Medical ethics: what physicians say, in their own words

Last updated September 20, 2026.

Read together, the 307 KevinMD posts on medical ethics say one thing consistently: the four principles are easy to recite and do not decide the hard cases. Physicians on the site describe informed consent as a two-page form nobody sits down to obtain, honesty as a liability inside institutions that treat disclosure as risk, conflict of interest as both a real corruption and an accusation that has become excessive, and rationing as something the United States already does and will not name. Since 2025 the word they reach for is conscience: moral distress is named in 17 percent of the 2025 and 2026 posts against 2 percent in 2013 to 2016. Where physicians disagree, on paternalism, on paying for organs and surrogacy, on how much conflict of interest matters, and on whether an oath means anything, both sides are on this page under their own names.

This page is a maintained record of what physicians, bioethicists, and medical students have written about medical ethics on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 307 essays and podcast transcripts with ethics, moral, consent, conscience, paternalism, futility, rationing, autonomy, the Hippocratic Oath, honesty, disclosure, confidentiality, or conflict of interest in the title, published between February 2005 and September 2026 by 206 named contributors, 184 of the posts bylined by physicians and 28 by authors with a doctorate in ethics or a related field. Of the 307, 110 were published from 2023 onward and 41 in 2026 alone, the most of any year. Every claim is attributed to a named author with the month it was published, quoted in the author’s own words, and linked to the original.

This record is about the ethics physicians argue in print. Assisted dying is on the End of life: what physicians say, in their own words record and posts about it were routed there; the disclosure of medical errors is on the Medical errors: what physicians say, in their own words record; the conflict between conscience and employers is also on the Physicians and administrators: what physicians say about who runs medicine, in their own words record; the ethics of AI has its own section here and a fuller one on the Artificial intelligence: what physicians say, in their own words record. Bioethicists and students are cited at the same weight as physicians and identified as such. Each section opens with a direct answer, then what named authors have said, in the order they said it. Contributors who sell services into this subject are identified where they are cited. This is physician opinion and argument, not an ethics consultation.

Physicians on KevinMD agree that medicine moved from paternalism to autonomy over fifty years and disagree about whether it should have gone all the way: a surgeon says she has seen very few physicians sit down to obtain consent, a bioethicist says the consent requirement in research is eroding, and, since 2020, physicians describe autonomy dying in the pandemic and shared decision making giving way to physicians who know best. Informed consent appears in 24 percent of posts in 2013 to 2016 and 13 percent since 2025; paternalism in 9 percent in 2020 to 2022.

PalMD, an internist writing under a pen name, wrote in December 2012 that “Over the last fifty years the reliance on paternalism has given way to our value of patient autonomy,” in “Hold your disgust: A nuanced look at paternalism in medicine.” Sara Scarlet, MD, a surgeon, wrote in September 2015 that “I’ve seen very few physicians sit down to obtain it,” in “Informed consent defines 21st-century medicine.” Richard Gunderman, MD, PhD and James Lynch, MD, a radiologist and an oncologist, wrote in July 2017 that “Each year, millions of patients and research subjects are asked to sign informed consent forms,” in “The decline and fall of informed consent.” Ruth Macklin, PhD, a bioethicist, wrote in August 2018 that “The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding,” in “The erosion of informed consent in medical research.” Courtney Markham-Abedi, MD, a psychiatrist, wrote in November 2020 that “Paternalism and autonomy are at separate ends of a fluid spectrum,” in “Weighing the ethics of paternalism and autonomy.” Garrett Jensen, an MD-PhD student, wrote in December 2020 that “I have just seen the death of patient autonomy and the phoenix-like rise of medical paternalism,” in “COVID, paternalism, and the death of patient autonomy.” DeAnna Pollock, MD, a physician, wrote in April 2026 that “Families feel pressured to accept what clinicians believe is the correct decision,” in “When shared decision making gives way to medical paternalism.” Wonyun Lee, MD, a psychiatrist trained in both countries, wrote in May 2026 that “In South Korea, beneficence, the physician’s ethical obligation to act in the patient’s best interest, often supersedes patient autonomy,” in “Patient autonomy in psychiatry and the ethics of care.”

What do physicians say about honesty and disclosure?

