Defensive medicine (DM) is a medical practice performed primarily to protect clinicians from potential legal liability or professional criticism, rather than it being indicated to benefit a patient’s health. The detrimental impact of this practice is recognised across healthcare systems globally, with studies indicating 80-90% of clinicians reporting defensive behaviours. In Australia, 43% of doctors reported increased referral rates and 55% ordered more tests owing to medicolegal concerns.
Despite many considering DM as ethically impermissible, particularly owing to unnecessary costs and risks imposed on patients, such high prevalence of defensive behaviours amongst doctors may be an indication that they consider this practice as morally permissible. This poses the question whether certain types of defensive behaviour could be ethically justifiable, specifically those that do not impose direct harm to patients or burden to the healthcare system.
The paper first explores and defines DM as a term, differentiating this concept from other neighbouring practices like cautious or unnecessary healthcare. It then analyses cases of defensive behaviour in the medical sector and explores the extent of ethical permissibility along the spectrum of different practices in terms of harmful outcome. In doing so, certain practices are differentiated from others to examine whether there is a case in which defensive behaviour may be more or less ethically permissible. Finally, the paper will propose a framework of criteria upon which to determine the level of ethical permissibility based on the characteristics of the defensive practice.