Ethics and Professionalism A Guide for the Physician
Assistant 1st Edition
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Ethics and
Professionalism
A Guide for the Physician
Assistant
Barry A. Cassidy, PhD, PA-C
Senior Vice-President Professional Services
NEXTCARE Urgent Care
Mesa, Arizona
Former Executive Director
Arizona Medical Board and Arizona Regulatory
Board of Physician Assistants
Former Professor, Associate Dean and Director
Physician Assistant Program
Midwestern University
Glendale, Arizona
J. Dennis Blessing, PhD, PA-C
Associate Dean for South Texas Programs
School of Allied Health Sciences
Professor and Chair
Department of Physician Assistant Studies
The University of Texas Health Science Center at
San Antonio
San Antonio, Texas
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F.A. Davis Company
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Copyright © 2008 by F.A. Davis Company
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Library of Congress Cataloging-in-Publication Data
Ethics and professionalism : a guide for the physician assistant /
[edited by] Barry A. Cassidy, J. Dennis Blessing.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-1338-6 (pbk. : alk. paper)
ISBN-10: 0-8036-1338-5 (pbk. : alk. paper)
1. Physicians assistants—Professional ethics. 2. Physicians assistants—Training of—Moral and ethical
aspects. 3. Medical ethics. I. Cassidy, Barry A. II. Blessing, J. Dennis.
[DNLM: 1. Physician Assistants—ethics. 2. Clinical Competence. 3. Decision Making. 4. Ethics, Clinical.
W 21.5 E84 2008]
R697.P45E84 2008
174.2—dc22 2007002960
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients,
is granted by F.A. Davis Company for users registered with the Copyright Clearance Center (CCC)
Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood
Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a sep-
arate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is:
8036-1338/08 0 $.10.
00Cassidy(F)-FM 6/4/07 11:27 PM Page v
Dedication
My efforts for this book are dedicated to the memory of Eugene A. Stead, Jr., MD, founding father
of the PA concept; and James R. Pluth, MD, retired thoracic and cardiovascular surgeon. Both men
were mentors, friends, and ethical role models for me. I also dedicate this book to my wife Barbie
Cassidy, who keeps me grounded and helps me live an ethical life with love.
—BAC
My efforts for this book are dedicated to Richard R. Rahr, EdD, PA-C, colleague, mentor, friend. A
role model and example of ethical behavior for us all.
—JDB
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Preface
This book was conceived more than 5 years ago. Its production was a labor of love and a program
of persistence. In our roles as educators of physician assistant students, we recognized that a text-
book discussing ethics and professionalism focused specifically for PA students would be helpful to
both them and their educators.
Physician assistants are unique health-care professionals in many ways. During the beginning
years of the profession, typical PA students had a significant amount of health-care experience; many
of them were military corpsmen and medics. This experience allowed these early PAs the opportu-
nity to see other health-care professionals in action and to appreciate not only the culture of the
physician-patient relationship but also the interdependent professional interactions of all members of
the health-care team.
Today’s PA students have far more academic preparation and less health-care experience than
their older colleagues. The PA medical education curriculum is academically intense and accom-
plished quickly. The clinical curriculum is also intense and attempts to provide PA students with clin-
ical exposure across a wide range of medical experiences and specialties. The standards for PA
education require curricula to include education in ethics and professionalism. A component of
becoming a critical thinker involves understanding the ethics of decision making that affects others.
Ethics and professionalism are usually included in the academic portion of the PA curriculum.
Faculty need to lead and encourage discussion and analysis of issues that involve professional behav-
ior and ethical conflicts to help students prepare for approaching clinical dilemmas. This text was
designed to help PA educators and students accomplish this important task.
In putting this book together, we looked across the nation for experts in physician assistant edu-
cation and ethical training who also had a clear understanding of the challenges facing PAs in today’s
practice environment. While many excellent books and treatises are available concerning issues in
medical ethics, none have been written from the perspective of a dependent practitioner who shares
in one of the most intimate of life’s experiences, the physician-patient relationship. For PAs and their
supervisors and patients, this has evolved to the physician assistant–patient–physician relationship.
It is not a lesser relationship; it includes all the same ethical and professional issues.
This book has been designed not only for today’s PAs but also for PAs in the future. Cases are
presented to help illustrate ethical principles and provide insight into the ethics and professionalism
considerations of being a PA student. All chapters are designed to stimulate discussion and blend
theory and practice.
Although the process of completing this work has been long, we hope you’ll agree that the wait
has been worthwhile.
