Divided loyalties and ambiguous relationships.

The author argues that conflicts of obligation may, but need not, give rise to issues of divided loyalties. Given this, the question then becomes under what circumstances and conditions a simple internal conflict may escalate into the problem of divided loyalties or fiduciary ambiguities. After discussing conflicts of obligation, it is asserted that loyalties are divided only when the demands of the various relationships involved are irreconcilable. As this is an extreme, the major problematic issues fall, then, in between, on multiple loyalties and ambiguous loyalties. How and where multiple loyalties arise, and under what conditions they may become ambiguous loyalties lead to the recognition that moral problems are created by leaving in ambiguity things about the relationships involved that would be better sorted out. Finally the author looks at situations in which physicians are systematically exposed to irresoluble ambiguity.