We've written extensively about the pressure on physicians to be more mindful of the cost of services they recommend and allow, spearheaded in many ways by the Choosing Wisely campaign. We've also seen evidence that physicians are sometimes willing to stretch the truth to get patients' care that is otherwise difficult to justify on paper.
A recent article in the Washington Post raises an ethical dilemma that touches on both issues. When patients do things that bring harm onto themselves, is it okay for doctors to use cost, evidence-based care or some other objective criterion as an excuse to act on a bias that patients don't deserve the intervention for which they're asking?
In the article, California pediatrician Rahul K. Parikh, M.D., describes a (de-identified) teenager who admits to using steroids and, once experiencing side effects, he and his father push to have his testosterone level checked before his body has had time to recover from the drugs in his system.
Parikh wrote the following about weighing his decision: "If this kid had decided to put his body at risk, despite all he surely knew about the dangers of getting juiced, did I owe him a largely unnecessary test? Such a test, which can range in price from $50 to a few hundred dollars, would merely confirm that he had taken steroids, but it would not change how I treated him."
He continued: "Saying 'no' to a patient is a right a doctor has when a test or treatment is unnecessary or likely to cause harm. But what about saying no if you decide the patient doesn't deserve it, because he or she made a bad choice?"
In this story, the doctor successfully stalled the test until the patient's symptoms subsided. But the scenario represents just one example of the new set of questions doctors have to ask themselves when making moral decisions about their patients.
Perhaps to soon offer some guidance, the American Medical Association (AMA) announced at its annual meeting this week that its Code of Medical Ethics will undergo its first overhaul in more than 50 years. The AMA will perform a comprehensive update of the code for clarity, consistency, relevancy and ease of use, according to a statement.
"Addressing some of the gaps in the Code as the practice of medicine has evolved and addressing some of the discrepancies within the Code will make it more useful for all physicians," Col. Paul Friedrichs, M.D,, a U.S. Air Force physician in Honolulu, said in the announcement.