The fiduciary obligation of physicians to "just say no" if an "informed" patient demands services that are not medically indicated.

After viewing several television commercials promoting a certain medical treatment and doing some related research on the Internet, a middle-aged man walks into his physician’s office and requests a prescription for an advertised “lifestyle” medication. He explains that he is going on a cruise with his girlfriend the following week and he needs the medication as soon as possible. The doctor reminds the patient that he has been treating him for high blood pressure and this drug may cause him some severe problems, possibly even a heart attack. The patient briefly considers the risks and then demands the drug anyway. The physician thinks to himself: “I just graduated from medical school with $250,000 of debt. Amanda and I just opened this practice, and we can’t afford to alienate patients if we want to stay afloat. I can’t believe how much we’re paying in rent and salaries, and my family seems to think it’s time we start living like a ‘doctor’s family.’ As a resident, I wouldn’t have given this guy this drug, but now I can’t afford to say no. Besides, I’ve fully explained the risks—it’s his call. And the risks aren’t that high. Plus, maybe his managed care plan will deem it medically unnecessary or impose a huge co-pay, and when he sees how much it’s going to cost him, he’ll just drop this idea.”