Making Ethical Rules for the Doctor-Patient Relationship | Cancer Control
Discusses the ethical obligations involved with the physician-patient relationship, It forms the basis for the physician-patient relationship. . While the physician has a moral obligation to obey the law, she must balance this. patient is a cornerstone of the ethical physician's practice. 2. In the context of the physician–patient relationship, a law, which in itself is unethical behavior. While a doctor may discharge a patient for any nondiscriminatory Removing a patient from your practice: A physician's legal and ethical responsibilities of a patient and termination of the physician-patient relationship.
The health-care provider is generally obliged to hold in confidence information concerning their patients. Let us consider this case study: Asha is a member of an extended family living under one roof in a slum in a big city.
The family must pool their resources to meet their needs. All family members, including the children, do what they can to contribute to the family income stream.
There are five adults: Asha has four children. She was 19 when she had her first child. She is now It is a loving family that holds traditional beliefs about the primacy of male elders. The two older adult male brothers are the most productive. They work as tailors but are only able to find casual employment that is not well paid.
The younger brother did not want to be a tailor but struggles to find any employment. Asha cleans the house of a comparatively wealthy family. The burden of cooking falls mostly to Asha who uses wood as fuel. Fish is a delicacy, which is had once every couple of weeks. Even so, Asha prefers to leave the fish for the adult males and her oldest male child.
Frequently she eats only rice. One day Asha becomes nauseous. She vomits and cannot stand up without assistance but she prefers to lie down. Hours pass and she does not improve. Her mother in law tries to give her a little of their precious water and a herbal remedy last used when Asha was pregnant and nauseated, without effect.
This goes on for some days. As she cannot work, Asha loses her job and is only intermittently capable of fulfilling her domestic responsibilities. His mother and brothers agree. Although it is supposed to be free, the family knows they will need to pay for whatever the hospital does not provide and this is likely to be many services and drugs if they are needed.
If Asha is admitted, at least two of them may have to find somewhere to stay near the hospital and this will cost too. Fortunately the youngest brother is able to look after the children, though he has found a short-term paying job and will need to leave the seven-year-old to look after the other children for hours at a time.
Luckily travel on a bus and a rickshaw to the hospital takes only two hours but they must wait a further six hours before they are seen. When they are finally seen the doctor asks Asha about her dizziness, and whether she has headaches. She asks Asha if she has had any trauma to her head or neck. Her condition could be due to a stroke but this is unlikely in someone her age. There may be other causes like middle ear infection, gastroenteritis, anaemia or labyrinthitis.
It may be something else. They can do blood and urine tests in the hospital. The doctor recommends that if these tests do not show anything Asha should have a an MRI, however this test will have to be done at a private hospital as the public hospital does not have an MRI.Medical Ethics 3 - Confidentiality & Privacy
She adds that although the MRI can be helpful it is not necessarily definitive. Asha will have to stay at the hospital under observation while the tests are done.
The family will have to pay for the tests at the public hospital because they are carried out by a private pathologist and family members will need to stay with Asha to look after her personal care, feed her, transport her within the hospital as needed and to obtain drugs if they are prescribed. The family asks how much these tests will cost.
Asha is alert but does not contribute to the discussion between the doctor and her family. The family decides they will pay for the blood and urine tests.
Principles of medical law and ethics – Knowledge for medical students and physicians
For instance, an intrapartum patient, with a complete placenta previa, who refuses to undergo a cesarean delivery, often does not present the option for the physician to withdraw from participation in her care see: In most cases, choices of competent patients must be respected when the patient cannot be persuaded to change them. What can a physician do with a particularly frustrating patient? Physicians will sometimes encounter a patient whose needs, or demands, strain the therapeutic alliance.
Many times, an honest discussion with the patient about the boundaries of the relationship will resolve such misunderstandings. The physician can initiate a discussion by saying, "I see that you have a long list of health concerns. Unfortunately, our appointment today is only for fifteen minutes. Let's discuss your most urgent problem today and reschedule you for a longer appointment. That way, we can be sure to address everything on your list. What do you think we could do to meet everybody's needs?
And yet, physicians may not abandon patients. When the physician-patient relationship must be severed, the physician is obliged to provide the patient with resources to locate ongoing medical care. When is it appropriate for a physician to recommend a specific course of action or override patient preferences?
Principles of medical law and ethics
Under certain conditions, a physician should strongly encourage specific actions. When there is a high likelihood of harm without therapy, and treatment carries little risk, the physician should attempt, without coercion or manipulation, to persuade the patient of the harmful nature of choosing to avoid treatment. Court orders may be invoked to override a patient's preferences.
However, such disregard for the patient's right to noninterference is rarely indicated.
Court orders may have a role in the case of a minor; during pregnancy; if harm is threatened towards oneself or others; in the context of cognitive or psychological impairment; or when the patient is a sole surviving parent of dependent children.
However, the use of such compulsory powers is inherently time-limited, and often alienates the patient, making him less likely to comply once he is no longer subject to the sanctions.
What is the role of confidentiality? Confidentiality provides the foundation for the physician-patient relationship. In order to make accurate diagnoses and provide optimal treatment recommendations, the physician must have relevant information about the patient's illness or injury.
This may require the discussion of sensitive information, which would be embarrassing or harmful if it were known to other persons. The promise of confidentiality permits the patient to trust that information revealed to the physician will not be further disseminated.
The expectation of confidentiality derives from the public oath which the physician has taken, and from the accepted code of professional ethics. The physician's duty to maintain confidentiality extends from respect for the patient's autonomy.
Would a physician ever be justified in breaking a law requiring mandatory reporting?