On honesty the physicians writing on KevinMD have moved from the exam room to the institution: in 2011 the question was whether a patient was lying, and in 2025 it is whether a clinician can afford to tell the truth inside a reporting system that treats disclosure as instability. The record also holds the history, 90 percent of physicians in 1961 preferring not to disclose a cancer diagnosis, and the newest case, a chatbot to which disclosure changed nothing. Honesty or lying appears in 15 percent of posts before 2013 and 16 percent since 2025.

Stewart Segal, MD, a family physician, wrote in September 2011 that “there is no room for dishonesty in the exam room,” in “Honesty between doctors and patients goes both ways.” John F. McGeehan, MD, an internist, wrote in June 2023 that “We have to work hard every day to continue to be honest with our patients and to ourselves,” in “Medical ethics: Navigating ambiguity, honesty, and patient well-being in health care.” Megan Nix, a writer and patient, wrote in November 2023 that “As recently as 1961, 90 percent of physicians preferred not to disclose cancer diagnoses to their patients,” in “There’s no place for ‘benevolent deception’ in obstetrics.” Jeremy Howick, PhD, a researcher and author, wrote in December 2023 that one could conclude “not prescribing placebos and allowing nocebo effects to thrive is unethical,” in “A manifesto for the next revolution in nocebo and placebo studies.” Jenny Shields, PhD, a clinical ethicist, wrote in July 2025 that “Clinicians are obligated to disclose risk, but disclosure itself becomes a liability,” in “Institutional reporting systems discourage clinical honesty.” Kathleen Muldoon, PhD, a medical educator, wrote in April 2026 asking “what happens when, in our own medical training environments, students are not practicing intellectual honesty,” in “Driving medical education reform through intellectual honesty.” Nicole Drapeau Gillen wrote in September 2026 of a patient who told a chatbot he was ill, that “Disclosure changed nothing about how the model responded,” in “AI psychosis and the myth that disclosure protects patients.”

What do physicians say about conflicts of interest?

Conflict of interest is the ethics argument physicians on KevinMD have had most sharply with each other. One side says the ties between physicians, guideline authors, patient groups, and industry are real and pervasive; the other says the pen-and-lunch policing has become excessive and self-defeating, and that disclosure manages nothing. Conflict of interest appears in 7 percent of posts in 2013 to 2016 and 4 percent since 2025.

Darrell E. White, MD, an ophthalmologist, wrote in December 2011 that in the current view “the simple existence of other interests is de facto evidence of some nefarious conflict of interest,” in “Stop trivializing conflict of interest.” Andreas Laupacis, MD and Karen Born, MSc, a physician and a researcher, wrote in February 2012 that “Conflicts of interest in medical research are extremely common,” in “Conflicts of interest don’t always involve money.” Rocky Bilhartz, MD, a cardiologist, wrote in June 2015 that “We’ve now managed to invent conflicts of interest that we can apply to other people,” in “Conflicts of interest aren’t only about financial incentives.” Dr. Saurabh Jha, a radiologist, wrote in July 2015 summarizing Lisa Rosenbaum’s argument that “our obsessing with physician’s ties with pharma and our demonizing of industry have become excessive,” in “The loud chorus against conflict of interest.” Janice Boughton, MD, an internist, wrote in February 2017 of patient advocacy groups, that “More than one in 10 of these organizations received over half of their support from industry,” in “Why should we worry about conflict of interest?” Frederic W. Grannis, Jr., MD, a thoracic surgeon, wrote in July 2026 asking of a trial’s authors “what corporation might market the new molecular testing product,” in “The conflict of interest behind a cancer screening test.”

What do physicians say about rationing and futile care?

Physicians on KevinMD have said since 2010 that the United States rations care and will not say so: by ability to pay, by insurers, by patients skipping their own medications. The futile-care essays are the same argument at the bedside, a million dollars spent on a patient who cannot recover and a family asked to decide. The pandemic made the rationing explicit for a year. Rationing appears in 24 percent of posts before 2013 and 16 percent since 2025; futile or futility in 14 percent before 2013.

