A bleeding controversy: duties and decisions in the face of conflicting advice

The authors use a composite case based on their experiences to illustrate the ethics of inter-professional conflict. An HDU team receive two telephone calls. One is from the patient's cardiologist, who states that a patient must be anti-coagulated without delay. The other is from the surgeon responsible for the patient's current admission, who states that the patient must under no circumstances be anti-coagulated. We argue that in the absence of a broad understanding of the patient's condition and values, specialists should be cautious when giving categorical orders or, at the very least, should provide the rationale for their advice to help the care leader in his or her decision-making.