In this issue of CQ, we are pleased to inaugurate a new Department, Professionalism, with an article by Jeffrey Blustein entitled “When Doctors Break the Rules: On the Ethics of Physician Noncompliance.” The article examines the ethical dilemmas physicians face when they believe that promoting the best interests of patients requires them to break one or more institutional rules. Because the article explores the scope of professional obligations to patients, it is a fitting essay with which to launch the new Department.

The goal of the Professionalism Department is to provide a forum for identifying, justifying, and applying standards for determining whether practices, decisions, and actions are professionally required, permitted, or prohibited. Submissions can address professionalism in medicine, nursing, pharmacy, psychology, psychiatry, dentistry, physical therapy, or any other healthcare or allied health discipline. Submissions may take the form of shorter or longer (3,000- to 5,000-word) articles, case studies, or commentaries.

Blustein’s essay considers whether there are ethical limits to what healthcare professionals may do to promote the health interests of patients. Future submissions might examine whether there are ethical limits to what healthcare professionals may refuse to do for patients. Conscience-based refusals to provide health-related goods and services have occasioned a sizeable literature that explores the requirements of professionalism in a variety of disciplines. However, reports of refusals by physicians to provide services to patients for a variety of reasons that are not conscience-based underscore the need for a broader examination of the requirements of professionalism. For example, shortly after the U.S. Congress passed the Patient Protection and Affordable Care Act in March 2010, a Florida urologist reportedly posted a sign on his office door stating: “If you voted for Obama . . . seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”Footnote ¹ It has also been reported that an increasing number of U.S. physicians are expected to refuse to accept Medicaid or Medicare patients in response to reductions in reimbursement rates. Some pediatricians currently refuse to accept patients if parents will not allow their children to receive the MMR (mumps, measles, and rubella) vaccine. Some physicians reportedly have refused to treat patients who engage in “unhealthful behaviors,” such as smoking, failing to control their weight, and abusing alcohol and/or drugs. Submissions might consider whether any of these refusals constitute unprofessional conduct.

Such refusals are only one type of issue that is suitable for the new Professionalism Department. Some additional possible topics include strikes; sex with patients and trainees; gaming the system; prescribing medications for physical and/or cognitive enhancement (e.g., steroids, Adderall, Ritalin, and Provigil); cosmetic surgery; responding to a colleague’s suspected incompetence or impairment due to drugs, alcohol, or illness; obligations toward other members of the profession; professional obligations during pandemics, bioterrorist attacks, and natural disasters; whether professionals have obligations to promote healthcare access and/or social justice; participation in capital punishment, assisted suicide, euthanasia, and enhanced interrogation (torture); collaboration with pharmaceutical or device manufacturers in research or educational activities; standards of care for providers donating services in resource-poor countries; and whether professionals have an obligation to keep their political views to themselves.

These are only a sample of the numerous topics within the scope of the CQ Professionalism Department. Submissions on these or any other topic related to professionalism are welcome. Manuscripts should conform to the CQ Guidelines for Contributors. All submissions should include an abstract and should be sent electronically to the Professionalism Department coeditors, Mark Wicclair (wicclair@pitt.edu) and David Barnard (barnard@pitt.edu).