title: The obligation of physicians to medical outliers: a Kantian and Hegelian synthesis.
abstract: BACKGROUND
  Patients who present to medical practices without health insurance or with serious co-morbidities can become fiscal disasters to those who care for them. Their consumption of scarce resources has caused consternation among providers and institutions, especially as it concerns the amount and type of care they should receive. In fact, some providers may try to avoid caring for them altogether, or at least try to limit their institutional or practice exposure to them.
  
  
  CONCLUSIONS
  We present a philosophical discourse, with emphasis on the writings of Immanuel Kant and G.F.W. Hegel, as to why physicians have the moral imperative to give such "outliers" considerate and thoughtful care. Outliers are defined and the ideals of morality, responsibility, good will, duty, and principle are applied to the care of patients whose financial means are meager and to those whose care is physiologically futile. Actions of moral worth, unconditional good will, and doing what is right are examined.
  
  
  CONCLUSIONS
  Outliers are a legitimate economic concern to individual practitioners and institutions, however this should not lead to an evasion of care. These patients should be identified early in their course of care, but such identification should be preceded by a well-planned recognition of this burden and appropriate staffing and funding should be secured. A thoughtful team approach by medical practices and their institutions, involving both clinicians and non-clinicians, should be pursued.
authors.affiliation: Department of Anesthesiology, Medical College of Ohio, 3000 Arlington Avenue, Toledo, Ohio 43614, USA. TPapadimos@mac.com
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Papadimos
authors.forename: Alan P
authors.initials: AP
authors.lastname: Marco
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D026689:Ethical Analysis; D006801:Humans; D018447:Medical Futility; D017057:Medically Uninsured; D028681:Moral Obligations; D016311:Outliers, DRG; D010684:Philosophy; D010820:Physicians / Q000941:ethics*; D011639:Public Opinion; D016079:Refusal to Treat / Q000941:ethics; D040841:Resource Allocation / Q000941:ethics*; D012935:Social Justice