Device Representatives in Hospitals: Are Commercial Imperatives Driving Clinical Decision-Making?

Journal of Medical Ethics 2018;44:589–592

U. of Adelaide Law Research Paper No. 2018-111

Posted: 10 Sep 2018

See all articles by Bernadette Richards

Bernadette Richards

University of Adelaide - School of Law

Multiple version iconThere are 2 versions of this paper

Date Written: September 3, 2018


Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: (1) impacts on healthcare costs, (2) the outsourcing of expertise and (3) issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries.

Keywords: Device, representatives, hospitals, commercial imperatives, clinical decision-making

JEL Classification: K00, K30, K32, K39

Suggested Citation

Richards, Bernadette, Device Representatives in Hospitals: Are Commercial Imperatives Driving Clinical Decision-Making? (September 3, 2018). Journal of Medical Ethics 2018;44:589–592, U. of Adelaide Law Research Paper No. 2018-111, Available at SSRN:

Bernadette Richards (Contact Author)

University of Adelaide - School of Law ( email )

Adelaide, South Australia 5005

Here is the Coronavirus
related research on SSRN

Paper statistics

Abstract Views
PlumX Metrics