“Let’s Consider a Second Opinion”: Conceptual and Practical Challenges in Ethically Utilizing Second Opinions in Clinical Conflict

Abstract: Clinical conflicts are rising as our society becomes increasingly polarized, mistrust in the medical community grows, and patients and families challenge the traditional power imbalance in medical practice. Second opinions are recommended when an intractable conflict arises between an inpatient clinical team and patient and family or when clinicians consider whether therapies are potentially inappropriate. They are a powerful tool when usual ways of addressing conflict fail and may provide additional expert opinion, repair distrust, or adjudicate conflict. Second opinions are required by a certain multi-society organizational policy statement, some state laws, and institutional policies; however, the process of obtaining a second opinion lacks conceptual clarity and standardization. How and when second opinions are obtained, documented, and interface with the clinical team and patients and families is widely variable and lacks clarity, allowing for significant bias and inequities. As ethicists play pivotal roles in both navigating clinical conflict and shaping how healthcare institutions approach second opinions, this case-based panel seeks to foster a deeper understanding of their conceptual and practical dimensions. The first panelist will present a case highlighting different reasons for seeking second opinions and how various parties understand them. The second panelist will use cases to demonstrate procedural injustices that may occur when lack of standardization leads to variability in offering or granting second opinions. Finally, the third panelist will address logistical hurdles to obtaining second opinions from outside institutions and detail successful mechanisms to address these challenges.

Keywords: Clinical bioethics, Second opinions, Conflict