Consider how decisions regarding one patient may also affect other patients and providers (justice). Plan and perform procedures and provide care with the intention of improving the patient s quality of life and/or decreasing the risk of mortality, independent of reim- bursement considerations and without inappropriate bias or influence from industry, administrators, referring physicians, or other sources. Before performing procedures, obtain informed con sent after giving an explanation regarding the details of the procedure and the risks and benefits of both the proce- dure and alternatives to the procedure. Plan and perform procedures according to standards of care and recommended guidelines, and deviate from them when appropriate or necessary in the care of individual patients. Seek advice, assistance, or consultation from colleagues when such consultation would benefit the patient. 4.2.1. Informed Consent Obtaining informed consent for procedures is a legal and ethical necessity. Ideally, informed consent is obtained long enough before the procedure that the patient can fully consider informed consent issues and discuss them with family or other providers, avoiding any sense of coercion. Ad hoc PCI, or PCI immediately following diagnostic proce- dures, presents special problems. When informed consent for PCI is obtained before diagnostic catheterization is per- formed, it is impossible to predict the levels of risk and benefit from an ad hoc PCI.310,311 If diagnostic catheterization reveals anatomy that poses a particularly high risk or for which the superiority of PCI compared with other strategies is unclear, the precatheterization informed consent discussion may be inadequate. In such cases, deferral of PCI until additional informed consent discussions and/or consultations occur may be appropriate, even though it inconveniences the patient and the healthcare system. It is the responsibility of the interventionalist to act in the patient s best interest in these circumstances. 