Ethical issues for the plastic surgeon in a tumultuous health care system: dissecting the anatomy of a decision.

[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.