Patient care often involves collaboration among physicians from different areas of specialization and diverse institutions. Moral quandaries can arise if collaborators do not have common ethical standards to guide their joint practice. Much public debate has been devoted to physician "conscientious objection," in which physicians refuse to participate in commonly accepted clinical practices, due to their personal moral or religious beliefs. Far less attention has been paid to a different situation, in which quandaries of collaboration stem more from uncertainty than from deep disagreement. Here the central ethical question may not be the dictates of personal conscience but the requirements of professional conscience, obligation and accountability. In some such circumstances, I propose, there may be justification for deference by one colleague to another's judgment or policy. I outline a set of provisional frameworks for evaluating deference-worthiness, drawing on insights from four relevant fields. I analyze examples from the context of organ donation and transplantation, a field in which urgent, inter-institutional collaboration is often expected but generally underexamined from a normative perspective.
