Tag Archives: medical ethics

A Final Note from Colt’s Corner

Substack Banner Henri Colt Art of Being Human


Dear Friends,

Over the past years, you chose to receive these brief reflections through Colt’s Corner. I have always been mindful that your attention is not casual—it is given, and you have generously subscribed to Colt’s Corner with interest and enthusiasm.

I’ve decided now to bring this work into a single, more deliberate space on Substack. Not simply as short reflections, but as a sustained body of writing that explores what it means to live, to act, and to care attentively. I publish essays and reflective pieces that move between clinical experience and personal narrative, between art, literature, philosophy, science, and medicine.

With that, Colt’s Corner will no longer be updated.

If these notes have been meaningful to you, I invite you to continue with me here: henricolt.substack.com

Judgment, Identity, and the Age of Systems


Medicine is no longer defined solely by what physicians can do, but by how they assume responsibility for decisions made within increasingly structured, technology-driven systems. As diagnostic pathways, algorithms, and artificial intelligence begin to organize clinical decisions in advance, the physician no longer stands outside the system, but operates within it. What can be done is expanding rapidly. Yet, as capability grows, so too does the burden of deciding what should be done.

In this evolving landscape, professional identity is shifting. It is no longer anchored primarily in technical skill, but in judgment—the ability to interpret, question, and assume responsibility within systems that increasingly shape the conditions of decision-making. Technology can organize information and suggest pathways, but it does not bear responsibility. That remains strictly human.

👉 Read the full essay on Substack:
Judgment, Identity, and the Age of Systems

If you like what you read, please follow me and subscribe to The Art of Being Human on SUBSTACK


This essay also accompanies a recent video lesson exploring these ideas in greater depth—particularly the evolving role of judgment in interventional pulmonology.

Watch here:  Who Are We Becoming

The Question Patients Cannot Answer

Physician torn between two worlds: patient care and data


Procedural medicine is built on the premise that skills can be seen, measured, and compared. Physicians who perform procedures are trained, above all, to intervene, and their success is often defined by dexterity, decisiveness, and outcomes. It is therefore natural that patients would want to choose their doctors based on published results of technical success. Yet, somewhat paradoxically, only a handful of specialties provide robust, publicly accessible, risk-adjusted outcomes that allow meaningful comparisons across institutions, and even fewer at the level of individual physicians.

In Interventional Pulmonology, where technological advances have expanded the ability to diagnose and treat complex airway diseases, this gap remains particularly evident. Patients who require these often life-altering or life-saving procedures are left without clear guidance on how to choose their physicians. The question they most want answered; Who is the best doctor for me? is one that medicine, despite its commitment to evidence and measurements, is not yet equipped to fully address.

👉 Read the full essay on Substack: The Question Patients Cannot Answer

If you like what you read, please follow me and subscribe to The Art of Being Human on SUBSTACK

Exponential Thinking…Wow

displays health care and scientific advances along a nonlinear curve


People in general, and physicians in particular, are not always comfortable with exponential thinking. This is because we live life linearly. We grow older year after year. We learn first to crawl, then walk, then run. We learn to invest month after month to grow our net worth (though it is here that most people learn the value of compounding), and in medicine, we learn step by step, often one patient at a time. 

This way of thinking has been at the root of apprenticeship-like medical training. Experience is linear, so is mentorship, and the backbone of health care delivery.

The same might be said of our approach to the natural history of disease. For most illnesses, we speak of progression in stages, and even in the case of infections, we describe phases that progress over time from incubation to prodrome, through illness, decline, and convalescence. 

We have learned through bitter experience, however, that many infectious diseases: measles, Ebola, influenza, and COVID-19, for example, spread exponentially. We have also learned of the dangers of something known as exponential growth bias, which is defined as “the pervasive tendency to linearize exponential functions when assessing them intuitively.” 

Our public health systems and millions of patients bear the consequences of such misunderstanding.

Exponential growth is usually defined as a process in which change accelerates in proportion to what already exists (the classic J-shaped curve on a graph). In other words, the larger something becomes, the faster it grows. This contrasts with linear growth, whereby a quantity increases at a constant rate over an equal interval of time (the classic straight line on a graph).

In science, medicine, technology, and finance, linear thinking underestimates the acceleration of anything that grows exponentially. At its core, exponential thinking demands attention to rates of change rather than the quantity of change. 

Tumor growth presents a humbling illustration. Tumor cells, for example, are known to increase in number in proportion to their existing volume. In pulmonary medicine and oncology, we use tumor doubling time (DT) and volume doubling time (VDT) to assess pulmonary nodules and malignancies. Because malignant growth often follows near-exponential kinetics in its early phases, a lesion that appears small in diameter and stable over a short interval of time may already be progressing along a steep growth curve and doubling in volume.