Doctor Grumpy, MD, a neurologist writing under a pen name, wrote in March 2010 that “This woman’s care has cost at least a million dollars here,” in “Futile care has human and financial costs.” Colin Son, MD, a surgical resident, wrote in April 2011 that reform advocates argue “we should embrace making rationing more rational with health care reform,” in “Rationing and limitations are inevitable in any health system.” Jim deMaine, MD, a pulmonologist, wrote in November 2012 of Oregon’s prioritized list that “This is what I would call rational rationing,” in “Does Oregon have the answer to rational rationing?” Robert Pearl, MD, a physician executive, wrote in March 2017 that “The word ‘rationing’ denotes a process for allocating essential resources in situations of scarcity,” in “Is health care rationing our only hope?” Edward Hoffer, MD, an internist, wrote in May 2019 that “We have rationing now, but the rationing is done by those who save money from doing this,” in “In a single-payer system, who will be doing the rationing?” Robert Pearl, MD, a physician executive, wrote in June 2019 that “Zolgensma, with its $2 million per-dose price tag, is a harbinger of rationing to come,” in “The ethics behind the world’s most expensive medication.” Elizabeth Sandel, MD, a physiatrist, wrote in June 2020 that “Medical rationing decisions are almost never reported,” in “Medical rationing in the age of COVID-19.” Narinder Singh Parhar, MD, a physician, wrote in June 2026 that “Patients delay appointments or ration medications because they simply cannot afford them,” in “Health care affordability is now a moral crisis.” Timothy Lesaca, MD, a psychiatrist, wrote in September 2026 that “The four principles of medical ethics offer familiar guidance,” and do not decide the hard cases, in “Medical ethics principles do not decide hard cases.”

What do physicians say about the Hippocratic Oath and conscience?

Physicians on KevinMD treat the oath as a real obligation and an unreliable text: tossed in the trash by modern practice, possibly not Hippocrates’ at all, rewritten until the newer versions stray, and, between 2019 and 2020, proposed for administrators by one physician and dismissed as pointless by an ethicist. Since 2025 the posts are about conscience under institutional pressure, and they name it moral distress. Hippocratic or oath appears in 15 percent of posts in 2013 to 2016 and 20 percent since 2025.

Jessica Gold, a medical student, wrote in June 2011 that “when I graduate I will get to spend time with my classmates writing our own oath,” in “Is First do no harm really part of the Hippocratic Oath?” Andrew Morton, MD, a physician, wrote in July 2014 that “in modern American medicine we have taken the Hippocratic Oath and summarily tossed it into the trash,” in “Throwing the Hippocratic Oath in the trash.” Mark Borden, MD, an emergency physician, wrote in May 2019 that “I believe that many hospital administrators will be proud to agree to and live by such an oath,” in “We need a Hippocratic Oath for administrators.” Paul B. Hofmann, DrPH, MPH, a hospital ethicist, wrote in January 2020 that “Developing a Hippocratic Oath for them would not make difference,” in “Would a Hippocratic Oath for health care executives make a difference?” Brian Elliott, MD, a physician, wrote in March 2023 of the scholar Ludwig Edelstein, that “He argued that The Oath was likely Pythagorean in nature,” in “The controversial origin of the Hippocratic oath.” Jeffrey A. Singer, MD, a surgeon, wrote in May 2023 that “These newer versions stray far from the oaths that older-generation doctors like me recited,” in “We need a new Hippocratic Oath that puts patient autonomy first.” Jenny Shields, PhD, a clinical ethicist, wrote in May 2025 that “Moral distress is the psychological toll of knowing exactly what the ethically appropriate action is,” and being prevented from acting on it, in “DSM-5 doesn’t name it, but moral distress is everywhere in medicine.” Patrick Hudson, MD, a physician, wrote in August 2025 that “When the answer is no, and when no internal mechanism can stop the harm, refusal becomes duty,” in “When conscience compels doctors to walk out.” Sami Sinada, MD, a physician, wrote in October 2025 that “You perform what the system demands and betray what your conscience knows,” in “Moral distress vs. burnout in medicine.”

What do physicians say about the ethics of research and AI?

The research ethics posts on KevinMD are about consent that was never asked: a Facebook experiment on 689,003 users, an agitation trial with opt-out consent, and trials in poor countries whose benefits flow elsewhere. Since 2019 the same questions are asked of AI, and the newest answer is that consent for an AI tool cannot be a one-time event. AI appears in 23 percent of the 2025 and 2026 posts against 0 percent in 2013 to 2016.

