Advancing physicians' skills versus safeguarding individual patient interests: an ethical dilemma.

The divide between medical innovation and routine clinical practice is a grey zone. Clinicians are often torn between their dual roles as healers and investigators, between the need to cure and the desire to improve existing practice. While medical research involves “experimentation” on human subjects to identify novel treatments, one is often tempted to use newer techniques to improve the outcomes of treatment in routine clinical practice. There is no controversy surrounding the adoption of a new therapy which has been proven to be superior to the existing methods of treatment and which can be delivered as well, if not better. However, a moral and ethical dilemma arises when the new therapy has not yet been proven to be superior and the treating physician is not certain that administering this treatment would be at least as good as providing standard care. This is especially so when dealing with potentially vulnerable patients. In procedure-related fields, such as surgery, endoscopy and interventional radiology or cardiology, this problem is compounded because the physician not only has to decide if the “new” treatment is truly experimental or just an adaptation of an established method, but also whether he/she possesses the skills and expertise required for the new procedure.