Failure to appreciate this dynamic reflects a misunderstanding of the difference between linear and exponential growth. This invites complacency and exposes both patients and their health care providers to the risks of delayed diagnostic or therapeutic intervention.

Today, artificial intelligence introduces similar nonlinear dynamics into interventional pulmonology. Navigation systems refine accuracy through iterative learning. Imaging segmentation algorithms improve multiplicatively as datasets expand. Risk stratification models enhance predictive power across tens of thousands of cases. What once required the slow accumulation of individual procedural experiences now crosses continents and health care institutions with the click of a computer mouse. 

We must understand that many clinical processes, technological advances, scientific discoveries, and healthcare system failures are not gradual. They often follow a nonlinear curve and accelerate dangerously once a critical threshold is reached. Thinking exponentially helps us recognize these nonlinear dynamics before a crisis appears. 

Acting before a threshold is reached, rather than reacting after it has been crossed, is a mark of responsible, ethical, and forward-thinking leadership.

  • Berg SH, Lungu DA, Brønnick K, et al. Exponential Growth Bias of Infectious Diseases: Protocol for a Systematic Review. JMIR Res Protoc 2022;24;11(10):e37441. doi: 10.2196/37441.
  • Beibei J, Daiwei H, Carlijn M. et al., Lung cancer volume doubling time by computed tomography: A systematic review and meta-analysis. European Journal of Cancer 2024;212:114339. 10.1016/j.ejca.2024.114339.

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What Remains After a Patient Dies

: A solitary human figure seated in a dim, quiet interior space, facing soft light


I’ve written before on Colt’s Corner about resilience in medicine, mostly in the context of endurance, burnout, and recovery. Recently however, I found myself returning to the question from a different direction, less as a skill to be cultivated and more as an ethical stance based on human connection. 


After a recent lecture, several nurses and physicians spoke about what remains after a patient dies. They asked how one can resume work after facing therapeutic failures repeatedly or after suffering the emotional toll of sustained compassionate caregiving. Their questions led me to revisit resilience not as toughness, but as a form of presence that allows compassion without collapse. 

For those interested in a more contemplative examination of the subject, I explored these reflections more fully in a recent essay on Substack: What Remains After a Patient Dies.


If you like what you read, please follow me and subscribe to The Art of Being Human on SUBSTACK

Communication in Health Care: Patients and Providers

Effective communication in healthcare

 Communication in health care relies on a foundation of trust and psychological safety amid unexamined assumptions, non-dits (which is French for things left unsaid), potentially mismatched expectations, asymmetries of knowledge and power, vulnerability, unspoken emotional defenses, and differences in understanding or health care literacy. Perhaps this is why effective communication requires more than clarity of language. It also requires our attention to meaning, context, and subjective experiences, including the “emotional baggage” carried by all those involved in our conversations.

Whenever we communicate, we receive, transmit, and interpret both information and feelings. Psychological research shows that effective communication in health care is tied to perceived empathy, narrative coherence, and opportunities for all involved parties to be heard. Taking the time to sit at the patient’s bedside and avoiding potential distractions such as phone calls, computer screens, or unnecessary interruptions can be key to establishing rapport. In my experience, providers operating under time constraints, emotional strain, or institutional pressures have difficulty recognizing how fear, hope, and struggles tackling ambiguity or uncertainty adversely affect their patients’ understanding. They risk using technical jargon, matter-of-fact approaches, or paternalistic attitudes to rush through a conversation, disregard differences in health care literacy, or achieve a specific desired outcome. Hence, health care providers might subconsciously or intentionally distance themselves emotionally from their patients. The result is a potential undermining of a patient’s trust. Consequently, both caring and compassion are sacrificed on the altar of efficiency.  

Interprofessional communication between physicians, nurses, technicians, and allied health professionals also has its challenges. Healthy dialogue means overcoming real and perceived hierarchical barriers and role ambiguities. It means negotiating intergenerational differences, acknowledging differing professional identities grounded in diverse yet strangely singular training paradigms, and recognizing inward disengagement even when outward appearances signal agreement or a willingness to comply.

Overall, this introduces yet another layer of complexity to effective communication. Cultural expectations can vary significantly among trainees, mid-career professionals, and more senior practitioners. Intergenerational differences of opinion might exist regarding what constitutes competence and professionalism, for example, or how to communicate with respect to cultural diversity. Not everyone has similar views on the appropriateness of multitasking (it took me a while to realize that young people can remember and reflect on what I say even while scrolling through pictures and texts on their mobile phones), or on when to rely on narrative versus factual reasoning. 

