Liberty and Medicine

Thursday, February 08, 2007

Can the rights of physicians and patients be reconciled?

A survey of physicians in the US shows a small, but significant, number of them believe they have no obligation to tell patients what medical options are open to them if those options violate the religious values of the physician -- regardless of the values of the patient. And 18 percent said they are not obligated to refer the patient to physicians who do provide that care.

Al Weir of the Christian Medical & Dental Associations argues this refusal of service protects the right of the doctor. “The doctor has the right to follow their own company and their own moral integrity.”

But there is a conflict here. It is not the doctor’s treatment choices that is under discussion. The physician is always free to follow his own advice with his own life.

But a physician may hold beliefs which conflict with the choices available to the patient. Should the physician be required to give advice if being truthful with the patient violates his “ethics”?

How does one protect both the rights of the patient and the physician? Is it possible to maximize the liberty of each?

The political Right tends to assume the doctor has the right to keep the patient in the dark about medical options because religious beliefs are paramount. Thus the patient can be kept the dark against their will. The political Left tends to assume the patient has the right to force the doctor to violate his own ethics. Each side is willing to use the force of law to impose their values on the other side.

Neither patient nor doctor should be put in a position of having the other make decisions for them without their consent. And it is possible for that to happen.

Let us assume a case where there are various treatments available: treatments A to J or ten treatments in all. The patient assumes the physician will let him know what options exist. That is a reasonable assumption to make and is mostly true.

But assume that the doctor has some sort of belief that makes treatments A, B, and C off the table for him. So he deceives the patient and tells him only of treats D through J. He can’t even tell the patient what treatments they might be because they violate his own values.

It seems the best option, which protects the maximum freedom of both physicians and patients, would be where the doctor is not obligated to discuss treatments he considers immoral. But he is obligated not to deceive this patient at the same time. It is a contractual duty. So the very least that is required of him is something along these lines:

“My personal beliefs do not allow me to inform you about options that may exist for you in regards to this condition.”

Such a statement informs the patient that he may wish to seek another physician. If the doctor feels he can not recommend another physician who would inform the patient about these treatments then he should be required to say: “Nor will I recommend physicians to you who might inform you about these treatments.”

At this point the patient is free to continue treatment or seek another physician. If they wish to allow the unknown beliefs of someone else to determine the medical care they seek is up to them. But it is unlikely many will take give this power over to the physician.

Since this option doesn’t require the physician to use or mention the treatments in question then why is that they have ot already opted for this alternative?

Could it be that some of these “morality” driven physicians are wish to protect their bottom line? If a physician who denies treatments to the patient based on his own values were to inform the patient that this was happening he knows that many, if not most, of the patients would desert him. His “values” are of value provided only the patient pays the cost of them.

If he is honest with his patients, and informs them that he intends to deny them information based on his values, he fears he will lose income. Deception of a patient for profit maximization is not a physician defending his highest moral values no matter what their defenders say.

If a physician has a moral value which forbids him or her from being honest with the patient then it is the physician not the patient who should pay the price for that value. Basic economics tells us that the number of physicians having said moral values will radically decline when they pay the price of their values instead of being able to pass them on to the uninformed patient.

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