domingo, 6 de marzo de 2016

BioEdge: Treating racist patients

BioEdge: Treating racist patients

Treating racist patients

Here’s an interesting ethical conundrum. How should a doctor respond if he or she is rejected because a racist patient rejects them? An article in the latest issue of the New England Journal of Medicine  opens with this confronting scenario:

A 77-year-old white man with heart failure arrives in the emergency department of an urban hospital at 3 a.m. with shortness of breath and a fever. When a black physician enters, the man immediately announces, “I don’t want to be cared for by a %$#!{& doctor!” Taken aback, the physician retreats from the room. She’s offended by the man’s rejection and demeaning language — but knows that he may have a serious medical condition and that she cannot treat him against his will. How should the physician proceed?
The authors suggest that encounters like this may become more common as the United States becomes more ethnically diverse. It is a tricky situation, because the patient has a right to refuse medical care, including care from a unwanted doctor. On the other hand, health care workers have a right not to be discriminated again. Nurses have successfully sued hospitals which required them to accommodate patients’ prejudices. Doctors, however, have not brought lawsuits, as their employment conditions are different.

The authors have created a template for examining the practical and ethical issues raised by these cases: “the patient’s medical condition, his or her decision-making capacity, options for responding to the request, reasons for the request, and effect on the physician”. They conclude:

Although institutions should not accommodate, for individual physicians the decision to accommodate may be sound when the accommodating physician is comfortable with the decision, employment rights are protected, and the decision does not compromise good medical care.
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Neurodegenerative disease is often cited as a reason for requesting assisted suicide or euthanasia. So insights into the motivations of profoundly disabled persons who want to live -- like British physicist Stephen Hawking -- are valuable.
Another victim of ALS in the same league as Hawking is Mario Melazzini, the new chairman of the board of the Italian counterpart to the FDA in the US. He has been in a wheelchair for 14 years and is completely dependent upon carers. Nonetheless he expresses an infectious optimism about life.
When I started to look at my disease with fresh eyes, I understood it and made a fresh start on life. The moment I stopped thinking about what I could not do because of ALS, but what I could still do for myself, for my children and friends, my life changed …

Life is a gift, an asset which must be nurtured from the moment of conception to natural end, even with illness. Life must not be manipulated according to an ideology. We need to realise that in any condition, when properly supported, everything can be seen as a great opportunity … The only incurable thing is the will to live!
More about Dr Melazzini here and here

Michael Cook

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