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To the Editor: Dr Bloche¹ offers a wealth of interesting thoughts about conflicting interests of clinicians, but fails to offer useful advice about what physicians should do. It is instructive to observe that physicians always have faced competing loyalties to society, which existing ethics do little to resolve.² It is less helpful to simply leave physicians to wrestle with these conflicts within their individual consciences, with the only guidance to consider "the moral weight [society] give[s] to controlling health care costs." More substantive principles, such as making the best use of resources available for a group of patients or exercising impartial clinical judgment regardless of insurance status, have been advanced³ and debated.^4-5

I take issue with 2 points in particular that underlie Bloche's ethical agnosticism. First, it is not the case that ethical theory is unable to address the moral force of patients' consent to role conflicts. This indeed is . . . [Full Text of this Article]