Much more can be said about communication in health care. In future essays, I will briefly address dialogue between health care providers and administrators, conversations with patients’ families, and the challenge of effective communication with staff, other team members, and direct reports. I will also discuss communication failures and why I believe the observation and improvement of communication skills should be an integral part of competency—based training.  

Maleficence in Healthcare

Shows doctors and examples of intentional and unintentional maleficence


Maleficence in healthcare refers to any intentional and unintentional harm caused by healthcare providers or health systems. It is usually discussed in contrast to nonmaleficence, the avoidance of causing harm, one of the pillars of the Four Principles approach to medical ethics proposed by Beauchamp and Childress in the 1970s.

Intentional maleficence manifests as deliberate actions that knowingly harm patients. Thankfully, it is rare, and acts of intentional hurt, deception, exploitation, or fraud are universally frowned upon by health care providers, professional organizations, institutions, and society at large. Any intentional infliction of harm obviously betrays patient trust, which is the foundation of all physician-patient relationships.

Some of the most notorious examples of intentional maleficence stem from authoritarian regimes or times of military conflict. Acts ascribed to Nazi healthcare providers before and during World War II are among those most frequently cited. Forced euthanasia, the deliberate killing of populations considered unworthy of life, forced sterilization programs, and harmful experimentation in the name of science (such as cold-water immersion, intentional injection, or exposure to knowingly toxic substances, etc.) illustrate how Nazi doctors, midwives, nurses, and technicians intentionally murdered, tortured, or abused patients and other victims of the repressive Nazi regime. 

Other flagrant examples of intentional maleficence occurred during Argentina’s brutal military dictatorship (1976-1983). During this time, some health care providers were complicit in the torture or murder of innocent victims detained by state agents. This included documenting false causes of death (such as falls from high places), administering drugs to torture victims, and falsifying records used to facilitate unlawful adoptions of disappeared children. 

Equally disturbing are discoveries made during and after the Second Gulf War (2003-2011). Health care providers pressured by Saddam Hussein’s oppressive Ba’ath regime allegedly falsified death certificates and misrepresented legal reports of torture. Also troubling are reports that psychologists and United States military personnel failed to report human rights abuses of detainees undergoing interrogations at Abu Ghraib and Guantanamo Bay. 

Of course, cases of intentional maleficence are not limited to health care delivery under authoritarian or military regimes. Other examples include unethical human experimentation, the deliberate withholding of treatment (the 40-year Untreated Syphilis Study at Tuskegee comes to mind), performing unnecessary procedures regardless of context, economic misconduct and fraudulent practices to satisfy scientific, personal, or financial ambitions, and ideologically-driven care that disregards patient welfare in favor of personal gain or adherence to doctrinal beliefs and political policies.

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While intentional maleficence is a clear violation of professional ethics and fiduciary duty, the picture is less clear in cases of unintentional maleficence, which is both more prevalent and ethically complex. Unintentional maleficence usually stems from cognitive and experiential bias, system pressures, fragmented care, miscommunication, a propensity to practice medicine defensively, clinical uncertainty, or unwarranted therapeutic zeal. It can also be an unfortunate and even deadly result of medical error, negligence or professional incompetence.

Unintentional maleficence often occurs despite well-intentioned practices. In these cases, ethical analysis is challenging because health care providers usually act in the pursuit of beneficence. A prime example is any medical intervention for which possibilities for an undesired outcome are underestimated or not revealed. High-risk treatments, polypharmacy in vulnerable populations, and technically correct but ethically damaging decisions are other instances where harm may occur despite a health care provider’s intention to help. A well-known illustration is “the double effect,” in which a medical intervention has two causally independent outcomes: one that is ethically and legally acceptable, such as the relief of pain or anxiety, and another that is not, such as a patient’s death from oversedation.

Maleficence in healthcare includes both intentional and unintentional harm caused by clinicians or systems, raising complex ethical challenges that go beyond nonmaleficence. In my opinion, more conversations about these topics are warranted within the Interventional Pulmonology community. This is because maleficence encompasses both intentional and unintentional harms arising from clinical actions, flawed decision-making, or omission. These may result in ethical violations, poor patient outcomes, and ideological harm. Health care providers, institutions, and professional societies are morally accountable to design systems that minimize foreseeable harm and respond proactively to sentinel events. They should create and support conditions that prioritize patient safety, transparency, overall well-being, and ethical awareness over convenience, personal gain, or professional protectionism.

