As a pathologist and medical educator in a country currently enduring a full-scale war, I see the dilemma between defensive medicine and medical ethics through a particularly urgent lens.

Defensive medicine may arise from legitimate fears—of litigation, professional ruin, or personal blame in an overstretched and often under-resourced healthcare system. In wartime Ukraine, physicians face not only legal and administrative pressures but also moral injury, physical risk, and burnout. In such settings, defensive practices might appear as a protective shield. Yet, they often lead to overdiagnosis, overtreatment, increased costs, and potential harm to the patient. More importantly, they erode the physician’s role as a patient advocate.

Medical ethics demands that our actions prioritize the well-being, autonomy, and dignity of the patient, not the legal safety of the doctor. When fear becomes the main driver of clinical decision-making, it distorts the physician–patient relationship and undermines trust in the profession.

That said, I believe the issue is not individual physicians making flawed choices but the structural, legal, and cultural conditions that incentivize defensive medicine. Ethics education, open discussion of medical errors, institutional protection for honest mistakes, and legal reform are crucial steps forward.

In the end, ethical medicine—even in war—means having the courage to act in the patient’s best interest, not our own.

Overprescription, injudicious use of medicine are rampant. Useless investigations are at peak. Nature is the best medicine. The symptoms of diseases are in fact for keeping disease process at bay. Can I get more anti-infective drug than the secretion of wbc cells and others. Think about the consequences of any inflammation in our body. Problem is that little learning is a dangerous thing. Remedy is the medical professionals to come forward together and to persuade all to have real thinking and promise not to use medicine in a injudicious manner.

ِDear Dr. Kuzyk,

I also believe that the issue lies not in the poor choices of individual doctors, but in the structural, legal, and cultural conditions that promote defensive medicine. Ethical medicine, in its true sense, involves having the courage to act in the best interests of the patient, which will ultimately benefit the medical staff as well. Saving lives and safeguarding the patient's interests should always be the top priority, and we must always bear in mind that one day we ourselves may be injured or ill. If we want our interests to be safeguarded on that day, we must consider the interests of our patients today, even if it goes against our own interests.