title: Ethical issues for the plastic surgeon in a tumultuous health care system: dissecting the anatomy of a decision.
abstract: BACKGROUND
  Society anticipates that plastic surgeons will make ethical decisions that are solely in the best interest of their patients. However, a variety of competing factors exert an influence on all decision-making processes.
  
  
  METHODS
  Multiple competing factors that commonly influence decision-making by plastic surgeons, on both conscious and subconscious levels, are identified. By exploring the ramifications of these factors, a more ethical outcome can be achieved.
  
  
  RESULTS
  Some of these competing interests that can sidetrack ethical decision-making include personal finances (e.g., ownership of surgical centers, selection of procedures, pricing); outside regulations (e.g., Emergency Medical Treatment and Active Labor Act of 1986 and care of the uninsured); and professional duty (e.g., informed consent, discussion of error).
  
  
  CONCLUSIONS
  Plastic surgeons who are aware of the competing interests that influence their decision-making processes stand a greater chance of achieving ethical outcomes. Nevertheless, with the growing volume of nonreimbursed care and expectations of perfect outcomes, achieving uniformly ethical decisions without burdensome self-sacrifice is difficult at best.
authors.affiliation: Glen Ridge and Roseland N.J.; and Iowa City, Iowa From private practice; Stern & Kilcullen, LLC; and University of Iowa Hospitals and Clinics.
authors.forename: Ross I S
authors.initials: RIS
authors.lastname: Zbar
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Taylor
authors.forename: John W
authors.initials: JW
authors.lastname: Canady
mesh_terms: D016265:Conflict of Interest; D003657:Decision Making / Q000941:ethics*; D004632:Emergency Medical Services / Q000941:ethics; D004992:Ethics, Medical; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008318:Malpractice / Q000331:legislation & jurisprudence; D019300:Medical Errors / Q000941:ethics; D009014:Morals; D019651:Plastic Surgery Procedures / Q000191:economics / Q000941:ethics*; D013518:Surgery, Plastic / Q000941:ethics*