23. Dr. Jones will not operate on patients with a DNR order. Deaths during surgery are tabulated and reported, and he is judged professionally (in part) by his mortality rate.
#	Response Date	Comment
1.	Tue, 3/13/07 10:56 PM	One could control for patients with DNR orders in the calculation of rates.
2.	Tue, 3/13/07 11:00 PM	on the situations involved, whether the procedures are palliative or restorative, etc.
3.	Tue, 3/13/07 11:31 PM	Ethical problem and COI depending on how being "judged" effects his behavior.
4.	Wed, 3/14/07 12:16 AM	if the patient is at immediate and extreme risk if the predictable life-saving operatin is not done and no other surgeon is available
5.	Wed, 3/14/07 1:40 AM	Not enough info to decide
6.	Wed, 3/14/07 2:57 AM	On what kind of surgery he does. If it is elective surgery I wouldn't want them to have a DNR order either.
7.	Wed, 3/14/07 12:53 PM	I see some of these examples as ethical issues but not necessarily COI - depends on how you define COI - in this case - if it's defined as Dr Jones having a conflict between his desire to have a low mortality rate and the DNR order - then yes - i guess it is a serious COI issue.
8.	Wed, 3/14/07 1:49 PM	I would prefer that all docs try to keep their mortality rates down. Maybe he/she is not so skilled as another. Perhps they need to have a longer window on counting deaths due to surgery if patients can be resuscitated only to die outside the OR. This is a measurement issue.
9.	Wed, 3/14/07 3:35 PM	seems more of an ethical issue
10.	Wed, 3/14/07 6:08 PM	Dr. Jones should be allowed to practice medicine based on his perception of professional risk
11.	Thu, 3/15/07 5:05 PM	Not Sure
12.	Mon, 3/19/07 12:13 AM	Depends on the need and risk of surgery
13.	Mon, 3/19/07 4:17 PM	Perhaps, he is being judicious and not performing unnecessary surgery that can be harmful
14.	Mon, 3/19/07 5:30 PM	Are these two facts related?
15.	Tue, 3/20/07 5:02 AM	this is not a fair assessment. he should only be compared to other doctors like himself who do not operate on patients with a DNR order
16.	Mon, 4/23/07 1:12 PM	If the tabulation of data is the only reason he will not operate on patients with a DNR order, that is a serious conflict of interest
17.	Mon, 4/23/07 1:29 PM	It depends on the types of surgeries he performs and the expected rate of complications requiring resussitation.
18.	Mon, 4/23/07 3:41 PM	It depends on why he refuses to operate on DNR patients.
19.	Tue, 4/24/07 9:49 PM	There are many factors that contribute to what patients are accepted by a physician for that physician's care and affect the practice of medicine, including non-clinical pressures, and if the Dr Jones doesn't agree with the grading system, Dr Jones shouldn't be forced to abide.
20.	Wed, 4/25/07 1:28 PM	To me, this is morally repugnant, but does not strike me as a conflict of interest, if there are other surgeons available to do the surgery.
21.	Wed, 4/25/07 5:49 PM	If someone is a DNR anyway, why will they want to go through surgery? For the most part, it is not a COI
22.	Thu, 4/26/07 9:19 PM	if surgey is indicated it would be a serious conflict
23.	Fri, 4/27/07 5:38 PM	May be unethical but not a COI
24.	Mon, 4/30/07 11:16 PM	I don't understand this scenario.
25.	Tue, 5/8/07 3:29 PM	....
26.	Wed, 5/9/07 1:02 PM	It depends on his motivation. If he does this for his mortality # then it is a serious COI. If, however, he believes that he puts these patients at risk of precipitating their death by taking them to surgery, then there is no COI.