagnosis: 1

19. How we act in an ethical dilemma speaks about us as physicians and people Pride (arguing about being right when you are wrong) Shame of making a mistake Questioning your worth as a person and a physician People may judge you on how you react The ethics of diagnosis: 2

20. Never cover-up a mistake No one wants to make mistakes but we all do Rarely (2% in surgical pathology) Most errors do not cause patient harm Some errors lead to serious harm, loss of liberty, or death Make a commitment to life-long learning The ethics of diagnosis: 3

21. Good ethics comes as much from the search to be ethical as it does from understanding ‘ethics How to be an ethical pathologist