Barry A. Cassidy, PhD, PA-C
J. Dennis Blessing, PhD, PA-C
vii
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Contributors
Barry A. Cassidy, PhD, PA-C Therese Jones, PhD
Senior Vice-President Professional Services Associate Professor
NEXTCARE Urgent Care Department of Internal Medicine,
Mesa, Arizona Division of Medical Ethics and
Former Executive Director Humanities
Arizona Medical Board and Arizona Regulatory Board of University of Utah Health Sciences Center
Physician Assistants Editor, Journal of Medical Humanities
Former Professor, Associate Dean and Director
James E. Meyer, MD
Physician Assistant Program
Midwestern University
Midwestern University
Glendale, Arizona
Glendale, Arizona
Elin Armeau, PhD, PA-C
Randy D. Danielsen, PhD, PA-C
Eastern Virginia Medical School PA Program
Arizona School of Health Sciences
Norfolk, Virginia
Associate Professor and Chair
Physician Assistant Studies Michael Potts, PhD
Mesa, Arizona Department of Philosophy and Religion
Methodist College
Ann Davis, MS, PA-C
Fayetteville, North Carolina
Director of State Government Affairs
American Academy of Physician Assistants Peter M. Stanford, MPH, PA-C
Alexandria, Virginia Academic Coordinator
Clinical Assistant Professor
Moira Fordyce, MD, MB, ChB, FRCP Edin, AGSF
Physician Assistant Department
Laguna Niguel, California
University of Maryland Eastern Shore
Danny L. Franke, PhD Princess Anne, Maryland
Alderson-Broaddus College
Philippi, West Virginia
FJ Gianola, PA-C
Faculty
MEDEX Northwest Physician Assistant Program
School of Medicine and Center for Health Sciences
Interprofessional Education and Research
University of Washington
Seattle, Washington
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Reviewers
Gilbert A. Boissonneault, Julie B. Keena, MMSc, PA-C Rena N. Mitchell, MS, CHES,
PhD, PA-C Chair and Associate Professor RPA-C
Professor Physician Assistant Program Acting Chairperson and Clinical
Division of Physician Assistant Nova Southeastern University Assistant Professor
Studies Naples, Florida Physician Assistant Program
University of Kentucky SUNY Downstate Medical Center
Pat Kenney-Moore, MS, PA-C
Lexington, Kentucky Brooklyn, New York
Associate Director and Academic
Courtney Cribbs Coordinator John M. Schroeder, JD, PA-C
Graduate Physician Assistant Program Director
Physician Assistant Program Oregon Health and Science University Physician Assistant Program
University of Findlay Portland, Oregon Idaho State University
Findlay, Ohio Pocatello, Idaho
Deborah E. Kortyna, MMS,
Katherine M. Erdman, PA-C Victoria Scott, MHS, PA-C
MPAS, PA-C Assistant Professor Director and Senior Physician
Assistant Director and Instructor Physician Assistant Program Assistant
Physician Assistant Program Chatham College Breast Wellness Clinic
Baylor College of Medicine Chatham, Pennsylvania Duke University Medical Center
Houston, Texas Durham, North Carolina
Clara LaBoy, MS, PA-C
Carl Fasser, BA, PA-C Assistant Professor Robert J. Spears, MPAS, PA-C
Director and Associate Professor School of Physician Assistant Studies Former Assistant Professor
Physician Assistant Program Pacific University Physician Assistant Program
Baylor College of Medicine Forest Grove, Oregon University of Findlay
Houston, Texas Findlay, Ohio
Mary Ann Laxen, MAB, PA-C
James Hammond, MA, PA-C Director and Associate Professor Erica Young
Director Physician Assistant Program Student
Physician Assistant Program University of North Dakota Physician Assistant Program
James Madison University Grand Forks, North Dakota Baylor College of Medicine
Harrisonburg, Virginia Houston, Texas
Anthony A. Miller, MEd, PA-C
Wanda Hancock, MHSA, Director
RT(R)(T), PA-C Division of Physician Assistant
Professor Emeritus Studies
Physician Assistant Program Shenandoah University
Medical University of South Carolina Winchester, Virginia
Charleston, South Carolina
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Acknowledgments
In modern times, no book is the result of the efforts of one person. Even the best writer needs help
with research, development, proofing, review, critique, and so forth. This effort is no different.
First, the contributors deserve the most praise for their work. Their efforts have resulted in a body
of work new to physician assistant literature. They are a truly dedicated group of people, and we are
lucky to be able to share in their expertise.
Our world presents a set of challenges at every level, and the professional and ethical develop-
ment of our students is one key to our survival and growth. Life, much less the practice of medicine,
presents us with ethical challenges every day. Every decision in medicine has an ethical component,
some with huge components that affect provider, patient, family, and society as a whole. Helping stu-
dents master and understand these ethics is a challenge. The needs of those students drive what we
do in education. So we must acknowledge our students—we are certain our contributors will agree—
as the primary source of our efforts to help define and clarify ethical challenges.
Equal thanks must go to the people who work “behind the scenes” at F.A. Davis. We know work-
ing with editors and authors is like herding cats, but the people at F.A. Davis are special, with high
levels of tolerance and patience. Our initial contact was Carl Holm, who directed us to Jennifer Pine
and Andy McPhee. Jennifer and Andy certainly went way beyond the call to duty to make this effort
succeed. Their guidance has been invaluable because this book took a lot of effort at every level and
more time than we ever imagined. We are sure that our stops, starts, turnabouts, and changes of
minds on this book would have driven other people crazy. Fortunately, they stayed sane (even when
we were not), and we are eternally grateful for that.
We also want to acknowledge our colleagues who inspire us to make such efforts and those who
support us while we do. Of course, we can never forget our families and friends. They are the ones
who keeps us grounded, which we often need.
xiii
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