Ethics consultations masking economic dilemmas in patient care

The ethical and economic aspects of treatment decisions are often intimately entwined. We demonstrate how clinical economic questions were raised in clinical ethics consultations involving three patients: a 49-year-old retarded man who required short-term tube feeding; a 74-year-old man with metastatic prostatic cancer whose relatives disagreed about whether or not he should have surgical treatment; and a 55-year-old man whose health maintenance organization declined to pay for liver transplantation. Ethics consultants can help to clarify financial constraints and to resolve financial conflicts of interest. All physicians must develop the ability to unmask economic issues in medical care.