Winston Chiong, MD, PhD, a neurologist and ethicist, wrote in July 2014 of a study in which “researchers manipulated the emotional content of 689,003 Facebook users’ news feeds,” in “Informed consent and the ethics of the Facebook news feed study.” Sharona Hoffman, JD, a law professor, wrote in September 2019 that “AI in medicine also raises significant legal and ethical challenges,” in “Artificial intelligence in medicine raises legal and ethical concerns.” Harvey Castro, MD, MBA, an emergency physician who consults on AI, wrote in November 2023 that medicine faces a shift “from being accountable for using AI to potentially being liable for not using it,” in “Navigating the AI revolution in medicine: from liability and technicalities to ethics and policy.” Ronke Lawal, MBA, who is building an AI mental health product, wrote in October 2025 that “Traditional informed consent is inadequate for AI-assisted care,” in “Ethical AI in mental health: 6 key lessons.” Timothy Lesaca, MD, a psychiatrist, wrote in July 2026 that “International research is not inherently exploitative,” but becomes so when the risks stay and the benefits leave, in “Clinical trial ethics fails the world’s poorest patients.” Arthur Lazarus, MD, MBA, a psychiatrist, wrote in August 2026 of teaching images, that “educators should explain where they came from, whose bodies made them possible,” in “The ethics of medical images begins with provenance.”

What do physicians disagree about?

On paternalism, PalMD says it is not prima facie bad and Garrett Jensen mourns autonomy; Wonyun Lee, MD, was trained to rank them both ways. On paying for bodies, Janet Radcliffe Richards, a philosopher, wrote in May 2012 that “the people who defend the restrictions argue that it would be morally wrong to allow many kinds of organ procurement,” in “How transplants are causing ethical dilemmas.” and Ruth Macklin, PhD, sees nothing wrong in principle with paid surrogacy. On conflict of interest, Andreas Laupacis, MD and Karen Born, MSc, calls it extremely common and Rocky Bilhartz, MD, says it has been invented to apply to other people. On the oath for administrators, Mark Borden, MD, wants one and Paul B. Hofmann, DrPH, MPH, says it would change nothing. On harm reduction, Amy Faith Ho, MD, an emergency physician, wrote in June 2017 that “Current debates centering on the opioid crisis and e-cigarettes further highlight our failure to practice harm reduction,” in “From ‘do no harm’ to ‘reduce harm.’ It’s time to change the paradigm.” The record does not resolve these; it dates them.

What would fix it? What physicians propose.

Asked what would fix the ethics of practice, physicians on KevinMD propose consent obtained by someone who sits down, ethics committees used before the third surgery rather than after, a consent form for CPR, history taught alongside principles, one research standard for every country, and analysis that changes when the facts do, and institutions that stop treating an honest clinician as a risk.

Jeffrey Hall Dobken, MD, MPH, a pediatrician and ethicist, wrote in May 2010 that “One week after this third surgical procedure, a bioethics committee meeting was called,” in “Ethics of futile care.” Janice Boughton, MD, an internist, wrote in June 2013 that “If a patient really wants CPR, he or she or a surrogate decision maker should sign a consent form,” in “Improving informed consent for resuscitation without playing God.” Travis N. Rieder, PhD, a bioethicist, wrote in October 2017 that “the solution to the prescription opioid problem cannot simply be to stop using them,” in “An ethical dilemma for doctors: When is it OK to prescribe opioids?” Jacob Riegler, a medical student, wrote in November 2020 that racial myths persist in students’ minds “all the more reason for historical ethics to be a requirement,” in “Medical ethics and medical school: a student’s perspective.” Timothy Lesaca, MD, a psychiatrist, wrote in July 2026 that “The same ethical standard should guide research everywhere,” in “Clinical trial ethics fails the world’s poorest patients.” Kyoko L. Yoda, DMD, MSPH, MSD, a dentist and public health educator, wrote in August 2026 that “If those facts change, then the ethical analysis should also evolve,” in “What ethics education owes students when evidence changes.”

How has the medical ethics conversation changed since 2005?

The record starts with Kevin Pho’s short commentaries from 2007 to 2011, 25 of them, counted here but not cited. The 2010 to 2015 posts are the classical arguments: futility, rationing, paternalism, placebo, the oath, and conflict of interest, argued by physicians and by two bioethicists who wrote regularly. The record thins from 2016 to 2019. The pandemic year is about rationing made explicit and autonomy suspended. Since 2023 the record has doubled, and its subjects are institutional honesty, moral distress, AI, research in poor countries, and whether shared decision making has quietly become paternalism again. Justice is named in 21 percent of the 2025 and 2026 posts against 11 percent in 2013 to 2016.

