Most discussions of fiduciary duty focus on medical decision-making, but that is not the only context in which the concept is important. Investment advisers have fiduciary duties to their clients: in this essay, we address those duties. Many advisers refuse to help their clients with ‘socially responsible’ investment plans, for a variety of reasons, among which are fiduciary concerns. We argue that the reasons generally given not to pursue a religious, environmental, or social investment strategy are mistaken, and, most importantly, that an investment adviser’s fiduciary duties may be met while providing such alternatives to clients.

Due to the enormous disparity of power in the child welfare professional-client relationship, a high level of trust is necessary for this relationship to achieve its intended benefits, including protecting, caring for, terminating parental rights to, and finding appropriate adoptive homes for, abused and neglected children. This paper first defines conflicts of interest as necessarily including the exercise of judgment, and then argues that contractual relationships between private child welfare agencies and public departments of child welfare often betray their fiduciary responsibilities through conflicts of interest inherent in these contracts, particularly as regarding incentives for and against finding permanent homes for abused and neglected children. Finally, I propose an evidence-based strategy to ameliorate conflicts of interest when making permanent placement decisions for foster children.

A sustained analysis of the moral permissibility of withholding or of the obligation to disclose information to an adopted child is lacking in the literature on parental duties, disclosures, and adoption. These two sets of questions raise issues that appear to fall within the parameters of the concepts of stewardship and gratitude. I propose that adoptive parents are the stewards of the information they receive concerning their child and I show how stewardship and gratitude can aid adoptive parents as they negotiate the terrain of disclosure.

In the psychotherapist-patient relationship, the therapist-fiduciary must deal with ambiguity, assume risks, and make decisions without final appeal to psychiatric theory. Ambiguity regarding patient autonomy poses treatment paradoxes. Caregiving that aims at autonomy can end up undermining it. Additionally, pursuit of autonomy can put the patient’s well-being at risk.

Medicine’s fundamental moral philosophy is the responsibility of caring for the ill, yet beneficence is not under the province of the law.Indeed, fiduciary responsibilities of doctors are limited. Instead, American law is preoccupied with protecting patient rights under the precept of patient autonomy, and contemporary medical ethics is dominated by these concerns. The extrapolation of autonomy rights from the political and judicial culture to medicine is, under ordinary circumstance, non-problematic. However, in instances of conflict, the dominance of autonomy reveals a hierarchy of values determining patient care. To illustrate the moral calculus of balancing competing principles, the ethical issues of involuntary treatment of psychotic patients are considered, and alternatives to the moral reasoning currently guiding the care of these individuals are offered to better solve the dilemma of respecting patient autonomy while still fulfilling the claims of physician responsibility.

Ethical fiduciaries in health care lack sufficient criteria for making ethical decisions. The authors introduce criteria from The Theory of Comfort as developed in the nursing literature. According to the theory, comfort is based in observation, measurable, and represents a nearly universal human need and interest. Use of the theory is illustrated through three case studies.

Health professionals, by agreeing to provide care, accept a fiduciary role that entails an obligation to preserve trust. We trust health professionals to be competent, to promote patient interests, and to properly utilize their discretionary power. While some health professionals argue that such activities as secretly screening for drugs or sexually transmitted diseases are necessary to fulfill their fiduciary obligations, these may actually constitute a breach of trust. In this paper, I argue that, in the specific case of Munchausen’s Syndrome by Proxy, covert surveillance is ethically justifiable and does not constitute a breach of trust and an abuse of the fiduciary relationship.