This problem is most extreme in the managed care plans that request the physician not to inform the patient about alternative treatments or tests, or that provide financial incentives that encourage the physician to deny the patient necessary care (see the discussion of the Shea case). This benefits the plan by preventing patient complaints about being denied alternative treatments. It completely defeats informed consent, however, and leaves the physician in an indefensible posture if the patient is injured.

Physicians can also have financial and personal conflicts of interest in medical research. A patient with a rare condition can make a physician’s reputation as a scientist. In the biotechnology area, a patient’s tissues can be the basis of extremely valuable commercial products. This was the subject of litigation in the Moore case, [Moore v. Regents of Univ. of Cal., 793 P.2d 479 (Cal. 1990) ] which involved a physician treating a patient who was afflicted with hairy-cell leukemia. During the treatment, the physician determined that the patient’s cells would be suitable for making into a cell line with commercial potential. The physician mislead the patient into consenting to numerous medical procedures to facilitate this research work by telling the patient that they were necessary for treating his medical condition. The patient eventually found out what was going on and sued the physician, claiming he was entitled to the value of the cell line derived from this tissue. The court found that whenever a physician has a financial conflict of interest with a patient, the physician’s fiduciary obligations require the physician to make a full disclosure of all relevant information to the patient.