Two things did not change. Autonomy is named in 15 to 43 percent of posts in every period. And the physicians who write about ethics on this site are mostly not ethicists; they are clinicians describing a case in which the principles did not tell them what to do.

Term 2005 to 2012 (66 posts) 2013 to 2016 (54 posts) 2017 to 2019 (34 posts) 2020 to 2022 (43 posts) 2023 to 2024 (35 posts) 2025 to 2026 (75 posts)
Informed consent 17 percent 24 percent 15 percent 5 percent 6 percent 13 percent
Autonomy 15 percent 33 percent 29 percent 19 percent 43 percent 36 percent
Paternalism 2 percent 20 percent 6 percent 9 percent 3 percent 3 percent
Honesty or lying 15 percent 22 percent 3 percent 12 percent 17 percent 16 percent
Conflict of interest 9 percent 7 percent 9 percent 0 percent 0 percent 4 percent
Rationing 24 percent 4 percent 24 percent 16 percent 3 percent 16 percent
Futile or futility 14 percent 6 percent 3 percent 2 percent 3 percent 4 percent
Hippocratic or oath 11 percent 15 percent 32 percent 37 percent 23 percent 20 percent
Moral distress or moral injury 2 percent 2 percent 6 percent 5 percent 6 percent 17 percent
Justice 11 percent 11 percent 6 percent 7 percent 9 percent 21 percent
AI 0 percent 0 percent 3 percent 0 percent 23 percent 23 percent

Term frequencies are the share of posts in each period whose text contains the term at least once, computed on the September 20, 2026 corpus of 307 posts with one stored expression per term.

The KevinMD medical ethics corpus by the numbers

These figures describe the set of KevinMD posts this page draws on. They are counts of what KevinMD has published, not a survey of physician views.

Measure Value
Posts in the corpus 307
Published 2023 or later 110
Published in 2026 (through September) 41
Named contributors 206
Posts bylined by physicians (MD or DO) 184
Posts by authors holding a PhD 28
Podcast episodes with transcripts 13
Kevin Pho’s 2007 to 2011 commentaries, counted but not cited 25
Posts not indexed, counted but not cited 16
Most frequent contributors M. Bennet Broner, PhD (8); Jim deMaine, MD (6); Ruth Macklin, PhD (5); Francisco M. Torres, MD (5); Michael Kirsch, MD (4)
Title matches routed or excluded 179: 4 assisted-dying posts to the end of life record, 175 with the subject thin in the text

How this page was built and how it is updated

The corpus was assembled from title searches for ethics, ethical, moral, informed consent, conscience, conscientious objection, paternalism, beneficence, nonmaleficence, futility, rationing, allocation, autonomy, the Hippocratic Oath, do no harm, bioethics, ethics committee, truth-telling, disclosure, confidentiality, whistleblowing, conflict of interest, placebo, deception, and honesty. Titles about work ethic and about moral injury as a burnout term were excluded. Assisted dying posts were routed to the end of life record, and posts whose text mentioned the subject fewer than three times were excluded. Term frequencies were computed against the full text of each post. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. 16 posts in the corpus are not indexed; they are counted but not cited. Quotations are taken verbatim from the original posts and were checked against the source text by script. Author credentials are as they appeared in the byline at publication; where the byline gave none, the credential is the one the post itself states. Bioethicists, a philosopher, a law professor, a patient, and medical students are cited at the same weight as physicians and identified as such. Contributors who sell services into this subject are identified where they are cited: Harvey Castro, MD, MBA, consults on AI, and Ronke Lawal, MBA, is building an AI mental health product. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. No ethics tag exists on KevinMD; the closest archives are the Physician category and the Patients tag. Related records: End of life: what physicians say, in their own words, Medical errors: what physicians say, in their own words, Physicians and administrators: what physicians say about who runs medicine, in their own words, Artificial intelligence: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

This page is updated as new essays on medical ethics are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Medical ethics: what physicians say, in their own words. KevinMD.com. Updated September 20, 2026. https://kevinmd.com/medical-ethics

The 52 KevinMD posts cited on this page, in order of publication