By Matt Kuhrt
When patients refuse care on the basis of their doctor's race or ethnic background, it raises a series of difficulties for both physicians involved and for the institutions that employ them. A story in Medscape Medical News looked at the ethical, legal and clinical quandaries generated by such cases.
Competent patients have a right to choose who administers their care. But in the case of an openly racist patient, that right has to be balanced against a physician's employment rights, as well as the physician's right to respectful and dignified treatment, says Alicia Fernández, M.D., who co-authored a recent New England Journal of Medicine (NEJM) article on the subject.
The NEJM study notes that not all requests from patients for doctors of a particular race or gender are unjustified. For diverse patients, medical care administered by culturally conversant physicians can produce a better standard of care and reduce complications involving end-of-life care, as FiercePracticeManagement has previously reported. However, the corrosive effect of racism, bigotry and misogyny on practicing physicians hurts medical practices if racist requests drive doctors from diverse backgrounds out of the system.
For Art Caplan, Ph.D., director of the Division of Medical Ethics at New York University School of Medicine, the motivation for a patient's request ought to have more determinative weight when considering a response. Balancing respect for patient wishes is "an admirable effort," he told Medscape Medical News, "but morally, I'm less enthusiastic when you're responding to hatred, bigotry, misogyny, or prejudice."
In the absence of hard guidance for hospitals and physicians, the NEJM article suggests five "ethical and practical factors" which ought to govern decision-making:
- The medical condition of the patient
- The patient's ability to make sound decisions about his or her care
- The doctor or institution's capability to accommodate the patient's request
- The patient's motivation in requesting care from a different physician
- The effect any decision made will have on the doctor involved
To learn more:
- read the Medscape story
- check out the NEJM article