  • Beauchamp TL and Childress JF (2019). Principles of Biomedical Ethics (8th ed). Oxford University Press.
  • Beecher HK. Ethics and Clinical Research. N Engl J Med 1966;274:1354-1360.
  • Weindling PJ (2004). Nazi Medicine and Nuremberg Trials. Palgrave Macmillan.
  • Reis C, Ahmed AT, Amowitz LL, et al. Physician Participation in Human Rights Abuses in Southern Iraq. JAMA. 2004;291(12):1480–1486. doi:10.1001/jama.291.12.1480.
  • Scheper-Hughes, N. The Ghosts of Montes de Oca: Buried Subtext of Argentina’s Dirty War.” The Americas2015;72(2):187-220. Project MUSE, https://muse.jhu.edu/article/579738.
  • Newly unredacted report confirms psychologists supported illegal interrogations in Iraq and Afghanistan. ACLU Release, April 30, 2008. https://www.aclu.org/press-releases/newly-unredacted-report-confirms-psychologists-supported-illegal-interrogations-iraq.

The Ethics of Truth-Telling in Procedural Medicine

Ethics of truth-telling shows patient asking about the doctor's experience.


In this first essay of the new year, I thought I would dedicate a few paragraphs to the ethics of truth-telling in procedural medicine. From the time they are medical students, doctors are burdened by decisions of what to say and how much to share with patients. The range of topics for which these decisions apply is extensive. These extend from revealing the extent of one’s own experience to discussing complications, obtaining valid informed consent, revealing medical error, and sharing diagnostic findings, prognosis, and the likelihood of cure or treatment failure.

The ethical space truth-telling occupies in procedural medicine is especially complex because physicians often find themselves incorporating infrequently practiced or newly learned procedures into their interventional practices. From the time one performs their first blood draw or lumbar puncture to one’s first attempts to perform a complex airway procedure, the questions are the same. How should physicians answer their patients’ queries regarding the extent of their experience? What must they share about the extent of their patient’s disease and diagnosis? What do they say (and to whom) if something goes wrong? How and when do they involve their patients’ family members, and how much personal opinion versus facts should they share about presumptive diagnoses and prognosis?

It is no surprise that the ethical obligation to tell the truth: to disclose risks, alternatives, limitations, and uncertainties, remains foundational in virtually every medical cultural environment. In this sense, truth-telling is not only legally required but also a moral obligation rooted in the ethical principle of respect for autonomy and the preservation of human dignity.

The devil, of course, is in the details. For example, is a doctor’s failure to tell a patient this is their “first time performing the procedure independently” any different from exaggerating about their level of experience? Is a physician’s desire to simplify, soften, or selectively emphasize certain information a form of coercion, a benevolent attempt to reduce anxiety and facilitate consent, or a subconscious effort to frame discussions in ways that conform with institutional norms or personal goals and values that might differ from those of their patients? 

From an ethics perspective of justice, truth-telling in procedural medicine cannot be separated from notions of equity, power, and access to understanding. Patients do not enter procedural encounters on equal footing with their health care providers. They are not only at a disadvantage due to illness-induced vulnerabilities. They are also affected by disparities in health education, socio-economic status, language fluency, healthcare literacy, and cultural biases regarding whether and how to question a physician’s experience and authority. To complicate matters further, procedural risks are probabilistic and often context-dependent. The ethical weight of truthful disclosure in these settings is therefore especially pronounced.

Many other aspects of care related to telling the truth warrant discussion. In this short essay, I simply suggest that truth-telling in procedural medicine occupies a central place surrounded by the triumvirate of clinical uncertainty, technical expertise, and patient vulnerability. Physicians who navigate these unsteady waters can be guided, however, by their personal integrity, a profound respect for their patients’ moral agency, and a steady commitment to medical professionalism regardless of institutional and societal pressures.

  • Beauchamp TL and Childress JF. Principles of Biomedical Ethics. 8th ed. Oxford University Press, 2019.
  • O’ Neill O. Autonomy and Trust in Bioethics. Cambridge University Press, 2002.
  • Sheldon M. Truth-telling in medicine. JAMA. 1982 Feb 5;247(5):651-4. PMID: 7054566.

Beneficence, Benevolence, and the Act of Doing Good

Woman holding heart benevolently to elderly woman with cane. Benevolence and good intentions


More than two thousand years ago, the Hippocratic Corpus (5th century BCE) fostered principles of beneficence, non-maleficence, confidentiality, and accountability to help guide physician practices and behaviors. These ideals were later embraced by Christian, Jewish, and Islamic ethical traditions from the Middle Ages through the Enlightenment. In 7th century China, Sun Simiao emphasized compassion, selfless dedication, and duty in his important work, On the Absolute Sincerity of Great Physicians, while Buddhist traditions, coexisting with ancient Confucianism, valued generosity (dāna) and the precept of non-injury. Across cultures and eras, medical ethics has thus joined duty with virtue, blending obligation and character to help define good medical practice.  

