Act ethically when ending patient-physician relationship
Act ethically when ending patient-physician relationship
Abandonment is central issue
Is a physician unable to exercise reasonable objectivity in providing care, or does the physician lack the requisite skill or training to help the patient? "Physicians can, and many would say should, terminate their relationship with patients when they can no longer help them," says John Banja, PhD, a medical ethicist at Emory University's Center for Ethics in Atlanta. "An important qualifier, however, is the phenomenon of abandonment."
Before a physician terminates a patient relationship, says Banja, he or she should give the patient adequate notice of that intention and provide the patient with names and contact information of health professionals who could see the patient, assuming the patient requires further treatment. A physician who terminates a relationship with a patient because the patient owes him or her money, or because the patient is rude, needs to make sure that such termination would not amount to abandonment, he warns.
If, for example, the patient is unable to identify another physician for needed care and becomes worse, the physician has hardly acted in the patient's best interests and can be sued for intentional abandonment, Banja explains. "If the physician is the only health professional reasonably available who can competently treat that patient's condition, he or she might have to do so regardless of how distasteful the task may be," he says. "This rarely happens, though, and in any event, physicians ultimately retire so the obligation to treat doesn't last forever."
However, physicians should keep this in mind if they would like to terminate a relationship because they intensely dislike a patient, or the patient doesn't pay his or her bills, says Banja. "I think it's enough for physicians to remember that they can't leave patients in dire straits. Once a physician has undertaken a patient's treatment, he or she is contractually bound to advance the patient's welfare," he says.
Most of the time, physicians won't have any trouble terminating their relationships with patients because it will be easy to arrange for another professional to take over the patient's care, Banja adds, "but the most ethically compelling reasons for physicians doing so are reasons that advance the patient's interests." If the physician's course of therapy is going nowhere, or he or she finds it particularly difficult to communicate with the patient, or finds him- or herself experiencing feelings for the patient that disrupt clinical objectivity, it might well be better to refer the patient to someone else, he explains.
"But physicians who terminate the relationships with patients in a way that leaves patients badly off have probably capitulated to their urge just to be rid of this individual, which doesn't meet the ethical standard of due care," says Banja.
In any non-emergency situation, a physician or any health care professional can decline to provide care for anyone unless otherwise required by their employer, but "the issue of abandonment arises," says Reed E. Pyeritz, MD, PhD, director of the Center for the Integration of Genetic Healthcare Technologies and professor of medicine and genetics at the University of Pennsylvania. "Most states have laws that prohibit abandonment. Similarly, all codes of ethics of professional societies consider abandonment unethical."
In order to terminate a physician-patient relationship, the physician must give notice of the intent to terminate that provides sufficient time for the patient to arrange alternative care, and consider suggesting alternatives, says Pyeritz. "An example is a pediatrician who refuses to see children whose parents decline routine vaccinations," he says. "The pediatrician may feel that the parents are not acting in the best interests of the child. Additionally, the pediatrician may feel that an unvaccinated child poses a risk in the waiting room."
Sources
John Banja, PhD, Medical Ethicist, Center for Ethics, Emory University, Atlanta. Phone: (404) 712-4804. E-mail: [email protected].
Douglas S. Diekema, MD, MPH, Director of Education, Treuman Katz Center for Pediatric Bioethics, Seattle (WA) Children's Hospital. Phone: (206) 987-4346. Fax: (206) 884-1091. E-mail: [email protected].
Daniel S. Kamin, MD, Staff Gastroenterologist, Boston (MA) Children's Hospital. Phone: (617) 355-7964. Fax: (617) 730-0496. E-mail: [email protected].
Reed E. Pyeritz, MD, PhD, Director, Center for the Integration of Genetic Healthcare Technologies/Professor of Medicine & Genetics, University of Pennsylvania, Philadelphia. Phone: (215) 662-4740. Fax: (215) 614-0298. E-mail: [email protected].
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