title: Ethics and high-value care.
abstract: High-value care (HVC) is en vogue, but the ethics of physicians' roles in the growing number of HVC recommendations demands further attention. In this brief report, we argue that, from the standpoint of individual physicians' primary commitments and duties to individual patients, not all HVC is ethically equal. Our analysis suggests that the ethical case for HVC may be both stronger and weaker than is ordinarily supposed. In some cases, HVC is not merely a 'good thing to do' but is actually ethically obligatory. In others, it is merely permissible-or even ethically suspect. More importantly, we suggest further that understanding HVC as ethically 'obligatory, permissible, or suspect' has implications for the design and implementation of strategies that promote HVC. For example, it questions the use of adherence to certain HVC recommendations as a physician performance metric, which may already be occurring in some contexts. Properly construed, ethics does not threaten HVC but can instead help shape HVC in ways that preserve the fundamental values of the medical profession.
authors.affiliation: Berman Institute of Bioethics and Division of General Internal Medicine, Johns Hopkins University and School of Medicine, Baltimore, Maryland, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: DeCamp
authors.affiliation: Divisions of General Internal Medicine and Health Care Policy & Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
mesh_terms: D003695:Delivery of Health Care / Q000941:ethics / Q000592:standards*; D019983:Guideline Adherence / Q000941:ethics*; D006801:Humans; D028681:Moral Obligations; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000941:ethics*; D011787:Quality of Health Care / Q000941:ethics / Q000592:standards*
keywords: Clinical Ethics; Codes of/Position Statements on Professional Ethics; Ethics