In contemporary healthcare ethics, beneficence is described as actions and rules aimed at benefiting others, helping them further their legitimate interests and preventing or removing potential harms. It is usually viewed as a moral obligation or duty rooted in professional responsibility. It defines what one ought to do in a particular situation, whether to improve patient welfare, protect life, or pursue specifically desired health-related outcomes.

Benevolence, by contrast, describes a disposition, not an obligation. The Oxford Dictionary of Philosophy defines it as the “general desire for the good of others, and a disposition to act so as to further that good.” While benevolence derives from the principle of beneficence, it is a moral virtue equated with charity, kindness, and generosity. As such, it can be distinguished from beneficence in that it is grounded in goodwill toward patients rather than in professional duty. While beneficence concerns right action, benevolence concerns right intention—and the two, though often aligned, are not identical.

This distinction becomes evident in clinical practice. For example, a physician may act beneficently toward a patient because of their sense of duty, even when the patient is abusive, dangerous, or requesting medical aid in situations that conflict with the physician’s personal values. In such cases, a doctor’s intrinsic desire “to do good” for their patient may be lacking, yet they may still act rightly and in accordance with professional standards. 

Benevolence, however, explains actions of a different type. Grounded in the humanity of health care providers, it reflects a physician’s disposition toward goodwill rather than obligation. It may motivate behaviors that are ultimately detrimental to a patient’s well-being when unchecked by professional or ethical norms. It may also explain why some providers undertake actions that are heroic or go beyond those required by duty. In the extreme, these may involve extraordinary personal sacrifice to aid vulnerable patients. 

In the end, the practice of medicine is judged not only by outcomes and rules, but by intention. Beneficence may compel right action in the right circumstances, while benevolence often reveals the moral character—the right reasons—from which care emerges. Together, they affirm essential moral dimensions of ethical medical practice.

Silent Wounds of Medical Betrayal

Betrayal in medicine, patients and physician harm


Betrayal occupies a unique space in the human experience, as anyone who has felt betrayed knows all too well. In the healthcare environment, it represents one of the most ethically charged and psychologically damaging forms of a relational breakdown. From this perspective, it is very different from romantic betrayal or interpersonal treachery. It is a breach of trust and responsibility, a sorry manifestation of the power imbalance that exists between physicians and their patients. In this first of several short essays on the subject, I address the silent wounds of medical betrayal on the perpetrators themselves.

Medical care is both highly technical and grounded in an often obscure and changing clinical science.  While most physicians do what they believe is in their patients’ best interests, some jeopardize their personal and professional integrity to comply with institutional guidelines, a mentor’s instructions, financial obligations, political positions, or their perceived need to embrace technological advances before supporting scientific evidence is established. 

Knowingly providing suboptimal medical care, failing to disclose conflicts of interest, or making misleading statements or false promises are just a few ways physicians betray their patients’ trust. But there are others. Alfred Tauber, author of Confessions of a Medical Man, for example, wrote of the dangers of the physician-technocrat who turns medical care into a business transaction, and Oliver Sacks, in A Leg to Stand On, described the devastating emotional impact on patients who feel abandoned by their caregivers.

When doctors nonchalantly neglect a patient’s humanity, however, they do more than a disservice to their profession and their patients. An act of betrayal shatters the moral basis of professional obligation, the ethical foundation that resides in a fiduciary trust built on a patient’s vulnerability and the physician’s promise of beneficence. For the perpetrator (is that too strong a word?) professional burnout, cynicism, and a growing sense of personal failure can ensue, with long-term effects on a health care provider’s mental health.

The emotional consequences for the instigator of such betrayals, whether the betrayal is of a patient or of the ethical obligations of the profession, are what psychologists call self-inflicted moral injuries. Shame and guilt, self-disgust, emotional exhaustion, and detachment from colleagues and patients can lead to increased feelings of anxiety or depression, substance abuse, and sleep disruption. Over time, these and others may lead to developing a distorted sense of professional obligations, poor performance, and loss of credibility. 

The effects of self-inflicted moral injury on one’s sense of meaning, purpose, and personal identity can be devastating. They may lead to abandoning the health care profession, and in worst case scenarios, to excessive drug and alcohol consumption, disruption of the nuclear family, and even suicide.

Committing an act of medical betrayal causes a silent wound that easily grows over time. The old adage, to forgive and forget, does not readily apply, and often, this wound requires professional help to heal.