Shared Responsibility After Referral: Ethical Challenges in Preventing Harm

Authors

  • Ohad Avny Department of Family Medicine, Clalit Health Services, Hebrew University of Jerusalem, Jerusalem, Israel
  • Mayer Brezis Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel https://orcid.org/0000-0002-3199-9641
  • Anat Tsur Department of Endocrinology and Metabolism, Clalit Health Services, Hebrew University of Jerusalem, Jerusalem, Israel https://orcid.org/0000-0001-8573-4705

DOI:

https://doi.org/10.7202/1126630ar

Keywords:

responsibility, accountability, referral, physician, care, harm

Language(s):

English

Abstract

The case illustrates how fragmented communication and blurred accountability between primary and specialty care can compromise the principles of beneficence and nonmaleficence, resulting in preventable harm for patients. To prevent such outcomes, healthcare providers should collaboratively determine who holds primary responsibility for the patient’s care at each stage of the referral process.

References

1. Frost DW, Toubassi D, Detsky AS. Rethinking the consultation process: Optimizing collaboration between primary care physicians and specialists. Canadian Family Physician. 2012;58(8):825-28.

2. Lee MS, Ray KN, Mehrotra A, et al. Primary care practitioners’ perceptions of electronic consult systems: A qualitative analysis. JAMA Internal Medicine. 2018;178(6):782-89.

3. Janssen M, Sagasser MH, Fluit CRMG, et al. Competencies to promote collaboration between primary and secondary care doctors: An integrative review. BMC Family Practice. 2020;21:179.

4. Timmins L, Kern LM, O’Malley AS, et al. Communication gaps persist between primary care and specialist physicians. The Annals of Family Medicine. 2022;20(4):343-47.

5. Cook RI, Render ML, Woods DD. Gaps in the continuity of care and progress on patient safety. BMJ. 2000;320(7237):791-94.

6. Kern LM, Bynum JP, Pincus HA. Care fragmentation, care continuity, and care coordination — How they differ and why it matters. JAMA Internal Medicine. 2024;184(3):236-37.

© Han Han Li

Downloads

Published

2026-06-22

How to Cite

[1]
Avny O, Brezis M, Tsur A. Shared Responsibility After Referral: Ethical Challenges in Preventing Harm. Can. J. Bioeth 2026;9:131-3. https://doi.org/10.7202/1126630ar.

Issue

Vol. 9 No. 3 (2026): Open Issue

Section

Case studies

License

Copyright (c) 2026 Ohad Avny, Mayer Brezis, Anat Tsur

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The Canadian Journal of Bioethics applies the Creative Commons Attribution 4.0 International License to all its publications. Authors therefore retain copyright of their publication, e.g., they can reuse their publication, link to it on their home page or institutional website, deposit a PDF in a public repository. However, the authors allow anyone to download, reuse, reprint, distribute, and/or copy their publication, so long as the original authors and source are cited.