I am a psychiatrist with an interest in addiction treatment in academic and clinical practice. I will discuss the ethical dilemmas for clinical practitioners at the interface of patient care. The clinician’s responsibility to deliver patient care is constrained by the resources to hand. The clinician has to ensure the primacy of his or her duty to the patient. These include the four pillars of medical practice: beneficence, non-maleficence, justice and autonomy. A tension arises between the sustainability of the business and the duties of clinicians who work there towards patients and society, which is expressed in any conflicts between best practice in a profit driven business and the role of clinical guidelines. Without discussing individual cases or practitioners I will discuss where the clinician’s responsibilities and the profit driven model may bifurcate and suggest a framework for resolution.

There is no funding for this work. I have previously worked in private and NHS detoxification units.